Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- WA-HANFORD-SADDLE NWR-FIRE-WB10BIL GRAVL
- Solicitation number
- 140FS326Q0057
About this file
This is a Past Performance Survey template designed for companies to document their contract history and performance qualifications. The form collects general business information including company name, address, organizational structure, and SAM.gov Unique Entity Identifier (UEI), along with details about the company president and vice president. The survey requires completion of up to three contract entries, whether from government or commercial sources, with detailed information for each contract including the contracting agency or company name, point of contact information, contract number, contract value, project title and location, and the respondent's role as prime contractor, joint venture participant, or subcontractor.
For each contract entry, the template requests the general scope of work performed, subcontracting details with total subcontract amounts, period of performance with both scheduled and actual completion dates, percentage of work completed, termination status, quality control and safety plan implementation, and documentation of any quality control or safety problems encountered and their resolutions. The survey must be completed and signed by an authorized representative with their name, title, phone number, email address, and date. This template is intended for use as a standard form to evaluate contractor past performance capabilities and reliability for federal contracting opportunities, such as the Department of Interior Fish and Wildlife Service solicitation referenced.
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| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0057.pdf | ||
| B08_-_WB10_Project_Gravel_SOW.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 .