Fillable Printable Performance Evaluation & Facilities Report
Fillable Printable Performance Evaluation & Facilities Report
Performance Evaluation & Facilities Report
SMALL
PERFORMANCE EVALUATION & FACILITIES REPORT
SECTION I - PCO REQUEST
1. OFFEROR/CONTRACTOR
b. REPRESENTATION
LARGE 8A MFGR DEALER
a. IDENTIFICATION (Name, address, telephone number, CEC, and point of contact)
c. INSPECTION POINT, IF DIFFERENT FROM ABOVE (Name, address, telephone
number, CEC, and point of contact)
3. SOLICITATION/CONTRACT NUMBER AND ESTIMATED DOLLAR VALUE
4. SPECIAL REQUIREMENTS (Delivery, 1st Article, Bid Sample Buy Am., SBSA, MAS)
5. SPECIAL INFORMATION FOR CONTRACT MANAGEMENT
6. REASON FOR REQUEST (CAL/date, New Supplier, New Product)
7a. REQUESTER (Name, organizational symbol, telephone number; and FAX number)
b. DATE
8. SOLICITATION ITEMS
ITEM
NO.
NOMENCLATURE AND NSN
(b)
PEAK MONTHLY
(c)
(d)
(a)
TOTAL
(a)
MONTHLY
CAPACITY
(b)
GOVERNMENT
COMMITMENTS
(c)
COMMERCIAL
COMMITMENTS
(d)
NET AVAIL.
REQUIREMENTS (Units)
SECTION II - QAS EVALUATION
9. MONTHLY COMMITMENTS AND CAPACITY
10. SUMMARY OF ACO/QAS FINDINGS (Past performance, production capacity, quality control system, representations, and favorable or unfavorable factors)
11. RECOMMENDATION
CAPABLE OF
PERFORMING
INCAPABLE OF
PERFORMING
12a. ZONE b. DATE RECEIVED c. CONTROL NUMBER
13. APPROVAL: DIRECTOR, CONTRACT MANAGEMENT DIVISION
a. PRINTED NAME
b. TELEPHONE NUMBER:
c. SIGNATURE d. DATE
GENERAL SERVICES ADMINISTRATION
GSA FORM 353 (REV. 9-93)
Prescribed by GSAR 509.106-2
EXCEPTION TO SF 1403-1406
APPROVED BY GSA/IRMS 10/94
14. TYPE OF COMPANY 15. KEY PERSONNEL INTERVIEWED
CORPORATION
PARTNERSHIP
OTHER (Specify)
a. NAME b. TITLE c. YRS. WITH FIRM
b. HOURS PER SHIFT
21a. SQ. METERS UNDER ROOF b. MANUFACTURING c. STGE.
d. CONSTRUCTION AND CONDITION e. NO. OF BLDG.
22. COMMENTS (Adequacy of personnel, equipment, and space)
23. SPECIAL TOOLING (Quantity, condition, plans for procuring, costs, delivery dates, and manufacturer's familiarity with use and handling)
24. PRODUCTION METHODS (Order tracking system, flow, assembly line, production cycle time, parts manufactured, parts contracted for/purchased)
16. YEAR ESTABLISHED
17a. PERSONNEL b. NO. ON HAND 18. PRODUCTION EQUIPMENT
PRODUCTION
QUALITY ASSURANCE
ENGINEERING
ADMINISTRATIVE
TOTAL
a. ON HAND b. QUANTITY c. CONDITION
19. UNION AFFILIATION - DATE AGREEMENT EXPIRES
20a. NUMBER OF SHIFTS
GSA FORM 353 (REV. 9-93) PAGE 2
25. OTHER ITEMS PRODUCED (Using same machinery, tools, equipment, and personnel as solicitation/contract item(s))
26. QUALITY SYSTEM REQUIREMENTS
a. DOCUMENTED QUALITY SYSTEM
b. ORGANIZATION AND MANAGEMENT RESPONSIBILITY
c. PROCESS AND SPECIAL PROCESS CONTROLS
d. INSPECTION, MEASURING AND TEST EQUIPMENT
GSA FORM 353 (REV. 9-93) PAGE 3
26. QUALITY SYSTEM REQUIREMENTS (Continued)
e. USE OF STATISTICAL TECHNIQUES
f. QUALITY RECORDS
g. TECHNICAL DOCUMENT CONTROL AND COMMUNICATIONS
h. PACKAGING, PACKING, AND MARKING
GSA FORM 353 (REV. 9-93) PAGE 4
c. SIGNATURE d. DATE
27. EEO COMPLIANCE (From observation only)
a. ARE EEO POSTERS DISPLAYED WHERE ALL EMPLOYEES CAN READ THEM?
b. GIVE ANY EVIDENCE OF SEGREGATED FACILITIES (Entrances, exits, drinking
fountains, eating, restrooms, etc.)
