Attachment_-_3_Past_and_Present_Performance_Questionnaire_15-R-0018.pdf

RFQ No.: FA5270-15-R-0018

Attachment 3, Past/Present Performance Questionnaire

ACCESS TO CARE (ATC) ADMINISTRATIVE SERVICES, Okinawa, Japan

PAST/PRESENT PERFORMANCE QUESTIONNAIRE

業務実績に関する質問調書（業者審査機密情報）

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

SECTION 1: CONTRACT IDENTIFICATION（契約）

A. Contractor（契約業者）: _____________________________________________________________

B. Cage Code of contractor contract was awarded to（業者ケージ番号）: _________________________________

C. Contract number（契約番号）: _______________________________________

D. Contract type（契約種類）: ______________________________

E. Was this a competitive contract?（競争入札契約であるか否か） Yes（そうである） _____ No（ない） _____

F. Period of performance（契約期間）: _________________________________________________________

G. Initial contract cost（初期契約金額）: $____________________________

H. Current/final contract cost（最終契約金額）: $_______________________________

I. Reasons for differences between initial contract cost and final contract costs（初期契約金額と最終契約金額との

違い理由）:

J. Description of service provided（業務内容）:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION（顧客／代理店）

A. Customer or agency name（顧客/代理店名）:

B. Customer or agency description (if applicable)（顧客／代理店業務）:

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

契約業務の地理的規模, 例-地域規模、全国規模、別域

SECTION 3: EVALUATOR IDENTIFICATION（評価者）

A. Evaluator's name （名前）:

B. Evaluator's title（役職名）:

C. Evaluator's phone/fax number（電話番号/ファックス番号）:

Number of years evaluator worked on subject contract（対象契約の担当年数）: _____________________

SECTION 4: EVALUATION（評価）

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:

各々の質問に対しての評価のレベルを以下に表示しております。該当評価を項目別に“X”印でご回答願います。

CODE PERFORMANCE LEVEL

EX 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.

青/超優良 -- 契約内容を満たし、さらに契約以上の多くの業務をした。対象の業務は契約業者の非常に

有効な処置で滞りなく完了した。

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.

紫/大変満足 -- 契約内容を満たし、さらに契約以上の業務をした。対象の業務に軽微な問題が生じても

業者の有効な是正処置で完了した。

SAT 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.

緑/満足 -- 契約要件は満たしている。契約履行中にいくつかの軽微な問題が生じたが業者の有効な是正

処置は満足であった。

MAR 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.

黄/不満 -- 契約業務の一部は不完全であった。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

あるか、又は業者の改善策は有効でないか十分に実行されていないと思われる。

Unsat 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.

赤/大変不満 -- 契約内容を殆ど満たしておらず、期間内に改善の見込みなし。契約した業務は業者の是

正処置不備による重大な欠陥がある。

N/A NOT APPLICABLE - Unable to provide a score.

該当なし

The questions shown below should be tailored to the Factors/Subfactors of the instant acquisition.

下記の質問は今回の入札に関する内容となっております。

Technical Performance 技術的能力 EX VG SAT MAR Unsat N/A

T1 Quality & repeatability of operations & maintenance.

T1 維持管理の質

T2 Quality of technical system testing and certification efforts

T2 技術的な検査及び認証

T3 Quality/integrity of technical data/report preparation efforts

T3 資料書の質と正確

T4 Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements

T4 品質管理プログラムの妥当性／有効性及び契約要件の順守

T5 Ability to implement current standard practices for computer hardware design, operation, maintenance, upgrades and configuration control

T5 現様式コンピュータ機種、操作、保全、改版、配置管理の改善

T6 Ability to implement current standard practices for computer software design, operation, maintenance, upgrades and configuration control

T6 現様式コンピュータソフトウェア、操作、保全、改版、配置管理の改善

T7 Adequacy/effectiveness of environmental safety procedures

T7 環境安全手順の有効性

Program Management 計画管理 EX VG SAT MAR Unsat N/A

P1. Effectiveness of overall contract management (including ability to effectively lead, manage and control the program)

