Attachment 6 ACM LBP Past Performance Questionnaire.pdf

FA5270-12-R-0011, Attachment 6

PAST PERFORMANCE QUESTIONAIRE

FOR

SOLICITATION NO. FA5270-12-R-0011

上記入札番号に参加される業者の過去の実績調査

The government is placing increased emphasis in its acquisitions on “Past Performance” as a source selection evaluation factor. You have been provided as a reference in response to subject solicitation for Sampling, Testing and Removal of Asbestos and Lead Base Paint, Various Buildings, Various Locations, Okinawa, Japan. In order for the government to evaluate the past performance of the firm providing you as a reference, please provide frank, concise comments regarding you assessment of the contractor’s performance regarding this project. Since the Past Performance Questionnaire is addressed to the US Government, please ensure all answers are in English or with English translation. In accordance with Federal Acquisiton Regulation (FAR) 15.306 (e)(4), the name of individuals providing reference information about an offeror’s past performance shall not be disclosed.

今回、在日米空軍カデナ基地にて公示されたアスベスト及び鉛塗料除去工事の入札に当たり、米国政府は請負

業者を選択し、評価する上で入札業者の過去の実績を調査する為のアンケートを行っております。お手数では

ありますが、下記のアンケートへのご回答をお願い致します。 尚、評価ならびに調査を実施しますのは米国

政府の為、ご回答はすべて英語でお願い致します。 当アンケート用紙の回答に関する情報を公表することは

ありません。

Upon completion of this survey, please fax it to 098-961-7626 (Commercial) or send it by e-mail to the address shown below no later than the proposal due date.

添えつけのアンケート用紙を記入後、入札締め切り日迄にＦＡＸ番号０９８－９６１－７６２６もしくは下記

のＥ－メール アドレス迄、ご送信お願い致します。

18th Contracting Squadron Infrastructure Flight (LGCC) Attn: A1C Brian Austin Comm: 098-961-4741 E-mail address: brian.austin@kadena.af.mil

GENERAL GUIDANCE FOR COMPLETING QUESTIONNAIRE（質問書の記入方法）

A. The questionnaire should be completed by the individual most knowledgeable of the Contractor’s day-to-day operations and overall condition of service being rendered. However, that individual is encouraged to supplement their own knowledge of the Contractor’s performance with the judgment of others in their organization, as applicable.

この質問書の回答は該当する工事現場を熟知している方に限らせて頂きます。ただし、回答者以外に当該業者

について知っている方の意見も合わせてご記入下さい。

B. Handwritten responses are sufficient. However, request they be legible. はっきりとていねいにご記入下さい。

C. Please provide explanatory narratives for as many responses as possible. These narratives need not be lengthy, just descriptive. Space for narrative comments is included after each question and on the last page of the questionnaire. If more space is needed, use the back of the questionnaire or attach additional pages.

できるだけ具体的にご回答下さい。回答は箇条書きでも構いません。回答欄が足りなければ用紙の裏面もしく

は別紙をご利用下さい。

D. As the questionnaire relates to a solicitation for construction work identified in the cover letter, request that all information provided within the questionnaire be safeguarded against unauthorized disclosure.

この質問書は見積書の表紙に記載されている工事の一部に含まれるためむやみに第三者に公開しないようご協

力下さい。

E. Do not request evaluation by subcontractors. 下請け業者による質問書の回答依頼は避けて下さい。施工発注

元に依頼下さい。 F. In the event of inconsistency between English language and translation thereof into Japanese language, the English language meaning shall control. このアンケートで英文と日本文の間に矛盾する個所がある場合には、英文の方

を優先させていただきます。

G. The following description should be used as a guide in providing element ratings:

評価の記号および詳細は下記の通り

Code（記号） Performance Level（評価方法）

E Exceptional: The contractor’s performance meets contractual requirements with many exceeded to the entire contructual requirements. The contractual performance of the element or sub-element being assessed was accomplished with no more than a few minor problems for which corrective actions taken by the contractor were highly effective.（優秀）当該業者は作 業内容をよく理解し、ほとんどにおいて基準値を超えている。

G Good: The contractor’s performance meets contractual requirements with some exceeded to the entire contractual requirements. The contractual performance of the element or sub-element being assessed was accomplished with no more than some minor problems for which corrective actions taken by the contractor were effective.（良好） 当該業者は作業内 容を理解し、いくつかの項目において基 準値を超えている。

S Satisfactory: The contractor’s performance meets contractual requirements. The contractual performance of the element or sub-element being assessed was accomplished contains some minor problems for which corrective actions taken by the contractor were satisfactory.

