Annual Feedback Questionnaire

ANNUAL FEEDBACK QUESTIONNAIRE

This Annual Feedback Questionnaire and Service Agreement is entered into by the parties identified below for the purpose of collecting, documenting and acting upon feedback regarding services provided during the preceding contract year. Client Name:   Service Provider Name:

WHEREAS

WHEREAS, the Service Provider has performed professional services for the Client during the preceding contract year and the parties wish to document performance and identify improvements and corrective measures; and

WHEREAS, the parties agree that documented feedback and any subsequent remedial actions are an integral part of the ongoing commercial relationship and may inform future scopes of work and compensation adjustments; and

WHEREAS, the parties desire to set forth certain administrative terms governing the collection, use, confidentiality and legal effect of this questionnaire and any attachments exchanged in connection with it.

SCOPE OF WORK

QUESTIONNAIRE

Please rate the Service Provider for each category (1 = Poor, 5 = Excellent):

Service Quality: 1 2 3 4 5

Communication and Responsiveness: 1 2 3 4 5

Timeliness / Meeting Deadlines: 1 2 3 4 5

Value for Cost: 1 2 3 4 5

Overall Satisfaction: 1 2 3 4 5

PAYMENT TERMS (IF APPLICABLE)

The parties acknowledge that any follow-up work, remedial tasks or additional services arising from this feedback may be billed in accordance with the existing commercial agreement. Payment Amount:

TERM AND TERMINATION

This Questionnaire is effective as of Start Date: and shall remain in effect until End Date: unless earlier terminated in accordance with the underlying services agreement or by mutual written agreement of the parties.

CONFIDENTIALITY

All feedback, reports, attachments and communications exchanged under this Questionnaire containing non-public business information shall be treated as Confidential Information of the disclosing party. Confidential Information shall not be disclosed to third parties and shall be used only for the purposes of performance improvement, contract administration and follow-up work, except as required by law. The receiving party shall use at least the same degree of care to protect Confidential Information as it uses to protect its own confidential information, but no less than reasonable care.

GOVERNING LAW

This Questionnaire and any dispute arising out of it shall be governed by the substantive laws of the jurisdiction agreed in the underlying services agreement. If no governing law is specified in such agreement, the parties agree that the laws of the state selected by the Client shall apply without regard to conflict of laws principles.

ENTIRE AGREEMENT

This Questionnaire, together with any referenced schedules or attachments and the parties' underlying services agreement, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior oral or written statements, negotiations and understandings regarding the same.

By signing below, each party certifies that the information provided is complete and accurate to the best of the respondent's knowledge and that the parties intend this document to be a binding statement of the feedback recorded and the administrative terms set forth herein.

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