Attachment__6 _Past_and_Present_Performance_Questionnaire.pdf

PAST AND PRESENT PERFORMANCE

QUESTIONNAIRE

FOR

SOLICITATION NO. FA5270-14-R-0020

Government Furnishings Drayage

Okinawa, Japan

(12 Pages to include this cover page)

FA5270-14-R-0020

Attachment #6, Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONAIRE

FOR

SOLICITATION NO. FA5270-14-R-0020

The government is placing increased emphasis in its acquisitions on “past or present performance” as a source selection evaluation factor. You have been provided as a reference in response to the subject solicitation for Government Furnishings Drayage, 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 your assessment of the contractor’s performance regarding this project. In accordance with FAR 15.306(e) (4), the name of individuals providing reference information about an offeror’s past performance shall not be disclosed.

Upon completion of this survey, please fax it to 634-1761 (DSN); 011-81-98-961-1761 (commercial) or send it by e-mail to the address shown below no later than 4:00 pm, 20 June 14 (Japan Standard Time).

18th Contracting Squadron/LGCA Attn: SSgt Joseph Wells Phone: 634-5834 Comm: 098-961-5834

Bldg. 99, Kadena AB, Okinawa E-mail address: joseph.wells.4@us.af.mil

The individual knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

In the event of inconsistency between English language and translation thereof into Japanese language, the English language meaning shall control.

If you have any questions concerning this survey, please call SSGt Joseph Wells at 634-5834 (DSN) 098-961-5834 (Commercial) or send e-mail. Your time and effort in providing this vitally important information are greatly appreciated.

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: _____________________________________________________________

B. Cage Code of contractor contract was awarded to: _________________________________

C. Contract number: _______________________________________

D. Contract type: ______________________________

E. Was this a competitive contract? Yes _____ No _____

F. Period of performance: _________________________________________________________

G. Initial contract cost: $____________________________

H. Current/final contract cost: $_______________________________

I. Reasons for differences between initial contract cost and final contract costs:

J. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name: _________________________________________________________________＿＿＿

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name:

B. Evaluator's title:

C. Evaluator's phone/fax number: ___________________________________________________________________

Number of years evaluator worked on subject contract: _____________________

SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

E EXCEPTIONAL - The contractor’s performance meets contractual requirements and exceeds many

(requirements) to the Government’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VG VERY GOOD- The contractor’s performance meets contractual requirements and exceeds some

(requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – 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.

M MARGINAL – 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.

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

N NOT APPLICABLE - Unable to provide a score.

<Quality of Work>

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

当該会社はサービス内容の品質管理を効果的に行う能力を有していますか。

E

VG

S

M

U

N/A

Comments (コメント・その理由など)

2. Contractor’s ability to meet appropriate staffing levels with sufficient number of qualified personnel with work ethic and customer service skills in order to provide required services.

当該会社が要求されたサービスを提供するための十分な作業人員、かつモラルの

ある作業員を確保していますか。

3. The Contractor substantiated credible pricing data for change orders/modification?

当該会社は過去に契約に変更があった際に信憑性のある見積り等を出しまし たか。

4. Was the contract partially or completely terminated for default or convenience?

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules).

契約不履行や都合によって当該会社との契約が一部、または全体的に解約と

なった経験がありますか？ あればご説明下さい。

Comments (コメント)

5. Was the ordered service moving for household goods?

当該会社に発注した業務は家財の引越業務でしたか。

[ ] はい

［ ］いいえ

6. The Contractor furnishes proper vehicles and crew members as ordered?

当該会社は発注通りに車両と引越作業員を手配できたでしょうか。

7. Have you ordered international moving service to this company? If so, please rate the quality of performance that they provided.

貴社は、当該会社に、海外向けの引越し作業を依頼したことがありますか。

あった場合、受けたサービスを評価してください。

8. Did you require appliance servicing and unservicing? If so, did the Contractor provide appropriate service?

家具の組み立てや家電機器の設置などは仕事内容に入っていた場合、当該会社は

適切なサービスを提供しましたか。

9. The Contractor provides appropriate transportation services for sensitive or hazardous freight movement.

梱包済みの引越家財を当該業者の倉庫に保管する業務が含まれていた場合、当

該会社は要求どおりに適切なサービスを提供しましたか。

10. Were there long-distance requirements? If so, did the Contractor perform the orders successfully?

国内長距離での引越業務の発注はありましたか？ あった場 合、当該業者は適 切なサービスを提供しましたか。

11. Were there any accidents/incidents during dangerous/hazardous freight movement?

当該会社は、引越作業の際、事故および車両故障などをを起こしたことがあり ますか。

YES はい[ ] NO いいえ [ ]

<Quality of Work>

12. How was the Contractor’s proper stowage of freight? Was it done without any damages to cargo?

当該会社は、適切に貨物の積込みを指示・確認し、輸送中に貨物へのダメージ を与えず輸送をしていましたか。

Comments (コメント・評価の理由など)

13. Have you filed claims involving loss or damage?

当該会社に損害によるクレームを申し立てたことがありますか？

YES

NO

YES (はい) Rate if the Contractor demonstrated a cooperative behavior.

