Atch_(c)_PPQ_Form.doc

CHT at CFAS Japan

N4008419R6301

NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Firm Name:

CAGE Code:

Address:

DUNs Number:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: FORMCHECKBOX Prime Contractor FORMCHECKBOX Sub Contractor FORMCHECKBOX Joint Venture FORMCHECKBOX Other (Explain)

Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: FORMCHECKBOX Firm Fixed Price FORMCHECKBOX Cost Reimbursement FORMCHECKBOX Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work FORMCHECKBOX High FORMCHECKBOX Med FORMCHECKBOX Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information

Name:

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: NAVFAC/USACE REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO USACE WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON USACE SOLICITATIONS. CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO USACE. PLEASE CONTACT THE OFFEROR FOR USACE POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

業者の評価の為の評価基準と定義

RATING

DEFINITION

NOTE

(E) Exceptional 特に優れている Performance meets contractual requirements and exceeds many to the Government/Owner’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 was highly effective.

仕事が契約内容と合致しており、顧客の希望を上回る点が多い。修正可能な範囲の軽微な不具合を含め、契約通りの内容である。修正箇所は非常に満足な結果である。 An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

(VG) Very Good 優れている Performance meets contractual requirements and exceeds some to the Government’s/Owner’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.

仕事が契約内容と合致しており、顧客の希望を多少上回る。修正可能な範囲の若干の不具合を含め、契約通りの内容である。修正箇所は満足な結果である。 A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been no significant weaknesses identified.

(S) Satisfactory 満足 Performance meets minimum contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

仕事が最低限の契約内容と合致している。修正可能な若干の不具合を含め、契約通りの内容である。修正箇所は特に問題ない結果である。 A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract. There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

(M) Marginal 問題あり Performance does not meet some 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. The contractor's proposed actions appear only marginally effective or were not fully implemented.

仕事が契約内容と合致していない。修正可能な不具合があるかどうかも把握できておらず、深刻な状態である。業者から提案される方法は効果的とは言えない、またはその方法を実行されてもいない。 A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

(U) Unsatisfactory 不満足、問題あり 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 contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

仕事が契約内容にほとんど合致しておらず、不具合の復旧も迅速ではない。不具合の修正も全く効果的ではなく、深刻な状態である。 An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating.

(N) Not Applicable 該当なし No information or did not apply to your contract 評価材料がない、または該当せず。 Rating will be neither positive nor negative.

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

該当する評価基準に○を付けて下さい。

1. QUALITY（仕事の質）:

a) Quality of technical data/report preparation efforts 技術データやレポートの質はよかったか？

E VG S M U N

b) Ability to meet quality standards specified for technical performance 工事又は提供されているサービスの品質は仕様書で要求されている技術基準に適合していたか？

E VG S M U N

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance 詳細な客先の助言無しで問題を適時/適正に解決ができたか？

E VG S M U N

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance) 品質管理プログラムは適切かつ有効で実際にその品質管理プログラムに基づいて品質管理が実施されていたか？（仕事に悪影響が出ることなく）

E VG S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE（期日の遵守）:

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below) 契約全体及びその中に含まれる重要な中間又は完了期限/期日は遵守されていたか？（もし損害賠償金が発生、または期限が遵守されていなかった場合、詳しくお書き下さい）

E VG S M U N

b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract 契約を遂行するための業者の資材調達、活用能力は？

E VG S M U N

3. CUSTOMER SATISFACTION（顧客の満足度）:

a) To what extent were the end users satisfied with the project?

どの程度の顧客満足度か？

E VG S M U N

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication) 業者は御社の担当者に協力的であったか？（業者との意見の相違、論争を有効に解決する能力、及びそれらへの書類での対応、真摯なコミュニケーション能力）

E VG S M U N

c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

業者の協力姿勢、ビジネスライクな態度、顧客の希望を考慮したかどうかについての満足度は？

E VG S M U N

d) Overall customer satisfaction 総合的な顧客満足度は？

E VG S M U N

4. MANAGEMENT/ PERSONNEL/LABOR（人員の管理）

a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force?

現場と人員の管理、下請け業者、取引業者、メーカー等との連携能力は？

E VG S M U N

b) Ability to hire, apply, and retain a qualified workforce to this effort この工事又はサービスを提供できる適任者を雇うことができたか？

E VG S M U N

c) Government Property Control 軍の土地や所有物に対する管理は？

E VG S M U N

d) Knowledge/expertise demonstrated by contractor personnel 専門知識の活用はなされていたか？

E VG S M U N

e) Utilization of Small Business concerns (Not applicable to contracts performed in Japan) スモールビジネスの契約方法の活用度（日本での契約にはあてはまらない）

E VG S M U N

f) Ability to simultaneously manage multiple projects with multiple disciplines 同時にいくつかの現場を平行して管理できていたか？

E VG S M U N

g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes 要求の変更に対しての、優先順位の把握、計画、遂行の対応能力は？

E VG S M U N

h) Effectiveness of overall management (including ability to effectively lead, manage and control the program) 仕事全体の管理は効果的に実施されていたか？（計画、管理、指導が的確に実施されていたか？）

E VG S M U N

5. COST/FINANCIAL MANAGEMENT（資金の管理）

a) Ability to meet the terms and conditions within the contractually agreed price(s)?

資金面で同意された内容の範囲において契約内容は遵守されたか？

E VG S M U N

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client 御社に利益をもたらす資金削減の提案や、先進的でよりよい方法の提案はされたか？

E VG S M U N

c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns) この仕事が、公共または米軍政府とのコストタイプの契約の場合、月々の請求書が裏付けになる書類とともに定期的に提出されていたか、月々の進捗状況と資金のレポート提出が予算を上回る、または下回ることなく正しく提出されていたか？

E VG S M U N

d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section.

業者の資金管理方法は適当であったか？ そうでない場合、詳しくお書き下さい。 Yes No

e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

この仕事が、公共または米軍政府との契約の場合、部分的に、又は全体が業者の責任（又はその他の理由）で解約されたり、又は解約手続き中であるか？

もし、上記の解約等に関連する警告文書等がすでに業者に出されている、もしくは何らかの解約手続きが進行中であれば、詳しくお書き下さい。 Yes No

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

この仕事を行った業者が財政/金融等の問題を抱えているような兆候はあったか？ もしあれば、下記に詳しくお書き下さい。 Yes No

6. SAFETY/SECURITY（安全面）

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

どの程度業者は承認された安全計画に基づく安全の管理ができていたか？ （御社との取り決めや法律、現場の特徴、安全、不具合に対する対応等を含む）

E VG S M U N

b) Contractor complied with all security requirements for the project and personnel security requirements.

人員に対する安全は確実に守られていたか？

E VG S M U N

7. GENERAL（総合評価）

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

緊急時の仕事又は仕事量の急増に十分に対応できたか？（軍の担当各所への適切なタイミングでの連絡を含む）

E VG S M U N

b) Compliance with contractual terms/provisions (explain if specific issues) 総合的に契約内容は遵守されていたと思うか？（そうでない場合、詳しくお書き下さい）

E VG S M U N

c) Would you hire or work with this firm again? (If no, please explain below) この業者をまた使いたいと思うか？（そうでない場合、詳しくお書き下さい） Yes No

d) In summary, provide an overall rating for the work performed by this contractor.

この仕事を行った業者の総合判定。

E VG S M U N

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

上記の設問にお答えになり、下記に文章にて業者の長所、短所、欠点など、業者の選定に役立つコメントがあればお書き下さい。

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SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104-4 Form PPQ-0 (9/30/11)