Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- AR - FELSENTHAL NWR - FUEL BPA
- Solicitation number
- 140FS326Q0055
About this file
This is a Past Performance Survey template designed to collect historical contract performance information from prospective contractors bidding on federal opportunities. The form requests general business information including company name, address, organization date, key personnel, and SAM.gov Unique Entity Identifier (UEI), along with clarification of the company's business structure (partnership, separate entity, or division). The survey requires detailed documentation of up to three completed or in-progress contracts or subcontracts, whether with government agencies or commercial entities, with preference given to government contract experience.
For each contract listed, respondents must provide comprehensive performance details including the contracting agency or company name, point of contact, contract number, contract amount, project title and location, general scope of work, the company's role (prime contractor, joint venture partner, or subcontractor), description of any subcontracted work with associated amounts, period of performance with scheduled and actual completion dates, percentage of work completed, termination status, and documentation of quality control and safety plans. The survey also requires description of any quality control or safety problems encountered and how they were resolved. The completed survey must be signed and dated by an authorized company representative with contact information, and includes a certification statement affirming the accuracy of the past performance information provided. This template is associated with solicitation 140FS326Q0055 for AR – Felsenthal NWR – Fuel BPA issued by the Department of the Interior Fish and Wildlife Service.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0055.pdf | ||
| B08_-_SOW_Bulk_Fuel_FY26.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 .