Atch 4-2_PPQ 6 Nov.docx

Solicitation No. FA520925R0001 Attachment 4-2

PRESENT/PAST PERFORMANCE SURVEY

履行履歴調査票 Date: 6 Nov 24

FROM: 374 CONS/PKBC

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ました。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、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がなく、問題があった場合も業者は有効な是正措置を取り完了した。

(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、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た際も、業者は有効な是正処置を取り完了した。

(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. 契約要件は満たした。履行中に軽微な問題が生じたが、業者による是正処置は満足のいくものであった。

(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った。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がない。契約した業務は完了されず、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) 業務内容:

e. Total Contract Amount 契約金額:

2.1. Service Scope (Please ☒ and specify a typical example (location) where service was provided if applicable. 提供した業務の範囲について、該当するものに☒を記入してください。

2.2. Service Complexity

Administrative Work for Solid Waste Management

List of documents:

c. Number of Worker Required for the Service.

2.3. Frequency of Service.

☐As Required in the Term of Contract契約期間内で必要時に実施 ☐Recurring Service, how often? 継続的なサービス。その頻度は？

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 氏名・役職:

c. Phone Number 電話番号:

E-mail Address 電子メールアドレス：

d. Address 住所:

e. Relationship to Project 契約案件における関係性：

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 (回答者、評価者が記入)

a. Quality of Work: Were you satisfied with the quality of service performed?

提供されたサービスや商品の満足度。

☐E ☐VG ☐S ☐N ☐M ☐U

b. Quality of Work: How effective did the contractor’s quality control and/or inspection procedure operate?

品質管理と作業場の検査手順は妥当か。

☐E ☐VG ☐S ☐N ☐M ☐U

c. Timely Performance/Schedule: Did the contractor provide the required service in a timely manner and on schedule?

契約者の作業は迅速で予定の納期に間に合ったか。

☐E ☐VG ☐S ☐N ☐M ☐U

d. Effectiveness of Management for resolution of issue, problem, and customer complaints: How well did the contractor resolve issue, problem, and customer complaints?

契約者の作業場の懸案、問題解決、苦情処理の対応はどうだったか。

☐E ☐VG ☐S ☐N ☐M ☐U

e. Compliance with the applicable rules, regulations, laws, including safety standards: How efficient was the contractor in abiding by all rules, regulations, 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るか。

☐E ☐VG ☐S ☐N ☐M ☐U

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

またこの会社に仕事を依頼したいですか？いいえの場合はその理由をお聞かせください。

☐Yes ☐No

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:

下記Eメールアドレスにご回答の返送お願いします。

E-mail: shoko.toda.jp@us.af.mil junko.maeda.jp@us.af.mil 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 戸田または前田 電話: 042-511-0100 電子メール shoko.toda.jp@us.af.mil junko.maeda.jp@us.af.mil

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