Proposal CheckIn SB Elevator Mod IDIQ Google Forms 2025 01 31.pdf
PDF 376 KB Posted
- Solicitation number
- 47PM0925R0004
About this file
This is a Google Forms proposal submission checklist and self-qualification assessment form for contractors bidding on a Small Business Elevator Modernization IDIQ contract. The form requests detailed information about the bidding company including SAM.gov registration details, UEI number, small business designations under NAICS 238290 (size standard $22M), and bonding capacity across different states.
The form requires contractors to provide past performance information for up to 10 elevator modernization projects, including contract numbers, award dates, completion dates, total contract values, subcontracting percentages, and work self-performed percentages. Additional requirements include submission of a 5-year safety report with OSHA 300 records, mechanics licenses, and confirmation of ability to obtain HSPD-12 clearances. The form concludes with a certification statement regarding the accuracy of information provided. Key proposal components referenced include Volume 1 (representations/certifications, GSA Form 527, SF1442) and Volume 2 (mechanics list and licenses).
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1. Email *
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Small Business Elevator Modernization
IDIQ
Proposal Checklist, Self Quali�cation Assessment, and Technical Acceptability
* Indicates required question
What is your Company Name as listed in SAM.gov? *
Who is the signature authority authorized to sign for your company? (First and last name)
What is the email address of the signature authority authorized to sign for your company?
What is the phone number of the signature authority authorized to sign for your company?
What is your Company's Unique Entity Identifer (UEI) issued by SAM.gov? *
1/31/25, 7:02 AM Small Business Elevator Modernization IDIQ https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 1/24
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Example: January 7, 2019
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Mark only one oval.
Yes
No
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Check all that apply.
Other than small business Alaskan Native Corporation SBA Certi�ed 8(a) SBA Certi�ed HUBZone Veteran Owned Small Business Service Disabled Veteran Owned Small Business (SDVOSB) Small Disadvantaged Business (SDB) Woman Owned Small Business (WOSB) Small Business (SB)
SAM.gov Expiration Date? *
Is your company publicly searchable on SAM?
Please ensure your SAM registration allows public display of information Example message from our Contractor Responsibility Assessment service of a vendor current in SAM but not publicly searchable “FedDataCheck was able to locate the vendor; however, the vendor has chosen to not have their entity information displayed publicly in SAM. ... For a vendor who is currently designated as nonpublic to become publicly searchable … These instructions can also be found online here (Link to change public searchability or https://www.fsd.gov/gsafsd_sp?
id=kb_article&sys_id=c5cd667b1bc8e5906397ec21f54bcbfb).”
Under the UEI listed above, what small business designation is your firm under NAICS 238290 (Size Standard $22M)?
1/31/25, 7:02 AM Small Business Elevator Modernization IDIQ https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 2/24 https://www.fsd.gov/gsafsd_sp?id=kb_article&sys_id=c5cd667b1bc8e5906397ec21f54bcbfb
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Mark only one oval.
Yes
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Not applicable
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Mark only one oval.
Yes
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QUALIFICATION ASSESSMENT
Certified by SBA? *
Are there any other names your Company has used? *
What is your Company's Cage Code? *
Did your proposal include a Volume 1 which included the requirements as listed in the solicitation including representations and certifications as contained in Section K of the solicitaiton, GSA Form 527, and SF1442 with signed copies of amendments.
https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 3/24
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Yes
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In addition to being a small business under the NAICS 238290, is your firm capable of self-performing 80% of the work as described in the solicitaiton (to include but not limited to modernizing controllers, fixtures, and door operators)?
https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 4/24
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Check all that apply.
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York - including New York City North Carolina North Dakota Ohio Oklahoma
Please mark the states that your firm has at least $500,000 single bonding capacity and $3 million aggregate bonding capacity.
https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 5/24
Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia American Samoa Guam Northern Mariana Islands Puerto Rico US Virgin Islands
Technical Acceptibility - safety and past performance
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Mark only one oval.
Yes
No
Did your proposal attach the required 5-year safety report as described in the solicitation with the attached OSHA 300 records to support the report?
https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 6/24
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Yes
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Past Performance
For questions related to previous work, please start with the most current to least current.
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Mark only one oval.
PRIME
SUBCONTRACTOR
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Example: January 7, 2019
Does your company have a 5 year record of performing 2 or more elevator modernizations per year?
Project 1 *
Project 1 CUSTOMER *
Project 1 Contract Number *
Project 1 Award Date * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 7/24
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Project 1 Essential Completion Date *
Project 1 Total Contract Award *
Project 1 Description *
Project 1 Total Subcontracting Dollars *
Project 1 Total Subcontracting Percentage *
Project 1 Percentage of work self-performed (in contract dollars not schedule) * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 8/24
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SUBCONTRACTOR
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Example: January 7, 2019
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Example: January 7, 2019
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Project 2 *
Project 2 CUSTOMER *
Project 2 Contract Number *
Project 2 Award Date *
Project 2 Essential Completion Date *
Project 2 Total Contract Award * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 9/24
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Mark only one oval.
