Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- FL ST MARKS NWR ROAD SIGN REPLACEMENT
- Solicitation number
- 140FS326Q0023
About this file
This is a Past Performance Survey template used to evaluate a contractor's experience and capabilities based on previously completed or ongoing contracts. The survey requests general business information including company name, address, organization date, key personnel, and SAM.gov Unique Entity Identifier, along with confirmation of business structure (partnership, separate entity, or division).
The core section requires detailed documentation of up to three representative contracts or subcontracts, whether from government or commercial sources. For each contract, respondents must provide the contracting agency or company name, point of contact information, contract number, contract value, project title and location, scope of work, the contractor's role (prime, joint venture, or subcontractor), and subcontract details. Additionally, the survey requires reporting on period of performance, scheduled versus actual completion dates, percentage of work completed, termination status, and implementation of quality control and safety plans. Respondents must describe any quality control or safety problems encountered and explain how those issues were resolved. The form concludes with certification requirements signed by the survey preparer, including name, title, phone number, email, and date. This survey is associated with the FL ST MARKS NWR ROAD SIGN REPLACEMENT solicitation (140FS326Q0023) issued by the Department of the Interior Fish and Wildlife Service.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0023.pdf | ||
| B03_-_Service_Contract_Act_WD___2015-4569.pdf | ||
| B08_-_SOW_-_Replacement_Lighthouse_Road.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 .