D.1_Solicit_Attachment_II.pdf

Combined Synopsis Solicitation M67400-22-Q-0004 ( Attachment II)

Questionnaire for Offeror’s Past Performance

The below listed contractor is currently providing or previously provided services for our company/agency:

Please indicate the information regarding the offeror that you are providing this questionnaire.

1. CONTRACT INFORMATION：

A. Contractor:

B. Contractor’s Address:

C. Point of Contact: 1 D. Contract Number:

E. Period of Performance (Basic year and all option years):

F. Contract Type：(Please check.)

a) Fixed Price

b) Cost Reimbursement

c) Other

G. Contract Amount (Base year and all option years) 1

H. Prime Contractor：(Please check.)$

YES NO

I. Descriptions of services provided/are currently rendered：

2. RESPONDENT INFORMATION

Please provide the information requested below to assist MCIPAC Regional Contracting Office in tracking responses and resolving conflicts. You may be contacted for additional information pertaining to past or present performance of the contractor identified in section 1 above. This information will be kept confidential.

Please provide the information regarding the respondent who is providing this questionnaire.

A. Name of Respondent: ＿＿＿＿＿＿＿＿＿＿＿＿＿＿

B. Position and Title: ＿＿＿＿＿＿＿＿＿＿＿＿＿＿ 1

C. Office Telephone Number: ＿＿＿＿＿＿＿＿＿＿＿＿＿

D. Office FAX number: ＿＿＿＿＿＿＿＿＿＿＿＿＿＿

E. Office Address: ＿＿＿＿＿＿＿＿＿＿＿＿＿＿

F. Relationship and Time Involved with the Contractor:

G. Date Questionnaire was completed: 1

3. PERFORMANCE INFORMATION: The definitions for the adjectival rating categories are provided below.

Definition of Rating

Definition of Rating:

RATING DEFINITION

(1) EXCEPTIONAL

Performance meets contractual requirements and exceeds many to the Government’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.

(2) VERY GOOD

Performance meets contractual requirements and exceeds some to the Government’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.

(3) SATISFACTORY

Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

(4) MARGINAL

Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed 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.

(5) UNSATISFACTORY

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Not Applicable There is no applicable portion.

When responding to the questions listed, please choose the rating on the scale of (1) to (5) that most accurately describes the contractor’s performance or situation. For any marginal (4) or unsatisfactory (5) rating, please provide explanatory narratives in the remarks block. These narratives need not be lengthy, just detailed. If a question is not applicable, choose N/A. If you choose a Yes/No answer that is marked with an asterisk (*), please provide a corresponding explanation in the remarks block. If more space is needed, use the back of the questionnaire or attach additional page. Handwritten responses to this questionnaire are acceptable. However, if responses are handwritten, please print legibly.

4. PAST PERFORMANCE QUESTIONNAIRE:

4.1 QUALITY OF SERVICE:

a. Contractor’s ability to meet minimum quality standards specified for performance.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

b. Contractor’s ability to effectively control the quality of services provided.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

c. Contractor’s compliance with contractual terms and conditions.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

4.2 TIMELINESS OF PERFORMANCE:

a. Contractor’s ability to meet specific response times and scheduled time frames for completion of specific tasks.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

b. Contractor’s responsiveness/timeliness for providing administrative reports/documents required by the contract.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

c. Contractor’s timeliness in responding to emergency service requirements.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

d. Provided timely resolution of contract discrepancies.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

4.3 BUSINESS RELATIONS:

a. Suggested alternative approaches to problems.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

b. Displayed initiative to solve problems.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

c. Contractor’s ability to identify problems and potential problems, and promptly notify the Contracting Officer/QAP.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

d. Contractor’s ability to correct problems and prevent or mitigate potential problems in timely manner.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

e. Contractor’s willingness to improve and correct noncompliance issues or concerns.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

f. Contractor’s ability to use effective approaches and provide technical expertise and resources to solve contract problems.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

g. Contractor’s flexibility in satisfying the requirements of its customers.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

Applicable

h. Extent to which the contractor provided prompt and courteous service when responding to customer complaints.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

Applicable

i. Ability to use effective approaches and provide technical expertise and resources to solve contract problems.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

Applicable

4.4 MANAGEMENT OF KEY PERSONNEL：

a. Working relationship with the quality assurance personnel, and customers.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

Applicable

b. Extent key personnel were knowledgeable about contractual requirements.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

Applicable

c. Contractor’s ability to meet appropriate staffing levels with qualified personnel in order to provide required services.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

4.5 COMPLIANCE WITH ENVIRONMENTAL, SAFETY, HEALTH, AND SECURITY REQUIREMENTS：

a. Contractor’s compliance with safety requirements.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

Applicable

b. Contractor’s compliance with security requirements.

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not

Applicable

c. Has the contractor ever received any Notice of Violations for noncompliance with environmental laws or regulations? YES* NO

Remarks: ________________________________________________________________

BASED ON ABOVE, WHAT IS YOUR OVERALL ASSESSMENT OF THE PAST PERFORMANCE FOR

THIS CONTRACTOR?

Exceptional Very Good Satisfactory Marginal Unsatisfactory Not Applicable

5. CONTRACTUAL CONSIDERATIONS：

a. Has an election ever been made not to exercise an option or continue relations due to contractor’s poor performance? If yes, explain. YES* NO

Remarks: ________________________________________________________________

b. Has a Contract Discrepancy Report ever been issued? If yes, explain.

YES* NO

Remarks: ________________________________________________________________

c. Was the contract partially or completely terminated for default or convenience? If yes, explain (e.g. inability to meet cost, performance, or delivery schedules). YES* NO

Remarks: ________________________________________________________________

6. CONCLUSION：

a. Based on this contractor’s overall performance, would you hire this contractor again? If no, explain. YES NO*

Remarks : ________________________________________________________________

The undersigned hereby confirms that the information provided in this document is correct as written. Should any corrections be required, the undersigned shall contact the Contract Specialist at Country Code + 81-98-970-3128 (Commercial) not later than 5 calendar days after the date of the signature below. This confirmation shall allow the MCIPAC Regional Contracting Office (RCO) to use the information contained herein as source selection information.

Signature Date

We’d highly appreciate your cooperation in this matter.