1240LR22Q0072-2.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

40LR

OGDEN UT 84401-2310

324 25TH ST

USDA-FS CSA INTERMOUNTAIN 6

CODE 16. ADMINISTERED BYCODE

X

X

X

561720

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR40LR

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

05/16/2022

208-373-4134JASON KING

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIME

07/01/2022 1400 MD

b. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

1240LR22Q0072

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER

1056261OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

COUNCIL ID 83612-9999

ATT JACKLYNN ZAMORA

500 E WHITELY

PAYETTE NATIONAL FOREST

USDA FOREST SERIVCE

15. DELIVER TO

BOISE ID 83709

ATT JASON KING

1249 S VINNELL WAY STE 200

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$19.50

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

USDA-FS CSA INTERMOUNTAIN 6

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Period of Performance: 07/01/2022 to 06/30/2027

0001 COUNCIL RANGER DISTRICT JANITORIAL CONTRACT

Product/Service Code: S201 Product/Service Description: HOUSEKEEPING-

CUSTODIAL JANITORIAL

Requisition No: 1056261

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

JASON D. KING

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

UEI

PNF COUNCIL RD JANITORIAL RFQ 1 of 48

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

PNF COUNCIL RD JANITORIAL RFQ 1240LR22Q0072

SECTION B – CONTINUATION OF SF-1449

**QUOTES ARE DUE BY: 07/01/2022 by 1400 MT**

SCHEDULE OF ITEMS/PRICE SCHEDULE

LINE

ITEM DESCRIPTION QUANTITY UNIT

UNIT

PRICE AMOUNT

Base Year – Janitorial Services July 15, 2022 – July 14, 2023

12 Month $ $

002 Option Year one – Janitorial Services July 15, 2023 – July 14, 2024

12 Month $ $

003 Option Year two – Janitorial Services July 15, 2024 – July 14, 2025

12 Month $ $

Option Year three – Janitorial Services July 15, 2025 – July 14, 2026

12 Month $ $

Option Year four – Janitorial Services July 15, 2026 – July 14, 2027

12 Month $ _____ $___________

Grand Total $

Description:

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

This solicitation is issued as an Request for Quotation (RFQ). The solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2022-04.

This procurement is set aside for small business (total small business). The NAICS code is 561720 and the Small Business Size Standard is $19.5.

The government intends to award a purchase order as a result of this RFQ solicitation that will include the terms and conditions set forth herein.

Submission shall be received not later than the response date defined above. Late submissions shall be treated in accordance with the solicitation provision at FAR 52.212-1(f).

Only e-mailed quotes will be accepted.

All interested companies shall provide a quotation for the following:

SECTION C – DESCRIPTION / SPECIFICATIONS / STATEMENT OF WORK

I. GENERAL REQUIREMENTS

A. DESCRIPTION OF WORK

The purpose of this contract is to secure janitorial services for the Council Ranger District Office in Council, Idaho. The Contractor is responsible for providing all labor, supervision, equipment and supplies not listed as Government-furnished items below necessary to perform services under the janitorial contract. All designated areas must present a clean, healthful, and well-kept appearance. The work will consist of cleaning floors, vacuuming carpets, cleaning furnishings/furniture. Total square footage of areas requiring cleaning is 10,000 square feet. There are five restrooms to clean, four in the main office and one in the warehouse. The contractor shall comply with required bio-based and bio-preferred materials requirements of the solicitation.

B. DELIVERY

Work required under this contract is at the Forest Service owned buildings recognized as Council Ranger District Office, Payette National Forest, in the town of Council, at 2092 Highway 95, Council, Idaho 83612.

II-3 - Period Of Performance

a. Base Year – The period of performance for this contract is July 15, 2022-July 14, 2023.

b. Option Year One – If the option for year one is exercised, the period of performance is from July 15, 2023-July 14, 2024.

c. Option Year Two – If the option for year two is exercised, the period of performance is from July 15, 2024-July 14, 2025.

d. Option Year Three – If the option for year three is exercised, the period of performance is from July 15, 2025-July 14, 2026.

e. Option Year Four – If the option for year four is exercised, the period of performance is from July 15, 2026-July 14, 2027.

III-4 - Government-Furnished Property

The Government will provide the following items of Government property to the Contractor for use in the performance of this contract. This property shall be used and maintained by the Contractor in accordance with the provisions of the “Government Property” FAR clause contained elsewhere in the contract.

The Government will deliver to the Contractor the following listed materials in accordance with the Government-Furnished Property Clause FAR 52.245-4:

1. The Forest Service shall provide the following supplies:

- Toilet Paper - Paper Towels - Keys to the Building

C. REQUIRED DELIVERY DATE:

Responses to the solicitation are due by 7/01/2022 at 2:00pm MDT. The performance of services are tentatively scheduled to begin on 7/15/2022.

SECTION II – DESCRIPTION/SPECIFICATIONS/ STATEMENT OF WORK

II- 1 - Scope of Work

The purpose of this contract is to secure janitorial services for the Council Ranger District Office in Council, Idaho. The Contractor is responsible for providing all labor, supervision, equipment and supplies not listed as Government-furnished items below necessary to perform services under the janitorial contract. All designated areas must present a clean, healthful, and well-kept appearance. The work will consist of cleaning floors, vacuuming carpets, cleaning furnishings/ furniture. Total square footage of areas requiring cleaning is 10,000 square feet. There are five restrooms to clean, four in the main office and one in the warehouse. The contractor shall comply with required bio-based and bio-preferred materials requirements of the solicitation.