PRIME
SUBCONTRACTOR
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Project 2 Description *
Project 2 Total Subcontracting Dollars *
Project 2 Total Subcontracting Percentage *
Project 2 Percentage of work self-performed (in contract dollars not schedule) *
Project 3 *
Project 3 CUSTOMER *
Project 3 Contract Number * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 10/24
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Example: January 7, 2019
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Project 3 Award Date *
Project 3 Essential Completion Date *
Project 3 Total Contract Award *
Project 3 Description *
Project 3 Total Subcontracting Dollars *
Project 3 Total Subcontracting Percentage *
Project 3 Percentage of work self-performed (in contract dollars not schedule) * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 11/24
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PRIME
SUBCONTRACTOR
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Example: January 7, 2019
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Example: January 7, 2019
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Project 4 *
Project 4 CUSTOMER *
Project 4 Contract Number *
Project 4 Award Date *
Project 4 Essential Completion Date *
Project 4 Total Contract Award * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 12/24
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Mark only one oval.
PRIME
SUBCONTRACTOR
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Project 4 Description *
Project 4 Total Subcontracting Dollars *
Project 4 Total Subcontracting Percentage *
Project 4 Percentage of work self-performed (in contract dollars not schedule) *
Project 5 *
Project 5 CUSTOMER *
Project 5 Contract Number * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 13/24
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Example: January 7, 2019
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Project 5 Award Date *
Project 5 Essential Completion Date *
Project 5 Total Contract Award *
Project 5 Description *
Project 5 Total Subcontracting Dollars *
Project 5 Total Subcontracting Percentage *
Project 5 Percentage of work self-performed (in contract dollars not schedule) * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 14/24
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SUBCONTRACTOR
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Example: January 7, 2019
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Example: January 7, 2019
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Project 6 *
Project 6 CUSTOMER *
Project 6 Contract Number *
Project 6 Award Date *
Project 6 Essential Completion Date *
Project 6 Total Contract Award * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 15/24
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Mark only one oval.
PRIME
SUBCONTRACTOR
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Project 6 Description *
Project 6 Total Subcontracting Dollars *
Project 6 Total Subcontracting Percentage *
Project 6 Percentage of work self-performed (in contract dollars not schedule) *
Project 7 *
Project 7 CUSTOMER *
Project 7 Contract Number * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 16/24
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Example: January 7, 2019
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Project 7 Award Date *
Project 7 Essential Completion Date *
Project 7 Total Contract Award *
Project 7 Description *
Project 7 Total Subcontracting Dollars *
Project 7 Total Subcontracting Percentage *
Project 7 Percentage of work self-performed (in contract dollars not schedule) * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 17/24
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SUBCONTRACTOR
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Example: January 7, 2019
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Example: January 7, 2019
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Project 8 *
Project 8 CUSTOMER *
Project 8 Contract Number *
Project 8 Award Date *
Project 8 Essential Completion Date *
Project 8 Total Contract Award * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 18/24
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Mark only one oval.
PRIME
SUBCONTRACTOR
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Project 8 Description *
Project 8 Total Subcontracting Dollars *
Project 8 Total Subcontracting Percentage *
Project 8 Percentage of work self-performed (in contract dollars not schedule) *
Project 9 *
Project 9 CUSTOMER *
Project 9 Contract Number * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 19/24
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Example: January 7, 2019
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Project 9 Award Date *
Project 9 Essential Completion Date *
Project 9 Total Contract Award *
Project 9 Description *
Project 9 Total Subcontracting Dollars *
Project 9 Total Subcontracting Percentage *
Project 9 Percentage of work self-performed (in contract dollars not schedule) * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 20/24
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SUBCONTRACTOR
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Example: January 7, 2019
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Example: January 7, 2019
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Project 10 *
Project 10 CUSTOMER *
Project 10 Contract Number *
Project 10 Award Date *
Project 10 Essential Completion Date *
Project 10 Total Contract Award * https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 21/24
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Technical Acceptability - contractor employees
Please provide the mechanics list and the licenses in the proposal documents as instructed in the solicitation.
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Mark only one oval.
Yes
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Project 10 Description *
Project 10 Total Subcontracting Dollars *
Project 10 Total Subcontracting Percentage *
Project 10 Percentage of work self-performed (in contract dollars not schedule) *
Did your proposal include a Volume 2 which includes a list of mechanics and a copy of each mechanic's license in accordance with the solicitation requirements?
https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 22/24
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Yes
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Certification: The proposal information submitted as part of the email package and contained within this Google Form is accurate and complete to the best of my knowledge and belief. Submission of this form and the emailed proposal is with the understanding that knowingly misreprenting information is a cause for suspension and/or debarment to receive federal contracts; termination for default; and prosecution under Federal criminal and/or civil law.
120.
This content is neither created nor endorsed by Google.
Do current and will future employees proposed to support the solicited requirements (any task orders under the IDIQ) have the ability to meet the minimum requirements to obtain an HSPD-12 clearances in accordance with the solicitation requirements?
I certify the proposal information submitted in both this form and over email in response to the solicitation is accurate and complete to the best of my knowledge and belief. Please type your full name and position in the company.
Forms
1/31/25, 7:02 AM Small Business Elevator Modernization IDIQ https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 23/24 https://www.google.com/forms/about/?utm_source=product&utm_medium=forms_logo&utm_campaign=forms https://www.google.com/forms/about/?utm_source=product&utm_medium=forms_logo&utm_campaign=forms https://www.google.com/forms/about/?utm_source=product&utm_medium=forms_logo&utm_campaign=forms https://docs.google.com/forms/d/1c7FYCeLt3Soo5uXxVktfGT_zAsHy8nwmMHtGHTykNu4/edit 24/24
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