B08_Solicitation_Attachment_3_-_Technical_and_Financial_Capability.pdf

RFQ 140P6218Q0045 ATTACHMENT 3

TECHNICAL & FINANCIAL CAPABILITY STATEMENT

Before awarding any Government contract, the Contracting Officer must determine that a proposed contractor is responsible. As used here, the term “responsible” means the Contracting Officer can reasonably expect satisfactory contract performance. A proposed contractor must have or be able to obtain (1) adequate financial resources, (2) be able to comply with the required or proposed delivery or performance schedule, (3) have a record of satisfactory performance , (4) have a satisfactory record of integrity and business ethics, (5) have the necessary organization, experience & technical skills needed, (6) have or be able to obtain production and technical equipment & facilities needed, and (7) be otherwise qualified and eligible to receive an award under applicable laws and regulations. The following information is needed for this determination and will be treated as confidential. The proposed contractor must demonstrate responsibility to the full satisfaction of the Contracting Officer. If the information is not provided or is incomplete the Contracting Officer may not be able to find a proposed contractor responsible.

* * Sign this form in all places indicated and attach copies of documents requested! * *

1. FINANCIAL: PROVIDE INFORMATION ABOUT THE FINANCIAL POSITION OF YOUR FIRM.

a. GOVERNMENT CONTRACT FINANCING IS NOT AUTHORIZED UNDER THIS CONTRACT. THEREFORE; DO YOU HAVE, OR ARE YOU ABLE TO OBTAIN, ADEQUATE FINANCIAL RESOURCES FOR PERFORMANCE OF

THIS CONTRACT.

[___] YES [___] NO

b. DO YOU HAVE OR ARE YOU ABLE TO OBTAIN THE INSURANCE, AND THE BONDING AND/OR PAYMENT

PROTECTION AS MAY BE REQUIRED FOR THIS CONTRACT?

[___] YES [___] NO

c. LIST YOUR BUSINESS’ BANK/FINANCIAL INSTITUTION INFORMATION.

NAME PHONE/EMAIL COMPLETE ADDRESS AND ZIP CODE TYPE ACCOUNT

d. LIST YOUR SURETY INFORMATION FOR PERFORMANCE, PAYMENT AND BID BONDING.

NAME OF FIRM:

COMPLETE ADDRESS AND ZIP CODE:

FIRM POC: PHONE: EMAIL:

NAME OF CERTIFIED SURETY: NAIC #:

2. AUTHORIZATION FOR RELEASE OF INFORMATION: ENTER INFORMATION, SIGN & DATE.

I authorize all of the listed references to release financial or business data or records to the National Park Service (NPS) upon request.

Name & Title of Quoter:_________________________________________________________

Signature: _______________________________________________ Date: _______________

Item 1.d.

is NOT APPLICABLE

3. ABILITY TO COMPLETE PERFORMANCE: (A) IT IS ANTICIPATED THE CONTRACT WILL BE

AWARDED IN THE LATE JUNE TO EARLY JULY 2018 TIMEFRAME. IF YOUR FIRM IS AWARDED THE CONTRACT, WILL YOUR FIRM BE ABLE TO DELIVER THE DUMPSTER(s) / CONTAINER(s) TO THE CONTRACT SITE AND BEGIN COLLECTIONS WITHIN THREE (3) BUSINESS DAYS FROM THE DATE OF CONTRACT AWARD? (B) IS YOUR FIRM ABLE TO MEET THE DELIVERY TIMES AND SCHEDULES AS SPECIFIED IN

ATTACHMENT 1?

(A) [_____] YES [_____] NO (B) [_____] YES [_____] NO

4. RELATIONSHIP WITH THE GOVERNMENT: IS THE OWNER OR ANY OFFICIAL OF THE FIRM AN

EMPLOYEE OF THE U.S. GOVERNMENT OR AN IMMEDIATE FAMILY MEMBER RESIDING IN THE SAME

HOUSEHOLD OF SUCH PERSON?

[___] YES [___] NO IF YES, EXPLAIN. INCLUDE NAME, POSITION HELD, RELATIONSHIP

5. RESOURCES: DO YOU HAVE OR ARE YOU ABLE TO OBTAIN THE PERSONNEL, EQUIPMENT,

MATERIALS, AND SOURCES REQUIRED FOR TIMELY AND COMPLETE PERFORMANCE OF THIS CONTRACT IF

AWARD IS MADE TO YOUR FIRM?

[___] YES [___] NO IF YOU DO NOT ALREADY HAVE ALL OF THE RESOURCES AVAILABLE,

EXPLAIN YOUR STRATEGY OR PLAN FOR ACQUIRING THEM?