II-2 - Project Location

Work required under this contract is at the Forest Service owned buildings recognized as Council Ranger District Office, Payette National Forest, in the town of Council, at 2092 Highway 95, Council, Idaho 83612, and Council Ranger Station Work Center, in the town of Council, at 500 E Whiteley Ave, Council, ID 83612

If the Government fails to make timely delivery of such Government-furnished property suitable for its intended use and upon timely notification from the Contractor, the Contracting Officer shall make an equitable adjustment of contract delivery performance dates or contract price, or both.

A key or a listing of numbers that activate the combination door lock(s) for access to the office building will be issued to the Contractor. In case of loss of said key, the Contractor will be billed for the changing of all locks to the building. The provided listing of numbers that activate the combination door lock(s) shall remain confidential by the Contractor. The listing of numbers that activate the combination door lock(s) will be changed periodically by the Forest Service and the Contractor will be apprised of the combination change. If the Contractor is not apprised of the combination change, it will be the Contractors responsibility to contact the COR (COR contact information will be provided at the time of award.

All Government furnished property will be located at the Office Building for use by the Contractor on-site. Upon completion of the contract, equipment or supplies identified above shall remain the property of the Government. The Contractor shall inform the designated Forest Service Contracting Officer Representative (COR) when supplied equipment or supplies identified need replacement. Written notification, communication by cell or landline phone, or communication by electronic messaging (text or email) shall be supplied to the designated Forest Service COR sufficiently in advance (1 week) to allow the COR to inspect, repair or acquire new equipment or supplies.

The Contractor shall be liable for the loss, damage or destruction of Government furnished property except for ordinary wear and tear, until completion of contracted work.

II-5 - Contractor-Furnished Property

The Contractor shall furnish:

a. All necessary supplies and materials including but not limited to trash bags and hand soap.

b. All Safety Data Sheet (SDS) for all chemicals used in the cleaning of these buildings.

SDSs shall be given to the COR prior to use.

c. All necessary cleaning equipment, which must be properly guarded and meet all OSHA standards. Such equipment shall be of the size and type customarily used by the janitorial profession. The vacuum cleaner shall be commercial type and capable of handling sand and gravel brought in by boots. Equipment designed for home use will not meet this specification.

d. Personal protective equipment including but not limited to gloves, hearing protection and eye protection.

II-6 - Bio-Preferred Products

The Contractor must comply with the Farm Security and Rural Investment Act of 2002 (FSRIA), 7 U.S.C. 8102; the Food, Conservation and Energy Act of 2008 (FCEA), 7 U.S.C. 8102; the Federal Acquisition Regulation; Executive Order 13514, “Federal Leadership in Environmental, Energy and Economic Performance,’ dated October 5, 2009; EO 13423, “Strengthening Federal Environmental, Energy and Transportation Management,” dated January 24, 2007; and Presidential Memorandum, “Driving Innovation and Creating Jobs in Rural America through Biobased and Sustainable Product Procurement,” dated February, 2012 to provide biobased products.

Finding Bio-Preferred products is simple, using the program’s online catalog. To view the catalog, go to www.biopreferred.gov.

II-7 - Technical Specifications

a. Basic Cleaning Services. The Contractor shall accomplish all cleaning tasks to meet the requirements of this Statement of Work (SOW).

1. Maintain Floors. All floors, except carpeted areas, shall be swept, dust mopped, damp mopped, wet mopped, dry buffed, and spray buffed, as needed, to ensure they have a uniform, glossy appearance and are free of dirt, debris, dust, scuff marks, heel marks, other stains and discoloration, and other foreign matter. Baseboards, corners and wall/floor edges shall also be clean. All floor maintenance solutions shall be removed from baseboards, furniture, trash receptacles, etc. Chairs, trash receptacles, and other moveable items shall be moved to maintain floors underneath these items.

All moved items shall be returned to their original and proper position.

2. Remove Trash. All trash containers shall be emptied and returned to their initial location. Boxes, cans, and papers placed near a trash receptacle and marked “TRASH” shall be removed. Any obviously soiled or torn plastic trash receptacle liners shall be replaced. The trash shall be deposited in the nearest outside trash collection container. Trash receptacles shall be left clean, free of foreign matter and free of odors.

3. Remove Recycling. All recycling containers shall be emptied and returned to their initial location. Any noticeable soiled or torn recycling receptacle liners shall also be replaced. Recycling materials shall be removed from the property and properly recycled. Receptacles shall be left clean, free of foreign matter and free of odors.

Cardboard boxes shall be gathered and properly recycled.

4. Clean Interior Glass/Mirrors. Clean all interior glass, including glass in doors, partitions, walls, display cases, directory boards, etc. After glass cleaning, there shall be no traces of film, dirt, smudges, water or other foreign matter.

5. Clean Drinking Fountains. Clean and disinfect all porcelain and polished metal surfaces, including orifices and drain, as well as exterior surfaces of fountain.

Drinking fountains shall be free of streaks, stains, spots, smudges, scale and other obvious soil.

PNF COUNCIL RD JANITORIAL RFQ 1240LR22Q0072

http://www.biopreferred.gov/

6. Vacuum Carpets. Vacuum carpted areas. After vacuuming, the carpeted area shall be free of all visible dirt, debris, litter and other foreign matter. Any spots shall be removed by carpet manufacturer’s approved methods as soon as noticed. All tears, burns, and raveling shall be brought to the attention of the government representative.

Area and throw rugs are included to receive this service.

I. Clean Carpets. Spot clean or shampoo dirty carpets over an area of 2 square feet or less. Spots must be removed immediately.

7. Vacuum and Clean Floor Mats. Vacuum and clean interior and exterior floor mats.

After vacuuming or cleaning, mats shall be free or all visible lint, litter, soil and other foreign matter. Soil and moisture underneath mats shall be removed, and mats returned to their normal location.

8. General Spot Cleaning. Perform spot cleaning on a continual basis. Spot cleaning includes but is not limited to removing, or cleaning smudges, fingerprints, marks, streaks, spills, etc., from washable surfaces of all walls, partitions, vents, grillwork, doors, door guards, doorhandles, push bars, kick plates, light switches, temperature controls, and fixtures. After spot cleaning, the surfaces shall have a clean uniform appearance, free of streaks, spots, and other evidence of soils.

9. General Dusting. All horizontal surfaces must be dusted or cleaned to eliminate dust collection. All countertops and tabletops will be free of all visible dust, debris, litter and other foreign matter.

10. Lights. Clean the light fixtures in the bathrooms and any light fixture covers that attract bugs and dust such that no bugs or dust is noticeable.

Contractor shall be responsible for making sure that all building lights are turned off, windows are closed and locked, doors are locked and the Forest buildings and offices are left in a safe and secure condition when janitorial services are completed and the Contractor is ready to leave.

b) Basic Restroom and Utility Room Cleaning Services. The Contractor shall accomplish all cleaning tasks to meet the requirements of this SOW.

Restroom services are to be performed three (3) times per week all year long at both the main office restrooms and the two Work Center restroom sites (located in the tree cooler and also in the office, beside the work out room).

1) Clean and Disinfect. Completely clean and disinfect all surfaces of sinks, toilet bowls, washbasins, base of toilet, urinals, lavatories, dispensers, plumbing fixtures, partitions, doors, walls and other such surfaces, using a germicidal detergent. After cleaning, receptacles will be free of deposits, dirt streaks, and odors. Disinfect all surfaces of partitions, stalls, stall doors, entry doors, (including handles, kick plates, ventilation grates, metal guards, etc.), and wall areas adjacent to wall mounted lavatories, urinals and toilets. All floor and sink drain traps should be free of debris, residue and odors. Clean and disinfect all porcelain and polished metal surfaces, including the orifices and drains.

2) Descale Toilet Bowls and Urinals. Descaling shall be performed monthly as a minimum and as often as needed to keep areas free of build-up i.e. soap film, hard water deposits, and other build-up. After descaling surfaces shall be free from streaks, stains, scale, scum, urine deposits and rust stains.

3) Sweep and Mop Floor. After sweeping and mopping, the entire floor surface, including grout, shall be free from litter, dirt, dust and debris. Grout on wall and floor tiles shall be free of dirt scum, mildew, residue, etc. Floors shall have a uniform appearance without streaks, swirl marks, detergent residue or any evidence of soil, stain, film or standing water. Moveable items shall be tilted or moved to sweep and damp mop underneath. Floors shall be stripped, scrubbed, waxed etc., as necessary to maintain sanitary conditions and a clean uniform appearance.

4) Stock Restroom Supplies. Contractor shall ensure restrooms are stocked sufficiently so that supplies including soap for the soap dispensers, toilet tissues and paper towels do not run out. Supplies shall be stored in designated areas. No overstocking shall be allowed. If supplies run out prior to the next service date, Contractor shall refill within one (1) day of notification.

5) Additional Cleaning Services. Vacuuming carpets, sweeping and mopping floors and stairs. Cleaning glass or front and back entry doors and wiping off fingerprints and smudges. Dusting open areas of desks and bookcases where not covered with items (Do not move items/paper, etc.). Emptying wastebaskets, replacing bag liners.

Placing trash in refuse bins located in parking lot.

c) Periodic Cleaning Services

1) Strip, Scrub, Seal and Wax Floors. Strip, scrub, seal and wax floors as necessary to maintain a uniform glossy appearance. A non-skid wax is required. A uniform glossy appearance is free of scuffmarks, heel marks, wax build-up, and other stains and discoloration.

2) Clean Interior Windows. Clean glass surfaces of large picture window. After surfaces have been cleaned all traces of film dirt smudges, water and other foreign matter shall be removed from frames, casings, sills and glass.

3) Clean Exterior Windows. After window has been cleaned, exterior frames, casings, sills and glass shall be free of all traces of film, dirt, smudges, water and other foreign matter.

4) Clean/Shampoo Carpets. All carpets shall be cleaned in accordance with standard commercial practices. A heavy-duty spot remover may be required in heavily soiled areas. After shampooing, the carpet area will be uniform in appearance and free of stains and discoloration. All cleaning solutions shall be removed from baseboards, furniture, trash receptacles, chairs and other similar items. Chairs, trash receptacles and other items shall be moved to clean carpets underneath and returned to their original location.

5) Monthly Cleaning Services. Cleaning all windowsills, heat registers and ceiling vents.

Cleaning windows and windowsills in foyer. Removing stains from carpet. Cleaning smudges from walls, doors and doorways. Dusting and polishing all wood cabinets and wood counter in front office.

6) Once Every Three Months. Dusting and cleaning all ceiling light fixtures, specifically light fixtures with covers in upstairs hallway and in women’s and men’s bathrooms and light fixtures in the basement hallway. Covers shall be removed and cleaned.

Dust cleaning all hanging fixtures and pictures in the front office and hallway.

7) In the entrance, during inclement weather, remove water, mud or snow from entrance doors and floors to keep clean and dry. Entrance is to be clean and dry before Contractor leaves at the end of work.

COUNCIL, IDAHO FOREST SERVICE RD

2092 HIGHWAY 95, COUNCIL, ID 83612

Certification of Vaccination The purpose of this form is to take steps to prevent the spread of COVID-19, to protect the health and safety of all Federal employees, onsite contractors, visitors to Federal buildings or Federally controlled indoor workspaces, and other individuals interacting with the Federal workforce. If you fail to submit this signed attestation or any required negative COVID-19 test, you may be denied entry to a Federal facility.

My Vaccination Status By checking the box below, I declare that the following statement is true:

I am fully vaccinated.1

1 The Centers for Disease Control and Prevention considers an individual fully vaccinated if they are:

• 2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or

• 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine

If you don’t meet these requirements, regardless of your age, you are not fully vaccinated.

I am not yet fully vaccinated.2

2 Either I have received my first dose of Moderna or Pfizer, and my second appointment is scheduled, or I received my final dose less than two weeks ago.

I have not been vaccinated.3

3 If you are not vaccinated due to medical or religious reasons, please check either “I have not been vaccinated” or “I decline to respond.”

I decline to respond.

I understand that if I decline to respond or am not fully vaccinated, I must comply with the following safety protocols while in a Federal facility:

• Wear a mask regardless of the level of community transmission;

• Physically distance; and

• Provide proof of having received a negative COVID-19 test from within the previous 3 days if I am a visitor or I am an onsite contractor who is not enrolled in an agency’s testing program.

I sign this document under penalty of perjury that the above is true and correct, and that I am the person named below. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (18 U.S.C. 1001). Checking “I decline to respond” does not constitute a false statement. I understand that if I am a Federal employee or contractor making a false statement on this form could result in additional administrative action, including an adverse personnel action up to and including removal from my position or removal from a contract.

Your printed name here:

Your signature here:

Date:

Directions and notice to Federal employees Consistent with guidance from the Centers for Disease Control and Prevention (CDC) and the Safer Federal Workforce Task Force, has established specific safety protocols for fully vaccinated people and not fully vaccinated people, respectively. You may be asked to submit this completed form to your employing agency.

In areas of low or moderate transmission, as defined by CDC, fully vaccinated people generally can safely participate in most activities, indoor or outdoor, without needing to wear a mask or maintain physical distance, and do not need to undertake regular testing—please note that consistent with CDC guidance, agencies may have different protocols for fully vaccinated people in specific work settings, such as healthcare settings. In areas of high or substantial transmission, everyone, including fully vaccinated people, must wear a mask consistent with Federal requirements.

Employees who disclose that they are fully vaccinated will comply with agency guidance for fully vaccinated individuals. Employees who are unvaccinated, are not fully vaccinated, or who choose not to provide vaccine information are required to comply with CDC and agency guidance for not fully vaccinated individuals, including wearing masks regardless of the transmission rate in a given area, physical distancing, regular testing, and adhering to applicable travel restrictions.

These requirements are to prevent the spread of COVID-19 to protect the health and safety of our workforce. Making a false statement on this form could result in an adverse personnel action against you, up to and including removal from your position.

Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement informs you of why you are being asked to provide this information.

Authority: We are authorized to collect the information requested on this form pursuant to Executive Order 13991, Protecting the Federal Workforce and Requiring Mask-Wearing (Jan. 20, 2021), Executive Order 12196, Occupational Safety and Health Program for Federal Employees (Feb. 26, 1980), and 5 U.S.C. chapters 11 and 79.

the US Department of Agriculture

Purpose: This information is being collected and maintained to promote the safety of Federal buildings and the Federal workforce consistent with the above-referenced authorities, the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force, and guidance from the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration.

Routine Uses: While the information requested on this form is intended to be used primarily for internal purposes, in certain circumstances it may be necessary to disclose this information externally, for example to disclose information to: a Federal, State, or local agency to the extent necessary to comply with laws governing reporting of communicable disease or other laws concerning health and safety in the work environment; to adjudicative bodies (e.g., the Merit System Protection Board), arbitrators, and hearing examiners to the extent necessary to carry out their authorized duties regarding Federal employment; to contractors, grantees, or volunteers as necessary to perform their duties for the Federal government; to other agencies, courts, and persons as necessary and relevant in the course of litigation, and as necessary and in accordance with requirements for law enforcement; or to a person authorized to act on your behalf. A complete list of the routine uses can be found in the system of records notice associated with this collection of information, OPM/GOVT-10, Employee Medical File System of Records, 75 Fed. Reg. 35099 (June 21, 2010), amended 80 Fed. Reg. 74815 (Nov. 30, 2015).

Consequence of Failure to Provide Information: Providing this information is voluntary.

However, if you fail to provide this information, you will be treated as not fully vaccinated for purposes of implementing safety measures, including with respect to mask wearing, physical distancing, testing, travel, and quarantine.

Please contact with questions. Please return this form to .

