B08_Att_2_AOC_collection.docx
DOCX document 16 KB Posted
- Attached to
- BLM FY24-2 Fall Consolidated Seed Buy. Federal contract opportunity
- Solicitation number
- 140L3724R0010
About this file
This document is an Attachment 2 for the Bureau of Land Management (BLM) FY24-2 Fall Consolidated Seed Buy solicitation. It is a form used to collect information on non-certified wildland collected or non-certified cultivated seed species and their area of origin. The form requires the seed collector to provide details such as the seed species, collection location (state, county, elevation, latitude, longitude), and contact information. The buyer of the seed is also required to sign the form, acknowledging the penalty for making false statements. The related federal contract opportunity is solicitation number 140L3724R0010, which is seeking non-certified wildland collected or non-certified cultivated seed for the BLM Idaho Region.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B09_QandAs_from_PreBid_Call_0001.docx | DOCX document | |
| Sol_140L3724R0010_Amd_0001.pdf | ||
| B08_Att_3_Seed_Analysis_Request_Form_revised_072024_0001.docx | DOCX document | |
| Sol_140L3724R0010.pdf | ||
| B08_140L3724R0010_24-2_Solicitation.pdf | ||
| B08_Att_3_Seed_Analysis_Request_Form__amended_for_2024.docx | DOCX document | |
| B08_Att_4_Itemized_Delivery_Sheet.xlsx | XLSX spreadsheet | |
| B08_Att_1-Bid_Request_Fall_24-2.xlsx | XLSX spreadsheet |
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Text version
ATTACHMENT 2
BLM - RSW SEED BUY
NON-CERTIFIED WILDLAND COLLECTED OR NON-CERTIFIED CULTIVATED SEED SPECIES/AREA OF ORIGIN CLAIMED (AOC) STATEMENT
NOTE: Attachment 2 shall be provided for all non-certified wildland collected or non-certified germplasm cultivated seed. Items identified with letter designator AOC in the schedule. This form is to be used only for non-certified germplasm seed – required at time of delivery.
I hereby claim that the seed collected was from _________________________ species.
Origin Information: (where the seed is growing).*
State: _________________________________________
County: _________________________________________
Elevation: _________________________________________
Latitude: _________________________________________
Longitude: _________________________________________
*If seed is cultivated, provide State, County, Elevation, Lat/Long and Lot Number for both the original claimed geographic site of the seed and where the cultivation site is located.
| __________________________________ | _________________ | |
| Seed Collector Signature | Date |
Seed Collector Name: __________________________________
Address: __________________________________
City/State/Zip __________________________________ Phone: _____________
Email address: __________________________________
This collected seed was sold to: __________________________________
Name and Address of Buyer: ____________________________________________________
| _______________________________________ | __________________ | ||
| Signature (Buyer) | Date |
The penalty for making false statements, relating to this statement, is as prescribed in 18U.S.C.1001, which states in part: A(a) Except as otherwise provided in this section, whoever, in any manner within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States, knowingly and willfully – (1) falsifies, conceals, or covers up by a trick, scheme, or device a material fact; (2) makes any materially false, fictitious or fraudulent statement or representation; or (3) makes or uses any false writing or document knowing the same to contain any material false, fictitious, or fraudulent statement or entry; shall be fined under this title or imprisoned not more than 5 years or both.
File details come from the government source that posted it. Updated .