ATTACHMENT C CONTRACTOR PERFORMANCE INFORMATION.pdf

Attachment C

CONTRACTOR PERFORMANCE INFORMATION

Contractor Name and Address (Identify Division)

1. Contract Number:

2. Type of Contract:

3. Contract Value (Current plus any unexercised options): $

(Please correct the above as needed.)

4. Period of Performance (including any option periods):

5. Description of Requirement:

6. Ratings. Summarize contractor performance and circle or type in the number below that corresponds to the performance rating for each category. Please see the attachment, which explains the rating scale.

Quality:

Comments:

Problem

Resolution:

Cost Control:

Timeliness:

Business

Relations:

Customer

Service:

7. Total score:

Evaluated by:

Agency/Organization_______________________________________ Date ____________

(In accordance with the Federal Acquisition Streamlining Act, the following information will not be released to the contractor.)

Name and Title _________________________________________

Telephone number _________________________

Signature _____________________________________________

E-mail address _______________________

Please return this form to the following address:

U.S. Department of Education

Contracts and Acquisitions Management

PCP Room 7123

550 12th Street, SW

Washington, DC 20202

Or e-mail to: Jennifer.Arthur@ed.gov

Or fax to: 202-245-6297

Attn: Jennifer Arthur

RFP #: ED-IES-12-R-0100 (internal tracking no. iesne120014)

SOURCE SELECTION INFORMATION—SEE FAR 3.104

Information entered on this form will be used in source selection decisions and is protected under subsection 3.104 of the Federal Acquisition Regulation. Do not disclose information entered on this form to the contractor or to any other person except as authorized by the Department of Education contracting officer.

Supplementary Questions

To assist the Department of Education contracting officer, we would greatly appreciate your taking the time to answer the following questions, if any, related to the contractor’s past performance: N/A