Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- MA-OFC RFG LE-VEHICLE UPFIT CHEVY TRL BS
- Solicitation number
- 140FS326Q0049
About this file
This is a Past Performance Survey template designed to collect information about a company's relevant contract experience for federal procurement evaluation purposes. The form requests general business information including company name, address, organizational structure, and SAM.gov Unique Entity Identifier (UEI), along with details about the company's president and vice president.
The survey requires documentation of up to three completed or in-progress contracts or subcontracts, with preference given to government contracts. For each contract, respondents must provide the contracting agency or company name, point of contact information, contract number, contract amount, project title and location, general scope of work, the company's role (prime, joint venture, or subcontractor), details of any subcontracted work, period of performance, scheduled and actual completion dates, percentage of work completed, termination status, and quality control and safety plan implementation. The form also requests documentation of any quality control or safety problems encountered and their resolutions. The survey concludes with certification requirements, including the signature, printed name, title, phone number, email address, and date from the survey preparer. This template is used to evaluate contractor past performance capabilities in the context of the Department of the Interior Fish and Wildlife Service solicitation for vehicle upfit services related to Chevrolet trailers.
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| File | Type | Posted |
|---|---|---|
| B08_-_NEW_LE_Vehicle_SOW.pdf | ||
| Sol_140FS326Q0049.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 .