5- Exhibit A- Quantities Prices and Data.pdf

Exhibit A Solicitation No. 444783-CC-25 Subcontract No. TBD 01/11/24 Page 1 of 22

MISSION SUPPORT AND TEST SERVICES, LLC

FIRM-FIXED-UNIT SERVICE SUBCONTRACT

EXHIBIT A

QUANTITIES, PRICES AND DATA

TABLE OF CONTENTS

FORM TITLE PAGE

FORM A CONSIDERATION SCHEDULE

FORM B SUBCONTRACTOR AND VENDOR LIST

FORM C EVALUATION CRITERIA

FORM D PAST PERFORMANCE QUESTIONNAIRE

FORM E EXPERIENCE STATEMENT

FORM F LOWER-TIER SUBCONTRACTOR EXPERIENCE STATEMENT

FORM G PROJECT ORGANIZATION DESCRIPTION

FORM H RESUMES OF KEY PERSONNEL

FORM I SAFETY PROGRAM

FORM J SAFETY AND HEALTH HISTORY

FORM K LOWER-TIER SUBCONTRACTOR SAFETY AND HEALTH HISTORY

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FORM A CONSIDERATION SCHEDULE

NOTE: Form A, with the blanks filled in based on the awarded proposal(s) or agreement of the Offeror and CONTRACTOR shall become part of the resulting subcontract.

SCHEDULE OF QUANTITIES AND PRICES

The Prices shown the table below are all-inclusive Firm-Fixed-Unit-Prices (including e.g., labor, materials, G&A, overhead, profit or fee, taxes (except sales tax)*, any other costs required to be paid by law, regulation, or ordinance, and any other cost of whatsoever nature). Payment of the Prices shall constitute full payment for the performance of the Work and covers all costs of whatever nature incurred by SUBCONTRACTOR in accomplishing the Work in accordance with the provisions of the Subcontract and are not subject to escalation for any cause, except as may otherwise be provided in this Subcontract.

The total Ceiling Value for the performance of all Work is [INSERT DOLLARS IN WORDS] dollars ($[ENTER

DOLLAR AMOUNT]).

*Sales tax is not included, but shall be added to each invoice as a separate line item if applicable to the CONTRACTOR under this Subcontract/Order in accordance with applicable state law.

The breakdown of the fixed price services for payment purposes is detailed below:

The aggregate of each line item will be used a firm fixed price per callout at specific depths. Each line item is the type of Geophysical Data to be collected and instruments to be used. If unable to obtain certain data, please enter “N/A” in the Firm Fixed Price column.

Note: Providing costs for each depth range does not guarantee that MSTS will utilize the services at those depths. Per the Statement of Work, Exhibit B, there is expected to be four (4) callouts, but there may be more or less, depending on the conditions while drilling.

Please provide a breakdown of data for the following depth ranges. Each callout will be considered a firm fixed unit price and MSTS will pay for each time the service is utilized.

Depth: 0’- 1,400’

Item Number

Description of Services Firm Fixed Price Per Data Sample

Collected 01 Multi-Arm (4+ Arm) Oriented Caliper $ 02 Spectral (U, K, Th, Total) Gamma Ray $ 03 Spontaneous Potential $ 04 Density $ 05 Neutron Positivity $ 06 Induction Resistivity/ Conductivity $ 07 Sonic $ 08 Optical Televiewer (Only on depths of 0’-1,400’) $ 09 Formation Micro imager $ 10 Acoustic Borehole Imager $ 11 Temperature $ 12 Borehole Deviation Survey $ 13 Mobilization, Including Travel (If required) $ 14 Demobilization $ Grand Total $

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Depth: 1,400’- 3,000’

Number

Description of Services Firm Fixed Price Per Data Sample

Collected 01 Multi-Arm (4+ Arm) Oriented Caliper $ 02 Spectral (U, K, Th, Total) Gamma Ray $ 03 Spontaneous Potential $ 04 Density $ 05 Neutron Positivity $ 06 Induction Resistivity/ Conductivity $ 07 Sonic $ 08 Formation Micro imager $ 09 Acoustic Borehole Imager $ 10 Temperature $ 11 Borehole Deviation Survey $ 12 Mobilization, Including Travel (If required) $ 13 Demobilization $

Depth: 3,000’- 5,000’

