Attachment_D-Past_Performance_Information_Form.pdf

Attachment D-Past Performance Information Form

VENDOR NAME:

PROJECT INFORMATION Contract No./Purchase Order:

Project Title/Location:

Type:

Original Contract Value: Final Contract Value:

Original Completion Date: Final Completion Date:

Number of Observer Services Provided under Contract/Purchase Order:

PROJECT DESCRIPTION

(Include relevance to solicitation project AND a description of services provided to vendor).

CUSTOMER EVALUATION

(To be completed by reference.

Provide actual evaluation form or letter format)

PROBLEMS ENCOUNTERED

and CORRECTIVE ACTIONS

TAKEN

POINT OF CONTACT (an individual who can evaluate performance)

Company Name:

Contact Name:

Relationship to Project:

Phone Number:

Email Address:

Fax Number:

ALTERNATE POINT OF

CONTACT (an individual who can evaluate performance)

Company Name:

Contact Name:

Relationship to Project:

Phone Number:

Email Address:

Fax Number:

Attachment D

EA133F-17-RP-1824