GENERAL SERVICES ADMINISTRATION ACQUISITION MANUAL (GSAM)

## Part 553—Forms

### Subpart 553.1—General

#### 553.101 Requirements for use of forms.

Parts 501–552 and 570 prescribe the requirements for use of GSA forms illustrated or referenced in this part. You may identify the prescription as follows:

(a) Forms available on-line. The list of forms available on-line in 553.370-1 identifies the basic prescription for each referenced form.

(b) Illustrated forms. The prescription for each illustrated form is identified by a cross-reference shown on the illustration. When a form is mentioned in more than one place in this regulation, the section referenced on the illustration is the section that contains the basic prescription.

#### 553.102 Current editions.

You must use the current edition of the forms identified in Subpart 553.3 unless otherwise authorized under this regulation.

#### 553.170 Establishing and revising GSA Forms.

(a) If two or more GSA Services or Offices use a GSA form, the Office of Acquisition Policy maintains the form.

(b) If only one GSA Service or Office uses a GSA form or if the form is used for a contract type unique to one Service or Office (e.g., construction contracts), that Service or Office is responsible for maintaining the form.

(c) Any proposed new or revised GSA acquisition related form must be submitted to the Office of Acquisition Policy for review and concurrence.

### Subpart 553.3—Illustrations of Forms

#### 553.300 Scope of subpart.

This subpart illustrates standard and GSA forms prescribed or referenced in Parts 501–551 and 570. Instructions on completing a form, if included, are identified by the suffix “I” after the GSAR section number.

#### 553.300-70 Forms not illustrated.

This subpart does not illustrate either:

(a) Standard forms illustrated in the FAR.

(b) Forms available on-line. You can access the forms listed below at the location indicated.

Reference | Form No. | Title | On-line Location
--- | --- | --- | ---
570.701 | Standard Form 2 | U.S. Government Lease for Real Property | http://www.gsa.gov/pbs/pe/stancla/stancla.htm
552.238-74 | GSA Form 72A | Contractor’s Report of Sales | http://vsc.gsa.gov
570.702(b) | GSA Form 276 | Supplemental Lease Agreement | http://www.gsa.gov/forms
513.302-70(b) | GSA Form 300 | Order for Supplies and Services | http://www.gsa.gov/forms
Subsection(alpha)70(number) | GSA Form 300A | Order for Supplies and Services (Continuation) | http://www.gsa.gov/forms
509.106-2 | GSA Form 353 | Performance Evaluation & Facilities Report | http://www.gsa.gov/forms
509.105-1(a) | GSA Form 527 | Contractor’s Qualifications and Financial Information | http://www.gsa.gov/forms
532.905-71(a) | GSA Form 1142 | Release of Claims | http://www.gsa.gov/forms
570.702(c) | GSA Form 1364 | Proposal to Lease Space | http://www.gsa.gov/forms
514.407-72 | GSA Form 1535 | Recommendation for Award(s) | http://www.gsa.gov/forms
513.106(c)(2) | GSA Form 2010 | Small Purchase Tabulation Source List/Abstract | http://www.gsa.gov/forms
532.905-70 | GSA Form 2419 | Certification of Progress Payments Under Fixed-Price Construction Contracts | http://www.gsa.gov/forms
501.603-3(b)(1) | GSA Form 3409 | Personal Qualifications Statement for Appointment as Contracting Officer | http://www.gsa.gov/forms
504.803(b) | GSA Form 3420 | Contract/Modification File Checklist File Format (Award) | http://www.gsa.gov/forms
503.104-5 | GSA Form 3617 | Record of Authorization of Access to Proprietary or Source Selection Information | http://www.gsa.gov/forms
570.702(a) | GSA Form 3626 | U.S. Government Lease for Real Property (Short Form) | http://www.gsa.gov/pbs/pe/stancla/stancla.htm

#### 553.370-300-I Instructions for using the GSA Form 300, Order for Supplies and Services.

(a) Completing the form.

Block 1, Date of Order. Enter the date the order is signed by the contracting/ordering officer.
Block 2, Order Number. If an order is being placed against an established contract, assign an order number in accordance with the procedures in GSAR 504.7001-3. This block does not apply to open market purchases/contracts.
Block 3, Contract Number. If an order is being placed against an established contract, insert the contract number of the contract that the order is being placed against. If an open market purchase/contract is involved, assign a contract number in accordance with the procedures in GSAR 504.7001-2.
Block 4, ACT Number. Assign an Accounting Control Transaction (ACT) number in accordance with NEAR system procedures. If the purchase is charged to the General Supply Fund (255X), contemplates periodic billing or is for an amount that exceeds $2,500, place the ACT number label on copy 1, the “paying office” copy. The ACT number label will be placed on the invoice for other purchases. NOTE: In some organizations, the “paying office” copy is forwarded to a Budget or Executive Office within the service or staff office where the ACT number label is affixed to the copy and forwarded to the appropriate Finance Division.
Block 5, Accounting Classification. Enter the accounting information in accordance with the procedures contained in the Accounting Classification Handbook (COM P 4240.1). The following blocks are mandatory and must be completed for each order: “FUND,” “ORG CODE,” “B/A CODE,” “O/C CODE,” “FUNC CODE,” and “C/E CODE.” The accounting information on modifications must be the same as the original order, unless the accounting information is being modified.
Block 6, Finance Division. To be completed by the Finance Division.
Block 7, To: Contractor. Enter the contractor's name and address, including zip code.
Block 8, Type of Order. Check “block A” when making an open market purchase/contract and refer to the date of the contractor's oral or written quotation in the space “REFERENCE YOUR.” Check “block B” when placing orders against established contracts. Check “block C” when using a GSA Form 300 to modify another GSA Form 300; enter the modification number and the authority for issuing the change, i.e., “changes” clause or other authority for issuing. Assign modification numbers in accordance with GSAR 504.7001-4.
Block 9, Taxpayer's Identification Number (TIN). This block is mandatory when making open market purchases of services from firms or individuals that are not incorporated (partnerships or sole proprietors). This requirement does not apply to supply purchases/contracts. Obtain the firm's or individual's TIN and enter it in “block A.” The Finance Division will return purchase orders if block 9A is incomplete. If the contractor refuses to provide a TIN, check “block B” to reduce payment by twenty percent. NOTE: The contractor must be informed before checking “block B” that failure to provide the TIN will result in twenty percent of the payment being withheld.
Block 10, Classification. Check the block in 10A that indicates the classification of the contractor. Definitions of “Small Business,” “Disadvantaged Business,” and “Women-owned Business” can be found at FAR 19.001 and 52.219-3. Check the block in 10B that indicates the type of business organization of the contractor. This block is mandatory when making open market purchases of services.
Block 11, Issuing Office. Enter the name, address, including zip code, and telephone number of the office making the purchase/contract.
Block 12, Remittance Address. Ask the contractor for the address that it would like the payment for the supplies or services to be mailed. The Finance Division can only make payments to the address indicated on the order. Therefore, in order for payments to be processed in a timely manner, the contracting officer must ask the contractor for a remittance address and enter it in “block 12.” If the contractor's invoice requests payment to be made to a different address than the one in block 12, the Finance Division will request the contracting officer to modify the order within 5 days to provide the proper “remit to” address. If the Finance Division does not receive a modification within 5 days, the invoice will be considered improper and will be returned to the contractor.
Block 13, Ship to. Enter the consignee address, including zip code, and telephone number.
Block 14, Place of Inspection and Acceptance. Enter the location where inspection and acceptance will occur.
Block 15, Requisition Office. Enter the name, correspondence symbol and telephone number of the office that requested the supplies or services be purchased.
Block 16, F.O.B. Point. Enter the appropriate f.o.b. point. See FAR 47.302 and 47.303 and GSAR 547.300.
Block 17, Government B/L No. When supplies are shipped using a Government Bill of Lading (GBL), enter the GBL number.
Block 18, Delivery f.o.b. point on or before. Enter the date when supplies or services are to be delivered. Terms such as “ASAP” are unacceptable.
Block 19, Payment/Discount Terms. Enter the prompt payment discount terms provided for in the contract when placing an order against an established contract or the discount terms offered if purchasing on the open market.
Block 20, Schedule. Enter a complete description of the supplies or services being procured, including quantity, unit price, total price and any periodic billing requirements. In addition, the estimated freight charges must be included when f.o.b. origin terms are used and a Government Bill of Lading (GBL) is not issued.
Periods for inspection and acceptance of contract deliverables or completed work that are different from the 5 days cited in the Prompt Payment clause on the reverse of the GSA Form 300, must be included in this block.
When a GSA Form 300 is used to modify another GSA Form 300, block 20 must describe in detail what is being modified, e.g., number of units from to , delivery date from to , etc. Indicate the impact of the modification on the total price, e.g., total price is increased from $ to $ , total price is decreased from $ to $ , or the price of the original order is unchanged.
Block 21, Receiving Office. Enter the name, correspondence symbol and telephone number of the office responsible for completing the receiving report.
Block 22, Shipping Point. When the Government is paying the transportation cost or reimbursing the contractor for transportation cost, enter the shipping point for the supplies being purchased. This information should be obtained from the seller.
Block 23, Gross Shipping Weight. When the Government is paying the transportation cost or reimbursing the contractor for transportation cost, enter the shipping weight for the supplies being purchased. This information can usually be obtained from the seller.
Block 24, Mail Invoice to. Enter the address of the issuing office (same as block 11) or other designated program office within the service or region for purchases which do not exceed $2,500 except for procurements charged to the General Supply Fund (255X) and procurements that anticipate periodic billings, e.g., utility contracts, recurring building service contracts, equipment rentals, etc. For all other purchases, enter the address of the appropriate Finance Division. Enter the “Fund” in designated area.
Block 25. If block 24 provides for the invoice to be submitted directly to the appropriate Finance Division, enter the Chief, Accounts Payable Branch in block A and his/her telephone number, including area code, in block B. If block 24 provides for the invoice to be submitted to the issuing office or other designated program office within the service or region, enter the name and telephone number, including area code, of an individual in that office.
Block 26. Enter the name of the contracting/ordering officer in block A and his/her telephone number, including area code, in block B. The name of the contracting/ordering officer typed in block A must correspond with the signature in block C. Obligating documents cannot be signed for a contracting/ordering officer.

