forms_to_return_with_offer_(140P8319R0001).docx

Experience and Past Performance READ CAREFULLY: The purpose of this form is for the offeror to list construction projects performed during the past five (5) years that are similar to the work described in this solicitation. The number of projects listed shall not exceed ten (10) and shall be numbered consecutively, beginning with the most recent project. Use this form to address your familiarity with the Scope of Work described in the plans and specifications and with the capability criteria described in the Request for Proposal. Include area codes with all telephone numbers. Type or print legibly.

It is especially important that the offeror disclose instances in which their past performance may be considered by others to be less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s past performance record.

Name of Contractor/Offeror:

Project Name:

Project Location:

Name of Owner:

Address of Owner:

Telephone Number:

Project Value:

Dates of Construction:

Description of the Project and Scope of Offeror’s Work

Performance Remarks

RFP #140P8319R0001, Rehabilitate Kalaloch Water Treatment System Olympic National Park

Description of the Project and Scope of Offeror’s Work (continuation)

Performance Remarks (continuation)

Key Personnel Qualifications READ CAREFULLY: The purpose of this form is for the Offeror to list the qualifications of all key personnel as described in the solicitation.

Experience and qualifications include those developed on previous jobs; jobrelated training courses; certificates and licenses; honors; and specialty skills that are relevant to the proposed project. Provide dates, but do not send documents.

Provide the state in which registration or license is held and the registration or license number. Fill in the information by typing or printing legibly.

NAME OF CONTRACTOR/OFFEROR:

PERSONNEL INFORMATION:

Name:

Job Title:

EDUCATION AND PROFESSIONAL REGISTRATION:

Top Educational Level Obtained:

Year:

Area of Specialization:

Professional Registrations:

EXPERIENCE AND QUALIFICATIONS

List of proposed subcontractors

The purpose of this form is for the Offeror to list the proposed subcontractors who will perform on the contract. Include a brief description of the work they will perform. Fill in the information by typing or printing legibly.

NAME OF CONTRACTOR/OFFEROR:

SUBCONTRACTOR NAME:

DUNS:

Address and website (if applicable):

DESCRIPTION OF PROPOSED SUBCONTRACT WORK:

SUBCONTRACTOR NAME:

DUNS:

Address and website (if applicable):

DESCRIPTION OF PROPOSED SUBCONTRACT WORK:

SUBCONTRACTOR NAME:

DUNS:

Address and website (if applicable):

DESCRIPTION OF PROPOSED SUBCONTRACT WORK:

SUBCONTRACTOR NAME:

DUNS:

Address and website (if applicable):

DESCRIPTION OF PROPOSED SUBCONTRACT WORK:

Subcontractor Reference READ CAREFULLY: The purpose of this form is for the offeror to provide references for key subcontractors identified in the Instructions, Conditions, and Notices to Offerors (Section L) who are considered critical to the successful accomplishment of the project. Use as many sheets as necessary. These subcontractor references should include additional relevant projects similar to the work described in the plans and specifications. Include area codes with all telephone numbers. Fill in the information by typing or printing legibly.

SUBContractor (PROPOSED):

ADDRESS:

Project Name:

Name of Owner:

Location:

Prime Contractor

Telephone Number:

Subcontract $ Value:

Dates of Construction:

Dates of Construction:

Description & Scope of Work specific areas of experience (SEE INSTRUCTIONS FOR THE SUBMISSION OF OFFERS AND OTHER INFORMATION – capability CRITERIA):

Description & Scope of Work {continuation} specific areas of experience (SEE INSTRUCTIONS FOR THE SUBMISSION OF OFFERS AND OTHER INFORMATION – capability CRITERIA) {continuation}:

General References READ CAREFULLY: The purpose of this form is for the offeror to provide the Government with general references in the spaces provided as described in the Instructions, Conditions, and Notices to Offerors (Section L). Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

It is especially important that the offeror disclose instances in which their relationships with the references may be considered less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s past performance record. Provide explanations on separate sheets as necessary.

Name of Contractor/Offeror:

Surety

Name of Surety:

Address of Surety:

Name of Agent:

Telephone Number:

Corporate Bank

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

Corporate Bank

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

Insurance Company

Name:

Address:

Name of Agent:

Telephone Number:

Types of Policies:

CERTIFICATIONS

52.204-8 Annual Representations and Certifications. (OCT 2018) [excerpt] (a)(1) The North American Industry Classification System (NAICS) code for this acquisition is 237110, Water and Sewer Line and Related Structures Contractors.

(2) The small business size standard is $36.5 million, average annual gross receipts for the past three years.

(3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees.

(b)(1) If the provision at 52.204-7, System for Award Management, is included in this solicitation, paragraph (d) of this provision applies.

(2) If the provision at 52.204-7 is not included in this solicitation, and the offeror is currently registered in the System for Award Management (SAM), and has completed the Representations and Certifications section of SAM electronically, the offeror may choose to use paragraph (d) of this provision instead of completing the corresponding individual representations and certifications in the solicitation. The offeror shall indicate which option applies by checking one of the following boxes:

[ ] (i) Paragraph (d) applies.

[ ] (ii) Paragraph (d) does not apply and the offeror has completed the individual representations and certifications in the solicitation.

52.209-7 Information Regarding Responsibility Matters (OCT 2018) [excerpt]

(a) Definitions. As used in this provision— “Administrative proceeding” means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables.

“Federal contracts and grants with total value greater than $10,000,000” means—

(1) The total value of all current, active contracts and grants, including all priced options; and

(2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules).

“Principal” means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).

(b) The offeror [ ] has [ ] does not have current active Federal contracts and grants with total value greater than $10,000,000.

52.209-13 Violation of Arms Control Treaties or Agreements-Certification (JUN 2018) [excerpt]

(b) Certification. [Offeror shall check either (1) or (2).] ___ (1) The Offeror certifies that– (i) It does not engage and has not engaged in any activity that contributed to or was a significant factor in the President's or Secretary of State's determination that a foreign country is in violation of its obligations undertaken in any arms control, nonproliferation, or disarmament agreement to which the United States is a party, or is not adhering to its arms control, nonproliferation, or disarmament commitments in which the United States is a participating state. The determinations are described in the most recent unclassified annual report provided to Congress pursuant to section 403 of the Arms Control and Disarmament Act (22 U.S.C. 2593a). The report is available via the Internet at https://www.state.gov/t/avc/rls/rpt/; and (ii) No entity owned or controlled by the Offeror has engaged in any activity that contributed to or was a significant factor in the President's or Secretary of State's determination that a foreign country is in violation of its obligations undertaken in any arms control, nonproliferation, or disarmament agreement to which the United States is a party, or is not adhering to its arms control, nonproliferation, or disarmament commitments in which the United States is a participating state. The determinations are described in the most recent unclassified annual report provided to Congress pursuant to section 403 of the Arms Control and Disarmament Act (22 U.S.C. 2593a). The report is available via the Internet at https://www.state.gov/t/avc/rls/rpt/; or ___ (2) The Offeror is providing separate information with its offer in accordance with paragraph (d)(2) of this provision.