4 - PPQ FA520920Q0024.pdf

Attachment 4 Solicitation No. FA520924Q0024

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

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 Paving and Marking BPA at Yokota Air Base and Geographically Separated Units (Tama, Tokorozawa, Owada and Momote), 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 (13 May 2024). 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 marina.williams.2@us.af.mil. Your completed questionnaire will become a part of the official Source Selection records.

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

在日米軍横田基地契約中隊では、入札番号、FA520924Q0024, 横田基地およびその周辺基地におけ

る舗装工事及び道路標示に関する包括購入協定の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、 2024 年 5 月 13 日までに、marina.williams.2@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。

YUKI WATABE

Contracting Officer

1 Atch:

Present/ Past Performance Questionnaire

DEPARTMENT OF THE AIR FORCE

PACIFIC AIR FORCES

FOR OFFICIAL USE ONLY

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

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 3.104, 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包 括購入協定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 表されません。

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

FOR OFFICIAL USE ONLY

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. 貴社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 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。(複数回答可)

Paint Removal from Airfield Pavements Sealing Cracks in Asphalt Paving Pavement Markings Not related to above works

FOR OFFICIAL USE ONLY

3. RESPONDENT IDENTIFICATION (回答者、評価者が記入): (This information will be kept confidential in accordance with FAR 3.104-3. 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ございます。ご理解、ご協力をお願いいた

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 契約案件における役割：

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?

E VG S N M U

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？

FOR OFFICIAL USE ONLY

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?

E VG S N M U

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: Marina Williams

E-mail: marina.williams.2@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：Marina Williams

電子メール：marina.williams.2@us.af.mil