Solicitation Attachment XV - Past Performance Survey

Past Performance Survey

PAST PERFORMANCE SURVEY

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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 DesignBid 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:

Past Performance Survey

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.

Past Performance Survey

1. Project Manager and/or Technical

Representative

2. Contracting Officer and/or

Procurement Manager

Name:

Office:

Address:

Telephone:
E-Mail: