Standard Form 1421 - Performance Evaluation (Architect-Engineer) - 1983
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21. PROJECT NUMBER
PERFORMANCE EVALUATION
(ARCHITECT-ENGINEER)
2. CONTRACT NUMBER
IMPORTANT: Be sure to complete Performance section on reverse. If additional space is necessary for any item, use Remarks
section on reverse.
3. TYPE OF REPORT (Check one)
4. REPORT NUMBER
5. DATE OF REPORT
COMPLETION
OF DESIGN
COMPLETION OF
TERMI-
INTERIM
OR STUDY
CONSTRUCTION
NATION
6. NAME AND ADDRESS OF CONTRACTOR
7. PROJECT DESCRIPTION AND LOCATION
8. OFFICE RESPONSIBLE FOR:
A. SELECTION OF CONTRACTOR
B. NEGOTIATION/AWARD OF CONTRACT
C. ADMINISTRATION OF CONTRACT
9. CONTRACT DATA
A. TYPE OF WORK
B. TYPE OF CONTRACT
FIXED-PRICE
OTHER (Specify)
COST-REIMBURSEMENT
C. PROJECT COMPLEXITY
D. PROFESSIONAL SERVICES CONTRACT
INITIAL FEE
TOTAL FEE
AMENDMENTS
CLAIMS BY CONTRACTOR
DIFFICULT
ROUTINE
NO.
AMOUNT
NO.
AMOUNT
$
$
$
$
SIMPLE
E. DATE CONTRACT AWARDED
F. CONTRACT COMPLETION DATE (Including extensions) G. ACTUAL COMPLETION DATE OF CONTRACT
10. KEY CONSULTANT DATA
A. NAMES
B. ADDRESS
C. SPECIALTY
A. INITIAL ESTIMATE
B. AWARD
C. ACTUAL
11. CONSTRUCTION COSTS
$
$
$
12. CONSTRUCTION CHANGES AND DEFICIENCIES
NUMBER
TOTAL
$
A. CONSTRUCTION CHANGES
B. CONSTRUCTION CHANGES RESULTING FROM
$
DEFICIENCIES IN A-E PERFORMANCE
$
C. DEFICIENCIES PAID FOR BY A-E
$
D. DEFICIENCIES PAID FOR BY GOVERNMENT
13. OVERALL RATING
14. RECOMMENDED FOR FUTURE CONTRACTS?
EXCELLENT
AVERAGE
POOR
YES
NO (If "NO," explain in REMARKS on reverse)
15A. NAME AND TITLE OF RATING OFFICIAL
16A. NAME AND TITLE OF REVIEWING OFFICIAL
15B. SIGNATURE
15C. DATE
16B. SIGNATURE
16C. DATE
STANDARD FORM 1421
NSN 7540-01-155-3244
(10-83)
Prescribed by GSA FAR (48 CFR) 5.236-2(d)
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