Past_Performance_Survey.pdf
PDF 155 KB Posted
- Attached to
- MD SPEC AGNT BALTIMORE - MOVING SERVICES
- Solicitation number
- 140FS326Q0176
About this file
This is a Past or Present Performance Survey form designed to collect information about a company's contract performance history for federal contracting purposes.
The form requests general business information including company name, address, UEI number from SAM.GOV, date of establishment, company leadership, and small business status. The primary section requires detailed documentation of up to three completed or in-progress contracts or subcontracts, with government contracts preferred but other commercial contracts acceptable as alternatives. For each contract, respondents must provide the contracting agency or company name, point of contact information, contract number, dollar amount, project title and location, general scope of work, the company's role (prime, joint venture, or subcontractor), 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 usage, any problems encountered with quality or safety, and resolution methods. The final section requires certification by an authorized company representative, including the preparer's name, phone, email, title, signature, and date. The survey serves as an evaluation tool for assessing a prospective contractor's past performance qualifications and capability to execute future federal contracts.
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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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