Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- AR-BIG LAKE NWR-AGGREGATE
- Solicitation number
- 140FS326Q0157
About this file
This is a Past or Present Performance Survey template used to collect information about a contractor's relevant experience with completed or in-progress contracts.
The form requires bidders to provide general company information including the firm's name, address, establishment date, company president and vice president names, UEI number from www.sam.gov, and small business status designation. The primary purpose of the survey is to document up to three contracts or subcontracts that the company has completed or has in progress, with government contracts preferred but other commercial contracts acceptable as alternatives. For each contract entry, respondents must supply the contracting agency or company name, point of contact with telephone number, contract number, and total contract or subcontract amount. Additional required details include the project title and location, general scope of work, the company's role as prime contractor, joint venture partner, or subcontractor, and a description of work performed and any work subcontracted to others with associated dollar amounts. The form also requires documentation of the period of performance in days, scheduled completion date, actual completion date, and percentage of work completed, along with indication of any termination, use of quality control and safety plans, any quality control or safety problems encountered, and how those problems were resolved. The form concludes with a certification section requiring the survey preparer's name, phone number, email address, title, signature, and date.
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| A04_SOW_Big_Lake_NWR_Aggregate.pdf | ||
| Sol_140FS326Q0157.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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