Attachment N - Past Performance Reference Form.docx

ATTACHMENT N – Past Performance Short Form Note: Part I is to be completed by the applicant. USAID will obtain the information to complete Part II.

PERFORMANCE REPORT - SHORT FORM

PART I: Award Information (to be completed by Offeror)

1. Name and Address of Organization for which the work was performed:

2. Award Number:

3. Award Type:

1. Award Value (TEC): (if sub-

2. agreement, sub-agreement value)

5. Contacts: (Name, Telephone Number and E-mail address)

6. Period of Performance:

7. Title/Brief Description of Product/Service Provided/ Results Achieved to Date:

8. Problems: (if problems encountered on this award, explain corrective action taken)

PART II: Performance Assessment (to be obtained by USAID—DO NOT COMPLETE)

1. Quality of product or service, including consistency in meeting goals and targets. Comment:

2. Cost control, including forecasting costs as well as accuracy in financial reporting. Comment:

3. Timeliness of performance, including adherence to contract schedules and other time-sensitive project conditions, and effectiveness of management to make prompt decisions and ensure efficient operation of tasks. Comment:

4. Customer satisfaction, including satisfactory business relationship to clients, initiation and management of several complex activities simultaneously, coordination among subcontractors and developing country partners, prompt and satisfactory correction of problems, and cooperative attitude in fixing problems. Comment:

5. Effectiveness of personnel including: effectiveness and appropriateness of personnel for the job; and prompt and satisfactory changes in personnel when problems where identified. Comment: