3000026542.Appendix A Cover Sheet Fill-In Form.docx
DOCX document 33 KB Posted
- Solicitation number
- 3000026542
- Issued by
- East Baton Rouge Parish, Baton Rouge City, Louisiana
About this file
This is an Appendix A Offeror Cover Sheet and Certification Statement for Request for Qualifications (RFQ) No. 3000026542 issued by the Louisiana Department of Environmental Quality for "Permit Processing Support" services. The RFQ solicits qualifications from contractors to provide environmental permitting support across four primary task areas: Environmental Air Permitting (including Title V Operating Permits, State Air Permits, Prevention of Significant Deterioration Permits, Nonattainment New Source Review Permits, and Acid Rain Permits); Environmental Water Permitting (Louisiana Pollutant Discharge Elimination System Individual Permits and Section 401 Water Quality Certifications); Solid Waste Permitting and Other Authorizations (including Type I, I-A, II, II-A, and Type III facilities, Waste Tire Processing and Collection Centers, Standard Permits, and Permit Renewals); and Hazardous Waste Permitting (including Treatment, Storage, and Disposal Facility Permits, Post-Closure Permits, Permit Renewals, and Class 3 Modifications). Offerors must indicate which task areas they are qualified to support and must comprehensively address the elements outlined in the RFQ's Statement of Work.
Offerors are required to complete and submit this cover sheet as part of their Statement of Qualifications, including company information, an official contact person, current and previous client lists with descriptions of work performed within the past two years, identification of any conflicts of interest, relevant professional licenses (Louisiana Professional Engineer and Professional Geologist/Geoscientist), and information on any proposed subcontractors. The submission certifies that the offeror is not debarred from submitting to Louisiana state or political subdivision contracts, that all information is accurate, that mandatory requirements will be met, and that the response is valid for at least 180 calendar days from the signature date. The offeror must also certify readiness to begin work by the approved contract start date and acceptance of all RFQ procedures, evaluation criteria, and mandatory contract terms and conditions as specified in the solicitation documents.
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Other files
| File | Type | Posted |
|---|---|---|
| 3000026542.Addendum 1 Appendix A Cover Sheet Fill-In Form.docx | DOCX document | |
| 3000026542.Addendum 1 RFQ.pdf | ||
| 3000026542-1.pdf | ||
| 3000026542.pdf | ||
| 3000026542.RFQ Permit Support for LDEQ.pdf | ||
| 3000026542.Appendix B Experience Table Fill-In Form.docx | DOCX document |
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Text version
RFQ No. 3000026542
APPENDIX A
OFFEROR COVER SHEET / CERTIFICATION STATEMENT
“Permit Processing Support” Louisiana Department of Environmental Quality
As part of the Offeror’s Statement of Qualifications (SOQ), this document must be completed and signed by the company’s authorized representative.
OFFEROR INFORMATION:
Company Name:
Company Address:
Do you intend to use any former public employees* on this contract? (Y/N) *See Section 3.2.6 of this RFQ for more information.
OFFICIAL CONTACT – The Department requests that the Offeror designate one (1) person to receive all documents. The Offeror should identify the Contact name and fill in the information below:
Official Contact Name:
Title:
Email Address:
Telephone No. ( )
TASK AREAS:
Indicate the Task Area(s) that the Offeror is submitting qualifications for and requests to be evaluated under this Request for Qualifications (RFQ) by marking the boxes provided. LDEQ will only evaluate the Task Area(s) and sub-category(s) that have been marked below.
The Offeror must comprehensively and separately address the elements of the RFQ for each Task Area (see RFQ Part III, SOQ Preparation Instructions) and describes their approach to completing the requirements described in Attachment 1, Statement of Work, Section 2.0, Contractor Tasks.
Task Area 1 – Environmental Air Permitting ☐ Part 70 (Title V) Operating Permits ☐ State Air Permits (including Synthetic Minor Air Permits) ☐ Prevention of Significant Deterioration (PSD) Permits ☐ Nonattainment New Source Review (NNSR) Permits (as a component of a Title V Operating Permit) ☐ Acid Rain Permits
Task Area 2 – Environmental Water Permitting ☐ Louisiana Pollutant Discharge Elimination System (LPDES) Individual Permits ☐ Section 401 Water Quality Certifications
Task Area 3 – Solid Waste Permitting and Other Authorizations ☐ Type I (Industrial) Solid Waste Disposal Facilities (LAC 33:VII) ☐ Type I-A (Industrial) Solid Waste Processing Facilities ☐ Type II (Non-industrial) Solid Waste Disposal Facilities ☐ Type II-A (Non-industrial) Solid Waste Processing Facilities ☐ Type III Construction and Demolition Debris or Woodwaste Disposal, or Processing, Separation or Composting Facilities ☐ Waste Tire Processing Facilities (La. R.S. 30:2418; LAC 33:VII, Subpart 2) ☐ Waste Tire Collection Center Facilities (Non-Governmental) ☐ Standard Permits ☐ Permit Renewals (on a case by case basis) ☐ Eligible Permit Modifications
Task Area 4 – Hazardous Waste Permitting ☐ Hazardous Waste Treatment, Storage, and Disposal Facility (TSDF) Permits ☐ Post-Closure Permits ☐ Permit Renewals ☐ Class 3 Modifications
CURRENT AND PREVIOUS CLIENTS / CONFLICTS OF INTEREST:
The Offeror must provide a list of current or previous clients, a description of the work provided in the past two (2) years from the SOQ submittal date, and identify any potential conflicts of interest due to previous work or that may arise during the contract duration (duplicate table as necessary and add as attachment).
Client (current or previous)
| Description of work provided within the past two (2) years |
| Description of potential conflicts of interest |
Selected Offerors will be required to maintain a list of other clients for review by LDEQ.
OTHER SUBMITTAL INFORMATION
Licenses:
| Type of License |
| License Number (s) |
| Louisiana Professional Engineer (P.E.) License |
| Louisiana Professional Geologist/Geoscientist License |
Subcontractors (duplicate table as necessary and add as attachment):
Subcontractor (include Company Name, Address, and Contact Person) Description of Services to be provided by Subcontractor
By its submission of this SOQ and authorized signature below, Offeror shall certify that:
1. The information contained in its response to this RFQ is accurate.
2. Offeror shall comply with each of the mandatory requirements listed in the RFQ and will meet or exceed the functional and technical requirements specified therein.
3. Offeror shall accept the procedures, evaluation criteria, mandatory contract terms and conditions (Appendix C) and all other administrative requirements set forth in this RFQ.
4. Offeror’s response shall be valid for at least one hundred eighty (180) calendar days from the date of Offeror’s signature below.
5. Offeror will be ready and able to begin work by the approved contract start date.
6. By submitting a SOQ, the Offeror certifies that it is not currently debarred from submitting SOQ for contracts issued by any political subdivision or agency of the State of Louisiana and that it is not an agent of a person or entity that is currently debarred from submitting SOQ for contracts issued by any political subdivision or agency of the State of Louisiana.
The undersigned hereby acknowledges they have read and understands all requirements and specifications of the Request for Qualifications (RFQ), including appendices and attachments.
Signature of Offeror or Authorized Representative:
| Typed or Printed Name: |
| Date: |
| Title: |
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