Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- TN-WEST TENNESSEE REFUGE-SEEDLINGS
- Solicitation number
- 140FS326Q0145
About this file
This is a Past Performance Survey template designed to collect information about a contractor's relevant experience with completed or in-progress contracts. The form requests general business information including company name, address, organization date, key personnel, and SAM.gov Unique Entity Identifier (UEI), along with company structure designation (partnership, separate entity, or division).
The survey captures detailed information on up to three representative contracts or subcontracts, requiring contractors to provide the contracting agency or company name, point of contact information, contract number, contract amount, project title and location, scope of work, the contractor's role (prime, joint venture, or subcontractor), subcontracted work details, period of performance, scheduled and actual completion dates, percentage of work completed, and termination status. Additionally, contractors must document quality control and safety plan implementation, identify any quality control or safety problems encountered, and explain how such problems were resolved. The form concludes with certification requirements, including preparer name, phone, email, title, signature, and date. This template is associated with Solicitation Number 140FS326Q0145 for West Tennessee Refuge Seedlings issued by the Department of the Interior Fish and Wildlife Service.
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Other files
| File | Type | Posted |
|---|---|---|
| B08_-_Seedling_Minimum_Requirements_2026.pdf | ||
| Sol_140FS326Q0145.pdf |
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Text version
PAST OR PRESENT PERFORMANCE SURVEY
Your Company Name:
Street Address:
City, State and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
| Company President: | Vice President: | |
| SAM.gov Unique Entity Identifier (UEI): | __ |
Is company a ; Partnership [ ] Separate entity [ ] Division [ ] N/A [ ]
2. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS
Complete and submit the information requested on page 2-4 below on prime contracts or subcontracts completed or in progress. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress.
a. First Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | ||
| Contract Number: | Contract/Subcontract Amount: $ | _____ |
Project Title and Location:
General Scope of Project: ____________
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
b. Second Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | ||
| Contract Number: | Contract/Subcontract Amount: $ | _____ |
Project Title and Location:
General Scope of Project: ____________
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
c. Third Contract:
Contracting Agency or Company:
| Point of Contact: | Telephone Number: | ||
| Contract Number: | Contract/Subcontract Amount: $ | _____ |
Project Title and Location:
General Scope of Project: ____________
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Describe any Work You Subcontracted to Others:
Total Amount of Subcontract(s): $
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: % Were You Terminated?
Quality Control or Safety Problems encountered (if any):
How were the problems resolved? _____
Type or Print Information Name of Survey Preparer
Phone:_________________ E-Mail;___________________________ Title Signature Date )4. Certification of Past Performance Information:
File details come from the government source that posted it. Updated .