Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- NC-ALLIGATOR RIV NWR-HVAC WATER TREATMEN
- Solicitation number
- 140FS326Q0182
About this file
This is a Past Performance Survey template designed to collect historical contract performance information from potential federal contractors. The survey requests general business information including company name, address, organizational structure, and SAM.gov Unique Entity Identifier (UEI). The primary focus is documenting up to three completed or in-progress contracts or subcontracts, whether government or commercial, with detailed information for each including the contracting agency or company name, point of contact, telephone number, contract number, contract amount, project title and location, scope of work, the respondent's role (prime contractor, joint venture partner, or subcontractor), and subcontract details.
For each contract listed, the survey requires specification of the performance period in days, scheduled and actual completion dates, percentage of work completed, termination status, and documentation of quality control and safety plans implemented. Respondents must also describe any quality control or safety problems encountered during performance and explain how those issues were resolved. The form concludes with certification requirements and requires the signature, printed name, title, phone number, email address, and date from the survey preparer. This template is a standard evaluation tool used by federal agencies, including the Department of the Interior Fish and Wildlife Service, to assess contractor capability and past performance prior to contract award.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0182.pdf | ||
| B08_-_SOW-GWVC_Water_Treatment_Services_for_HVAC.docx | DOCX document | |
| B03_-_Service_Contract_Act_WD_2015-4407.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 .