（普通）当該業者は作業内容を理解し、平均値を満たしている。

M Marginal: The contractor’s performance does not meet some contractual requirements.

the entire 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 or the contrator’s proposed actions appear only marginally effective or were not fully implemented.（劣る）当該業者の作業内容は、いくつかの項目 において基 準値に満たない。重大な問題が生じた際、当該業者の解決策は限定的、

もしくは適切だったとは言えない。

U Unsatisfactory: The contractor’s 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 being assessed contains a serious problem(s) for which the contractor’s corrective actions appear unsatisfactory or were ineffective.（非常に劣る）当該業者の作業内容は、 多くの項目において基 準値に満たないもので、尚且つ修復作業も迅速ではなかった。 重大な問題が生じた際、当該業者の解決策は全く適切だったとは言えない。

N Neutral: Performance was not observed or not applicable to the current effort being reported against.

（該当無し）該当せず

PART I GENERAL INFORMATION （概要・概略）

回答者の氏名 連絡先

NAME OF RESPONDENT: TELEPHONE:

回答者の役職名 職場

POSITION TITLE: ORGANIZATION:

日付

DATE:

当該業者 工事請け負い番号

CONTRACTOR: CONTRACT NUMBER:

担当者名 連絡先

POINT OF CONTACT: TELEPHONE:

工事の名称

CONTRACT TITLE:

施工内容もしくは内訳 PROJECT: (A brief description of work performed).

施工現場

LOCATION OF PROJECT: 落札金額・請け負い総額

AWARD AMOUNT: $/¥ PRESENT AMOUNT: $/¥

工事の種類 工事期間

CONTRACT TYPE: CONTRACT PERIOD:

アスベスト及び鉛塗料除去工事の占める割合 PERCENTAGE OF PROJECT ASBESTOS AND LEAD-BASE PAINT SAMPLING, TESTING, AND REMOVAL

RELATED_______%

PART II

PERFORMANCE INFORMATION

The following questions are two (2) types: YES/NO and RATING. The YES/NO questions should be supplemented with an explanatory narrative if the answer is “YES”. When responding to the RATING type questions, choose the letter on the scale of N to E, which most accurately describes the Contractor’s performance or situation. If the question is not applicable, circle “N/A”. Responses to the RATING type questions should be supplemented with explanatory narrative as well, use remarks section or additional sheets if necessary. The letter N to E correspond with the following values:

下記の設問は“はい・いいえ”と“６段階評価”の２種類から成り立っています。“はい・いいえ”の設問で

“はい”とお答えにになった場合、その理由も合わせてご記入下さい。６段階評価の設問はもっともあてはま

るものを丸でお囲み下さい。合わせてその理由もご記入下さい。いずれにも該当しない場合は“該当なし”と

お答え下さい。６段階評価の採点方法は下記の通り；

E = Exceptional（優秀）G = Good(良好) S = Satisfactory（普通）M =Marginal (劣る) U = Unsatisfactory (非常に劣

る) N = Neutral (該当無し)

QUALITY CONTROL (作業の品質)