Directions and notice to Federal contractors In areas of low or moderate transmission, as defined by CDC, fully vaccinated people generally can safely participate in most activities, indoor or outdoor, without needing to wear a mask or maintain physical distance, and do not need to undertake regular testing—please note that consistent with CDC guidance, agencies may have different protocols for fully vaccinated people in specific work settings, such as healthcare settings. In areas of high or substantial transmission, everyone, including fully vaccinated people, must wear a mask consistent with Federal requirements.

You may be asked to show this form and/or information from a health screening upon entry to a Federal building or Federally controlled indoor worksites, and/or to a Federal employee who is supervising or managing your work on Federal premises. Please maintain this form during your time on Federal premises.

Please contact with questions.

your supervisor your supervisor your Contracting Officer Representative

Directions and notice to visitors In areas of low or moderate transmission, as defined by CDC, fully vaccinated people generally can safely participate in most activities, indoor or outdoor, without needing to wear a mask or maintain physical distance, and do not need to undertake regular testing—please note that consistent with CDC guidance, agencies may have different protocols for fully vaccinated people in specific work settings, such as healthcare settings. In areas of high or substantial transmission, everyone, including fully vaccinated people, must wear a mask consistent with Federal requirements.

You may be asked to show this form and/or information from a health screening upon entry to a Federal building or Federally controlled indoor worksites. Please maintain this form during your visit. You may be asked to show this form as part of your in-person participation in a Federally hosted meeting, event, or conference. If you are entering to obtain a public service or benefit and are not fully vaccinated, you must comply with all relevant CDC guidance, including mask wearing and physical distancing requirements, however this form and the requirement to show a negative COVID-19 test do not apply to you.

Public burden information Public burden reporting for this collection of information is estimated to average 2 minutes per response, including time for reviewing instructions and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to PRA@opm.gov. The OMB clearance number 3206-0277, is currently valid.

may not collect this information, and you are not required to respond, unless this number is displayed.

The US Department of Agriculture

STATE OF IDAHO CERTIFICATE OF VERIFICATION

OF WORKERS' COMPENSATION INSURANCE

Read thoroughly before completing form.

WHAT ARE THE WORKERS’ COMPENSATION REQUIREMENTS?

The Idaho Workers' Compensation Law requires that employers who hire one or more, either full or part-time employees, to perform work in the State of Idaho, carry workers' compensation insurance unless specifically exempted. Failure to comply could result in monetary penalties as well as an injunction to prohibit the employer from operating the business. Failure to carry workers’ compensation insurance for employees is a misdemeanor under Idaho Law.

WHO MUST COMPLETE THIS FORM?

Any person, partnership, limited liability company, corporation or firm who is bidding on a contract for the United States Department of Agriculture/Forest Service (USFS) for work that is within the State of Idaho and who has been notified by the USFS that he/she/it has been selected for a USFS contract.

WHEN MUST THE FORM BE COMPLETED?

The form must be completed and forwarded to one of the Industrial Commission offices when you are notified by the USFS that you have been selected for a USFS contract. The approval of the Industrial Commission is required prior to the final award.

ADDITIONAL COMMENTS:

Failure to complete any part of the form that is applicable to your operations could result in a delay in processing.

If any of the work is to be performed by sub-contractors, each sub-contractor must obtain and complete a Certificate of Verification of Workers' Compensation insurance.

If your business is a partnership, limited liability company or corporation, each partner/member/corporate officer must sign the form where designated.

You must submit a separate verification form for each contract awarded.

ONCE THE BIDDER HAS COMPLETED AND SIGNED THE FORM, FAX, MAIL, OR DELIVER IT TO THE APPROPRIATE INDUSTRIAL COMMISSION OFFICE. IF YOU HAVE ANY QUESTIONS, CONTACT A COMPLIANCE REPRESENTATIVE

AT ANY OF THE FOLLOWING OFFICES:

North Idaho 1221 Ironwood Street, Suite 100

COEUR D'ALENE ID 83814

(208) 769-1565 or FAX (208) 769-1465

Southwest Idaho 317 Main Street

P 0 BOX 83720, BOISE ID 83720-0041

(208) 334-6032 or 1-800-950-2110 or FAX (208) 334-5145

Southeast Idaho 1070 Hiline, Suite 300

POCATELLO ID 83201

(208) 236-6366 or FAX (208) 236-6040 https://iic.idaho.gov/wp-content/uploads/sites/16/2018/01/ic_wc_verification.pdf

FOR I.C. USE ONLY

IC# __________________

Received _____________

STATE OF IDAHO

CERTIFICATE OF VERIFICATION

OF WORKERS' COMPENSATION INSURANCE

Date: ___________________

1. Contractor's Name ____________________________________________________________________

2. Business Name ________________________________________________________________________

3. Contractor's Federal Identification Number ___________________________________________

4. Contractor's Business Address ________________________________________________________ Street, Box # City, State Zip

5. Contractor's Business Telephone Number _______________________________________________

6. Contractor's Home Address ____________________________________________________________ Street, Box # City, State Zip

7. Name of Supervisor in charge of project ______________________________________________

8. Supervisor's Business Address ________________________________________________________ Street, Box # City, State Zip

9. Supervisor's Business Telephone ______________________________________________________

10. Supervisor's Home Address ____________________________________________________________ Street, Box # City, State Zip

11. Classification of Business

(a) G Corporation (List names, addresses & telephone numbers of corporate officers and directors, and percent of ownership.)

(b) G Partnership/Limited Liability Company (List partner/member names, addresses, telephone numbers, and percent of ownership.)

(c) G Sole Proprietorship

(d) G Other - Please explain

Description of Project

12. Contract # ______________________________________ Estimated Start Date______________

13. Location of Work_____________________________________________________________________

14. Description of Work _________________________________________________________________

15. Forest Service District Office Overseeing Contract __________________________________

16. DO YOU HAVE WORKERS' COMPENSATION INSURANCE? G Yes G No

PNF COUNCIL RD JANITORIAL RFQ

1240LR22Q0072

17. Workers' Compensation Insurance Company

Name of Carrier____________________________________________________________________

Policy # ____________________________________ Effective Date ______________________

Name of Agent ________________________________ Tel. # ______________________________

Address ____________________________________________________________________________ Street, Box City, State Zip

Extraterritorial Coverage #_________________________________________________________

State ______________ Date Approved _______________ Expiration Date _____________

18. If Contractor is a sole proprietorship/partnership/limited liability company , will workers other than the proprietor or partners/members be performing any of the work to be done under this contract?

G Yes G No

a. If yes , state the approximate number of such workers and, if known, their names, permanent addresses, telephone numbers, and date of hire. (Attach additional pages, if needed.)

19. If Contractor is a corporation , will workers who are not officers and 10% shareholders and directors of the corporation be performing any of the work to be done under this contract?

G Yes G No

If yes , state the approximate number of such workers and, if known, their names, permanent addresses, telephone numbers, and date of hire. (Attach additional pages, if needed.)

20. Do you intend to use any sub-contractors to assist you in the performance of this contract? Note: All sub-contractors used on this contract must also submit a Certificate of Verification of Workers' Compensation Insurance for approval prior to commencing work on this contract.

G Yes G No

If yes , state their names, business names, permanent addresses and telephone numbers.

21. Based upon my knowledge of the work to be performed under the contract specified on page 1 and upon my knowledge of work practices, methods and technologies to be applied during this contract, I estimate that __________ workers are necessary to do the work in the time prescribed, assuming average production rates and conditions.

22. I certify that the above information is true and correct to the best of my knowledge and belief. Further, I agree to inform the Industrial Commission Compliance Officer if there is any change in the above information during the time this contract is in effect.

Type or Print Contractor's Name

By: ___________________________________________ Signature

Date: _________________________________________

23. If the business is a partnership, limited liability company or corporation, this document requires the signature of all of the partners/members/corporate officers.

(Attach additional pages if necessary.)

___________________________________________________________ Date _________________ Partner/Member/Corp. Off. Title % of Ownership

___________________________________________________________ Date _________________ Partner/Member/Corp. Off. Title % of Ownership

___________________________________________________________ Date _________________ Partner/Member/Corp. Off. Title % of Ownership

___________________________________________________________ Date _________________ Partner/Member/Corp. Off. Title % of Ownership

CONTRACTOR - DO NOT WRITE BELOW THIS LINE

Based solely upon the assertions above set forth, and without warranty of continued compliance, the Idaho Industrial Commission finds that Contractor:

G Currently carries workers' compensation insurance as required by state law.

G Has a current extraterritorial on file from the State of ______________ which covers only _________________ based employees while working temporarily in the State of Idaho. Extraterritorial coverage expires __________________.

G Is not required to provide workers' compensation insurance because:

G Is a partnership/limited liability company/sole proprietor which employs no workers other than the partners/members/sole proprietor and will not employ any other workers under this contract.

G Is a corporation which employs no workers other than individuals who are corporate officers, directors and 10% shareholders and will not employ any other workers under this contract.

G Other (Specify) :

(By making the above finding, the Commission does not warrant continued compliance.)

G Has not obtained the required workers' compensation insurance.

Industrial Commission Compliance Officer

Date___________________________________

Contract/Solicitation # ________________

"REGISTER OF WAGE DETERMINATIONS UNDER | U.S. DEPARTMENT OF LABOR

THE SERVICE CONTRACT ACT | EMPLOYMENT STANDARDS ADMINISTRATION

By direction of the Secretary of Labor | WAGE AND HOUR DIVISION

| WASHINGTON D.C. 20210

| Wage Determination No.: 2015-5513

Daniel W. Simms Division of | Revision No.: 17 Director Wage Determinations| Date Of Last Revision: 03/15/2022

Note: Contracts subject to the Service Contract Act are generally required to pay at least the applicable minimum wage rate required under Executive Order 14026 or Executive Order 13658.

|If the contract is entered into on or |With certain exceptions Executive Order | |after January 30 2022 or the |14026 applies to the contract. | |contract is renewed or extended (e.g. |The contractor must pay all covered workers | |an option is exercised) on or after |at least $15.00 per hour (or the applicable | |January 30 2022: |wage rate listed on this wage determination| | |if it is higher) for all hours spent | | |performing on the contract in 2022. | |If the contract was awarded on or |With certain exceptions Executive Order | |between January 1 2015 and January 29|13658 applies to the contract. | |2022 and the contract is not renewed |The contractor must pay all covered workers | |or extended on or after January 30 |at least $11.25 per hour (or the applicable | |2022: |wage rate listed on this wage determination| | |if it is higher) for all hours spent | | |performing on the contract in 2022. |

The applicable Executive Order minimum wage rate will be adjusted annually. Additional information on contractor requirements and worker protections under the Executive Orders is available at https://www.dol.gov/agencies/whd/government-contracts.