P1 契約全般の管理能力（管理、プログラムの操作力を含む）

P2. Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes)

P2 業者の協力態勢（議論等の解決力も含む）

P3. Timeliness/effectiveness of contract problem resolution without extensive customer guidance

P3 独力での問題解決

P4. Understand/complied with customer objectives and technical requirements

P4 顧客の目的や技術的要件への応答

P5. Successfully responded to emergency and/or surge situations

P5 緊急事態への対応

P6. Quality/effectiveness of sub-contracted efforts

P6 下請負契約業務の質

P7. Effectiveness of material management (including Government Furnished Property or Material)

P7 器材管理（米政府所有物、器材を含む）

P8. Effectiveness of acquisition management

P8 業務管理

P9. Contractor proposed alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the customer

P9 価格削減、保全性向上、顧客利益の為の代替方法の提案

P10. Contractor implemented responsive/flexible processes to improve quality and timeliness of support.

P10 質向上、適時支援のための柔軟な対応

Transition/phase-in 引継ぎ EX VG SAT MAR Unsat N/A

T1. Contractor ability to smoothly transition resources and personnel.

T1 引き継ぎ業者への順応な対応と協力

T2. Contractor effectiveness on maintaining continuity of mission support while transitioning/phasing in resources and personnel to support other efforts.

T2 引継ぎ時における業務継続の為の対応と協力

Employee Retention/Attraction 雇用能力 EX VG SAT MAR Unsat N/A

E1. Ability to hire/apply a qualified workforce to this effort.

E1 資格従業員の雇用能力

E2. Ability to retain a qualified workforce on this effort.

E2 資格従業員保有

E3. Effectiveness of employee compensation towards quality of work.

E3 従業員奨励

Cost Performance 価格性 EX VG SAT MAR Unsat N/A

C1 Accuracy in forecasting contract costs

C1 契約予測金額の正確性

C2 Ability to meet forecasted costs and perform within contract costs

C2 契約金額内での業務実施

C3 Ability to alert Government of unforeseen costs before they occur

C3 想定外金発生前の通知

C4 Sufficiency and timeliness of cost reporting

C4 経費報告書の情報と適時性

2. Please discuss each and every response for which you indicated B/E (Blue/Exceptional), Y/M (Yellow/Marginal) or R/U (Red/Unsatisfactory) in response to the questions above (use additional sheets, if necessary).

上記の質問に対し貴社が青／超優良、黄/不満、赤/大変不満と示した各々全てのお答えに関しては十分な検討を願い

ます。（別紙への記入も可能です）

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

米軍契約のみに関して：契約者の不履行や契約便宜上により契約を破棄したり、または破棄保留となったことはあり

ますか？

Yes（ある）___ Default（不履行による契約破棄）___ Convenience（便宜上の破棄）＿＿

Pending Terminations (契約破棄保留）___

No (なし） ___

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

あるとお答えの場合はご説明下さい（例：金額、業務、納期スケジュールに関してなど）

SECTION 5: NARRATIVE SUMMARY（概要）

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs?

将来的にこの業者への業務提供の確約はありますか？ または貴社の重大な仕事を依頼をしますか？

Please provide any additional comments concerning this contractor’s performance, as desired.

業者に関して追加記載があればご記入下さい。

Evaluator’s Signature Date

記入者署名 日付

Thank you for your prompt response and assistance!

迅速なご回答とご協力ありがとうございました。

Please return this completed questionnaire to:

記入済みのこの用紙は下記の E メールかファックス番号へご送信下さい。

Mailing Address（メールアドレス）: yasuko.yonehara.1.jp@us.af.mil

Or FAX to（ファックス番号）: DSN 634-4795 011-81-611-734-4795（米国サイドよりの送信）/098-938-

1111、 内線 634－4795（日本国内基地外からの送信） mailto:yasuko.yonehara.1.jp@us.af.mil