Number

Description of Services Firm Fixed Price Per Data Sample

Collected 01 Multi-Arm (4+ Arm) Oriented Caliper $ 02 Spectral (U, K, Th, Total) Gamma Ray $ 03 Spontaneous Potential $ 04 Density $ 05 Neutron Positivity $ 06 Induction Resistivity/ Conductivity $ 07 Sonic $ 08 Formation Micro imager $ 09 Acoustic Borehole Imager $ 10 Temperature $ 11 Borehole Deviation Survey $ 12 Mobilization, Including Travel (If required) $

01/11/24 Page 4 of 22

Depth: 5,000’- 7,000’

Number

Description of Services Firm Fixed Price Per Data Sample

Collected 01 Multi-Arm (4+ Arm) Oriented Caliper $ 02 Spectral (U, K, Th, Total) Gamma Ray $ 03 Spontaneous Potential $ 04 Density $ 05 Neutron Positivity $ 06 Induction Resistivity/ Conductivity $ 07 Sonic $ 08 Formation Micro imager $ 09 Acoustic Borehole Imager $ 10 Temperature $ 11 Borehole Deviation Survey $ 12 Mobilization, Including Travel (If required) $

2. MODIFICATION PRICING MULTIPLIERS/RATES

A. MODIFICATION PRICING MULTIPLIERS

The Pricing Multipliers provided in Subsection B below are "fixed" mark-ups for the purpose of negotiating Firm-Fixed-Price Subcontract modifications. No categories other than those annotated below shall be applied to price changes. The pricing multipliers below shall apply to Subcontract modifications for the duration of the Subcontract. Both additive and deductive modifications shall be subject to these multipliers. Any changes made to this Subcontract will be in accordance with Exhibit C, C-20, “Changes.” Changes include change orders, revisions, modifications, equitable adjustments, and anything else which would require or result in a modification to this Subcontract or a Task Order (if applicable) in accordance with the Changes Clause. The SUBCONTRACTOR shall adhere to the pre-established modification multipliers for Bonds, G&A, and Profit. SUBCONTRACTOR shall enforce through negotiations with its Lower-Tier Subcontractors the rates in the table below for modifications. The CONTRACTOR shall review all SUBCONTRACTOR quotes to ensure compliance with contractual terms.

B. SUBCONTRACTOR’S MODIFICATION PRICING MULTIPLIERS SCHEDULE – DATE OF AWARD THROUGH

COMPLETION OF ALL WORK

Description Percentage Rate Subcontractor General & Administrative (G&A) Rate Subcontractor Profit Rate Lower-Tier Subcontractor General & Administrative (G&A) Rate Lower-Tier Subcontractor Profit Rate

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C. WORK CONTROL PRICING RATE SCHEDULE

The pricing rate provided in the table in Subsection D below are applicable to modifications requiring work control. The fixed-price hourly-rate applies to a single management-level representative to develop project-specific Work Control Packages. Work includes, but is not limited to, conducting the Job Hazard Analysis of the work, sequencing job steps, identifying required construction disciplines, scope of work verification, etc.

This individual must have signatory authority for the firm.

The SUBCONTRACTOR shall adhere to the pre-established Work Control rate for modifications. The CONTRACTOR shall review all SUBCONTRACTOR quotes to ensure compliance with contractual terms.

D. WORK CONTROL PRICING RATE – DATE OF AWARD THROUGH COMPLETION OF ALL WORK

Description Rate

Work Control Package Development Per Labor Hour

E. SUBCONTRACT MODIFICATION SUMMARY LEVEL BREAKDOWN

As part of the SUBCONTRACTOR’S submittal for modification pricing, a summary level breakdown of labor, materials and equipment shall be included. The SUBCONTRACTOR shall provide the following information at a minimum, but not limited to:

1. Labor shall be listed by labor category, work description, unit of measure, quantity, hourly labor rate burdened and unburdened, a description of the burden categories and burden amounts (i.e., %), and extended total. This shall also include a written explanation of the basis for the estimated labor hours for each labor category.

2. Materials shall be listed by item, stock number where applicable, unit of measure, unit price, quantity, and extended total. Miscellaneous items shall be completely defined. This shall also include a written explanation of the basis for the estimated materials quantities for each material type.