State: Idaho

Area: Idaho Counties of Adams Elmore Payette Valley Washington

**Fringe Benefits Required Follow the Occupational Listing**

OCCUPATION CODE - TITLE FOOTNOTE RATE

01000 - Administrative Support And Clerical Occupations 01011 - Accounting Clerk I 14.51*** 01012 - Accounting Clerk II 16.29 01013 - Accounting Clerk III 18.22 01020 - Administrative Assistant 20.51 01035 - Court Reporter 22.66 01041 - Customer Service Representative I 13.65*** 01042 - Customer Service Representative II 14.90*** 01043 - Customer Service Representative III 16.74 01051 - Data Entry Operator I 12.52*** 01052 - Data Entry Operator II 13.66*** 01060 - Dispatcher Motor Vehicle 19.13 01070 - Document Preparation Clerk 14.98*** 01090 - Duplicating Machine Operator 14.98*** 01111 - General Clerk I 13.55*** 01112 - General Clerk II 14.78*** 01113 - General Clerk III 16.59

01120 - Housing Referral Assistant 20.98 01141 - Messenger Courier 12.22*** 01191 - Order Clerk I 14.76*** 01192 - Order Clerk II 16.11 01261 - Personnel Assistant (Employment) I 16.32 01262 - Personnel Assistant (Employment) II 18.26 01263 - Personnel Assistant (Employment) III 20.36 01270 - Production Control Clerk 22.46 01290 - Rental Clerk 13.28*** 01300 - Scheduler Maintenance 16.83 01311 - Secretary I 16.83 01312 - Secretary II 18.82 01313 - Secretary III 20.98 01320 - Service Order Dispatcher 17.11 01410 - Supply Technician 20.51 01420 - Survey Worker 16.69 01460 - Switchboard Operator/Receptionist 14.03*** 01531 - Travel Clerk I 13.31*** 01532 - Travel Clerk II 13.92*** 01533 - Travel Clerk III 15.15 01611 - Word Processor I 14.98*** 01612 - Word Processor II 16.83 01613 - Word Processor III 18.82 05000 - Automotive Service Occupations 05005 - Automobile Body Repairer Fiberglass 21.80 05010 - Automotive Electrician 21.13 05040 - Automotive Glass Installer 20.70 05070 - Automotive Worker 20.60 05110 - Mobile Equipment Servicer 16.84 05130 - Motor Equipment Metal Mechanic 23.18 05160 - Motor Equipment Metal Worker 20.60 05190 - Motor Vehicle Mechanic 23.18 05220 - Motor Vehicle Mechanic Helper 16.82 05250 - Motor Vehicle Upholstery Worker 19.46 05280 - Motor Vehicle Wrecker 20.60 05310 - Painter Automotive 21.93 05340 - Radiator Repair Specialist 20.70 05370 - Tire Repairer 17.61 05400 - Transmission Repair Specialist 23.18 07000 - Food Preparation And Service Occupations 07010 - Baker 14.39*** 07041 - Cook I 12.35*** 07042 - Cook II 14.08*** 07070 - Dishwasher 9.86*** 07130 - Food Service Worker 11.86*** 07210 - Meat Cutter 17.18 07260 - Waiter/Waitress 9.13*** 09000 - Furniture Maintenance And Repair Occupations 09010 - Electrostatic Spray Painter 20.72 09040 - Furniture Handler 15.30 09080 - Furniture Refinisher 20.72 09090 - Furniture Refinisher Helper 18.12 09110 - Furniture Repairer Minor 18.59 09130 - Upholsterer 20.66 11000 - General Services And Support Occupations 11030 - Cleaner Vehicles 11.74*** 11060 - Elevator Operator 13.30*** 11090 - Gardener 20.67 11122 - Housekeeping Aide 13.30*** 11150 - Janitor 13.30*** 11210 - Laborer Grounds Maintenance 16.14 11240 - Maid or Houseman 11.62*** 11260 - Pruner 14.49*** 11270 - Tractor Operator 19.16 11330 - Trail Maintenance Worker 16.14

