Attachment_4-Past_Performance_Form.pdf

RFP SOL‐391‐13‐000005

Amendment No.1

Dated February 05, 2013

ATTACHMENT 4

PAST PERFORMANCE SHORT FORM

Note: Part I is to be completed by the applicant. USAID will obtain the information to complete Part II.

PERFRMANCE REPORT – SHORT FORM

PART 1: Award Information (to be completed by Applicant)

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

2. Award Number:

3. Award type:

4. Award Value (TEC): $

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:

RFP SOL‐391‐13‐000005

Amendment No.1

Dated February 05, 2013

Past Performance Report ‐

8. Offeror:

9. Information Provided in Response to RFA/RFP No:

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

1. Quality of Product or Service:

2. Cost Control:

3. Timeliness of Performance:

4. Customer satisfaction – Client:

5. Customer Satisfaction – End Users:

6. Effectiveness of key‐Personnel: