D.6 ProposalForm_1240LQ21R0001.docx

INTERMOUNTAIN ZONE CONTRACT SERVICE AREA 5

PROPOSAL FORM

Solicitation No.: 1240LQ21R0001 | Divide Ranger District (DRD) Janitorial Services Multi-Year

Contractor Name

Date

Proposal Form Instructions. The proposal form will be used to make an evaluation and arrive at a determination as to whether the proposal will meet the requirements of the Government. Therefore, the offeror information contained herein must present sufficient information to reflect a thorough understanding of the requirements and a detailed description of the techniques, procedures, and program for achieving the objectives of the Statement of Work (Or Section C for applicable solicitations), demonstrate the experience and provide the past performance in accordance with Section E of the solicitation terms and any additional information necessary for a sufficient responsive determination. Please complete all areas and return in accordance with the instruction provided in the solicitation terms.

☐ a. Plan of Work. In narrative format, provide a summary, explaining how this project will be performed. The technical proposal should correspond with and support the project schedule and pricing offer. Include the average number of employees that are assigned to perform the work and explain how that average is determined. If Offeror intends to use subcontractors on the contract site, provide the completed Subcontractor Approval Form (FS 6300-11).

*Due to the current COVID-19 pandemic, offeror is to include in the narrative, a plan for complying and implementing COVID-19 local (city and county), state and federal laws/restrictions/guidance.

The Government should be able to clearly identify how the offeror will perform the work requirements. This should include the number of resources and explain how any specialized equipment is being utilized, which should match that listed under Item b below. DO NOT EXCEED THE SPACE PROVIDED.

Type Plan of Work Here.

Contractor Name

Date

☐ b. Equipment. Offeror is required to furnish, with their proposal, a listing of specific equipment available for use under each pay item, and shall include make and model, year, present value, listing of attachments if applicable and any other pertinent information to enable the government to accurately evaluate the proposal. List all the equipment you own or have available through a rental agreement to be used on this contract/agreement. Provide a detailed description of the Equipment including your maintenance and cleaning plans.

Additional Comments Pertaining to Equipment Here.

☐ c. Designation of Representatives. This tells the Government who the Government contacts are authorized to speak to from the offerors company.

Key Personnel Contract Manager Overwrite Here Phone Overwrite Here Email Overwrite Here

Site Lead/Supervisor Overwrite Here Phone Overwrite Here Email Overwrite Here

Reserved Overwrite Here Phone Overwrite Here Email Overwrite Here

Reserved Overwrite Here Phone Overwrite Here Email Overwrite Here

Designated Representative This delegation extends authority to take any action necessary with respect to the execution of work, including acknowledging receipt of Notice to Proceed, Suspend and Resume Work Orders, and Notices of Noncompliance. The items check below indicates additional authority authorized by this delegation:

☐ Sign progress payment estimates and invoices.

☐ Sign contract modifications.

☐ Sign final payment estimate and invoice and contract release.

☐ Execute contract termination settlement agreement.

☐ Full authority in all contractual matters.

Name

Title

☐ d. Experience Questionnaire. Document experience in accordance with solicitation requirements using the data below. DO NOT EXCEED THE SPACE PROVIDED.

1. Contractor Name, Address and Telephone No.

2. Business ☐ Company ☐ Co-partnership ☐ Corporation ☐ Individual ☐ Non-Profit Organization Date

(a) prime contractor ____ and/or (b) sub-contractor ____?

5. List below, a minimum of three (3) projects your firm has completed relating to this solicitation within the last three years:

(5a) CONTRACT

AMOUNT

(5b) TYPE OF PROJECT AND BRIEF DESCRIPTION (5c) NAME, ADDRESS, AND TELEPHONE NO. OF OWNER/PERSON TO CONTACT FOR PROJECT INFORMATION

6. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

(6a) CONTRACT

NUMBER

(6b) DOLLAR AMT.

OF AWARD

(Date) (6e) PERCENT

COMPLETED

(6f) ANTICIPATED COMPLETE DATE

7a. Have you ever failed to complete any work awarded to you? ☐ Yes ☐ No 7b. Has work ever been completed by performance bond? ☐ Yes ☐ No 7c. If “Yes” to either item 8a or 8b specify location(s) and reason(s) why:

7d. Did you look at the project site(s) on-the-ground? ☐ Yes ☐ No

8. Organization and work that will be available for this project.

a. (1) Minimum No. of Employees: _____ and (2) Maximum No. of Employees: ______

b. Are employees regularly on your payroll: ☐ Yes ☐ No

9. List below the experience of the principal individuals of your business:

(9a) INDIVIDUAL’S NAME

EXPERIENCE

(9d) MAGNITUDE AND TYPE OF WORK

10. Contractor Inspection. Describe Contractor Self Inspection Procedures which you will use to insure quality for this contract.

I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any person’s name as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project. ___________ (Initial)

Contractor Name

Date

☐ e. Bio-Based / Sustainable Procurement Program.

As required by the Farm Security and Rural Investment Act of 2002 and the Energy Policy Act of 2005 (7 U.S.C. 8102(c)(3)), this solicitation/contract requires the use of Biobased products to the extent that such products are reasonably available, meet agency or relevant industry performance standards are reasonably priced.

Biobased products, within categories of products listed by the United States Department of Agriculture in 7 CFR part 3201, subpart B) to be used or delivered in the performance of the contract. Any other than biobased products that are not purchased by the offeror as a direct result of this contract, will comply with the applicable specifications or other contractual requirements. Information about this requirement and these products are available at http://sftool.gov/green-products/1/construction-materials.

Sustainable Products Statement of Intent (Check Only One)

☐ There are no expectations or intent of utilizing biobased products for this requirement at this time. The contractor certifies that it understands that the government requires the use of Biobased products to the extent reasonably available. Should any product be required throughout the duration of this contract, the Contractor will provide the government an updated form listing the products used that are in compliance with the Farm Security and Rural Investment Act of 2002 and the Energy Policy Act of 2005. The contractor also certifies that failure to comply with the requirements should product be required may result in penalties.

☐ The Contractor proposes utilizing non-designated products. The following justification is provided for use of those items identified as non-designated products.

Type Here

☐ The following biobased products will be utilized for this requirement. The listing below contains all recycled-content products, biobased products, environmentally preferable products and services, and non-ozone depleting substances to be acquired, used, and installed in the performance of this contract.

By submitting this information with the proposal, I certify that the information provided above is true to the best of my knowledge.

Representative’s Name

Representative’s Signature

Contractor Name

Date

☐ f. 52.204-24, Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (OCT 2020) Please complete items d(1) and (2).

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Items. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision— Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition. (1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(c) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM) (https://www.sam.gov) for entities excluded from receiving federal awards for "covered telecommunications equipment or services".

(d) Representation. The Offeror represents that—

(1) It ☐will, ☐will not provide covered telecommunications equipment or services to the Government in the performance of any contract, subcontract or other contractual instrument resulting from this solicitation. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds "will" in paragraph (d)(1) of this section; and

(2) After conducting a reasonable inquiry, for purposes of this representation, the Offeror represents that— It ☐ does, ☐ does not use covered telecommunications equipment or services, or use any equipment, system, or service that uses covered telecommunications equipment or services. The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds "does" in paragraph (d)(2) of this section.

(e) Disclosures. (1) Disclosure for the representation in paragraph (d)(1) of this provision. If the Offeror has responded "will" in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(2) Disclosure for the representation in paragraph (d)(2) of this provision. If the Offeror has responded "does" in the representation in paragraph (d)(2) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the OEM or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the PSC of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

☐ g. Certification. The items contained herein have been completed and are submitted in response to solicitation 1240LQ21R0001. By signing this certification, I certify that the information provided within this Technical Proposal Form for solicitation 1240LQ21R0001 is complete and true to the best of my knowledge.

Company Name:

Representative’s Name:

Representative’s Phone:

Representative’s Email:

Representative’s Signature:

Today’s Date: