Attachment J.3 - Past Performance Sheet.rtf

Past Performance Report Form

CONTRACTOR PERFORMANCE REPORT - SHORT FORM

PART I. Contract Information (to be completed by Offeror)

1. Name of Contracting Entity:

2. Contract No.:

3. Contract Type:

Dates:

4. Contract value (TEC):

5. Description of Work/Services:

6. Problems: (If problems encountered on this contract, explain corrective action taken.) N/A

7. Contact (Name, Telephone # and E-Mail Address):

a. Contracting Officer:

b. Technical Officer (COTR):

8. Offeror:

9. Information Provided in Response to RFP No.:

PART II. Performance Assessment (to be completed by Agency):

1. Quality of product or Service. Comment:

2. Cost Control. Comment:

3. Timeliness of performance. Comment:

4. Customer satisfaction - client. Comment:

5. Customer satisfaction - end users. Comment:

6. Effectiveness of key personnel. Comment:

Information Provided By: Phone/Fax/Internet address Date:

Name:

Information Collected By: Name/Office: Signature:

OMB NO.: 9000-0142