Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- ME-RACHEL CARSON NWR CLEANING SERVICES
- Solicitation number
- 140FS326Q0144
About this file
This is a Past or Present Performance Survey form designed to collect and evaluate a company's contract history and performance capabilities for federal procurement purposes.
The survey requires companies to provide general business information including company name, address, UEI number from SAM.GOV, date established, company leadership, and small business status. The core of the form requests detailed information on up to three completed or in-progress contracts or subcontracts, with preference given to government contracts but allowing for non-government contracts if government experience is unavailable. For each contract, respondents must document the contracting agency or company, point of contact information, contract number and amount, project title and location, general scope, the company's role (prime, joint venture, or subcontractor), work performed, subcontracted amounts, period of performance, scheduled and actual completion dates, percentage of work completed, termination status, quality control and safety plan implementation, and any problems encountered with resolution methods. The survey includes a certification section requiring the preparer's typed name, phone number, email address, title, signature, and date. This template allows evaluators to assess contractor reliability, past performance outcomes, quality management practices, safety compliance, and ability to manage subcontractors across multiple contract examples.
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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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