3d.__Atch_3_(Survey).pdf

RFP No. FA5209-16-R-0023

ATTACHMENT 3

FOR OFFICIAL USE ONLY 1

PRESENT/PAST PERFORMANCE QUESTIONNAIRES

履行実態調書

Date:

FROM: 374th Contracting Squadron/LGCA

Unit 5228, Bldg 620

Yokota Air Base

Fussa-shi, Tokyo 197-0001

1. INSTRUCTION:

374th Contracting Squadron/LGCA, Yokota Air Base, Japan is in the process of selecting a contractor for our U.S. Government contract. The contractor listed below has provided the following contract information as a reference for its (or its subcontractor’s) present/past performance information (PPI).

Please provide frank, concise comments regarding your assessment of the contractor’s performance regarding this contract at paragraph 4, Questionnaire. After completing this survey, please directly send it to this office as instructed on the last page of this survey. In accordance with FAR 15.306(e)(4), the names of individuals providing reference information about an offeror’s present/past performance shall not be disclosed. Your prompt attention to this survey will be greatly appreciated.

横田基地契約中隊では、現在、在日米軍の業務委託契約における請負業者の選定を行っております。下

記の入札参加業者より過去又は現在における業務実績（又はその下請け業者の業務実績）として以下の

契約の申告がありました。つきましては、この契約における貴殿の率直で簡潔なご意見をパラグラフ 4、

Questionnaireにご回答を頂きたく添付の履行実態調書をお送りした次第です。ご記入いただいた回答書

は、最終ページの案内に従い当契約中隊まで直接御返送ください。尚、米国連邦調達規則 15.306(e)(4)に

則りご回答者名は公表致しません。ご協力に感謝いたします。

2. CONTRACT INFORMATION: (The offeror shall fill in. 下記の情報は入札参加業者が記入。)

Name of Offeror 入札参加業者名

PPI Reference No. PPI照会番号

If the offeror uses subcontractor’s PPI, provide the subcontractor’s information.

入札参加業者が下請け業者の業務実績を使用

する場合は、その下請け業者の情報を記入

Contracting/Ordering Activity 契約/発注者名

Contract No. / Title 契約番号 / 契約名

Period of Performance 契約期間

Total Contract Value (If multi-year, provide

“per year” value too.) 契約金額合計 (複数年

契約は、年間金額も明記)

Was a prime contractor or subcontractor?

元請け業務であったか？下請け業務か？

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3. RESPONDENT IDENTIFICATION: (Contracting/Ordering Activity must fill in. 契約/発注者が

ご記入ください。)

Company Name 会社名

Name of Respondent 回答者の氏名

Job Title for the Contract (Ex. Inspector, Contracting

Officer, etc.) 契約における役職 (例: 検査官、契約官等)

Phone Number/ Fax 電話番号/ファックス番号

E-mail Address 電子メールアドレス

Date Questionnaire Completed 回答日

4. QUESTIONNAIRE: (Contracting/Ordering Activity must fill in. 契約/発注者がご記入下さい。)

a. DESCRIPTION OF WORK 契約内容

Please check () all applicable box(es) in the following table if your requirement includes/included any of the listed work elements. Please also provide a brief description of your requirement.

以下の表に記載の業務のうち、貴殿(貴社)の契約に含まれる/含まれていた全ての業務にチェック()

を入れてください。併せて簡単な契約概要も教えてください。

FACILITIES

Completed

Removal of interior wall (non-load bearing)

Installation/Removal of Raised Flooring

Installation/Removal of wiring/network cables

Removal of Video Teleconference equipment

Video Wall installation and testing

Installation and furniture

Software package for video teleconference equipment

Brief Description of Work 契約概要

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b. RATING 評価

Referring to the following rating scale, please circle the rating to each question that most accurately describes the contractor’s performance or situation. Please also provide brief comment/explanation to your evaluation as much as possible. 下記の評価指針を参照し、各設問で最も近いと思われる評価に

「○」を付けてください。又、出来るだけその評価に対する説明、コメントもご記入ください。

RATING SCALE 評価指針

Exceptional (E)

超優良

Performance meets contractual requirements and exceeds many to the customer’s benefit. The contractual performance of the element or sub-element being evaluated 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、更に多くの点で高い満足が得られた。業者の非

常に有効な作業対応でほぼ何の問題もなく完了した。

Very Good (VG)

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 evaluated 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、更に幾つかの点で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、業者は適切な是正処置を取って完了した。

Satisfactory (S)

満足

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

契約要件を満たしている。履行中に軽微な問題が生じたが、業者は満足の

ゆく是正処置を取った、又は取ったように思われる。

Marginal (M)

不満

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

契約上いくつかの点で要件を満たしていない。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、又は十

分に実行されていないと思われる。

Unsatisfactory (U)

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(s) for which the contractor’s corrective actions appear or were ineffective.

