Solicitation Attachment XV - Past Performance Survey.pdf

Past Performance Survey

PAST PERFORMANCE SURVEY

Past Performance Project List Reference No. (#1-#N)

Provide the information requested in this form for each one of the present or past contracts you have identified. Provide a separate completed form for each contract identified.

A. Prime Contractor on Project (Company/Division):

CAGE Code:

Unique Entity ID:

Role of Offeror in Effort (Prime Contractor, Sub Contractor, JV Partner, Teaming Partner, Predecessor Company, Consultant, Key Personnel):

B. Project Title:

C. Contract Specifics:

1. Complete Name of Customer:

2. Customer Address and Telephone #:

3. Contract Number or Citation:

4. Type of Contract (Design-Build or Design- Bid Build):

5. Preponderance of Work (Existing Whole Building Renovation, Utility Infrastructure Repair/Construction, or Other):

6. Period of Performance (Calendar Days):

7. Place of Performance (City, State):

8. Initial Contract Price: $

9. Final Amount Invoiced/Invoiced to Date: $

10. Original Contract Completion Date:

11. Current Sched Contract Completion Date:

12. If complete, Final Completion Date:

OR Estimated Percent Completion:

D. Description of Work:

E. Relevance: Describe how the work under this contract relates to the relevancy (scope, magnitude, and complexity) to the effort of individual task orders contemplated to be issued on this contract.

1. Project Manager and/or Technical Representative

2. Contracting Officer and/or Procurement Manager

Name:

Office:

Address:

Telephone:

E-Mail: