STATE OF IOWA
IOWA DEPARTMENT OF ADMINISTRATIVE SERVICES
GENERAL SERVICES ENTERPRISE - PROCUREMENT SERVICES
Hoover State Office Building, Level A
Des Moines, IA
50319-0105
VENDOR PERFORMANCE REPORT
Complete this form to report issues pertaining to
vendor performance/service,
product or unsatisfactory
service to General Services Enterprise - Procurement Services.
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Agency |
Vendor |
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Address |
Address |
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Telephone |
Agency
Requisition Number |
PO
Number |
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Product
Covered by Issue |
Contract
Award Number |
Brand
Name |
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Date
Product Received |
Date
Product First Utilized |
Invoice
Number |
Code
Number |
NATURE OF ISSUE
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QUALITY/QUANTITY |
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Quality
of product inferior |
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Unsatisfactory/unauthorized
substitute made |
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Unsatisfactory
workmanship in installation |
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Damaged
or defective |
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Product
lacks required inspection or grade certification |
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Product
received was not same as bid or sampled |
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Less
than ordered |
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More
than ordered |
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Other
- Specify: |
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DELIVERY |
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Delivery
not made within specified delivery |
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FOB
point not as specified on purchase order |
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No
notice of delayed delivery |
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Received
in damaged condition Carrier notified |
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Incorrect
shipping address |
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Partial
delivery - cannot deliver balance of order |
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Excessive
partial shipments |
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Non-delivery |
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Method
not as specified, before/after hours |
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Other
- Specify: |
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OTHER |
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Improper
labeling |
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Unsatisfactory
packing |
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Failure
to resolve complaint properly |
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Invoice
inaccuracies |
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Service
deficiencies |
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Other
- Specify: |
REMARKS:
Give
detailed, specific, factual explanation of complaint in this space. Attach additional sheet if necessary.
RECOMMENDATION for
settlement of complaint:
For your information For return
and reimbursement of product
Complaint Executed
By:
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Name: |
Title: |
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Phone: |
FAX: |
Date: |
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Complainant
notified of disposition: |
Yes |
No |
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AGENCY USE ONLY
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Disposition
of Complaint: |
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Purchasing
Agent: |
Date: |
updated 06/04/09