Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- LA-FWS GRAND COTE NWR-AC HEATING UNIT
- Solicitation number
- 140FS326Q0183
About this file
This is a Past Performance Survey template used to collect and document a contractor's historical performance on government and commercial contracts. The survey gathers comprehensive business information including company organization details, SAM.gov Unique Entity Identifier, and company leadership contacts. The form requests detailed information on up to three completed or in-progress contracts or subcontracts, with preference given to government contracts but allowing for commercial contract experience if government experience is unavailable.
For each contract listed, respondents must provide contracting agency or company name, point of contact information, contract number, dollar amount, project title and location, scope of work, the contractor's role (prime, joint venture, or subcontractor), subcontract details, performance timeline, completion status, percentage of work completed, termination history, quality control and safety plan implementation, and description of any quality control or safety problems encountered with resolution methods. The form concludes with certification fields for the survey preparer's signature, title, contact information, and date. This template is designed to be used as a supporting document for the Fish and Wildlife Service's solicitation for LA-FWS Grand Cote NWR AC Heating Unit (Solicitation Number 140FS326Q0183) to evaluate contractor qualifications and past performance capabilities.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0183.pdf | ||
| B03_-_Service_Contract_Act_WD_2015-5197.pdf | ||
| Scope_of_Work_for_LO_Offcie_AC_Replacement.docx | DOCX document |
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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 .