TE5_2-040_Contractor_Self-Evaluation.docx

TE 5.2-040

General Instructions

1. The enclosed Contractor Self-Evaluation form shall be completed monthly by the Contractor and submitted to the Contracting Officer (KO) and Contracting Officer’s Representative (COR).

2. Report shall be submitted to the KO in accordance with a mutually established submittal schedule.

3. The Overall assessment Quality of Work category definitions.

Exceptional* - Definition: Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

Very Good - Definition: Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor was effective.

Satisfactory - Definition: Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal - Definition: Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.

Unsatisfactory* - Definition: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Contractor Self-Evaluation

1. CONTRACT NUMBER:

2. CONTRACT PERIOD OF PERFORMANCE: (Click here to enter text.)

3. CONTRACTOR: (Click here to enter text.)

4. OVERALL ASSESSMENT: Complete items 4a through 4d below. Provide supporting detailed explanation in Item 6, as necessary. Attach additional documentation for supporting evidence if required.

a. Quality of Work ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory

*(Detailed narrative justification required in Item 6a below to support Quality of Work rating)

b. Deliverables provided by the contractor this month (list them here):

c. Was the contractor’s performance timely? ☐ YES ☐ NO**

**(If answered “NO”, provide explanation in Item 6b below)

d. Are there any significant issues that should be brought to the contracting officer’s attention?

☐ YES*** ☐ NO

***(If answered “YES”, provide explanation in the applicable item(s) in Section 6 below)

e. Is action being taken by contractor to correct discrepancies?

☐ YES**** ☐ NO**** ☐ NA (no discrepancies this month)

****(If answered “YES” or “NO”, provide explanation in the applicable item(s) in Section 6 below)

5. CUSTOMER COMPLAINTS:

a. Number of customer complaints:

b. Number of VALID customer complaints:

6. ADDITIONAL COMMENTS (to support responses provided in Section 6 above, as necessary).

Rate each area below and provide comments if your rating is above or below Satisfactory:

a. Quality: ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory

b. Schedule: Work ☐

Very Good ☐ Satisfactory ☐

Unsatisfactory

c. Cost Control: Work ☐

Very Good ☐ Satisfactory ☐

Unsatisfactory

d. Management: ☐

Very Good ☐ Satisfactory ☐

Unsatisfactory

e. Utilization of Small Business: ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory

f. Regulatory Compliance: ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory

g. Other Areas:

9. SIGNATURE: This Contractor Self-Evaluation was prepared by:

Name / SIGNATURE / DATE