Past_Performance_Survey.docx
DOCX document 24 KB Posted
- Attached to
- NH-FWS - GREAT BAY NWR-JANITORIAL CONTRA
- Solicitation number
- 140FS326Q0092
About this file
This is a Past Performance Survey template designed to document a contractor's historical performance on completed or in-progress contracts. The form collects general business information including company name, address, organizational structure, SAM.gov Unique Entity Identifier (UEI), date established, and key personnel.
The survey requires detailed documentation of up to three representative contracts or subcontracts, whether government or commercial. For each contract, respondents must provide the contracting agency or company name, point of contact information, contract number, contract amount, project title and location, scope of work, the contractor's role (prime, joint venture, or subcontractor), subcontracting details with amounts, performance period, scheduled and actual completion dates, percentage of work completed, termination status, and information regarding quality control and safety plans implemented. The form also requires description of any quality control or safety problems encountered and how they were resolved. The survey must be signed and dated by the preparer with their contact information and title included. This template is intended to be used as an evaluation tool for assessing contractor capability and past performance for the NH-FWS Great Bay National Wildlife Refuge Janitorial Services contract opportunity (Solicitation 140FS326Q0092) issued by the Department of the Interior Fish and Wildlife Service.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0092.pdf | ||
| B08_-_SOW_Great_Bay_NWR_Cleaning_2026.pdf | ||
| B03_-_Service_Contract_Act_WD_2015-4043.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 .