Atch 3 PP Survey Tama.pdf

Solicitation Number: FA5209-23-Q-0044 Attachment 3 – Present/Past Performance Survey

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PRESENT/PAST PERFORMANCE SURVEY

現在及び過去の契約履行実績調査

The contractor listed below has provided the following project as a reference for past performance. Please provide frank, concise comments regarding your assessment of the contractor’s performance regarding this project. 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書をお送りした

次第です。尚、米国連邦調達規則に則り回答者のお名前は公表致しません。

1. CONTRACT INFORMATION: The below listed contractor has identified they provided or are currently providing services for your company/agency. 下記業者より貴殿との業務委託の申告がありました。

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:

2. RESPONDENT IDENTIFICATION: (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、ご了

承いただくとともに、ご協力お願いします。

a. Compay’s Name 貴社名:

b. Name and Title 担当者氏名と役職:

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:

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g. Date Questionnaire Completed 回答日:

3. PERFORMANCE INFORMATION: When responding to the descriptive statements, choose the rating that most accurately describes the contractor’s performance or situation. If the statement is not applicable, circle “NEUTRAL”.

The ratings correspond with the following descriptive values.

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。質問事項が案件に該当しない場合

“NEUTRAL”となります。

RATING SCALE 評価指針

(E)xceptional （超優良）: 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、多くの点で高い満足が得られた。対象の業務は業者の非常に有効な処置で難

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、業者は適切な是

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、業者は満足のゆく是正処置を取った。

(N)eutral （該当なし）: Did not observe performance in this area. この設問は当案件に当てはまらない。

(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.

契約上いくつかの点で要件を満たしていないことがあった。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. 殆どの契約内容を満

たしておらず、期間内に改善の見込みなし。対象の業務は、業者が是正処置を取らないなど重大な欠陥がある。

< See continuation pages for questionnaire. > ＜ 質問表は次項 ＞

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4. QUESTIONNAIRE & COMMENT 質問表及びコメント (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 E VG S N M U or items supplied?

提供されたサービスや商品の満足度。

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

契約者の提供するサービスや商品は迅速かつ予定どおりであったか？

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

契約者はサービス提供における懸案、問題解決、苦情処理にどの程度長けていたか？

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?

E VG S N M U

契約者のサービスに関連する全ての法規や安全基準をどの程度順守していたか？

f. Would you hire this contractor again? If no, why? YES NO 需要があればまたこの業者にサービス提供を依頼したいか？もし「いいえ」の場合の理由は？

g. Overall Rating 総合評価: E VG S N M U

h. Additional Comments/Remarks その他:

Your corporation is highly appreciated. Please fax or e-mail completed questionnaires to:

ご協力頂きありがとう御座いました。下記のファックス番号もしくは、電子メールアドレスに

ご回答の返送お願いします。

374th Contracting Squadron/PKBB Bldg 620, Yokota Air Base Fussa, Tokyo 197-0001 Japan POC: Mr. Benjamin Warren

Ms. Mio Miyabayashi

TEL: 042-552-3011 / FAX: 042-553-7786 DSN:

225-5458 / 225-8911 E-mail address: benjamin.warren.7@us.af.mil mio.miyabayashi.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 第 374契約中隊

契約担当官: ワレン ベンジャミン 宮 林 未 央

TEL: 042-552-3011 / FAX: 042-553-7786

軍電: 225-5458 / 225-8911 電子メールアドレス: benjamin.warren.7@us.af.mil mio.miyabayashi.jp@us.af.mil