(b) Distribution.

(1) The distribution for orders (GSA Form 300) that do not exceed S2,500, except those orders charged to the General Supply Fund (255X) or those which anticipate periodic billing, will be as follows:

Copy 1 | Paying Office (Original)—Retain in the contract file or send to the program office within the service or region responsible for preparing the receiving report (Copy 6). DO NOT send to the paying office until the invoice is received and approved for payment.
Copy 2 | Contractor's original
Copy 3 | Purchase File (Contracting/Ordering Officer)
Copy 4 | Purchase Office (Distribution as necessary)
Copy 5 | Consignee
Copy 6 | Receiving Report (Paying Office)
Copy 7 | Memorandum (Distribution as necessary)

(2) The distribution for orders (GSA Form 300) that exceed $2,500, is charged to the General Supply Fund (255X), or that anticipates periodic billing will be as follows:

Copy 1 | Paying Office (Original)
Copy 2 | Contractor's Original
Copy 3 | Purchase File (Contracting/Ordering Officer)
Copy 4 | Purchase Office (Distribution as necessary)
Copy 5 | Consignee
Copy 6 | Receiving Report (Paying Office)—Not applicable to State A.I.D. overseas orders.
Copy 7 | Memorandum (Distribution as necessary)

(c) Certifying receipt and processing payments for procurements requiring a written purchase order (GSA Form 300).

(1) When supplies or services are received, the contracting/ordering office or designated program office will certify receipt and acceptance and indicate the amount approved for payment on copy 6, Receiving Report, of the GSA Form 300 or 300-1. When multiple deliveries/payments are required, additional copies of the receiving report (copy 6) may be reproduced or the GSA Form 3025 or 3025A, Receiving Report, used to certify receipt and acceptance. Photocopied signatures will not be accepted on the receiving report.

NOTE: It is important that the date of receipt and the date of acceptance entered in the certification on the receiving report be accurate. Those dates are used to calculate the due date for payments, and interest on overdue payments. The contracting/ordering officer or a designated representative should certify receipt and authorize payment by signing the certification on the receiving report.

(2) Invoices received by issuing offices or other designated program offices must be time stamped to indicate the date of receipt, checked to verify the accuracy of the invoiced amount, and forwarded within 5 workdays (after receipt of the invoice or acceptance of the supplies and/or services, whichever is later), to the appropriate Finance Division for payment. Copy 1 of the GSA Form 300/300-1 and a receiving report (Copy 6 of the GSA Form 300/300-1 or GSA Form 3025/3025A, Receiving Report) should be forwarded with the invoice to finance.

(3) When invoices are submitted directly to the Finance Division, contracting/ordering offices or other designated program offices will certify receipt and acceptance and authorize payment for supplies or services by completing copy 6 of GSA Form 300/300-1 or the GSA Form 3025/3025A, Receiving Report, in accordance with paragraph (a)(1) above and sending it to the appropriate Finance Division within 5 workdays after supplies or services are received and accepted.

#### 553.370-353-I Instructions for completing GSA Form 353, Performance Evaluation & Facilities Report (PEFR)

Completing Section I—PCO Request. Blocks 1 through 8 are to be completed by the contract specialists/Procuring Contracting Officer (PCO) requesting the PEFR.

