Attachment 5 Past and Present Performance Questionnaire.docx

RFQ No.: FA5270-20-Q-A017 Atch Past and Present Performance Questionnaire (PPQ)

29 Oct 2020

MEMORANDUM FOR SUGGESTED CONTRACTOR’S CUSTOMER

FROM: 18 CONS/PKA

Bldg. 99, Unit 5199 Kadena AB, Okinawa, Japan

SUBJECT: Past Performance Questionnaire

The 18 CONS/PKA of the United States Air Force, Kadena Air Base, Japan is in the process of competitively selecting a source for Solicitation No. FA5270-21-Q-A001, Appliance Drayage at Kadena Air Base and other military installations in Okinawa.

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. Please turn in the written response no later than November 17, 2020, 11:00 am (Japan Standard Time). 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 narimitsu.higa.jp@us.af.mil . Please call Narimitsu Higa at 098-938-1111, extension 634-4107 if you have any questions. Your completed questionnaire will become a part of the official Contractor Quote records.

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

PRESENT/PAST PERFORMANCE SURVEY

履行履歴調査票

FROM: 18 CONS/PKA

Unit 5199, Bldg 99 Kadena AB, Okinawa, Japan

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.

RATING SCALE 評価の目安

(E) Exceptional (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。

(VG) Very Good ( 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) Satisfactory ( 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) Neutral (どちらでもない): Did not observe performance in this area. 履行内容に該当なし。

(M) Marginal ( 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) Unsatisfactory (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. Reference Number 履歴番号(Circle one): No. 1 -履歴1, No. 2 -履歴2, No. 3 -履歴3,

b. Contractor (Company/Agency) 契約者:

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

d. Prime contractor or subcontract主契約者(元請) または 再委託契約者 (下請) (Circle one)

Prime contractor (元請), Sub contract (下請), Other (その他)

e. 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:

f. Contract Value/Amount (Per Year and/or Total) 契約金額(単年度合計と総契約金額合計):

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:

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 (Check One いずれかに｢✔｣を付けてください)

提供されたサービスや商品の満足度はどうですか。

E VG S N M U |_| |_| |_| |_| |_| |_|

-品質管理と作業上の検査手順は妥当ですか。

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ってましたか。

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。

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すか。

E VG S N M U |_| |_| |_| |_| |_| |_|

-総合評価

E VG S N M U |_| |_| |_| |_| |_| |_|

-これまでに業務改善命令をだしたことがありますか。もしYESの場合は下記の記入欄に詳細を記入してください。

YES NO |_| |_|

-需要があれば、またこの業者に依頼しますか。

YES NO |_| |_|

a. Additional Comments/Remarks その他:

Upon completion of this survey, please send it by email to the address shown below no later than November 17, 2020, 1100 hrs (Japan Standard Time).

18th Contracting Squadron/PKA Attn: Narimitsu Higa Phone (DSN): 634-4107 Unit 5199 Bldg 99, Kadena AB, Okinawa Japan 904-0000 Email: narimitsu.higa.jp@us.af.mil 第18契約中隊事務所 担当：Narimitsu Higa Phone (DSN): 634-4107 建物番号99番 嘉手納基地内 904-0000 Email: narimitsu.higa.jp@us.af.mil

Thank you for your cooperation. ご協力ありがとうございました。