01. How would you describe the Contractor’s workmanship?

E G S M U N 業者の技量をどう評価しますか？

02. How would you describe the Contractor’s quality control plan? E G S M U N

業者の品質管理計画をどう評価しますか？

03. How would you describe the Contractor’s implementation of their quality control plan? E G S M U N

業者の品質管理計画に基づく工事の履行をどう評価しますか？

04. Quality of the quality control documentation

業者の品質管理の提出資料、記録等をどう評価しますか？ E G S M U N

05. How would you describe the Contractor’s storage of materials?

E G S M U N 業者の資材管理をどう評価しますか？

06. How would you describe the Contractor’s adequacy of materials?

E G S M U N 業者は適切な資材を提供してますか？

07. How would you describe the Contractor’s adequacy of submittals?

業者は適切な資材資料、施行詳細を提出してましたか？

08. How would you describe the Contractor’s adequacy of QC testing?

E G S M U N 業者は適切な品質管理検査をしてましたか？

09. How would you describe the Contractor’s adequacy of as-builts?

E G S M U N 業者は適切な実施設計書を提出してましたか？

10. How would you describe the Contractor’s adequacy of specified materials?

E G S M U N 業者は仕様書に従って適切な資材を提供しましたか？

11.1. Did the Contractor identify/correct deficient work

in a timely manner? YES NO N/A

欠陥作業を確認し期限内に修復されましたか?

11.2 If yes, How would you describe the Contractor’s workmanship for the subject matter?

上の答えが“はい”の場合、その際の技量をどう評価しますか？

TIMELY PERFORMANCE

01. How would you describe the Contractor’s adequacy of initial progress schedule?

業者の工事工程表は適切でしたか？

02. Did the Contractor adherent to meet approved progress schedules? YES NO N/A

工程表に添って工事を遂行しましたか？

03. How well did the Contractor resolve delays? E G S M U N

工期に遅れがあった際、的確に処理されましたか？

04. How well did the Contractor submit required documentations timely? E G S M U N

工程に応じて必要な書類は期限どうりに提出されましたか？

05. How well did the Contractor complete punchlist items? E G S M U N

手直し工事は的確にされましたか？

06. Did the Contractor submit updated and revised progress schedules in timely manner when it needed? YES NO N/A

何らかの理由で工期に変更が生じた際、 それに見合った工程表が提出されましたか？

07. How well did the Contractor conduct warranty response? E G S M U N

保証期間内の工事は的確に処理されましたか？

MANAGEMENT EFFECTIVENESS

01. How well did the Contractor cooperation and responsiveness? E G S M U N 問題が発生した際、協力的に問題を解決しましたか？

02. How well did the Contractor management of resources/personnel? E G S M U N

資材や人材の管理はどうでしたか？

03. How well did the Contractor coordinate and control of subcontractor(s)? E G S M U N

下請け業者のコーディネートと管理はどうでしたか？

04. How well did the Contractor site clean up? E G S M U N

工事現場は清掃、整理整頓されていましたか？

05. How well did the Contractor job-site supervision effectively? E G S M U N

工事現場の管理は適切でしたか？

06. How well did the Contractor comply with the laws and the regulations? E G S M U N

業者は法や規則を守っていましたか？

07. How well did the Contractor conduct professional conduct? E G S M U N

仕事は専門職にふさわしい姿勢、内容でおこなわれましたか？

08. How well did the Contractor review/resolve subcontractor’s issues? E G S M U N

下請け業者と問題が発生した際、速やかに問題を解決しましたか？

COMPLIANCE WITH SAFETY STANDARDS

01. How would you rate the adequacy of the Contractor’s safety plan? E G S M U N

事故防止対策は万全でしたか？

02. How well did the Contractor implement their safety plan?

工事は事故防止対策に基づいて施工されましたか？

03. How well did the Contractor correct the noted items? E G S M U N

不手際を指摘された際、すみやかに修正しましたか？

PRICING OF MODIFICATIONS

01. How well did the Contractor provide substantiated pricing data for proposed modifications? E G S M U N

契約改訂の際、正確な価格資料を提出しましたか？

02. How accurate, complete and reasonable were the Contractor’s supporting prices for modifications? E G S M U N

上記の契約改訂の際に提出された見積書は正確、 完全、そして価格は妥当 でしたか？

REMARKS:

Please address all areas of concern, as well as any strengths or weaknesses you’d like to highlight.

先記の項目以外に当該業者の長所および短所があればご記入下さい。

Please list other known references regarding the Contractor’s performance:

（当該業者について他に知っている方がいればご記入下さい。）

TELEPHONE/

NAME ADDRESS FAX NUMBERS

（氏名） （住所） 電話番号 ファックス番号

御協力どうもありがとうございました。