Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- AR- WAPANOCCA NWR-SB2 AGGREGATE
- Solicitation number
- 140FS326Q0155
About this file
This is a Past or Present Performance Survey form used to collect contract performance history from companies responding to federal solicitations. The form requests general business information including company name, address, establishment date, president and vice president names, SAM.GOV UEI number, and small business status designation.
The survey requires detailed information on up to three completed or in-progress contracts or subcontracts, whether government or commercial in nature. For each contract, respondents must provide the contracting agency or company name, point of contact information, contract number, contract amount, project title and location, general scope of work, and the company's role (prime contractor, joint venture partner, or subcontractor). Additional required information includes description of any subcontracted work, total subcontract amounts, period of performance in days, scheduled and actual completion dates, percentage of work completed, termination status, quality control and safety plan implementation, any quality control or safety problems encountered and their resolution, and whether the contract was terminated. The form concludes with a certification section requiring the survey preparer's name, phone number, email address, title, signature, and date. Government contracts are preferred but not required; companies without government contract experience may submit information on other commercial contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| A04_SOW_Wapanocca_NWR_Aggregate.pdf | ||
| B03_Wage_Determination.pdf | ||
| Sol_140FS326Q0155.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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