Host Agency:

Report Type: Interim Report

Report Date:   From: mm/dd/yyyy To: mm/dd/yyyy

Evaluating Organization:

Contracting Office:

Contract Number:

Order Number:

Contractor Name and Address:

TIN:

DUNS: 
SIC/NAICS:

Commodity Code:
Procurement Method:

Contract Type:

Amount of Basic Contract:

Total Amount of Modifications:

Liquid Damages Assessed:

Net Amount Paid Contractor:

Award Date:

Original Completion Date:

Final Completion Date:

Date Work was accepted:

Description of Requirement:

Quality of Product or Service

0=Unsatisfactory    1=Poor    2=Fair    3=Good    4=Excellent    5=Outstanding   

N/A

0

1

2

3

4

5

Quality of Workmanship :

Adequacy of the CQC Plan :

Implementation of CQC Plan:

Quality of QC Documentation:

Storage of Materials :

Adequacy of Materials:

Adequacy of Submittals :

Adequacy of QC Testing:

Adequacy of As-Builts:

Use of Specified Materials:

Identification/Correction of Deficient Work :

Government Comments for Quality of Product or Service

Cost Control

0=Unsatisfactory    1=Poor    2=Fair    3=Good    4=Excellent    5=Outstanding   

N/A

0

1

2

3

4

5

Cost Control:

Government Comments for Cost Control

Timeliness of Performance

0=Unsatisfactory    1=Poor    2=Fair    3=Good    4=Excellent    5=Outstanding   

N/A

0

1

2

3

4

5

Adequacy of Initial Progress Schedule:

Adherence to Approved Schedule:

Resolution of Delays:

Submission of Required Documentation:

Completion of Punch List Items:

Submission of Updated and Revised Progress Schedules :

Warranty Response:

Government Comments for Timeliness of Performance

Effectiveness of Management / Business Relations

0=Unsatisfactory    1=Poor    2=Fair    3=Good    4=Excellent    5=Outstanding   

N/A

0

1

2

3

4

5

Cooperation and Responsiveness:

Management of Resources/Personnel:

Coordination and Control of Subcontractors:

Adequacy of Site Clean-Up:

Effectiveness of Job-Site Regulations:

Compliance With Laws and Regulations:

Professional Conduct:

Review/Resolution of Subcontractor's Issues:

Change Order Activity (By Contractor):

Adequacy of Work Force:

O & M Manuals/Instructions:

Spare Parts Delivery:

Government Comments for Effectiveness of Management / Business Relations

Compliance With Labor Standards

0=Unsatisfactory    1=Poor    2=Fair    3=Good    4=Excellent    5=Outstanding   

N/A

0

1

2

3

4

5

Correction of Noted Deficiencies:

Payrolls Properly Completed and Submitted:

Compliance With Labor Laws and Regulation With Specific Attention to the Davis-Bacon Act and EEO Req:

Government Comments for Compliance With Labor Standards

Compliance With Safety Standards

0=Unsatisfactory    1=Poor    2=Fair    3=Good    4=Excellent    5=Outstanding   

N/A

0

1

2

3

4

5

Adequacy of Safety Plan:

Implementation of Safety Plan:

Correction of Noted Deficiencies:

Government Comments for Compliance With Safety Standards

Overall Rating

0=Unsatisfactory    1=Poor    2=Fair    3=Good    4=Excellent    5=Outstanding   

N/A

0

1

2

3

4

5

Overall Rating:

Government Comments for Overall Rating

Subcontracts

Are subcontracts involved ?

Government Comments for Comment on subcontracts

Contractor Key Personnel

Contractor Manager/Principal Investigator

Government Comments for Contractor Manager/Principal Investigator

Contractor Key Person

Government Comments for Contractor Key Person

Contractor Key Person

Government Comments for Contractor Key Person

Small Business Subcontracting Plan

Did the contractor make a good faith effort to comply with its subcontracting plan consistent with the goals and objectives, reporting and other aspects of the plan?

If this is a bundled contract, did the contractor meet the goals and objectives for small business participation?

Government Comments for Comments on Small Business Subcontracting Plan

Small Disadvantaged Business Goals

Did the contractor make a good faith effort to comply with its subcontracting plan consistent with the goals and objectives, for small disadvantaged business (SDB) participation,monetary targets for SDB participation, and required notifications?

Government Comments for Meeting SDB Subcontracting Requirements

Customer Satisfaction

Is/was the contractor committed to customer satisfaction?

Would you recommend the selection of this firm again?

Government Comments for Customer Satisfaction

Project Officer/COTR

Contractor Representative

Contracting Officer