3. Equipment shall be listed by item, model number where applicable, unit of measure (daily, weekly, monthly), unit price, quantity, and extended total. This shall also include a written explanation of the equipment needs.

4. Additional design if required shall include the price of preparation of all detailed drawings, engineering specifications, a material list, and submittal of design drawings for review. Provide breakdown of design prices for both Design – 60 % Draft (Title II) and Design – 100 % Complete (Title III). This shall also include a written explanation of the necessity for additional design work.

Pricing received from Lower-tier Subcontractor(s) by the SUBCONTRACTOR shall conform to the same requirements noted above.

Certified Cost or Pricing Data: In addition to the requirements stated herein, Subcontract modifications which are likely to exceed $2,000,000 shall be governed by FAR clause 52.215-13, Subcontractor Certified Cost or Pricing Data-Modifications. SUBCONTRACTOR shall submit certified cost or pricing data and certification as required by that clause.

F. MODIFICATION BUY AMERICAN CERTIFICATION

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Buy American Certification will be included in each Modification Request for Quotation (RFQ) for certification by the awardee that all construction materials furnished under the modification are of domestic origin or otherwise in compliance with the Buy American Act.

3. TRAINING AND BADGING

CONTRACTOR-Provided Training: After award and before SUBCONTRACTOR personnel may commence any on-site work at CONTRACTOR facilities, all SUBCONTRACTOR personnel (including any lower-tier Subcontractor personnel) scheduled to perform activity level work on-site will be required to complete, at a minimum, CONTRACTOR-provided General Training and Work Control Training. The total amount of training time for each individual is estimated to be 6 hours. The CONTRACTOR will provide this training one time for all SUBCONTRACTOR on-site personnel prior to commencement of on-site work at no cost to the SUBCONTRACTOR. The SUBONTRACTOR’S time for the initial training session(s) shall be compensated using the following hourly rate which shall apply for all SUBCONTRACTOR personnel who are required to take the training: $_____/Hr.” or The estimated cost to the SUBCONTRACTOR for the time its on-site personnel will be required to take the initial training is included in the Firm-Fixed-Price specified herein for the performance of this Subcontract. If, due to turnover of trained personnel, the SUBCONTRACTOR needs additional training sessions during performance of the work for replacement personnel, the CONTRACTOR will provide the training but will not compensate the SUBCONTRACTOR for the time spent in training by the additional personnel to replace those personnel already trained.

Personnel who have previously completed NNSS General Training are not required to be re-trained if this training is current. Check with the Subcontract Technical Representative (STR) after award.

4. PAYMENT TERMS

Enter any prompt payments discount or Net 30 Days .

Electronic funds transfer is the preferred method of payment used by Mission Support and Test Services, LLC. To take advantage of this expedited payment process, complete FRM-0870. Link to form:

http://www.nnss.gov/docs/docs_procurement/frm0870.pdf

5. MEASUREMENT FOR PAYMENT

A. Firm-Fixed-Unit Payments

Firm Fixed Unit Payments shall be made for the successful completion of a callout identified at specific depths in the Consideration Schedule, Exhibit A, Form A. Payments shall be made in accordance with clause D-9, Invoicing and Payment. All milestone payments in the aggregate (as discussed below) for the subcontract shall be equal to the Total Firm-Fixed-Price identified in the Consideration Schedule.

6. SUBCONTRACT NOT TO EXCEED/CEILING VALUE

The Not to Exceed (NTE)/Ceiling Value of this Subcontract is To Be Determined dollars ($ To Be Determined). The total payments under this Subcontract shall not exceed the NTE/Ceiling Value of this Subcontract unless the ceiling value is modified by in writing by the Subcontract Administrator in advance.

http://www.nnss.gov/docs/docs_procurement/frm0870.pdf

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FORM B SUBCONTRACTOR AND VENDOR LIST

Subcontractor shall employ the following lower-tier subcontractors and/or vendors who will furnish major components, materials or equipment for performance of the work:

Name & Address

Work Description

Terms* Value Business Type *

If no lower-tier subcontracts or purchases are anticipated, enter the word “NONE.

NOTES: *

1. TERMS: Enter Lump Sum, Unit Price, etc.

2. Business Type: Enter SB for Small Business, SDB for Small Disadvantaged Business, WOSB for

Women-Owned Small Business, VOSB for Veteran-Owned Small Business, and SDVOSB for Service Disabled Veteran-Owned Small Business.

NOTE: This Form will become a part of the resultant subcontract.

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FORM C EVALUATION CRITERIA

1.

CONTRACTOR intends to award a subcontract resulting from this Solicitation to the responsible OFFEROR whose proposal conforms to the solicitation. CONTRACTOR reserves the right to determine that proposals are outside the competitive range at any time during the evaluation process. OFFERORS whose proposals are determined to be outside the competitive range will be promptly notified.

In its sole discretion, CONTRACTOR may, but is not required to:

A. Accept or reject any proposal for any reason with or without prior discussions with the OFFEROR;

B. Waive any requirements of this solicitation or the Solicitation Documents or waive any noncompliance in any proposal;

C. Make award decisions on the basis of the information and proposals received from the OFFEROR and/or additional information received from other sources;

D. Select one or more competitive proposals for further technical review prior to award;

E. Make an award with or without discussions;

F. Obtain additional information of whatsoever nature from any OFFEROR for consideration in the award decision;

G. Amend this solicitation for any reason whatsoever;

H. Cancel this solicitation for any reason whatsoever;

I. Take any other action whatsoever in relation to this solicitation.

2. GENERAL CONSIDERATIONS

In addition to the evaluation of each OFFEROR’S proposal, CONTRACTOR will consider each OFFEROR’S adherence to the terms and conditions. All Exceptions and Deviations will be evaluated on a case-by-case basis. Exceptions and Deviations may result in the proposal not being selected for award.

3.

A. TRADEOFF PROCESS:

This procurement will use a Best Value tradeoff process assessing merit factors as well as price/cost. This selection process will allow tradeoffs among cost/price and non-cost factors allowing CONTRACTOR to accept other than the lowest priced proposal. Proposals will be rated using a scoring system. The CONTRACTOR will select the OFFEROR whose proposal is technically acceptable and whose technical and price relationship is most advantageous to the CONTRACTOR and the Government. The CONTRACTOR will award to an OFFEROR, other than the lowest responsive and responsible OFFEROR, if the evaluation indicates that the OFFEROR’S proposal is sufficiently superior from a technical standpoint so as to warrant payment by the CONTRACTOR of a premium (i.e., difference in price between the superior proposal and lower responsive proposals) for such superiority. The proposed price between OFFERORS in the competitive range, especially between proposals which have fairly equal technical ratings, may be the major deciding factor in selection of a proposal for award. CONTRACTOR shall not select a proposal whose proposed price is disproportionately greater than the added benefit to the CONTRACTOR/Government of any technical superiorities.

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SCORED CRITERION

The following Criterion will be evaluated and scored:

Criterion Description Importance

1 Ability to Collect Geophysical Data Most Important 2 Equipment Specifications and

Limitations Equal to Criterion 1

3 Logging Capability and Experience Slightly Less Than Criterion 2 4 Ability to mobilize in 24 hours Less Important that Criterions 1, 2, and 3 5 Past Performance Least Important

NOTE: Failure of the offeror to provide complete information may impair the CONTRACTOR's ability to accurately evaluate the proposal, resulting in potentially lower scores for one or more of the Criteria described below.

NOTE: Failure of the offeror to provide complete information may impair the CONTRACTOR's ability to accurately evaluate the proposal, resulting in potentially lower scores for one or more of the Criteria described below and/or elimination of the proposal from further consideration.

Criterion 1: Ability to Collect Geographical Data

The OFFEROR shall demonstrate their ability to collect the following geophysical data sets:

1. Multi-Arm (4+ Arm) Oriented Caliper

2. Spectral (U, K, Th, Total) Gamma Ray

3. Spontaneous Potential

4. Density

5. Neutron Porosity

6. Induction Resistivity/Conductivity

7. Sonic

8. Optical Televiewer (Camera) (Just Callout #1)

9. Formation Micro imager

10. Acoustic Borehole Imager

11. Temperature

12. Borehole Deviation Survey

The OFFEROR shall include a summary level work plan that demonstrates their ability to collect the geophysical data mentioned above. The work plan shall include how the OFFEROR will execute the geophysical logging given the anticipated borehole diameters and downhole conditions described in Exhibit B, Statement of Work (SOW).

