Past_Performance_Survey.pdf
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- Attached to
- NY-MONTEZUMA NWR-INTERPRETIVE SIGN DESIGN
- Solicitation number
- 140FS326Q0161
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PAST OR PRESENT PERFORMANCE SURVEY
This document is a Past or Present Performance Survey form used to collect detailed information about a company's contract history and performance capabilities for federal procurement evaluation purposes.
The form requires companies to provide general business information including company name, address, date established, UEI number from SAM.GOV, company leadership names, 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 allowance for other commercial work if government experience is unavailable. For each contract, respondents must provide the contracting agency or company name, contract number, point of contact, contract amount, project title and location, general scope, the company's role (prime, joint venture, or subcontractor), description of subcontracted work with amounts, period of performance in days, scheduled and actual completion dates, percentage of work completed, termination status, quality control and safety plan implementation, and detailed descriptions of any quality control or safety problems encountered and their resolutions. The survey concludes with a certification section requiring the preparer's name, phone, email, title, signature, and date. This form serves as a standardized mechanism for evaluating vendor past performance during the federal procurement process.
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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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