zS02 St Pete Perimeter Fence - PAST OR PRESENT PERFORMANCE SURVEY.pdf

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Attached to
Z1DA--Construction of Perimeter Fence at the St Petersburg VA Regional Office
Solicitation number
36C10D23R0006
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About this file

This document outlines requirements for a federal contract to install a perimeter fence at the St. Petersburg VA Regional Office. The contractor will be responsible for removing an existing vinyl fence and installing approximately 500 linear feet of new fencing and pedestrian gates around buildings 46 and 47. The fence must be installed to withstand hurricane force winds in accordance with local and federal guidelines. The contractor must submit shop drawings and an as-built documentation package following completion of the work. The contract will require adherence to all applicable safety, security and environmental regulations. The work must be completed by March 15, 2023 and is subject to quality assurance oversight by the contracting officer's representative.

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PAST OR PRESENT PERFORMANCE SURVEY – 36C10D23R0006

Your Company Name:__________________________________________________________________

Street Address:________________________________________________________________________

City, State, and Zip code:________________________________________________________________

1. GENERAL BUSINESS INFORMATION

Date Firm Organized/Established:___________________________

Company President:__________________________ Vice President:_____________________________

Unique Entity ID (UEI):_________________

Is company a: Partnership [ ] Separate Entity [ ] Division [ ] N/A [ ]

2. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS

Complete and submit the information requested on pages 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.

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 was the problem resolved?:__________________________________________________________

b. Second Contract:

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?:______________

c. Third Contract:

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?:______________

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