Project Name
Project No. ___________
UFC 4-721-11.1, UEPH Complexes, 26 Nov 01
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 - 6
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