Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- GA-PIEDMONT NWR HERBICIDE SPRAYING SERVICES
- Solicitation number
- 140FS326Q0142
About this file
This is a Past or Present Performance Survey template used to collect contractor performance history information for federal contract evaluation purposes.
The form requests comprehensive business information including company name, address, UEI number from SAM.GOV, date of establishment, key executives, and small business status. The primary focus is documenting up to three completed or in-progress contracts or subcontracts, with preference for government contracts but acceptance of commercial contracts if government experience is unavailable. For each contract, respondents must provide the contracting agency or company name, point of contact with telephone number, contract number, contract value, project title and location, general scope of work, the company's role (prime, joint venture, or subcontractor), description of work performed, subcontract details and amounts, period of performance in days, scheduled and actual completion dates, percentage of work completed, termination status, and quality control and safety plan implementation. The form requires detailed documentation of any quality control or safety problems encountered and explanation of how issues were resolved. The survey concludes with a certification section requiring the preparer's name, phone, email, title, signature, and date. This template appears designed as a standardized evaluation tool for assessing contractor capability and reliability based on documented past performance across multiple project engagements.
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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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