11360 - Window Cleaner 14.81*** 12000 - Health Occupations 12010 - Ambulance Driver 17.77 12011 - Breath Alcohol Technician 20.65 12012 - Certified Occupational Therapist Assistant 28.33 12015 - Certified Physical Therapist Assistant 25.75 12020 - Dental Assistant 17.20 12025 - Dental Hygienist 42.08 12030 - EKG Technician 31.28 12035 - Electroneurodiagnostic Technologist 31.28 12040 - Emergency Medical Technician 17.77 12071 - Licensed Practical Nurse I 18.46 12072 - Licensed Practical Nurse II 20.65 12073 - Licensed Practical Nurse III 23.01 12100 - Medical Assistant 16.99 12130 - Medical Laboratory Technician 23.33 12160 - Medical Record Clerk 16.96 12190 - Medical Record Technician 21.38 12195 - Medical Transcriptionist 16.78 12210 - Nuclear Medicine Technologist 45.36 12221 - Nursing Assistant I 11.73*** 12222 - Nursing Assistant II 13.19*** 12223 - Nursing Assistant III 14.39*** 12224 - Nursing Assistant IV 16.15 12235 - Optical Dispenser 18.77 12236 - Optical Technician 18.46 12250 - Pharmacy Technician 19.49 12280 - Phlebotomist 16.58 12305 - Radiologic Technologist 29.92 12311 - Registered Nurse I 23.16 12312 - Registered Nurse II 28.33 12313 - Registered Nurse II Specialist 28.33 12314 - Registered Nurse III 34.28 12315 - Registered Nurse III Anesthetist 34.28 12316 - Registered Nurse IV 41.09 12317 - Scheduler (Drug and Alcohol Testing) 25.58 12320 - Substance Abuse Treatment Counselor 24.88 13000 - Information And Arts Occupations 13011 - Exhibits Specialist I 17.24 13012 - Exhibits Specialist II 21.35 13013 - Exhibits Specialist III 26.12 13041 - Illustrator I 17.24 13042 - Illustrator II 21.35 13043 - Illustrator III 26.12 13047 - Librarian 23.65 13050 - Library Aide/Clerk 13.53*** 13054 - Library Information Technology Systems 21.35 Administrator 13058 - Library Technician 16.22 13061 - Media Specialist I 15.41 13062 - Media Specialist II 17.24 13063 - Media Specialist III 19.22 13071 - Photographer I 15.02 13072 - Photographer II 16.80 13073 - Photographer III 20.81 13074 - Photographer IV 25.46 13075 - Photographer V 30.80 13090 - Technical Order Library Clerk 16.55 13110 - Video Teleconference Technician 18.11 14000 - Information Technology Occupations 14041 - Computer Operator I 16.16 14042 - Computer Operator II 18.07 14043 - Computer Operator III 20.15 14044 - Computer Operator IV 22.55 14045 - Computer Operator V 24.79

14071 - Computer Programmer I (see 1) 18.65 14072 - Computer Programmer II (see 1) 23.10 14073 - Computer Programmer III (see 1) 14074 - Computer Programmer IV (see 1) 14101 - Computer Systems Analyst I (see 1) 14102 - Computer Systems Analyst II (see 1) 14103 - Computer Systems Analyst III (see 1) 14150 - Peripheral Equipment Operator 16.16 14160 - Personal Computer Support Technician 22.55 14170 - System Support Specialist 24.97 15000 - Instructional Occupations 15010 - Aircrew Training Devices Instructor (Non-Rated) 30.88 15020 - Aircrew Training Devices Instructor (Rated) 37.37 15030 - Air Crew Training Devices Instructor (Pilot) 44.78 15050 - Computer Based Training Specialist / Instructor 30.88 15060 - Educational Technologist 27.30 15070 - Flight Instructor (Pilot) 44.78 15080 - Graphic Artist 22.46 15085 - Maintenance Test Pilot Fixed Jet/Prop 44.78 15086 - Maintenance Test Pilot Rotary Wing 44.78 15088 - Non-Maintenance Test/Co-Pilot 44.78 15090 - Technical Instructor 20.20 15095 - Technical Instructor/Course Developer 24.71 15110 - Test Proctor 16.27 15120 - Tutor 16.27 16000 - Laundry Dry-Cleaning Pressing And Related Occupations 16010 - Assembler 10.39*** 16030 - Counter Attendant 10.39*** 16040 - Dry Cleaner 12.40*** 16070 - Finisher Flatwork Machine 10.39*** 16090 - Presser Hand 10.39*** 16110 - Presser Machine Drycleaning 10.39*** 16130 - Presser Machine Shirts 10.39*** 16160 - Presser Machine Wearing Apparel Laundry 10.39*** 16190 - Sewing Machine Operator 13.07*** 16220 - Tailor 13.81*** 16250 - Washer Machine 10.89*** 19000 - Machine Tool Operation And Repair Occupations 19010 - Machine-Tool Operator (Tool Room) 23.88 19040 - Tool And Die Maker 29.01 21000 - Materials Handling And Packing Occupations 21020 - Forklift Operator 18.67 21030 - Material Coordinator 22.84 21040 - Material Expediter 22.84 21050 - Material Handling Laborer 14.57*** 21071 - Order Filler 12.91*** 21080 - Production Line Worker (Food Processing) 18.67 21110 - Shipping Packer 16.69 21130 - Shipping/Receiving Clerk 16.69 21140 - Store Worker I 13.21*** 21150 - Stock Clerk 17.93 21210 - Tools And Parts Attendant 18.67 21410 - Warehouse Specialist 18.67 23000 - Mechanics And Maintenance And Repair Occupations 23010 - Aerospace Structural Welder 27.79 23019 - Aircraft Logs and Records Technician 22.09 23021 - Aircraft Mechanic I 26.38 23022 - Aircraft Mechanic II 27.79 23023 - Aircraft Mechanic III 29.09 23040 - Aircraft Mechanic Helper 19.10 23050 - Aircraft Painter 24.90 23060 - Aircraft Servicer 22.09 23070 - Aircraft Survival Flight Equipment Technician 24.90 23080 - Aircraft Worker 23.50 23091 - Aircrew Life Support Equipment (ALSE) Mechanic 23.50

I 23092 - Aircrew Life Support Equipment (ALSE) Mechanic 26.38

II

23110 - Appliance Mechanic 23.88 23120 - Bicycle Repairer 16.48 23125 - Cable Splicer 43.57 23130 - Carpenter Maintenance 20.98 23140 - Carpet Layer 22.41 23160 - Electrician Maintenance 26.33 23181 - Electronics Technician…