05 PPQ FA520920Q0028.pdf

Attachment 5

Solicitation No. FA520920Q0028

FOR OFFICIAL USE ONLY

MEMORANDUM FOR CONTRACTING ACTIVITY

FROM: 374 CONS/PKBA

Unit 5228, Bldg. 620, Yokota Air Base

Fussa-shi, Tokyo, Japan

SUBJECT: Past Performance Questionnaire

FOR OFFICIAL USE ONLY (関係者のみ閲覧可)

The 374 CONS/PKBA of the United States Air Force, Yokota Air Base, Japan is in the process of competitively selecting a source for a Cleaning and Inspection of Kitchen Hoods and Exhaust Systems at

Yokota Air Base and Tama Service Annex, Japan.

One of the considerations in proposal evaluation is the verification of the offeror's past performance on contracts or other work efforts, which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the enclosed questionnaire. Our schedule is extremely tight and we desire your written response no later than 24 Jul 20, 10:00 AM. This schedule will allow us sufficient time to analyze the data prior to the start of negotiations.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to shoko.saito.jp@us.af.mil. Your completed questionnaire will become a part of the official Source Selection records.

Your assistance is greatly appreciated and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

在日米軍横田基地契約中隊では、入札番号、FA520920Q0028, 横田基地ならびに多摩サービス補助施設の

厨房用排気フード及び排気設備の定期清掃委託業務につきまして、請負業者を選定しております。入札審査の一

環として、入札参加業者の「要求されているサービスを行う能力」を確認しております。その際、貴社のように既にその

業者との取引のある発注者からの情報を参考にさせていただいております。質問内容につきましては、以下のアンケー

トをご覧ください。大変お手数ではございますが、以下のアンケートをご記入いただき、2020年 7月 24日 10:00までに、 shoko.saito.jp@us.af.mil までメール添付にてお送りくださいますようお願い申し上げます。また、ご質問等ございました

ら下記連絡先までいつでもお問い合わせください。ご回答いただきましたアンケートは業者選定の公式書類のひとつと

なります。ご協力に感謝いたします。

TOMOKO SHIODA

Contracting Officer

1 Atch:

Present/ Past Performance Questionnaire

DEPARTMENT OF THE AIR FORCE

PACIFIC AIR FORCES

mailto:shoko.saito.jp@us.af.mil mailto:shoko.saito.jp@us.af.mil

PRESENT/PAST PERFORMANCE SURVEY

履行履歴調査票

FROM: 374 CONS/PKBA

Unit 5228, Bldg 620 Yokota Air Base

Fussa-shi Tokyo 197-0001

1. INSTRUCTION: The contractor, who sent this survey, has provided the following project as a reference for their present/past performance. Please provide frank, concise comments regarding your assessment of the contractor’s performance regarding this project. When responding to the descriptive statements, choose the rating that most accurately describes the contractor’s performance or situation. The ratings correspond with the following descriptive values. In accordance with FAR 15.306(e)(4), the names of individuals providing reference information about an offeror’s past performance shall not be disclosed. 横田基地契約中隊では在日

米軍の業務委託契約において応札業者の受注実績とその履行内容を落札の選定基準に加えております。つきまし

ては貴殿の率直で簡潔なご意見を頂きたく添付の調査票をお送りした次第です。下記の説明に最も近いと思われる

評価を項目別にご回答願います。尚、米国連邦調達規則に則り、回答者のお名前は公表いたしません。

RATING SCALE 評価の目安

(E)xceptional （非常に優れている）: Performance meets contractual requirements and exceeds many to the customer’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. 契約内容を満たした上でさらに多くの利益を顧客に与えた。対象となる業務はほとんど問題もなく、あった

場合でも業者の有効な是正措置で問題なく完了した。

(V)ery (G)ood （大変満足）: Performance meets contractual requirements and exceeds some to the customer’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

契約内容を満たした上でさらに、高い満足が得られた｡ 対象の業務に軽微な問題が生じても、業者は有効な是正

処置を取って完了した。

(S)atisfactory （満足）: Performance meets contractual requirements. The contractual performance of the element or sub-element being assessed contains some minor problems for which corrective actions taken by the contractor were satisfactory. 契約要件は満たしている。履行中に軽微な問題が生じたが、業者の是正処置は満