Block 1—OFFEROR/CONTRACTOR.
Block la—IDENTIFICATION (Name, address, telephone number, CEC, and point of contact). Enter the name, address, complete telephone number (including area code), the Contractor Establishment Code (CEC), and the name of the individual that is the offeror/contractor's point of contact.
Block lb—REPRESENTATION. Check the appropriate boxes according to the offeror/contractor representations in the offer.
Block 2—INSPECTION POINT, IF DIFFERENT FROM ABOVE (Name, address, telephone number, CEC, and point of contact). If the inspection point is at a separate location from the offeror/contractor listed in Block 1, the PEFR should be requested at the inspection point. The PEFR request should be sent to the Contract Management zone where the inspection point is located, regardless of the location of the production point.
Enter the name, address/location (no post office boxes), complete telephone number (including area code), CEC, and, if available, the name of the individual that is the point of contact at the inspection point.
If there are multiple inspection points, separate requests must be made for each location. If multiple PEFRs are required for one offeror/contractor due to multiple inspection points, use Block 5 to notify the Quality Assurance Specialist (QAS) of all additional related PEFRs.
Block 3—SOLICITATION/CONTRACT NUMBER AND ESTIMATED DOLLAR VALUE. Enter the complete solicitation number, or contract number in cases of options, and the estimated dollar value of the items for which the offeror/contractor is being considered. If the PEFR is being requested for the purpose of exercising an option (additional quantity or extended period), enter the dollar value of the option only, not the full contract value.
Block 4—SPECIAL REQUIREMENTS (Delivery, lst Article, Bid Sample, Buy American, SBSA, MAS). Enter the delivery requirements (in number of days) and any special requirements that are applicable to the procurement; e.g., first article sample, bid sample, Buy American Act applies, Small Business Set Aside (SBSA), Multiple Award Schedule (MAS), quick ship provisions, backup contract, options versus a base contract, etc.
If anything other than a complete PEFR is being requested, clearly specify what limited information is needed. For example, in the case of a MAS proposed award or exercising an option for additional quantities or an extended period of tine, the PCO may request only certain information rather than a full PEFR.
While the QAS cannot certify that the contractor/offeror is a small business or qualifies as a dealer under the requirements of the Walsh-Healey Act, the PCO may request that the QAS advise of any conditions observed that would give reason to challenge the contractor/offeror's representations as reflected in Block lb. The QAS will address any issues regarding representations in Block 29.
Block 5—SPECIAL INFORMATION FOR CONTRACT MANAGEMENT. Enter any special information that would assist the QAS or the Administrative Contracting Officer (ACO) in evaluating the proposed contractor, such as: protests received, any allegations made by competitors that the PCO would like to have checked out, any information on problems experienced with bid samples, etc.
As noted in (2) above, if multiple PEFRs have been requested due to separate inspection points, so note. Specify the name and location (city and state) of the additional inspection points. This will enable the QAS and ACO to coordinate with other Regional Contract Management Divisions if necessary.
Block 6—REASON FOR REQUEST (CAL/date, new supplier, new product). Enter the reason for the request; e.g., offeror/contractor is on the Contractor Alert List (CAL) (if so, state the CAL date), new product, new supplier, no recent PEFR, etc. Explain fully when the dollar value of the proposed award is below the small purchase threshold.
Block 7—REQUESTER.
Block 7a—REQUESTER (Name, organizational symbol, telephone number, and FAX number). Enter the typed/printed name of the contract specialist/PCO making the PEFR request. The contract specialist's signature, organizational symbol, complete telephone number (including area code), and FAX number.
Block 7b—DATE. Enter the date of the request.
Block 8—SOLICITATION ITEMS.
Block 8a—ITEM NUMBER. Enter the solicitation/contract item number. This will assist the QAS and ACO in readily identifying the item in the solicitation/contract for which the offeror/contractor is being considered.
Block 8b—NOMENCLATURE AND NSN. Enter the nomenclature and national stock number (NSN), if applicable, for each item for which the offeror/contractor is being considered.

##### REQUIREMENTS (Units)

Block 8c—PEAK MONTHLY. For each item enter the offeror/contractor's stated peak monthly supply potential. If the offeror/contractor has not given its monthly supply potential, enter 125 percent of the Government's estimated monthly requirement.
Block 8d—TOTAL. On definite quantity solicitations/contracts, enter the total quantity required. If the PEFR is being requested for exercising an optional quantity, enter the total quantity of the option only, not the entire contract quantity. For other contract types (requirements or indefinite quantity), enter the total estimated quantity for the entire contract period.

(a) Completing Section II—QAS EVALUATION. Blocks 9 and 14 through 30 are to be completed by the QAS. Blocks 9, 10, 11, and 13 are to be completed last. Blocks 10 through 12 are to be completed by the Contract Management Division Director or his/her designee. Block 13 is to be completed by the Contract Management Division Director or Acting Director. Authority to sign Block 13 shall not be delegated below the level of Director, Contract Management Division.