The work plan shall also include:

• Contingency plans for tight or adverse hole conditions

• Anticipated logging procedure durations

• Methodology for depth control and cable stretch correction of the logging string.

• Plan for providing redundant logging tools and equipment

• Description of tool calibration plan and schedule

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The technical evaluation will evaluate whether the summary level Work Plan meets the acceptable requirements and whether the OFFEROR understands and can complete geophysical logging as defined in Exhibit B, SOW. OFFERORS who can only provide a subset of the datasets listed above will still be considered and the omission of datasets will not automatically result in an unactable scoring.

The evaluation may be scored higher if the OFFEROR clearly demonstrates the ability to exceed the acceptable expectations for safe and efficient geophysical logging practices.

Criterion 2: Equipment Specifications and Limitations

OFFEROR shall submit detailed equipment information for every geophysical logging tool that will be utilized to gather geophysical data. This information shall include, at a minimum, instrument name, manufacturer, diagram/schematic, operating procedures, borehole type/fluid, and limitations, including the following instrument measurement and mechanical specifications where applicable:

Instrument Measurement Specifications

• Data type, including unit(s) of measurement

• Logging rate

• Measurement range

• Resolution

• Accuracy

• Depth of investigation

Instrument Mechanical Specifications

• Maximum outer diameter

• Maximum borehole diameter

• Minimum borehole diameter

• Maximum operating temperature

• Maximum operating pressure

• Maximum dogleg severity

• Maximum borehole inclination

• Weight

• Length

OFFERORS with equipment that exceed the acceptable requirements identified in Exhibit B, SOW may be scored higher.

Criterion 3: Logging Capability and Experience

The OFFEROR shall provide a description of their capability and experience providing geophysical well logs to the estimated target depth in similar geologic settings as described in Exhibit B, SOW. Use Exhibit A, Form E, Experience Statement, for the OFFEROR, and Exhibit A, Form F, Lower-tier Subcontract Experience Statement for any lower-tier subcontractors.

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OFFERORS that demonstrate a more comprehensive experience providing geophysical logs in boreholes of similar diameter and depth to those described in Exhibit B, SOW will be scored higher.

Criterion 4: Ability to mobilize in 24 hours The OFFEROR shall demonstrate their ability to mobilize to the NNSS, as described in Exhibit B, SOW within a 24-hour notice.

OFFERORS that demonstrate shorter mobilization times may be scored higher. OFFERORS that cannot mobilize to the NNSS within a 24- hour time will not automatically be scored as unacceptable.

Criterion 5: Past Performance The OFFEROR shall identify past performance under existing and prior contracts for similar work. The OFFEROR shall use Exhibit A, Form D – Past Performance Questionnaire. The OFFEROR shall provide this questionnaire to a minimum of three (3) with a maximum six (6) of its clients and have them return the form as indicated. The OFFERORS are cautioned to include all projects of a similar or reasonably similar nature, scope, and budget for at least the previous (5) five-year period. The evaluation will focus on the degree of customer satisfaction, quality of work performed and timeliness of performance. If no past performance questionnaire is received on an OFFEROR, then this criterion will receive a neutral rating. Offerors that demonstrate more positive the past performance, can obtain a higher score.

Minimum Requirement Offeror must receive an acceptable rating/score in all criteria to be considered for award.

Offeror must receive an acceptable rating in all criteria to be considered for award.

For each criterion or sub-criterion, the evaluator shall assign an adjectival rating with a corresponding numerical rating within the range indicated (below). This will be the basis for determining how many of the available points will be assigned to each proposal for each criterion.

Superior (81-100) - Significantly exceeds performance requirements or capability in a beneficial way, and/or substantial and clearly defined response, and/or an innovative response, and has no weaknesses.

Exceptional (61-80) - Exceeds specified performance or capability in a beneficial way, and/or a substantial and clearly defined response, and/or has value added features, and has no significant weakness.

Acceptable (41-60) - Meets requirements, all critical criteria met, and/or proof of experience supplied (as applicable), has good probability of satisfying the requirement, and any weaknesses can be readily corrected.

Marginal (21-40) - Does not clearly demonstrate that evaluation standards are fully met; and/or there is not sufficient data to permit a comprehensive evaluation; and/or the proposal does not provide a good match to requirements; contains weaknesses and/or significant weaknesses indicating a low probability of satisfying the requirement.

