Past_Performance_Survey.pdf
PDF 132 KB Posted
- Attached to
- Rehab Office Building - WV
- Solicitation number
- 140FC226R0006
About this file
This is a Past or Present Performance Survey form used to collect and document a company's contract history and performance record.
The survey requires companies to provide general business information including company name, address, date established, company leadership, Dun & Bradstreet number, and business structure (partnership, separate entity, division, or N/A). The primary focus is Section 2, which requests detailed information on up to three completed or in-progress contracts or subcontracts. For each contract, respondents must supply the contracting agency or company name, point of contact with telephone number, contract number, contract amount, project title and location, and general scope of work. Respondents must identify their role as prime contractor, joint venture participant, or subcontractor and describe the work performed. Additional required information includes details on any subcontracted work with associated dollar amounts, period of performance in days, scheduled and actual completion dates, percentage of work completed, termination status, and whether quality control and safety plans were implemented. The survey also requests disclosure of any quality control or safety problems encountered and how they were resolved. Government contracts are preferred, though other contract experience may be submitted if government contract experience is unavailable. The form concludes with a certification section requiring the survey preparer's name, phone, email, title, signature, and date.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| B09_Summary_of_abatement_work_0001.pdf | ||
| B09_Q_A_0001.docx | DOCX document | |
| Sol_140FC226R0006_Amd_0001.pdf | ||
| B09_lead_survey_results_and_diagrams_0001.pdf | ||
| Quote_Schedule_final.pdf | ||
| Sol_140FC226R0006.pdf | ||
| SOW_revised.pdf | ||
| Wages.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:
Dun & Bradstreet Number: __
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:
Point of Contact: Telephone Number:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: %
c. Third Contract:
Point of Contact: Telephone Number:
Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:
Scheduled Completion Date:
Actual Completion Date: Percentage of Work Completed: %
4. Certification of Past Performance Information:
Type or Print Information
Name of Survey Preparer _______________________________Phone:_________________
E-Mail;___________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
File details come from the government source that posted it. Updated .