Block 9a—MONTHLY CAPACITY. Determine the maximum production capacity. In making this determination, factors to be considered should include, but are not limited to:

(1) Reviewing past production records on the same or similar items;

(2) Considering employment level and number of shifts in operation during this period;

(3) Planning and scheduling of production equipment;

(4) Flexibility for reassignment of operation to alternate production equipment; and

(5) Time required to test.

Enter the total quantity for each item that can be produced in one month. Maximum production capacity must be determined by taking into consideration all items being evaluated, all operating processes, functions, equipment, and personnel.

Block 9b—GOVERNMENT COMMITMENTS. Determine and verify the number of units committed under existing Government contracts.
Block 9c—COMMERCIAL COMMITMENTS. Determine and verify the number of units committed under existing commercial contracts.
Block 9d—NET AVAILABLE. Subtract the total number of units in b and c from the number of units in a, and enter the results in Block 9d.
Block 10—SUMMARY OF ACO/QAS FINDINGS (Past performance, production capacity, quality control system, representations, and favorable or unfavorable factors). This Block is to be completed by the Contract Management Division Director, or his/her designee. Give a summation of the past performance, production capability and capacity, quality control system, purchasing, subcontracting procedures, problems with representations, and records at the manufacturing plant on items identical or similar-to the proposed award items.
Block 11—RECOMMENDATION. This Block is to be completed by the Contract Management Division Director or his/her designee.
Check the appropriate box; i.e., capable of performing or incapable of performing. One of the boxes must be checked.
Block 12. This Block is to be completed by the Contract Management Division Director or his/her designee.
Block 12a—ZONE. The receiving Contract Management Division shall enter the number of the zone where the survey will be conducted.
Block 12b—DATE RECEIVED. The surveying zone shall enter the date the Contract Management Division received the request from the procurement office.
Block 12c—CONTROL NUMBER. The surveying zone shall enter the control number assigned to the PEFR by the Contract Management Division.
Block 13—APPROVAL: DIRECTOR, CONTRACT MANAGEMENT DIVISION.
Block 13a—PRINTED NAME. The typed or printed name of the Contract Management Director approving the PEFR shall be entered in this block.
Block 13b—TELEPHONE NUMBER. Enter the telephone number (including area code) of the Contract Management Division Director.
Block 13c—SIGNATURE. After reviewing the completed form, the Director, Contract Management Division, or the Acting Director, shall sign the Form. Authority to approve the PEFR shall not be delegated below this level. Signature indicates a full review of the completed GSA Form 353 and agreement with its full contents.
Block 13d—DATE. Enter the date signed.
Block 14—TYPE OF COMPANY. Check corporation, partnership, or other. If “other,” specify; e.g., sole proprietor, etc.
Block 15—KEY PERSONNEL INTERVIEWED.
Block 15a—NAME. List the name(s) of the individual(s) interviewed.
Block 15b—TITLE. Give the organizational title(s) of the individual(s) interviewed.
Block 15c.—YEARS WITH FIRM. Enter the number of years each individual interviewed has been employed by the company.
Block 16—YEAR ESTABLISHED. Enter the year the current company/division was established.
Block 17—PERSONNEL. In Block 17b, headed “NO. ON HAND”, enter the actual number of employees corresponding to the categories listed in Block 17a; i.e., Production, Quality Assurance, Engineering, and Administrative. If more employees are needed to produce the solicitation/contract item(s), comment in Block 22. Indicate their plans to recruit.
Block 18—PRODUCTION EQUIPMENT.
Block 18a—ON HAND. List the major production equipment necessary to produce the solicitation/contract item(s) physically in the plant.
Block 18b—QUANTITY. Enter the number of pieces of equipment for each entry in Block 18a.
Block 18c—CONDITION. Indicate whether the equipment is in condition to adequately produce the solicitation/contract item(s).
Block 19—UNION AFFILIATION—DATE AGREEMENT EXPIRES. List the union affiliations and the expiration date of each agreement. Comment on any imminent strike or labor unrest conditions in Block 22.
Block 20.
Block 20a—NUMBER OF SHIFTS. Enter the number of shifts worked per day.
Block 20b—HOURS PER SHIFT. Enter the number of hours worked in each shift.
Block 21.
Block 21a—SQUARE METERS UNDER ROOF. Enter the total number of square meters the offeror/contractor has under roof.
Block 21b—MANUFACTURING. Enter the total number of square meters the offeror/contractor uses for manufacturing.
Block 21c—STORAGE. Enter the total number of square meters the offeror/contractor uses for storage of raw materials, components, and end items.
Block 21d—CONSTRUCTION AND CONDITION. Describe the construction and condition of the buildings.
Block 2le—NUMBER OF BUILDINGS. Enter the number of buildings at this location.
Block 22—COMMENTS (Adequacy of personnel, equipment, and space). Enter any comments relative to adequacy or inadequacy of:

(1) Available personnel;

(2) Any imminent strike conditions;

(3) Equipment necessary to produce the solicitation/contract item(s); and

(4) Space for manufacturing and storage.