28. REMARKS AND ADDITIONAL COMMENTS
29. QAS ANALYSIS AND RECOMMENDATION
30. QUALITY ASSURANCE SPECIALIST
a. PRINTED NAME
b. TELEPHONE NUMBER:
YES NO
GSA FORM 353 (REV. 9-93) PAGE 5
NO
NOYES
YES
Type Age
NOYES
CC
CC
CCGC
CCGC
e. Percent PO's Delinquent to
Original Due Date:
l. Number Show Cause Ltrs:
k. Number Cure Ltrs:
j. Number QDN's:
I. Percent PO's T for D:
h. Number PO's T for D:
g. Percent PO's Delinquent:
f. Total Number PO's Issued:
d. Total Number PO's Issued:
c. FSC/Nomenclature
b. Contract Period:
p. Nonconforming
Supplies Accepted
s. Contract T for D:
r. Holds:
q. Complaints:
o. 1st Article
n. Deviation:
Number Failed Correct
Number Category I
Number Contractor Liable
Total
1st Submission Accept.
On Time
GC
Percent Test Failed
Number Failed
Number Testsm. Laboratorya. Contract Number:
SECTION III - PERFORMANCE HISTORY AND ACO ANALYSIS
t. ACO COMMENTS
31. SUMMARY OF CONTRACTS (Beginning with the most recent contract)
t. ACO COMMENTS
a. Contract Number: m. Laboratory: Number Tests
Number Failed
Percent Test Failed
GC
On Time
1st Submission Accept.
Total
Number Contractor Liable
Number Category I
Number Failed Correct
n. Deviation:
o. 1st Article:
q. Complaints:
r. Holds:
s. Contract T for D:
p. Nonconforming
Supplies Accepted:
b. Contract Period:
c. FSC/Nomenclature:
d. Total Number PO's Issued:
f. Total Number PO's Issued:
g. Percent PO's Delinquent:
h. Number PO's T for D:
i. Percent PO's T for D:
j. Number QDN's:
k. Number Cure Ltrs:
l. Number Show Cause Ltrs:
e. Percent PO's Delinquent to
Original Due Date:
GC CC
GC CC
CC
CC
YES NO
AgeType
YES
YESN/A
N/A
NO
NO
GSA FORM 353 (REV. 9-93) PAGE 6
NO
NOYES
YES
Type Age
NOYES
CC
CC
CCGC
CCGC
e. Percent PO's Delinquent to
Original Due Date:
l. Number Show Cause Ltrs:
k. Number Cure Ltrs:
j. Number QDN's:
I. Percent PO's T for D:
h. Number PO's T for D:
g. Percent PO's Delinquent:
f. Total Number PO's Issued:
d. Total Number PO's Issued:
c. FSC/Nomenclature
b. Contract Period:
p. Nonconforming
Supplies Accepted
s. Contract T for D:
r. Holds:
q. Complaints:
o. 1st Article
n. Deviation:
Number Failed Correct
Number Category I
Number Contractor Liable
Total
1st Submission Accept.
On Time
GC
Percent Test Failed
Number Failed
Number Testsm. Laboratorya. Contract Number:
t. ACO COMMENTS
31. SUMMARY OF CONTRACTS (Continued)
t. ACO COMMENTS
a. Contract Number: m. Laboratory Number Tests
Number Failed
Percent Test Failed
GC
On Time
1st Submission Accept.
Total
Number Contractor Liable
Number Category I
Number Failed Correct
n. Deviation:
o. 1st Article
q. Complaints:
r. Holds:
s. Contract T for D:
p. Nonconforming
Supplies Accepted
b. Contract Period:
c. FSC/Nomenclature
d. Total Number PO's Issued:
f. Total Number PO's Issued:
g. Percent PO's Delinquent:
h. Number PO's T for D:
I. Percent PO's T for D:
j. Number QDN's:
k. Number Cure Ltrs:
l. Number Show Cause Ltrs:
e. Percent PO's Delinquent to
Original Due Date:
GC CC
GC CC
CC
CC
YES NO
AgeType
YES
YES NO
NO
GSA FORM 353 (REV. 9-93) PAGE 7
N/A
N/A
33. ACO SUMMARY ANALYSIS OF OVERALL PERFORMANCE AND RECOMMENDATIONS
31. SUMMARY OF CONTRACTS (Beginning with the most recent contract)
t. ACO COMMENTS
a. Contract Number: m. Laboratory Number Tests
Number Failed
Percent Test Failed
GC
On Time
1st Submission Accept.
Total
Number Contractor Liable
Number Category I
Number Failed Correct
n. Deviation:
o. 1st Article
q. Complaints:
r. Holds:
s. Contract T for D:
p. Nonconforming
Supplies Accepted
b. Contract Period:
c. FSC/Nomenclature
d. Total Number PO's Issued:
f. Total Number PO's Issued:
g. Percent PO's Delinquent:
h. Number PO's T for D:
I. Percent PO's T for D:
j. Number QDN's:
k. Number Cure Ltrs:
l. Number Show Cause Ltrs:
e. Percent PO's Delinquent to
Original Due Date:
GC CC
GC CC
CC
CC
YES NO
AgeType
YES
YESN/A NO
NO
c. SIGNATURE d. DATE
34. ADMINISTRATIVE CONTRACTING OFFICER
a. PRINTED NAME
b. TELEPHONE NUMBER:
GSA FORM 353 (REV. 9-93) PAGE 8
