Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- NH-GREAT BAY NWR HVAC SYSTEM REPLACEMENT Federal contract opportunity
- Solicitation number
- 140FS326Q0137
About this file
This is a Past or Present Performance Survey form, which is a template designed to collect information about a company's contract performance history for evaluation purposes in federal contracting.
The survey requests general business information including company name, address, organization date, UEI number from SAM.GOV, and small business status. Section 2 requires documentation of up to three completed or in-progress contracts or subcontracts, with preference for government contracts. For each contract listed, respondents must provide: contracting agency or company name, point of contact and telephone number, contract number and dollar amount, project title and location, general scope, the firm's role (Prime, Joint Venture, or Subcontractor), description of work performed and any subcontracted work, total subcontract amounts, period of performance in days, scheduled and actual completion dates, percentage of work completed, termination status, and documentation of quality control and safety plans used. The form also requires detailed narrative responses regarding any quality control or safety problems encountered and their resolution. Section 4 includes a certification block requiring the survey preparer's typed or printed name, phone number, email address, title, signature, and date.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sol_140FS326Q0137.pdf | ||
| B03_Wage_Determination.pdf | ||
| A04_Great_Bay_HVAC_Replacement_SOW.pdf |
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Text version
ATTACHMENT 3 page 1 of 5
PAST OR PRESENT PERFORMANCE SURVEY
Your Company Name:
Street Address:
City, State/Territory and ZIP Code:
1. GENERAL BUSINESS INFORMATION
Date Firm Organized/Established:
Company President: Vice President:
WWW.SAM.GOV UEI Number:_______________ __
Is company a small business? YES [ ] NO [ ] 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.
http://www.sam.gov/
ATTACHMENT 3 page 2 of 5
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?
ATTACHMENT 3 page 3 of 5
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: %
ATTACHMENT 3 page 4 of 5
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: %
ATTACHMENT 3 page 5 of 5
4. Certification of Past Performance Information:
Type or Print Information
Name of Survey Preparer _______________________________
Phone:__________________________ E-Mail;___________________________
Title__________________________________________
Signature______________________________________
Date__________________________________________
| PAST OR PRESENT PERFORMANCE SURVEY |
| 1. GENERAL BUSINESS INFORMATION |
| 2. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS |
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