Block 23—SPECIAL TOOLING (Quantity, condition, plans for procuring, costs, delivery dates, and manufacturer's familiarity with use and handling). List any special tooling such as molding equipment, special dyes, and special printing plates required to fabricate the solicitation/contract item(s), showing quantity on hand and present condition. If the necessary tooling is not on hand, enter the source where it will be obtained and the costs. Determine that the delivery dates of any new special tooling will meet contract delivery dates. Indicate manufacturer's familiarity with use and handling.
Block 24—PRODUCTION METHODS (order tracking system, flow, assembly line, production cycle time, parts manufactured, parts contracted for/purchased). Determine the process utilized by the offeror/contractor for tracking incoming Government purchase orders to assure adequate controls are in place. Determine that production methods are adequate to produce all items listed in Block 8 of this PEFR request. Provide a narrative to describe the processes. Include a listing of the significant items manufactured as well as those purchased. Record the production cycle tine. List any deficiencies noted and indicate what corrective action the offeror/contractor will take before the start of the contract.
Block 25—OTHER ITEM(S) PRODUCED (Using same machinery, tools, equipment, and personnel as solicitation/ contract item(s)). List all item(s) (other than the solicitation/contract items under evaluation) being produced, or scheduled into production, that use the same machinery, tools, equipment, and personnel required for the solicitation/contract item(s).
Block 26—QUALITY SYSTEM REQUIREMENTS.
Block 26a—DOCUMENTED QUALITY SYSTEM. Describe the offeror/contractor's current documented quality procedure and overall Conformance to the proposed contract requirements. Include a description of how the contractor ensures that incoming materials conform to contract requirements.
Block 26b—ORGANIZATION AND MANAGEMENT RESPONSIBILITY. Identify person(s) responsible and their authority in the quality organization. Describe management policy, controls, and objectives. Identify any training plan for personnel activities affecting quality.
Block 26c—PROCESS AND SPECIAL PROCESS CONTROLS. Describe process status controls, e.g., non-conforming material control, product segregation and traceability (use of tags, labels, marking, etc.). Identify process verification and inspection stations, as well as controls where product and special process characteristics are monitored.
Block 26d—INSPECTION, MEASURING, AND TEST EQUIPMENT. Identify inspection, tests, facilities, equipment, calibration plan, and overall program adequacy. Also identify any outside test facilities to be used. Explain the degree to which they will be utilized, and describe their adequacy.
Block 26e—USE OF STATISTICAL TECHNIQUES. Specify the sampling plans and/or statistical process controls used by the offeror/contractor. Determine if the plans are acceptable under the contract requirements.
Block 26f—QUALITY RECORDS. Describe the maintenance, identification, collection, indexing, filing, storage and disposition of records. Determine that the quality records adequately document the process controls and the inspections and tests performed as provided in the documented quality procedures.
Block 26g—TECHNICAL DOCUMENT CONTROL AND COMMUNICATIONS. Comment on the following:

(1) The offeror/contractor's control of technical documents, drawings, specifications, standards, commercial item descriptions, item purchase descriptions, etc., the control of changes to these documents, and communication and distribution of information;

(2) The adequacy of production technical documents;

(3) The contractor's understanding of the scope and nature of the work required and the specific issue of the technical documents involved; and

(4) Adequacy of controls and lines of communication between contractor, suppliers, and vendors concerning contract administration responsibilities.

Block 26h—PACKAGING, PACKING, AND MARKING. Explain how the offeror/contractor plans to fulfill the contract requirements for packaging, packing (including palletization), and marking. Describe plans to control the quality. Comment on the offeror/contractor's understanding of any military requirements.
Block 27—EEO COMPLIANCE (From observation only). To be completed only when the potential contract will exceed $10,000. The QAS will observe, but not inquire of the bidder, whether the plant appears to be in compliance with EEO clause (see FAR 52-222.26).
Block 27a—ARE EEO POSTERS DISPLAYED WHERE ALL EMPLOYEES CAN READ THEM? Check yes or no, as appropriate.
Block 27b—GIVE ANY EVIDENCE OF SEGREGATED FACILITIES (Entrances, exits, drinking fountains, eating, rest rooms, etc.). Enter details of any segregated facilities noted except facilities such as rest rooms or locker rooms segregated on the basis of gender.
Block 28—REMARKS AND ADDITIONAL COMMENTS. This Block is to be used for continuation space for additional information from any other blocks.
If the QAS is denied admittance, document the details and individuals involved.
Block 29—QAS ANALYSIS AND RECOMMENDATION. Enter information regarding the offeror/contractor's performance, such as, synopsis of quality complaints, information on administrative holds, related replacement actions, unresolved QDNs and/or unacceptable performance with respect to timely corrective actions, etc.
If the offeror/contractor is on the CAL, the QAS shall specifically address the criteria for which they were placed on the CAL, including identifying and analyzing any corrective actions taken and the current performance with regard to those CAL criteria.
Describe any favorable or unfavorable conditions that might affect contractor's performance, considering familiarity with the product, contract terms, technical documents, test requirements, and special requirements. Note whether there are any deficiencies in meeting quality system requirements and indicate their seriousness. State whether the supplier appears reliable, is able to make changes before the start of production, and is willing to correct deficiencies. Describe any reasons to question or challenge the offeror/contractor's representations (reflected in Block lb). Any additional remarks or comments can be continued in Block 28 or on plain bond paper if space is needed.