Unacceptable (0-20) - Fails to meet minimum requirements; contains significant weaknesses and/or deficiencies from requirements; indicates a lack of understanding of requirements; and would require a major revision to make the proposal acceptable.

Although price will not be scored, it can be the determining factor between proposals within the competitive range. CONTRACTOR will evaluate proposals for award purposes by adding the total price for options to

01/11/24 Page 12 of 22 the total price for the base period. CONTRACTOR may determine that a proposal is unacceptable if the option prices are unbalanced. Evaluation of the options will not obligate CONTRACTOR to exercise the option(s).

B. Price Evaluation CONTRACTOR will review pricing for completeness, reasonableness and realism. The purpose of the review will be to ensure, to the maximum extent feasible, that OFFEROR'S proposed prices are complete and realistic in relation to the solicitation, and the technical proposals are reasonable in relation to known market pricing. Realism is the compatibility of the OFFEROR'S proposed price with proposal scope and required effort. Completeness is the responsiveness of the offer in providing the areas of price required by the RFP and scope of work. All the cost information required by the RFP must be submitted. An unrealistic price proposal may be grounds for eliminating a proposal from competition either on the basis that the OFFEROR does not understand the requirement or the OFFEROR has made an improvident proposal.

Although price will not be scored, it can be the determining factor between proposals within the competitive range. CONTRACTOR will evaluate proposals for award purposes by adding the total price for options to the total price for the base period. CONTRACTOR may determine that a proposal is unacceptable if the option prices are significantly unbalanced. Evaluation of the options will not obligate CONTRACTOR to exercise the option(s).

4. PREPARATION OF PROPOSAL (Technical and Pricing) Proposals shall be submitted on the forms furnished, or copies thereof, and must be manually signed. No erasures are permitted. If changes appear on the forms, the erroneous information must have a single line drawn through the information and be initialed and dated by the person signing the proposal.

Proposals must be submitted in separate volumes: Technical and Price. The proposal shall contain all pertinent information requested in sufficient detail to permit a thorough evaluation. If the requested information is not located in the proper section, the information may be considered omitted.

a. Technical proposals submitted in response to this RFP shall comply with the following requirements:

- No cost information is to be included in technical proposal.

- Proposal shall not merely offer to perform work IAW the special conditions, but shall explain how the OFFEROR plans to accomplish the requirements. That is, repeating the special conditions without sufficient elaboration will not be acceptable.

- Complete information for best value determination

b. Proposals will be evaluated as set forth in paragraph 3 above.

c. Format and Content

The technical proposal should clearly address each of the technical proposal evaluation criteria in Form C above. It should be presented in as much detail as practical and include the following as a minimum:

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OFFEROR shall include in its proposal the following:

Volume 1 – Technical information should clearly address each of the technical proposal evaluation criteria in paragraph A above. It should be presented in as much detail as practical and include the following as a minimum:

A. Criterion 1: Summary Level Work Plan B. Criterion 2: Equipment Specification and Limitations C. Criterion 4: Discuss ability to mobilize within 24 hours’ notice D. Form B- Subcontractor and Vendor List Without Prices E. Criterion 5: Form D – Past Performance Questionnaire F. Form E – Experience Statement G. Criterion 3: Form F – Lower Tier Subcontractor Experience Statement H. Form G – Project Organization Description I. Form H - Resumes of Key Personnel J. Information/summary as to how instrument accuracy is assured and verified (e.g. Calibrations)

Volume 2 – Safety information shall be provided for the Determination of Responsibility

A. Form I– Safety Program B. Form J – Subcontractor Safety and Health History C. Form K – Lower-Tier Subcontractor Safety and Health History

Volume 3 – Pricing proposal shall include completed:

A. OFFEROR’S Proposal Letter, signed and dated B. Form A- Consideration Schedule completed in its entirety C. Form B- Subcontractor and Vendor List with Prices D. Key Personnel from Special Conditions, Exhibit D, Section D-16 E. FRM-0870, Supplier Payment Information F. IRS Form, W-9

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FORM D PAST PERFORMANCE QUESTIONNAIRE

Upon completion, please return to:

MISSION SUPPORT AND TEST SERVICES, LLC

Attention: Calvin Callahan, NLV018 Email Address: CallahCD@nv.doe.gov

RFP: 444783-CC-25

Firm Name: Mission Support and Test Services (MSTS) Contract Number: TBD

The above noted firm’s past performance is being assessed for technical evaluation purposes. You are requested to complete the following and email to the above noted address no later than January 9, 2025. Additional comments are welcome. Provide additional sheets if necessary.

Please provide a brief narrative/description of the services provided, including contract period of performance, type of contract (firm fixed price, cost plus, etc.), and contract award amount:

Does the work involve [Insert brief description of the statement of work] support activities?

YES NO

Please briefly describe the work:

Were there any change orders made to the base contract? YES NO If yes, please explain:

Has this contract been partially or completely terminated for default or convenience?

YES NO

Please describe the circumstances:

Was the quality of personnel compliant with the contract requirements?

(i.e., technical excellence, qualifications, quality, promptness etc.) YES NO Additional Comments:

Were Indefinite Delivery Indefinite Quantity (IDIQ) or Basic Ordering Agreement (BOA) /Releases staffed on time

YES NO N/A

(if applicable) Additional Comments:

Were there any lost time incidents or OSHA violations associated with this contract?

YES NO

Additional Comments:

Were there any Security issues (i.e. Export control issues, infractions, controlled articles/substance issues, Foreign

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Interests issues, cyber issues, etc.) associated with this contract?

YES NO

Additional Comments:

How effective was the CONTRACTOR in the areas below. Use the following adjectives to rate the effectiveness of the contractor:

Superior = 4 - Significantly Exceeded Minimum Requirements

Exceptional = 3 - Exceeded Minimum Requirements

Acceptable = 2 - Met Minimum Requirements

Marginal = 1 Less than Minimum Requirements with Satisfactory Results

Unsatisfactory = 0 Did not meet minimum requirements

Responsive to Customer Needs 4 3 2 1 0

Demonstrated ability to hire, maintain, and replace, if necessary, qualified personnel:

4 3 2 1 0

Using the adjective ratings above, how would you rate the contractor’s overall performance (please circle one)?

SUPERIOR EXCEPTIONAL ACCEPTABLE MARGINAL UNSATISFACTORY

Highest Rating-------------------------------------------------------------------------------------------------Lowest Rating

Additional Comments:

Name & Date Company Title Address

Note: This Form is for evaluation purposes only and will not be a part of the resultant subcontract.

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FORM E EXPERIENCE STATEMENT

The OFFEROR submits the following statement as to its experience qualifications. In the case of a joint venture, separate forms will be submitted for previous experience of the joint venture and the experience of each party of the joint venture.

This company has been engaged in the contracting business under its present business name for years.

Experience in work of a nature similar in type and magnitude to that set forth in the Statement of Work (SOW) extends over a period of years.

All awarded contracts have been satisfactorily completed, except as follows (name any and all exceptions and reasons therefore, attaching additional pages if necessary):

The following contracts, covering work similar in type and magnitude to that set forth in the SOW, have been satisfactorily completed within the last 5 years preceding the due date for proposals specified in the solicitation or are now in progress for the following owners or prime contractors.

NAME, ADDRESS/CONTACT AND

TELEPHONE NUMBER

WORK

DESCRIPTION

VALUE LOCATION START/STOP

Note: This Form is forevaluation purposes only and will not be a part of the resultant subcontract.

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FORM F LOWER-TIER SUBCONTRACTOR EXPERIENCE STATEMENT

This statement of experience qualifications is submitted for the following lower-tier subcontractor or supplier. In the case of multiple lower-tier subcontractors or suppliers, separate forms will be submitted for previous experience of each lower-tier subcontractor or supplier.

COMPANY NAME: PHONE:

CONTACT: FACSIMILE:

ADDRESS:

This company has been engaged in the contracting business under its present business name for years.

Experience in work of a nature similar in type and magnitude to that set forth in the SOW extends over a period of years.

All awarded contracts have been satisfactorily completed, except as follows (name any and all exceptions and reasons therefore, attaching additional pages if necessary):

The following contracts, covering work similar in type and magnitude to that set forth in the SOW, have been satisfactorily completed within the last 5 years preceding the due date for proposals specified in the solicitation or are now in progress for the following owners or prime contractors.

