Attachment (6) Past Performance Questionnaire N4008422R7003.doc

CUI//FEDCON [when filled in]

Source Selection Information--See FAR 2.101 and 3.104 [when filled in] Maintenance Services for Wastewater Treatment Plant, N40084-22-R-7003

Bldg. 961, NAF Misawa, Japan CUI//FEDCON [when filled in]

Source Selection Information--See FAR 2.101 and 3.104 [when filled in] Maintenance Services for Wastewater Treatment Plant, N40084-22-R-7003

Bldg. 961, NAF Misawa, Japan

Source Selection Plan

ATTACHMENT (6)

1. The NAVFAC Form PPQ shall be utilized for all evaluations that require a Past Performance Questionnaire (PPQ).

2. Solicitations utilizing PPQs shall include the language cited below in the RFP.

Solicitation Submittal Requirements: IF A COMPLETED CPARS EVALUATION IS AVAILABLE, IT SHALL BE SUBMITTED WITH THE PROPOSAL. IF THERE IS NOT A COMPLETED CPARS EVALUATION, the Past Performance Questionnaire (PPQ) included in the solicitation is provided for the offeror or its team members to submit to the client for each project the offeror includes in its proposal for Factor 3, Past Performance. AN OFFEROR SHALL NOT SUBMIT A PPQ WHEN A COMPLETED CPARS IS AVAILABLE.

IF A CPARS EVALUATION IS NOT AVAILABLE, ensure correct phone numbers and email addresses are provided for the client point of contact. Completed PPQs should be submitted with your proposal. If the offeror is unable to obtain a completed PPQ from a client for a project(s) before proposal closing date, the offeror should complete and submit with the proposal the first page of the PPQ (Attachment 6), which will provide contract and client information for the respective project(s). Offerors should follow-up with clients/references to ensure timely submittal of questionnaires. If the client requests, questionnaires may be submitted directly to the Government's point of contact Shigenori Wada, via email at Shigenori.Wada.JA@fe.navy.mil prior to proposal closing date. Offerors shall not incorporate by reference into their proposal PPQs or CPARS previously submitted for other RFPs. However, this does not preclude the Government from utilizing previously submitted PPQ information in the past performance evaluation.”

ATTACHMENT 6

NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information

Firm Name:

CAGE Code:

Address:

Entity Identifier Number:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: FORMCHECKBOX Prime Contractor FORMCHECKBOX Sub Contractor FORMCHECKBOX Joint Venture FORMCHECKBOX Other (Explain)

Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: FORMCHECKBOX Firm Fixed Price FORMCHECKBOX Cost Reimbursement FORMCHECKBOX Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work FORMCHECKBOX High FORMCHECKBOX Med FORMCHECKBOX Routine

How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information

Name:

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: NAVFAC REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO NAVFAC WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON NAVFAC SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO NAVFAC. PLEASE CONTACT THE OFFEROR FOR NAVFAC POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

RATING

DEFINITION

NOTE

合を含め、契約通りの内容である。修正箇所は

非常に満足な結果である。

by the contractor were effective.

仕事が契約内容と合致しており、顧客の希望を

多少上回る。修正可能な範囲の若干の不具合を

含め、契約通りの内容である。修正箇所は満足

な結果である。

lower than Satisfactory solely for not performing beyond the requirements of the contract.

identified corrective actions. The contractor's proposed actions appear only marginally effective or were not fully implemented.

仕事が契約内容と合致していない。修正可能な

不具合があるかどうかも把握できておらず、深

刻な状態である。業者から提案される方法は効

果的とは言えない、またはその方法を実行されてもいない。

具合の復旧も迅速ではない。不具合の修正も全

く効果的ではなく、深刻な状態である。

(N) Not Applicable 該当なし No information or did not apply to your contract 評価材料がない、または該当せず。 Rating will be neither positive nor negative.

Contractor Information (Firm Name): _____________________________________

Client Information (Name): _____________________________________________

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

該当する評価基準に○を付けて下さい。

1. QUALITY（仕事の質）:

a) Quality of technical data/report preparation efforts 技術データやレポートの質はよかったか？

contract quality assurance requirements (without adverse effect on performance)

品質管理プログラムは適切かつ有効で実際にその品質管理プログラム

に基づいて品質管理が実施されていたか？（仕事に悪影響が出ることなく）

2. SCHEDULE/TIMELINESS OF PERFORMANCE（期日の遵守）:

significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below)

契約全体及びその中に含まれる重要な中間又は完了期限/期日は遵守さ

れていたか？（もし損害賠償金が発生、または期限が遵守されていな

かった場合、詳しくお書き下さい）

3. CUSTOMER SATISFACTION（顧客の満足度）:

a) To what extent were the end users satisfied with the project?

どの程度の顧客満足度か？

(including the ability to successfully resolve disagreements/disputes;

responsiveness to administrative reports, businesslike and communication)

業者は御社の担当者に協力的であったか？（業者との意見の相違、論

争を有効に解決する能力、及びそれらへの書類での対応、真摯なコミ

ュニケーション能力）

Contractor Information (Firm Name): __________________________________ ________________________________________________ . ___________________________________________________________________________________________________________

Client Information (Name): __________________________________________

d) Overall customer satisfaction

総合的な顧客満足度は？

4. MANAGEMENT/ PERSONNEL/LABOR（人員の管理）

b) Ability to hire, apply, and retain a qualified workforce to this effort この工事又はサービスを提供できる適任者を雇うことができたか？

c) Government Property Control

軍の土地や所有物に対する管理は？

d) Knowledge/expertise demonstrated by contractor personnel 専門知識の活用はなされていたか？

f) Ability to simultaneously manage multiple projects with multiple disciplines 同時にいくつかの現場を平行して管理できていたか？

5. COST/FINANCIAL MANAGEMENT（資金の管理）

Contractor Information (Firm Name): __________________________________

Client Information (Name):__________________________________________

timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns)

この仕事が、公共または米軍政府とのコストタイプの契約の場合、

月々の請求書が裏付けになる書類とともに定期的に提出されていた

か、月々の進捗状況と資金のレポート提出が予算を上回る、または下

回ることなく正しく提出されていたか？

No

No completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

この仕事が、公共または米軍政府との契約の場合、部分的に、又は全

体が業者の責任（又はその他の理由）で解約されたり、又は解約手続

き中であるか？

もし、上記の解約等に関連する警告文書等がすでに業者に出されている、

もしくは何らかの解約手続きが進行中であれば、詳しくお書き下さい。

No

6. SAFETY/SECURITY（安全面）

safety, adhere to its approved safety plan, and respond to safety issues?

(Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

どの程度業者は承認された安全計画に基づく安全の管理ができていたか？

（御社との取り決めや法律、現場の特徴、安全、不具合に対す

る対応等を含む）

b) Contractor complied with all security requirements for the project and personnel security requirements. 人員に対する安全は確実に守られていたか？

Contractor Information (Firm Name): __________________________________

Client Information (Name): __________________________________________

7. GENERAL（総合評価）

No

d) In summary, provide an overall rating for the work performed by this contractor.

この仕事を行った業者の総合判定。

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary): 上記の設問にお答えになり、下記に文章にて業者の長所、短所、欠点など、業者の選定に役立つコメントがあればお書き下さい。 Form PPQ-0 (9/30/11)

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

業者の評価の為の評価基準と定義

Rev. Dec 2021 CUI//FEDCON [when filled in]

Source Selection Information--See FAR 2.101 and 3.104 [when filled in] Rev Dec 2021 CUI//FEDCON [when filled in]

Source Selection Information--See FAR 2.101 and 3.104 [when filled in]