In this analysis, the QAS must specifically state a recommendation of “capable” or “incapable” of performing.

Enter any information available regarding other pending awards which would represent commitments that may cause conflict on capacity if awarded. Provide as much detail as possible, such as points of contact.
Block 30—QUALITY ASSURANCE SPECIALIST.
Block 30a—PRINTED NAME. Enter the typed or printed name of the QAS conducting the review and completing Section II of the PEFR.
Block 30b—TELEPHONE NUMBER. Enter the telephone number of the zonal office where questions regarding the PEFR are to be fielded.
Block 30c—SIGNATURE. The QAS shall sign the report. When the GSA Form 353 is electronically transmitted, a signature is not necessary.
Block 30d—DATE. Enter the date the QAS portion is completed and signed.

(b) Completing Section III—PERFORMANCE HISTORY AND ACO ANALYSIS.

Performance data must cover all current GSA contracts and small purchases, as well as all GSA contracts and small purchases that have been completed and/or terminated within the last three years.

If GSA contract performance data is not available, the ACO shall so indicate, and request the QAS to obtain any performance data available from the offeror/contractor on other Government or commercial contracts.

NOTE: At the discretion of the zone Contract Management Director, Section III may be completed concurrently by the ACO while Section II is being completed by the QAS, or completed by the ACO prior to forwarding the PEFR to the QAS for completion of Section II.

Block 31—SUMMARY OF CONTRACTS (Beginning with the most recent contract). No blocks are to be left blank. If the number is zero, enter “0”. If the item is not applicable, enter “N/A” (This should be a rare circumstance). If the information is not available or unknown, enter “UKN”. Space is provided for two contracts. List the data for the most recent contract first and continue on to the oldest contract last. If the offeror/contractor has held more than two contracts in the past three years, provide the data on additional pages. If additional space is needed, duplicate page 7 of the PEFR.

For Blocks 31b through 3lu enter the data as indicated below corresponding to each contract listed in Block 31a.

