Attachment_6,_Past_Performance_Questionaire.pdf

RFP NO. FA5270-17-Q-0011

Attachment 6, Past and Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE

QUESTIONNAIRE

FOR

SOLICITATION NO. FA5270-17-Q-0011

Wastewater Treatment Plant Operation and

Maintenance, Camp Courtney, Okinawa, Japan

(6 Pages to include this cover page)

PAST AND PRESENT PERFORMANCE QUESTIONAIRE

FOR

SOLICITATION NO. FA5270-17-Q-0011

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 the subject solicitation for Wastewater Treatment Plant Operation and Maintenance, Camp Courtney, Okinawa, Japan. In order for the government to evaluate the 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) or send it by e-mail to the address shown below no later than 3:00 pm, Thursday, 7 September 2017 (Japan Standard Time).

18th Contracting Squadron/LGCA

Attn: SSgt Darrell Thornburgh

Tel No.: Kadena auto attendant 098-938-1111, obtain secondary dial tone to call DSN 634-4107

Bldg. 99, Kadena AB, Okinawa

E-mail address: darrell.thornburgh@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 Darrell Thornburgh at 634-4107

(DSN) 098-938-1111, extension 634-4107 (Commercial) or send e-mail. Your time and effort in providing this vitally important information are greatly appreciated.

PRESENT/PAST PERFORMANCE SURVEY

履行履歴調査票

7 September 2017 (2017年 9月 7日)

FROM: 18 CONS/LGCA

Unit 5199, Bldg 99

Kadena AB

Okinawa, Japan

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.

嘉手納基地契約中隊では在日米軍の業務委託契約において応札業者の受注実績とその履行内容を落札の選定基準に加え

ております。つきましては貴殿の率直で簡潔なご意見を頂きたく添付の調査票をお送りした次第です。下記の説明に最

も近いと思われる評価を項目別にご回答願います。尚、米国連邦調達規則に則りご回答内容は一切公表いたしません。

RATING SCALE 評価の目安

S U

Satisfactory 満足 Unsatisfactory 不満

During the contract period, contractor performance met contract requirements.

For any problems encountered, contractor took effective corrective action.

契約期間中、当該業者の作業内容は要件を満たして

いる。問題が生じた場合、業者の有効な是正処置が

取られた。

During the contract period, contractor performance did not meet contract requirements. For any problems encountered, corrective action appeared only marginally effective, not effective, or not fully implemented. Customer involvement was required.

契約期間中、当該業者の作業内容は要件を満たしてい

ない。問題が生じた場合、業者の改善策は有効でない

か、十分に実行されていない。

2. CONTRACT INFORMATION (応札する業者が記入): The below listed contractor has identified they provided or are currently providing services for your company/agency. 貴殿との委託

業務は以下の通りです。

a. Reference Number 履歴番号(Circle one): No. 1 -履歴 1, No. 2 -履歴 2, No. 3 -履歴 3,

b. Contractor (Company/Agency) 契約者:

c. Contractor Address/Phone 契約者の住所・電話番号:

d. Prime contractor or subcontract 主契約者(元請) または 再委託契約者 (下請) (Circle one)

Prime contractor (元請) , Sub contract (下請) , Other (その他)

e. Title of Program/Contract 契約件名:

1) Contract Number 契約番号:

2) Period of Performance 契約期間:

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

業務の内容:

f. Contract Value/Amount (Per Year and/or Total) 契約金額(単年度合計と総契約金額合計):

3. RESPONDENT IDENTIFICATION (回答者、評価者が記入): (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.

ご回答の内容は公表いたしません。審査の手続き上、再度連絡を取らせていただく場合がありますので、ご理解、ご協

力お願いします。

a. Company’s Name 会社名:

b. Name and Title お名前と役職:

c. Phone Number 電話番号:

FAX ファックス:

E-mail Address 電子メールアドレス：

d. Address 住所:

e. Relationship to Project 契約案件における地位：

f. Length of Involvement in Project 契約案件の担当年数:

g. Date Questionnaire Completed 回答日:

4. QUESTIONNAIRE 調査票 (Circle Oneいずれかに｢｣を付けてください)

S U

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

提供されたサービスや商品の満足度はどうですか。

2. (Quality of Work) How effective did the contractor’s quality control and/or inspection procedures operate ?

品質管理と作業上の検査手順は妥当ですか。

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

契約者の作業は迅速で予定の納期に間に合ってましたか。

4. (Effectiveness of Management for Resolution of Issues, Problems, and Customer Complaints) How well did the contractor resolve Issues/Problems/Customer Complaints?

契約者は作業上の懸案、問題解決、苦情処理に長けていましたか。

5. (Compliance with the Applicable Rules, Regs, Laws, including Safety Standards) How efficient was the contractor in abiding by all Rules, Regs, Laws, and Safety Standards?

契約者の作業は関連する全ての法規や安全基準を守っていますか。

6. Overall Rating 総合評価

7. Was the contractor ever issued a cure or show cause notice under the referenced contract? If yes, explain outcome in “remarks.”

これまでに業務改善命令をだしたことがありますか。もしYESの場合は記入

欄に詳細を記入してください。

YES/NO

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

需要があれば、またこの業者に依頼しますか。

YES/NO

9 Is the contractor rated in CPARS (Contractor Performance Assessment

Report System)?

契約者の評価は CPARS (評価報告システム) を用いて行っておりますか。

YES/NO

a. Additional Comments/Remarks その他:

Upon completion of this survey, please send it by email to the address shown below no later than 7 September 2017 1500hrs (Japan Standard Time).

本アンケートの回答につきましてはご記入後、第18 契約中隊/契約課、もしくは電子メールにて下記あて先に2017年9月7

日 15:00 までにお送り下さいますようお願い致します。

Thank you for your prompt response and assistance!

Please return this completed questionnaire by email to:

Email Address: darrell.thornburgh@us.af.mil mailto:darrell.thornburgh@us.af.mil