(Submit a copy to the Contractor Performance Assessment Report System (CPARS) focal point upon award, along with the CPARS access request format at 5153.303-10. Other formats may be used if all applicable information below is included. )

CONTRACT NUMBER: ________________________

ORDER NUMBER _ _______________(Include General Services Administration (GSA) number and basic procurement instrument identification “F” order number.)

CONTRACT TITLE/EFFORT DESCRIPTION: __________________________________________ _________ ___________________________

CAGE CODE:_ _______ DUNS:________________ PSC:________ NAICS: ______ _ _____

CONTRACTOR NAME, A D DRESS (as listed in System for Award Management, www.sam.gov): ___________________ _ _____________________________________________ ___ _________

BUSINESS SECTOR (Circle one): Systems or Non-systems

LOCATION OF CONTRACTOR PERFORMANCE (if other than contractor address above): ______________________________________________________________________ ___ ____

CONTRACT AWARD DATE ___________ _ EFFECTIVE DATE: ___________________

COMPLETION DATE (Include last possible date, if all options exercised): ______________

DOLLAR VALUES:

AWARDED VALUE (Grand total, including unexercised options): _______________

CURRENT VALUE (Current funded amount as of registration date. Use target price or total estimated amount for incentive contracts.): ____________________________

CONTRACT TYPE (Circle one. For hybrid, put a “P” next to the predominate type and identify other type with an “O” next to it.):

FFP __ FPI ___ FPR ___ CPFF ___ CPIF ___ CPAF ___ HYBRID _ __ OTHER: _________________

COMPETITIVE (Basis of award): YES or NO

PROGRAM/PRODUCT/PROJECT M ANA G E R _ __________________

E-MAIL: _____________________________ TELE: _________________

CONTRACT SPEC IALIST ___________________

E-MAIL: ____________________________ TELE: _________________

CONTRACTING OFFICER _ __________________

E-MAIL:_ ___________________ TELE: ____ __ ___________

GOV ERMEN T C ONTRACTING OFFICER’S REPRESENTATIVE / QUALITY ASSURANCE EVALUATOR _ __________________

E-MAIL:_ ____________________________ TELE: _________________

CONTRACTOR PROGRAM MANAGER:_ ___ _ _________________________ TELE:_________________E-MAIL: ___________________________________

PERIOD OF PERFORMANCE (POP) FOR 1 ST ASSESSMENT:

FROM:_ ______ _ ____ TO:___________ CPAR COMPLETED:_________

OPTION 1 POP FROM:_ __________ TO:___________ CPAR COMPLETED:_________

OPTION 2 POP FROM:_ __________ TO:_______ ____ CPAR COMPLETED:_________

OPTION 3 POP FROM:_ __________ TO:______ _____ CPAR COMPLETED:_________

OPTION 4 POP FROM:_ __________ TO:______ _____ CPAR COMPLETED:_________

(View completed reports in the Past Performance Information Retrieval System-Report Card, available via the Internet at https://www.ppirs.gov.)