足であった。

(N)eutral （どちらでもない）: Did not observe performance in this area. 履行内容に該当なし。

(M)arginal （不満）： Performance does not meet some contractual requirements. The contractual performance of the element or sub-element reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented. 履行は一部不完全であった。対象の業務に、業者の是正手段の不備による重大な欠陥がある。

業者の改善策は有効でないか十分に実行されていないと思われる。

(U)nsatisfactory （大変不満）: Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-elements being assessed reflects a serious problem for which corrective actions were not accomplished. The contractor did not take any corrective actions. 契約内容を満たしておらず、期間内に改善の見込みなし。契約した業務は完了せず、業者は是正処置を

怠った。

2. CONTRACT INFORMATION (応札する業者が記入): The below listed contractor has identified they provided or are currently providing services for your company/agency.貴殿との委託業務は以下の通りです。

a. Contractor (Company/Agency) 契約者:

b. Contractor Address/Phone契約者の住所・電話番号:

c. Prime contractor or subcontract主契約者 または 再委託契約者 (元請/下請)

d. Title of Program/Contract 契約件名:

1) Contract Number 契約番号:

2) Period of Performance 契約期間:

3) Services Provided (explain in detail the type of services provided by the contractor)

業務の内容:

e. Total Contract Amount 契約金額:

f. Service Scope (Please check if applicable) 提供した業務範囲について、該当するものにチェックマークを記入

してください。

Cleaning Services

( Kitchen hoods Ducts Exhaust systems )

3. RESPONDENT IDENTIFICATION (回答者、評価者が記入): (This information will be kept confidential in accordance with FAR 15.306(e)(4). You may be contacted for additional information pertaining to past or present performance of the contractor identified in section 1 above. ご回答の内容は公表いたしません。

審査の手続き上、再度連絡を取らせていただく場合がありますので、ご理解、ご協力お願いします。

a. Company’s Name会社名:

b. Name and Title お名前と役職:

c. Phone Number 電話番号: _______________ FAX ファックス: ______________

E-mail Address 電子メールアドレス： ＿＿＿＿＿＿＿＿＿＿＿

d. Address 住所: _________________________________________

e. Relationship to Project 契約案件における地位：

f. Length of Involvement in Project 契約案件の担当年数: ______________

g. Date Questionnaire Completed 回答日: ___________

4. QUESTIONNAIRE 調査票 (Circle Oneいずれかに｢｣を付けてください)

a. (Quality of Work) Were you satisfied with the quality of service performed or items supplied? E VG S N M U

提供されたサービスや商品の満足度のいかがでしたか？

b. (Quality of Work) How effective did the contractor’s quality control and/ E VG S N M U or inspection procedures operate ?

品質管理と作業上の検査手順は妥当でしたか？ c.

(Timely Performance/Schedule) Did the contractor provide the required service and other contract correspondence in a timely manner and on schedule?

E VG S N M U

契約者は作業や必要書類の提出等の納期/期日を守りましたか？

d. (Effectiveness of Management for Resolution of Issues, Problems, and Customer Complaints) How well did the contractor resolve Issues/

Problems/Customer Complaints?

契約者は作業上の懸案、問題解決、苦情処理に長けていましたか？

e. (Compliance with the Applicable Rules, Regs, Laws, including Safety

Standards) How efficient was the contractor in abiding by all Rules, Regs, Laws, and Safety Standards?

契約者の作業は関連する全ての法規や安全基準を守っていましたか？

f. Would you hire this contractor again? If no, why? YES NO

機会があれば、またこの業者に依頼したいですか？「いいえ」の場合は理由をお聞かせください。

g. Overall Rating 総合評価: E VG S N M U

h. Additional Comments/Remarks その他:

Please e-mail completed questionnaires to the address shown below:

ご回答後、下記連絡先までメール添付にてご返送いただきますようお願い申し上げます。

374 CONS/PKBA

Unit 5228, Bldg 620 Yokota Air Base

Fussa-shi Tokyo 197-0001

Attn: Shoko Saito

E-mail: shoko.saito.jp@us,af,mil

〒197-0001

東京都 福生市 在日米軍 横田基地内

建物番号 620, 374契約中隊

担当：齋藤笙子

電子メール：shoko.saito.jp@us.af.mil