Project Name
Project No. ___________
UFC 4-214-02, TEMF, 24 July 03
PAST PERFORMANCE EVALUATION QUESTIONNAIRE
Upon completion of this form, please send directly to the U.S. Army Corps of Engineers
in the enclosed addressed envelope or fax [or e-mail] to [FAX NUMBER], ATTN: [Contract
Specialist]. Do not return this form to our offices. Thank you.
1. Contractor/Name & Address (City and State):
2. Type of Contract: Fixed Price ________ Cost Reimbursement ________
Other (Specify) ________________________________
3. Title of Project/Contract Number:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. Description of Work: (Attach additional pages as necessary)
5. Complexity of Work: High ________ Mid _________ Routine __________
6. Location of Work:______________________________________________
7. Date of Award: ________________________
8. Status:
Active _________ (provide percent complete)
Complete __________ (provide completion date)
9. Name, address and telephone number of Contracting Officer's Technical
Representative:
00110 - 7
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