申し立てをされた経験が有る場合、当該会社の対応を右の５段階で評価して下

さい。

If YES, records of claims? (はい)の場合、契約期間中申し立てたクレームの数は？ ( 件)

NO (いいえ) トラブルの経験無しの場合、N/A に○をつけてください。

14. Was there a requirement for providing movement exceeding below for a total weight? If the answer is YES, was the contractor successful in meeting this requirement?

当該会社に一日の総重量が下記に匹敵する重量を超える引越案件を過去に発注

したことがありましたか。もしあった場合、当該業者は発注通りににサービス

を提供できたでしょうか。

a. 一日総重量総計 18,000 ポンド（およそ 8.2 トン分）を超える引越業務 YES あり [ ] NO なし [ ]

15. Did the Contractor furnish proper containers, crates, cardboards, and packing materials?

当該業者が提供した梱包用コンテナ・クレート・資材などは適切なものでした か。

16. Were there any oversized household goods in your requirement? If so, did the Contractor provide proper service?

寸法が大きめの家財が含まれていた場合、当該業者は適切なサービスを提供し

ましたか。

<Timely Performance/Schedule>

15. Were there required performance time frames? What time frames were required, and did the Contractor meet them?

貴社は、発注の際、作業開始・終了時間を指定していましたか。指定していた

という場合、どのような指定時間でしたか。また、その指定時間通り にサー

ビスは提供されましたか。

18. Contractor’s ability to meet specific response times and required time frames for providing the services.

当該会社が要求されている時間内に適切にサービスを供給できる能力を評価し

てください。

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

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

当該会社は緊急のサービスが必要になったときに迅速に対応する能力があると

思われますか。また顧客の要求に応じて臨機応変な対応をとることが出来ます

か。

20. Contractor’s responsiveness/timeliness for providing monthly reports/ documents/ submittals required by the contract.

当該会社は月例報告書や書類の提出に際して契約で要求されているとおりに 対処し、期限も守られていますか。

<Effectiveness of Management for Resolution of Issues/Problems/Customer Complaints>

21. Were key personnel knowledgeable about contractual requirements?

当該会社の現場監督者は契約内容について精通していますか。

22. Have you had any manning/staffing problems, such as, under manning, no-qualified personnel? And after recognizing the problems, the problems have been solved and contractor demonstrated a cooperative behavior?

人員不足や能力不足などによる問題やトラブルのご経験がありましたか。それ

らの処理 においては問題解決が協力的になされましたか。

YES NO

YES (はい) Rate if the Contractor demonstrated a cooperative behavior.

トラブルの経験有りの場合、当該会社は問題解決に協力的で あったかを 5 段階で評価下さい。

NO (いいえ) トラブルの経験無しの場合、N/A に○をつけてください。

23. Provided timely resolution of contract discrepancies/problems. Contractor’s ability to correct problems and prevent or mitigate potential problems in a timely manner.

当該会社は契約に定められた職務を遂行する上で問題があった場合に迅速に解

決することが出来ている。かつ潜在的な問題を事前に予防したり軽減したりす

る能力があると考えられますか。

24. If the company used subcontractors, how well did the company manage subcontractors?

当該会社が協力・下請け負い会社に業務を外注している場合、当該会社による

協力・下請け負い会社に対しての管理はきちんと行われていますか。

25. Does the company resolve issues, problems, customer complaints in a timely manner?

当該会社は契約や業務上の問題やクレームに対する対応を速やかに行っていま すか。

<Compliance with the Applicable Rules, Regs, Laws, including Safety Standards>

26. Contractor’s safety standards to meet the applicable Government policies, regulations, and contract requirements.

駐車違反なども含め、当該会社の提供するサービスの安全基準は該当する法規

と契約に則り対応できていますか。

27. Based on this contractor’s overall performance, would you hire this contractor again?

過去から現在における当該会社のサービス実績を総合的に判断して、貴社では

当該会社を今後も取引継続先と考えていらっしゃいますか。

OVERALL RATING (総合評価)

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

FOR THIS CONTRACTOR? AND WHY?

上記の評価に基づいて、当該会社に対する総合的評価をお答え下さい。

2. Please discuss each and every response for which you indicated as marginal or unsatisfactory in response to the questions above (use additional sheets, if necessary).

3. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes___ Default ___ Convenience ＿＿ Pending Terminations ___

No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs? Has election ever been made not to exercise a contract option or continue relations due to the contractor’s poor performance?

Overall Assessment E VG S M U N

What is your overall assessment of this past performance for this contractor?

Would you hire this contractor again? If not, explain.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Mailing Address: joseph.wells.4@us.af.mil

Or FAX to:

011-81-98-961-1761/098-961-1761