J_16 West Coast Past Performance Questionnaire 23March2010.doc

ATTACHMENT C

PAST PERFORMANCE QUESTIONNAIRE COVER SHEET

(NOTE TO OFFEROR: For each past performance questionnaire to be completed by a client and submitted to the Government as a reference, provide a copy of this cover sheet with your proposal identifying the client’s point-of-contact information. Ensure correct phone numbers and email addresses are provided for the client point of contact.)

1. OFFEROR:

2. FIRM BEING EVALUATED:

3. CONTRACT NUMBER:

4. TITLE OF CONTRACT:

5. REFERENCE ORGANIZATION NAME:

6. EVALUATOR’S CONTACT INFO:

a. NAME & TITLE:

b. PHONE NUMBER:

c. FAX NUMBER:

d. EMAIL ADDRESS:

PAST PERFORMANCE QUESTIONNAIRE

Instructions:

· Sections I and II to be completed by the Offeror/Major Subcontractor and provided to the reference (Government personnel that had experience with the Offeror/Major Subcontractor on a previous relevant contract). The reference, in turn, to verify Sections I through III, complete the questionnaire, 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 references.

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

· Sections III through VII to be completed in their entirety by the reference.

Message to the reference: Your assistance is requested by the HQMC 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:Kevin.faughan@usmc.mil or fax to (703) 695-6382.

I. Solicitation Data (for the proposed effort)

II. Current or Historical Contract Information

Reference: The performance data submitted by the Offeror is FORMCHECKBOX

FILLIN \* MERGEFORMAT correct or FORMCHECKBOX incorrect.

CONTRACTOR NAME & ADDRESS:

Contract No

Type of Contract

Contract Value

Period of Performance/Delivery Schedule

Project/Requirement Description

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

PRIME

FORMCHECKBOX

SUBCONTRACTOR

Convenience

FORMCHECKBOX

Default

FORMCHECKBOX

N/A

III. Reference Information

Reference Name

Title

Phone Number/Email Address

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

Procuring Contracting Officer (PCO)

Administrative Contracting Officer (ACO)

Contract Specialist

Contracting Officer’s Representative (COR)

Technical Project Lead/Project Officer

Quality Assurance Specialist

Defense Contract Audit Agency (DCAA) Auditor

Other:

IV. Evaluation Definitions

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