契約内容をほどんど満たしておらず、適時に改善の見込みがない。業者の

是正処置に効果がない、又は効果が無いと思われ、対象の業務に重大な欠

陥がある。

Not Applicable (NA)

該当なし

The statement is not applicable.

質問事項が該当しない。

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(1) Did the service provided by this contractor meet the performance work statement, specifications, etc. of your contract? この業者の作業内容は作業指示書や仕様書等の内

容を満たしていましたか？

E VG S M U NA

(2) How effective were the contractor’s quality control and/or inspection procedures? この業者の品質管理や検査手順はい

かがでしたか？

(3) Did the contractor submit required documentation (work schedule, reports, data, etc.) in a timely manner? この業者は

要求されている書類 (作業予定表、報告書、資料など) を期

日通りに提出していましたか？

(4) Were the above-mentioned submittals adequate to support the contract work? 上記の提出物は適切な内容のものでした

か？

(5) Did the contractor adhere to the work schedule?

作業予定表は厳守されていましたか？

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(6) How was the effectiveness of the contractor’s job site supervision? この業者の現場管理能力はいかがでしたか？

(7) Did the contractor retain managers/supervisors with the technical and administrative abilities needed to meet contract requirements? この業者は契約で要求されている技能及び実

務能力のある現場管理者・監督者を雇用していましたか？

(8) Did the contractor’s key personnel meet the qualifications as required in the contract? 主要作業員の資格は、契約で要求

されている内容を満たしていましたか?

(9) Did the contractor always hire and retain a sufficient number of employees for the performance of the contract work? こ

の業者は常に充分な作業員数を雇用し維持していましたか？

(10) Was the contractor able to solve contract performance problems without extensive guidance from your procurement or technical personnel? この業者は独力での問題解決能力が

ありましたか？

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(11) How well did the contractor substantiate pricing data for change orders/modifications if there were any? 契約に変更

があった場合、変更内容に対する見積り等には信憑性があり

ましたか？

(12) During the performance of the contract work, did the contractor respond to any immediate maintenance/repair request in a timely manner if there were any? 契約期間中に

緊急の点検や修理の要求があった場合、この業者は迅速に対

応をしましたか?

(13) If a warranty issue arose, did the contractor provide timely assistance? 保証問題があった場合、適時に対応をしてい

ましたか？

(14) How was the contractor’s compliance with laws and regulations? 規則や法律の遵守状況についてはいかがでし

たか？

(15) Would you hire this contractor again? この業者と再度契約

を結びたいと思う。

Yes No

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(16) Overall Rating 総合評価 E VG S M U NA

Note: The contracting/ordering activity may be contacted for additional information pertaining to past/ present performance of the contract being evaluated. Your understanding and cooperation are greatly appreciated. 審査の手続き上、評価対象の契約について再度連絡を取らせていただく場合が

あります。ご了承いただくとともに、ご協力をお願いします。

Your corporation is highly appreciated.

ご協力いただき、有難うございました。

Please fax or e-mail the completed questionnaire to:

下記のファックス番号、もしくは電子メールアドレス宛にご回答の返送をお願いします。

374 CONS/LGCAB

Unit 5228, Bldg 620 Yokota Air Base

Fussa-shi Tokyo 197-0001

Attn: Kanae Yamamoto (Ms.)

Fax: 042-551-0973

Tel: 042-551-6120

DSN 225-9643

E-mail To: kanae.yamamoto.jp@us.af.mil

〒197-0001

東京都 福生市 在日米空軍 横田基地

建物番号 620 契約中隊

担当: 山本香苗

Fax: 042-531-0973

電話: 042-551-6120

電子メール：kanae.yamamoto.jp@us.af.mil mailto:kanae.yamamoto.jp@us.af.mil mailto:kanae.yamamoto.jp@us.af.mil