Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- FL-ARTH LOXAHATCHEE NWR-WATER PLANT MAIN
- Solicitation number
- 140FS326Q0090
About this file
This is a Past Performance Survey template designed to collect information about a contractor's relevant experience on completed or in-progress contracts. The survey requests general business information including company name, address, date established, key personnel, and SAM.gov Unique Entity Identifier (UEI), along with identification of the company structure (partnership, separate entity, or division).
The survey requires contractors to provide detailed information on up to three representative contracts or subcontracts, including the contracting agency, point of contact, contract number, contract amount, project title and location, scope of work, the contractor's role (prime, joint venture, or subcontractor), subcontracting activities, period of performance, scheduled and actual completion dates, and percentage of work completed. Additionally, contractors must disclose whether they were terminated, whether quality control and safety plans were implemented, any quality control or safety problems encountered, and how those problems were resolved. The survey concludes with certification fields for the survey preparer's name, contact information, title, signature, and date. This template is applicable to the Department of the Interior Fish and Wildlife Service solicitation 140FS326Q0090 for the FL-ARTH Loxahatchee NWR-Water Plant Main project.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0090.pdf | ||
| B08_-_PWS_ARMLNWR_WATER_TREATMENT_PLANT_MAINTENANCE.pdf | ||
| B03_-_Wage_Determination.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 .