Block 31a—CONTRACT NUMBER. Enter the contract number.
Block 31b—CONTRACT PERIOD. Enter the contract period; i.e., the beginning and ending Julian dates.
Block 31c—FSC/NOMENCLATURE. Enter the FSC and nomenclature.
Block 31d—TOTAL NUMBER OF PURCHASE ORDERS ISSUED. Enter the total number of purchase orders issued.
Block 3le—PERCENT POs DELINQUENT TO ORIGINAL DUE DATE. Enter the percentage of purchase orders delinquent based on the original due date; specifying in the spaces provided the number that were Government Caused (GC) and the number that were Contractor Caused (CC).
Block 31f—NUMBER PURCHASE ORDERS DELINQUENT. Enter the number of purchase orders delinquent (16 or more days); specifying in the spaces provided the number that were Government Caused (GC) and the number that were Contractor Caused (CC).
Block 3lg—PERCENT POs DELINQUENT (CC). Divide the total of contractor caused late purchase orders (Block 31f (CC)) by the total number of purchase orders issued (Block 31d) to determine the percent of purchase orders delinquent due to contractor failure. Enter the resulting percentage.
Block 31h—NUMBER OF PURCHASE ORDERS TERMINATED FOR DEFAULT. Enter the number of purchase orders that were terminated for default.
Block 31i—PERCENT OF PURCHASE ORDERS TERMINATED FOR DEFAULT. Divide the number of purchase orders terminated for default (Block 31i) by the total number of purchase orders issued (Block 31d). Enter the resulting percentage.
Block 31j—NUMBER QDNs. Enter the number of Quality Deficiency Notices (QDNs) issued.
Block 31k—NUMBER CURE LETTERS. Enter the number of Cure Letters issued.
Block 311—NUMBER SHOW CAUSE LETTERS. Enter the number of Show Cause Letters issued.
Block 31m—LABORATORY. In the space labeled “Number Tests”, enter the total number of laboratory submissions conducted. In the second space, labeled “Number Failed”, enter the number of laboratory submissions where the item(s) tested failed to meet requirements. In the third space, labeled “Percent of Test Failed,” enter the percent of the laboratory submissions which failed. To derive the percent, divide the number of failed submissions) by the total number of submissions)
Block 31n—DEVIATION. Deviations are request(s) by the contractor for changes in requirements prior to the beginning of production. In the first space, labeled “GC” (Government caused), enter the number of deviations granted that were caused by the Government; e.g., faulty Government technical documents. In the second space, labeled “CC” (contractor caused), enter the number of deviations granted that were caused by the contractor.
Block 31o—lst ARTICLE. If no First Article sample was required under the contract, check “N/A.” If a First Article was required, check “yes” or “no” in the space labeled “On Time” to show whether the contractor offered the sample on time. In the space labeled “1st Submission or Accepted,” check “yes” or “no” to show whether the first submission of the first article sample was accepted.
Block 31p—NONCONFORMING SUPPLIES ACCEPTED. Enter the number of purchase orders where nonconforming supplies were accepted by the Government.
Block 3lq—COMPLAINTS. In the space under “Complaints” labeled “Total” enter the total number of customer complaints received. In the space labeled “Number Contractor Liable” enter the number of complaints with contractor liability that were found to be justified following investigation. In the space labeled “Number Category I” enter the number of complaints that were determined to be Category I complaints. In the final space under “Complaints” labeled “Number Failed Correct” enter the number of complaints where the contractor failed to take timely and adequate corrective action.
Block 3lr—HOLDS. List only those holds that are over 90 calendar days old. In the space under “Holds” labeled “Type” enter the type of hold; e.g., 51—Quality; 53—Litigation, etc. In the space labeled “Age” enter the age of the hold in terms of calendar days. In Block “t.—ACO COMMENTS” for the specified contract, provide a brief narrative on the hold. Describe any problems resulting from the contractor's failure to resolve the situation.
Block 31s—CONTRACT TERMINATED FOR DEFAULT. Check the “Yes” or “No” box, indicating whether the contract was terminated for default. Provide details in Block 31t.
Block 31t—ACO COMMENTS. Enter any additional information for the contract specified. Provide an explanation of the data and an evaluation of the contractor's performance under this specific contract.
Block 32—SUMMARY OF SMALL PURCHASES.
Block 32a—TOTAL NUMBER OF PURCHASE ORDERS ISSUED. Enter the total number of small purchase orders issued to the offeror/contractor over the past three years.
Block 32b—TOTAL DOLLAR VALUE. Enter the total dollar value of all small purchase orders issued to the offeror/contractor over the past three years.
Block 32c—32o. Enter data in accordance with the instructions for Blocks 3le–3lr with the corresponding headings.
Block 32p—ACO COMMENTS (Small Purchases). Enter any additional information to the data listed. Provide an explanation of the data and an evaluation of the contractor's performance on small purchases.
Block 33—ACO SUMMARY ANALYSIS OF OVERALL PERFORMANCE AND RECOMMENDATION. Provide a detailed analysis of all data gathered. Evaluate the offeror/contractor's past performance, current standing, and potential for future performance. Identify any patterns of improvement or deterioration in performance. In this analysis, the ACO must specifically state a recommendation of “award” or “no award.”
Block 34—ADMINISTRATIVE CONTRACTING OFFICER.
Block 34a—PRINTED NAME. Enter the typed or printed name of the ACO conducting the review and completing Section III of the PEFR.
Block 34b—TELEPHONE NUMBER. Enter the telephone number where the ACO can be reached.
Block 34c—SIGNATURE. The ACO shall sign the report.
Block 34d—DATE. Enter the date the ACO portion is completed and signed.

Copies and distribution. A separate GSA Form 353 must be used for each inspection point. An original and 3 copies of the GSA Form 353 must be prepared. The original and first copy must be forwarded to the Quality Assurance Branch in the zone in which the facilities are located. The second copy must be sent to the Quality Assurance Division, Central office, and the third copy retained as the file copy. The original and each of the two forwarded copies must be accompanied by:

(1) A copy of the solicitation;

(2) A copy of all pertinent information submitted by the offeror, including delivery time, and where applicable, the offeror's indicated monthly production capacity or supply potential (in lieu of extracting such information from the offer, copies of the offer or pertinent pages thereof may be furnished);

(3) Any pertinent correspondence between GSA and the offeror; and

(4) Any other information the buying activity has which should be considered by the Quality Assurance Branch in making the evaluation.