Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- MA-FT RIVER DIV OF SOC-TAP-RAIL SUPPORT
- Solicitation number
- 140FS326Q0151
About this file
This is a Past or Present Performance Survey form used to document a company's contract performance history during federal procurement evaluations.
The form collects general business information including company name, address, organization date, UEI number from SAM.GOV, company leadership, and small business status. The primary section requires detailed information on up to three completed or in-progress 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, dollar amount, project title and location, scope of work, and the company's specific role as prime contractor, joint venture partner, or subcontractor. Additional required details include the period of performance in days, scheduled and actual completion dates, percentage of work completed, termination status, use of quality control and safety plans, any quality control or safety problems encountered, and how those problems were resolved. The form also requires documentation of any subcontracted work, including the total subcontract amounts. A certification section on the final page requires the survey preparer to provide their name, phone number, email address, title, signature, and date. This form serves as a standard mechanism for evaluating contractor past performance capabilities and reliability during source selection decisions.
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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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