Attachment_5-_CONTRACTOR_PERFORMANCE_REPORT-SHORT_FORM.docx

CONTRACTOR PERFORMANCE REPORT-SHORT FORM

CONTRACTOR PERFORMANCE REPORT - SHORT FORM

PART I: Contract Information (to be completed by Contracting Officer)

1. Name of Contracting Entity:

2. Contract Number:

3. Contract Type:

4. Contract Value (TEC):

5. Description of Work/Services:

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

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

a. Contracting Officer:

b. Other:

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. Comment:

5. Effectiveness of key personnel. Comment:

Information Provided by: Information Collected by:

Name: Name/Office:

Phone/Fax/Internet Address: Signature: _______________________________

Date:

OMB No. 9000-0142