Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- BIL Aerial Herbicide Application Services Federal contract opportunity
- Solicitation number
- 140FS326Q0079
About this file
This is a Past Performance Survey template designed to collect information about a contractor's completed or in-progress contracts and subcontracts. The document requests general business information including company name, address, date of establishment, key personnel, and SAM.gov Unique Entity Identifier (UEI), along with the contractor's business structure classification (partnership, separate entity, or division).
The survey requires detailed documentation of up to three representative contracts or subcontracts, whether with government or private entities. For each contract, respondents must provide the contracting agency or company name, point of contact information, contract number, total contract amount, project title and location, general scope of work, the contractor's role (prime, joint venture, or subcontractor), details of any subcontracted work and associated amounts, period of performance, scheduled and actual completion dates, percentage of work completed, and termination status. Additionally, the survey requires contractors to document their use of Quality Control and Safety Plans, describe any quality control or safety problems encountered, and explain how such problems were resolved. The form concludes with certification fields for the survey preparer's name, title, phone number, email, signature, and date.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0079.pdf | ||
| B03_-_Service_Contract_Act_WD_2015-4341.pdf | ||
| B08_-_Aerial_Herbicide_SOW_2026.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 .