Attch 3 - Past Performance Data Sheet-Questionniare.docx

Attachment 3: Past Performance Data Sheet / Questionnaire M0068126R0005

Instructions:

· Fill out 1 of these for each Past Performance reference.

· Sections I and II to be completed by the Offeror/Major Subcontractor and provided to the assessor (Government personnel who had experience with the Offeror/Major Subcontractor on a previous relevant contract). The assessor, in turn, to verify Sections I and II, complete the questionnaire (Section III), and submit to the Contracting Office. The Offeror should also submit with its proposal (by the closing date of the Solicitation) copies of Sections I and II of all questionnaires as provided to assessors.

· Section II to be validated by the assessor. If any information is incorrect herein, please annotate and provide the correct information accordingly.

· Section III to be completed in their entirety by the assessor.

Message to the assessor: Your assistance is requested by the USMC to assist with establishing the performance history for the Contractor named below. In efforts to expedite receipt of the requested information, the Contracting Office respectfully requests that you do not mail hard copies. Instead, please e-mail the completed questionnaire(s) to: Jody.Koch@usmc.mil. Responses are due by:

26 October 2026 at 0900 (AM, local time, Los Angeles, CA)

1. Referenced Contract Data:

Contractor Name:

Contract Number:

Client / Agency:

Type of Contract:

Total Dollar Value of work performed:

Period of Performance:

Compliance with Clause FAR 52.219-8, Utilization of Small Business Concerns, under this referenced effort

Please select from the following as it applies to this contract:

Requirement Description: Include a description of the work performed, specific responsibilities of the Offeror, major deliverables produced, performance measures/service levels applied, any problems/issues that occurred and correction action taken.

Describe how the scope is similar to this requirement:

Describe how the magnitude is similar to this requirement:

Describe how the complexity is similar to this requirement:

1. Contact Information for Reference:

Name

Title

Phone Number/Email Address:

Identify their role in the contract award or administration and the period of involvement.

Procuring Contracting Officer (PCO)

Administrative Contracting Officer (ACO)

Contract Specialist

Contracting Officer’s Representative (COR)

Technical Project Lead/Project Officer

Quality Assurance Specialist

Other:

1. Performance Evaluation

Please provide ratings and comments regarding the Contractor’s performance in each area below using the following ratings: Exceptional, Very Good, Satisfactory, Marginal, Unsatisfactory, or Not Applicable (N/A). See next page for definition of ratings. For ratings of “Exceptional” or “Unsatisfactory,” please provide a brief explanation.

OVERALL PERFORMANCE RATING

Please provide an overall rating of the Contractor’s performance for the referenced contract/delivery order.

a.) Quality of Product or Service: Conformance to contract requirements, appropriateness of personnel, accuracy of reports, and technical excellence b.) Timeliness or Scheduling of Supplies/Deliveries: Timeliness of performance, met interim milestones, reliable, responsive to technical and contractual direction as to scheduling.

c.) Business Relations/Customer Satisfaction: Effective management, prompt notification of problems, reasonable/cooperative behavior, proactive, timely award and management of subcontracts, effective small business/small disadvantaged business subcontracting program and satisfaction with Contractor’s service.

d.) Key Personnel and Staffing (Including Subcontractors): Qualified personnel, effective performance and conduct.

Would you hire this Contractor to provide supplies/services for your organization in the future? Yes |_| No |_| Please provide comments using additional pages if desired

Evaluation Definitions

The following definitions should be used in your assessment of Contractor performance.

DISTRIBUTION: DoW COMMUNITY ONLY

DISTRIBUTION: DoW COMMUNITY ONLY

SOURCE SELECTION INFORMATION - SEE FAR 2.101 AND 3.104 DISTRIBUTION: DoW COMMUNITY ONLY