(Example Only)
Agency Name ________________
Office Name ________________
Agency Contract No. _____________
DOA Contract No. __________________
Contractor ________________
Beginning and Ending Dates for Contract ____________to __________
Description of Services:
Deliverable Products:
(What were final products, if any? Were they delivered on time?
Were they usable?...)
Overall Performance:
(List weak points, strong points. Would you hire this contractor again?)
Signature of Program Official _____________
Approved by: _____________
La. Admin. Code tit. 34, § V-199