Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- MS-FWS NOXUBEE NWR-FUEL BPA SETUP
- Solicitation number
- 140FS326Q0074
About this file
This is a Past Performance Survey form designed to evaluate contractor performance on past federal projects. The survey collects structured feedback from government representatives regarding a contractor's historical performance across multiple key evaluation criteria. The form requests detailed information about the contractor's ability to meet schedules, quality of work, cost control, business practices, and overall past performance rating. Respondents are asked to provide specific examples and explanations to support their ratings, allowing the government to assess contractor reliability and competency for future contract awards. The survey includes sections for rating performance on a numerical scale, written comments justifying those ratings, and contact information for the government official completing the evaluation.
This tool is typically used during the evaluation process for solicitation 140FS326Q0074 (MS-FWS Noxubee NWR-Fuel BPA Setup) administered by the Department of the Interior Fish and Wildlife Service. The past performance information gathered through this survey informs the agency's source selection decision by providing documented evidence of how potential contractors have performed on comparable government contracts, enabling the agency to make informed decisions about contractor capability and suitability for the Blanket Purchase Agreement (BPA) establishment for fuel services at the Noxubee National Wildlife Refuge in Mississippi.
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Other files
| File | Type | Posted |
|---|---|---|
| Fuel_Quote_Schedule.docx | DOCX document | |
| B08_-_Noxubee_NWR-_Bulk_Fuel__Statement_of_Work.pdf | ||
| Sol_140FS326Q0074.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 .