5) Atc4_PPQ FA520921R0001 (draft).pdf

Attachment 4 Solicitation No. FA520921R0001

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 the project for the Operation and Maintenance of Tower Apartments at Yokota Air Base, Japan.

One of the considerations in proposal evaluation is the verification of the offerors' 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 (Day Month Year). 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 miya.nemoto.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、FA520920R0023, 在⽇⽶空軍横⽥基地の住宅⽤マンションの運

営、管理委託業務につき、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」を確認します。その際、貴社のような、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、添付のアンケートをご覧ください。お⼿数ではございますが、添付

のアンケートを 202X 年 XX ⽉ XX ⽇までに記⼊をし、当⽅まで送っていただけると幸いです。アンケートに対する回答

はワードで作成し、そのまま miya.nemoto.jp@us.af.mil までメール送信してください。また、ご質問などございましたら、 いつでも問い合わせていただいて結構です。いただい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。

CAITLIN FROST

Contracting Officer

DEPARTMENT OF THE AIR FORCE

PACIFIC AIR FORCES

DRAFT

FOR OFFICIAL USE ONLY

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) Place of Performance 作業先住所:

4) 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。（複数選択可）

General Operation and Maintenance (O&M) Services 運転保守義務

Building O&M (general) ビルの運営・管理（メンテナンス）業務全般

Fire Alarm & Fire Extinguishing Systems 消防⽤設備（避難、消⽕、警報設備）

Management of Water Supply & Drainage Facilities 給排⽔設備の管理 設備

O&M of AC Equipment 空気調和設備（ボイラー、空調機）

General Cleaning Services(fan coil, storm pit) 清掃管理業務（ストームピット、コイルファン）

Service Call services 管理サービス業務（電話交換）

Facility Condition Assessments 施設のインフラ評価

O&M of Electrical Equipment (generators, lights) 電気設備（ジェネレータ、照明）

Routine Inspection ＆Maintenance 点検整備業務（建築構造物、建築設備の点検調査）

Apartment Management (Making Repair plans) マンション管理業務（主に修繕計画の作成） Repair of Household Appliances (refrigerator, washer, dryer, oven etc. )

⽣活家電等の修理（冷蔵庫、洗濯機、オーブン等）

Handyman Services ⼀般的なハンディマン業務

g. Complexity 業務の複雑さについて

Housing maintenance services scope 業務を⾏ったビルの規模

Number of Buildings 棟数_______________________________________________

Number of Floors per Building ⼀棟当たりの階数_____________________________

Number of Rooms per Building ⼀棟当たりの部屋数___________________________

Housing maintenance services building type ビルの種類（対象のビル種を以下より選択して下さい）:

Residential Building 住宅ビル・マンション:

Commercial Building 商業ビル:

Building Complex 複合施設:

“Apartment”* Building アパート:

Dormitory 宿舎:

* When written as “Apartment”, it is to be understood as the Japanese definition which we define as, a low-rise (three stories max) wooden structure housing unit with no elevator.

Number of types of reports submitted 報告書の種類数：

Number of workers 作業⼈数：

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 in a timely manner and on schedule?

E VG S N M U

契約者の作業は迅速で予定の納期に間に合いましたか？

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、苦情処理に⻑けていましたか？

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、下記電⼦メールアドレスへご返送の程よろしくお願いいたします。

374 CONS/PKBA

Unit 5228, Bldg 620 Yokota Air Base Fussa-shi Tokyo 197-0001 Attn: Miya Nemoto

E-mail: miya.nemoto.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

宛先：根本ミヤ

電⼦メール：miya.nemoto.jp@us.af.mil