6_Atch_4_-_PP_Survey.doc

Attachment 4 - Past Performance Survey Solicitation No. FA5209-19-U-0022

PRESENT/PAST PERFORMANCE SURVEY

Date:

FROM: 374 CONS/PKBB

Unit 5228, Bldg. 620 Yokota Air Base Fussa-shi Tokyo 197-0001

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

(E)xceptional : 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.

(V)ery (G)ood : 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.

(S)atisfactory: 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.

(N)eutral : Did not observe performance in this area.

(M)arginal： 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.

(U)nsatisfactory : 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.

2. CONTRACT INFORMATION: The below listed contractor has identified they provided or are currently providing services for your company/agency.

a. Contractor (Company/Agency) :

b. Contractor Address/Phone:

c. Prime contractor or subcontract

d. Title of Program/Contract:

1) Contract Number:

2) Period of Performance :

3) Services Provided (explain in detail the type of services provided by the contractor):

e. Total Contract Amount:

3. RESPONDENT IDENTIFICATION: (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.

a. Company’s Name:

b. Name and Title:

c. Phone Number : _______________ FAX : ______________

E-mail Address : ＿＿＿＿＿＿＿＿＿＿＿

d. Address: _________________________________________

e. Relationship to Project : ________________________________________________

f. Length of Involvement in Project : ______________

g. Date Questionnaire Completed : ___________

4. QUESTIONNAIRE (Circle One)

a. (Quality of Work) Were you satisfied with the quality of service performed or items supplied?

E VG S N M U

b. (Quality of Work) How effective did the contractor’s quality control and/

E VG S N M U

or inspection procedures operate ?

c. (Timely Performance/Schedule) Did the contractor provide timely response to any inquiries/requests to perform the best service?

d. (Timely Performance/Schedule) Did the contractor provide the required service in a timely manner and on schedule?

e. (Management Effectiveness) How did the contractor maintain/manage contractor personnel training records?

h. Would you hire this contractor again? If no, why?

YES

NO

i. Overall Rating:

j. Additional Comments/Remarks:

Please fax or e-mail completed questionnaires to the address shown below:

Address:

374 CONS/PKB

Unit 5228, Bldg. 620 Yokota Air Base

Fussa-shi Tokyo 197-0001

Attn: DAISUKE KAWASAKI Fax: 011-8142-530-7538

Phone: 011-8142-552-3011 E-mail: daisuke.kawasaki.jp@us.af.mil, joel.yerkey@us.af.mil Thank you very much for your cooperation.

FOR OFFICIAL USE ONLY