6. Atch 3. Questionnaire - PPT.doc

RFP No. FA5209-11-R-0005

RFP No. FA5209-11-R-0005

PAST PERFORMANCE QUESTIONNAIRE

PART I INFORMATION ON OFFEROR AND CONTRACT

The offeror shall fill in this PART I in both of English and Japanese (Only English for U.S. Govt. contract).

(PART Iは、入札参加業者が英語と日本語で記入してください。米国政府との契約については英語のみで結構です。)

NAME OF THE OFFEROR:

入札参加（調査対象）業者名:

INFORMATION ON CONTRACT TO BE EVALUATED （調査対象契約情報）:

Y (Yen)

*Insert $” value only for the contract awarded in U.S. dollar ($).

PART II QUESTIONNAIRES

Contracting activity shall answer questions in this PART II concerning the information in PART I. Please write in English if possible.

（PART IIはPART Iの情報について、発注元が各質問にお答え下さい。可能であれば、英語で記入して下さい。）

SECTION 1: EVALUATOR IDENTIFICATION

A. Evaluator’s name/title/phone #:

（記入者の氏名･職名･電話番号）

SECTION 2: CONTRACT/CONTRACTING ACTIVITY IDENTIFICATION

A. If you find incorrect information in Part I, please correct it here. （Part I の情報に誤りがあれば、当欄で訂正してください）

B. Circle one of applicable Construction Contract Type to the contract described in Part I above. Circle all applicable Work Scopes/Contents which are included in that contract. (該当する工事契約型式を、一つ○で囲んでください。該当する工事内容を、全て○で囲んでください。) Construction Contract Type (工事契約型式):

Type 1: Design-Build construction contract (performed for U.S. Federal Agencies or U.S. commercial customers) Type 2: Construction Only contract (performed for U.S. Federal Agencies, U.S. commercial customers, Government of Japan or its political subdivisions, or local commercial customers) Work Scopes/Contents (工事内容):

Maintenance, Repair, Renovation, Alteration, New construction and associated Architecture/Engineering work, with multiple disciplines, such as Building Renovation, Repair, Additions/Upgrades, along with specific work in Heating, Ventilation and Air Conditioning (HVAC), Electrical, Mechanical.

Specify any other major trades/work below when included:

SECTION 3: QUALITY EVALUATION

Each code as “your response” is defined as follows: （「回答」としての各記号は以下のように定義されます。）

(特に優れている)

- The contractor’s performance meets contractual requirements with many exceeded to your benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective. (この業者は、多くの点で便宜を図り, ほとんど問題なく、契約上の必要条件を満たしている。）

(優れている)

– The contractor’s performance meets contractual requirements with some exceeded to your benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective. (この業者は、いくつかの点で便宜を図り，軽微な問題もあったが、効果的に解決し、契約上の必要条件を満たしている。）

(満足)

- The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.（この業者は、軽微な問題もあったが、満足のいく解決策をとり、契約上の必要条件を満たしている。）

(多少問題あり)

- Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.（この業者は、いくつかの点において、契約上の必要条件を満たしていない。重大な問題があり、その解決方法も今だ明らかではなく、申し出された解決方法、その効果に疑問があり、又は、十分に、問題の解決方法が、実行されなかつた。）

(不満)

- Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problems(s) for which the contractor’s corrective actions appear or were ineffective. （この業者は、多くの点において、契約上の必要条件を満たしておらず、適時の修復は、見込めない。重大な問題があり、その問題に対するこの業者の解決方法に疑問があり、又は、その解決方法が有効的ではなかつた。）

(該当なし)

- Unable to provide a score.（質問に関連し、該当なし）

Please indicate your satisfaction with the contractor’s performance quality under the contract to be evaluated, by circling an appropriate code provided to the right of each question. (各質問の右側にある適切な記号を○で囲むことで、調査対象契約に関して、この業者の工事に対する満足感を示してください。)

A. Quality Control

Quality of Workmanship; Adequacy of the Contractor Quality Control (CQC) Plan; Implementation of the CQC Plan; Quality of QC documentation; Adequacy of QC testing

(技術や品質管理について評価をしてください)

Adequacy of submittals; Adequacy of As-Builts

(竣工図や材料承認など、提出物について評価をしてください)

Identification/correction of deficient work in a timely manner (欠陥品や問題点に対する解決案・解決方法について評価をしてください)

B. Timely Performance

Adequacy of initial progress schedule; Adherence to approved schedule;

Resolution of delays (工程表の遵守状況や遅延への対応について評価をしてください)

C. Effectiveness of Management

Cooperation and responsiveness; Management of resources/personnel; Coordination and control of subcontractors; Review/resolution of subcontractor’s implementation of subcontracting plan; Effectiveness of job site supervision; Adequacy of site clean-up; Professional conduct

(現場管理について評価をしてください)

D. Compliance with Safety Standards

Adequacy of safety plan; Implementation of safety plan; Correction of noted discrepancies （安全対策について評価をしてください）

E. Overall Quality Rating (U.S. Government Contracts Only) （調査対象契約が米国政府とのものではない場合、次に進んでください）

If you have rating on DD2626/SF1420, put the overall rating here:

If you assessed Liquidated damages, write reasons here:

Note: Questions in this section are based on evaluation elements of DD Form 2626, PERFORMANCE EVALUATION.

SECTION 4: NARRATIVE SUMMARY

A. Please write this contractor’s greatest strength and weakness in the performance of the contract, which you would like to highlight:

（この業者の、調査対象契約の、調査対象契約に関する長所や短所について、お気づきの点があればご記入ください）

B. Please write any reservations about soliciting this contractor:

（この業者に対する今後の入札・発注予定について、差し支えなければご記入ください）

C. Please write any additional comments concerning this contractor’s performance (use the below or reverse/additional sheets as necessary):

（この業者のパフォーマンスについての追加コメントがあればご記入ください）

Thank you for your prompt response and assistance! （ご協力ありがとうございました）

When filled in, this document is for official use only.（記入後関係者のみ閲覧可)

Attachment 3 When filled in, this document is for official use only.（記入後関係者のみ閲覧可)