6. EQUIPMENT SPECIFICATIONS: DESCRIBE THE TYPE OF CONTAINERS, ALONG WITH THEIR CUBIC YARD CAPACITY, OUTSIDE DIMENSIONS (HEIGHT, WIDTH, LENGTH) AND TYPE OF ACCESS. ALSO PROVIDE PHOTOGRAPH(s) OF EACH TYPE CONTAINER THAT WOULD BE PROVIDED. (IF MORE SPACE IS NEEDED

FOR YOUR RESPONSE, PLEASE ATTACH ADDITIONAL SHEET.)

WASTE/TRASH CONTAINER:_____________________________________________________________________

RECYCLING CONTAINER: ________________________________________________________________________

Name & Title of Quoter:___________________________________________________________

Signature:______________________________________Date:_____________________________

7. PERMITS: DOES QUOTER HOLD A CURRENT WASTE HAULER PERMIT ISSUED BY THE STATE OF MISSOURI, DEPARTMENT OF NATURAL RESOURCES? SUBMIT COPY OF PERMIT WITH YOUR QUOTE.

[___] YES [___] NO

IS QUOTER IN GOOD STANDING (NO VIOLATIONS WITHIN THE PAST THREE (3) YEARS)?

[___] YES [___] NO

8. SAFETY / ACCIDENT PREVENTION: CONTRACTORS MUST BE COMMITTED TO PROVIDING A SAFE AND HEALTHFUL WORK ENVIRONMENT FOR ALL OF ITS EMPLOYEES AND OTHERS THAT MAY WORK, VISIT OR ENTER THE WORK SITE. CONTRACTORS ARE TO MANAGE AND CONDUCT BUSINESS OPERATIONS IN A

MANNER THAT OFFERS MAXIMUM PROTECTION TO EACH AND EVERY EMPLOYEE AND ANY OTHER

PERSON THAT MAY BE AFFECTED BY CONTRACTOR’S OPERATIONS. THE CONTRACTOR SHALL PROVIDE A WORKING ENVIRONMENT THAT IS PROACTIVE IN SAFETY AND ACCIDENT PREVENTION, HAS IDENTIFIED

AND RECOGNIZES POTENTIAL HAZARDS AND CONDITIONS ASSOCIATED WITH THE WORK TO BE

PERFORMED, AND WILL PROVIDE A COMPREHENSIVE SAFETY / ACCIDENT PREVENTION PLAN THAT, AT A MINIMUM, ADDRESSES THESE HAZARDS AND CONDITIONS, FOR ITS EMPLOYEES AS WELL AS NON- EMPLOYEES / PUBLIC WHO ARE AT, OR IN THE VICINITY OF THE CONTRACT SITE. QUOTER CERTIFIES THAT IT DOES HAVE SUCH A SAFETY / ACCIDENT PREVENTION PLAN IN PLACE AND WILL SUBMIT A COPY

TO THE CONTRACTING OFFICER WITHIN TWO (2) BUSINESS DAYS OF CONTRACT AWARD.

[___] YES [___] NO

9. OTHER AUTHORITIES: DUE TO THE URGENCY WHICH MAY EXIST IN MAKING A RESPONSIBILITY

DETERMINATION, IF YOU ARE UNABLE TO BE IMMEDIATELY REACHED TO PROVIDE ADDITIONAL

INFORMATION OR CLARIFICATION OF YOUR RESPONSES SUBMITTED ON THIS FORM OR REGARDING YOUR QUOTATION SUBMITTAL, ARE THERE ANY OTHER INDIVIDUALS WHO HAVE THE AUTHORITY TO RESPOND

ON BEHALF OF YOU OR YOUR FIRM? [___] YES [___] NO IF YES, PROVIDE THEIR

NAME(S), POSITION, AND CONTACT INFORMATION. ALSO INDICATE IF THE INDIVIDUAL(S) HAS AUTHORITY TO SIGN AND/OR ACT ON YOUR OR YOUR FIRM’S BEHALF REGARDING ANY FOLLOW-ON CONTRACT ACTION OR ACTIVITIES WHICH MAY RESULT._______________________________________________________

10. CERTIFICATIONS: READ CAREFULLY THEN COMPLETE INFORMATION REQUESTED BELOW.

I certify that the information provided is true and may be relied upon in determining my responsibility and capability. If the information is incorrect, incomplete, unable to be validated, or misleading, I understand and agree that sufficient basis exists to determine my quotation unacceptable, and/or me nonresponsible for the performance of the contract; or, if the contract has been awarded, to terminate the contract for cause based upon fraud or misrepresentation in its inception.

COMPLETE BUSINESS ______________________________ NAME & TITLE __________________________________

NAME AND ADDRESS: OF QUOTER:

_______________________________ DUNS #: _________________________________

PHONE NUMBER: _______________________________ SIGNATURE: _________________________________

FAX NUMBER: _______________________________ DATE: _________________________________

E-MAIL ADDRESS: _______________________________