Department of General Services                                                                                                                                                                                                                                                                            Contracts Management Unit
PROCUREMENT DIVISION                                                                                                                                                                                                                                                                                                    CMU 08-04
                                                                                                                                                                                                                                                                                                                       REV 02/15/08
                                                    SUPPLIER PERFORMANCE REPORT
GENERAL INFORMATION
 NAME:                                         TELEPHONE #:                                         EMAIL:                                                                                                                                                                                                                                                         DATE:
 DEPARTMENT NAME:                                                                                                                                                                                AGENCY ORDER #:
 CONTRACTOR NAME:                                                                                                                                                                                LEVERAGED PROCUREMENT AGREEMENT #:
                                                                               (check all applicable boxes)
    DELIVERY DATE(S)                                    DELIVERY                                                                                     SPECIFICATION                                                                                               CONSEQUENCES                                                                                                             ACTIONS
                                                                                                    Other (explain in comments)
                                                                                                                                                                                                                               Other (explain in comments)
                                                                                                                                                                                                                                                                                                                                                          Other (explain in comments)
                                                                                                                                                                                                                                                                                                                                                                                                              Other (explain in comments)
                                                                                                                                                                                                                                                                                                                                  Excessive Admin. Time
                                                                                                                                                                                                                                                                                                          Emergency Purchase(s)
                                                                                                                                                                                                                                                                                   Unscheduled Overtime
Purchase Order
                                                                                                                                                                                                                                                             Operational Changes
                                                                                                                                                                                           Marking/Packaging
                    Actual
   Required
                   Delivery
                                                                                                                                                                           Wrong Product
   Delivery
                                                                                     Non-Delivery
                                                                                                                                                             Wrong Brand
                   Date(s)
                                                                                                                                              Poor Quality
                                                                                                                                                                                                               Palletization
    Date(s)
                                 Compliant
                                                                                                                                  Compliant
                                                                                                                                                                                                                                                                                                                                                                                        Accepted
                                                                                                                                                                                                                                                                                                                                                                                                   Rejected
                                                            Partial
                                                                      Short
                                                    Early
                                                                              Over
                                             Late
 COMMENTS: Include all applicable information (issue, event, date, time)
Return completed form with any applicable attachments to the DGS Buyer/Contract Administrator:
            DGS - Procurement Division
            Acquisitions & Contracts Section
            707 3rd Street, 2nd Floor, MS 201
            West Sacramento, CA 95605
            Facsimile: (916) 375-4613