J.11_-_Contractor_Performance_Report_-_Short_Form.docx

Attachment J. 11

CONTRACTOR PERFORMANCE REPORT - SHORT FORM

PART I: Contract Information (to be completed by offeror)

1. Name of Contracting Entity:

2. Contract Number:

3. Contract Type:

4. Contract Value (TEC): (if subcontract, subcontract value)

5. Description of Work/Services:

6. Problem: (if problems encountered on this contract, explain corrective action taken)

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

7a. Contracting Officer:

Phone Number:

Email Address:

7b. Technical Officer(CTO):

Phone Number:

Email Address:

7c. Other:

8. Offeror:

9. Information Provided in Response to RFP No.: