FOR OFFICIAL USE ONLY (WHEN COMPLETED)
1.
CONTRACT
NUMBER
PERFORMANCE EVALUATION
(CONSTRUCTION)
2.
CEC NUMBER
IMPORTANT: Be sure to complete Part III - Evaluation of Performance Elements on reverse.
PART I - GENERAL CONTRACT DATA
3.
TYPE OF
EVALUATION (X one)
4.
TERMINATED
FOR DEFAULT
INTERIM (List percentage
%)
FINAL
AMENDED
5.
CONTRACTOR
(Name, Address, and ZIP Code)
6.a. PROCUREMENT METHOD (X one)
SEALED BID
NEGOTIATED
b.
TYPE
OF CONTRACT (X one)
FIRM FIXED PRICE
COST REIMBURSEMENT
OTHER (Specify)
7.
DESCRIPTION AND
LOCATION OF WORK
8.
TYPE AND
PERCENT OF SUBCONTRACTING
d.
NET AMOUNT PAID
a.
AMOUNT OF
BASIC
b.
TOTAL
AMOUNT OF
c.
LIQUIDATED
CONTRACTOR
CONTRACT
MODIFICATIONS
DAMAGES ASSESSED
9. FISCAL DATA
$
$
$
$
a.
DATE OF
AWARD
b.
ORIGINAL CONTRACT
c.
REVISED CONTRACT
d.
DATE WORK
10. SIGNIFICANT
COMPLETION DATE
COMPLETION DATE
ACCEPTED
DATES
PART II - PERFORMANCE EVALUATION OF CONTRACTOR
11. OVERALL RATING (X appropriate block)
UNSATISFACTORY (Explain
OUTSTANDING
ABOVE AVERAGE
SATISFACTORY
MARGINAL
in Item 20 on reverse)
12. EVALUATED BY
a. ORGANIZATION (Name and Address (Include ZIP Code))
b.
TELEPHONE NUMBER
(Include Area
Code)
c.
NAME
AND TITLE
d.
SIGNATURE
e.
DATE
13. EVALUATION REVIEWED BY
a. ORGANIZATION (Name and Address (Include ZIP Code))
b.
TELEPHONE NUMBER
(Include Area
Code)
c.
NAME
AND TITLE
d.
SIGNATURE
e.
DATE
14. AGENCY USE (Distribution, etc.)
EXCEPTION TO SF 1420 APPROVED BY GSA/IRMS 6-94
DD FORM 2626, JUN 94
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