NAME, ADDRESS/CONTACT AND

TELEPHONE NUMBER

WORK

DESCRIPTION

VALUE LOCATION START/STOP

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FORM G PROJECT ORGANIZATION DESCRIPTION

OFFEROR is to attach an organizational chart with numbers and titles of key personnel and numbers and categories of home office personnel. Additionally, the OFFEROR is to provide a written description of the organization, defining lines of authority/responsibility/communication and the overall working of the organization with particular emphasis on interface and the procedures for monitoring and controlling the work.

OFFEROR is to attach a narrative, not to exceed three pages, describing its plan for Subcontract execution. This plan should be developed in conjunction with the organizational chart, resumes, and proposed lower-tier subcontractors/vendors. The narrative shall explain the management approach to this project as well as the flow of work from start to conclusion.

OFFEROR also must include capacity to perform information that links directly to each function listed on the organizational chart (i.e., the name of the person and the percentage of utilization in the program).

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FORM H RESUMES OF KEY PERSONNEL

OFFEROR is to provide a resume for each key person to be assigned to the Subcontract, containing at least the following information on each person.

1. TITLE:

2. NAME:

3. EDUCATION/QUALIFICATIONS:

4. PRESENT POSITION IN OFFEROR’S COMPANY:

5. RELEVANT EXPERIENCE:

6. EMPLOYMENT HISTORY:

7. CITIZENSHIP:

Attach and properly designate additional pages, if necessary.

NOTE: This Form is for evaluation purposes only and will not be a part of the resultant subcontract.

Approved personnel listed in the Special Condition titled “Approval of SUBCONTRACTOR Key Personnel” may not be replaced without CONTRACTOR’s approval of the replacement personnel.

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FORM I SAFETY PROGRAM

OFFEROR shall submit the following Safety and Health data with its proposal:

Environmental Safety & Health Requirements:

The SUBCONTRACTOR’s commitment to Environmental Safety and Health will be evaluated on their written

Safety Management Program as represented by the company’s written safety programs, policies, procedures, and understanding of requirements and safe job performance through:

Work Definition Hazard Identification & Control Hazard Performing Work Safely Self-Improvement Worker Training

Additional Information for evaluation purposes:

Resume of Company Safety Manager Resume of proposed Site Safety Representative (see Attachment A for qualification requirements) Completed Health History Forms

Subcontractor Lower-Tier Subcontractors

Insurance EMR verification for past three (3) years Subcontractor Lower Tier Subcontractors

Note: An Experience Modification Rate (EMR) of 1.0 or less is acceptable (Pass). If an EMR exceeds 1.0 for any year, the SUBCONTRACTOR and/or their LOWER-TIER SUBCONTRACTORS shall:

a. Supply information that clearly and completely explains the excessive rate(s)

b. Provide objective evidence that the root cause(s) of the excessive rate(s) have been identified and corrective actions implemented that have resulted in measurable improvements in safety performance, e.g.

lower incident rates, less severe incidents, and subsequent reductions in the EMR.

Pertinent information will be written into the appropriate Subcontract documents.

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FORM J SAFETY AND HEALTH HISTORY

Submittals:

1. Company Safety Program/applicable procedures

2. Resume of Company Safety Manager

3. Resume of proposed Site Safety Representative (reference Attachment A, Qualification Requirements for Safety Representative)

4. Insurance EMR verification

1. General Subcontractor Name:

2. NAICS Code: 541360- Geophysical Surveying and Mapping Services

3. Number of Lower-Tier Subcontractors expected on-site?

4. Lower-Tier Subcontractor Name Discipline:

5. Workers’ Compensation Insurance Carrier letter providing your firm’s Interstate EMR for the three

(3) most recent years. Attach letter and input rates and total hours worked.

Year: EMR: Insurance Carrier:

Year: EMR: Insurance Carrier:

Year: EMR: Insurance Carrier:

6. Number of OSHA Inspections previous 5 years. Year(s):

7. Number of OSHA Citations previous 5 years Type:

8. Use your OSHA 300 Log to fill in number of injuries and illnesses for previous three years:

a) Number of lost workday cases Year:

# Hours Worked:

b) Number of restricted workday cases Year:

# Hours Worked:

c) Number of cases with medical attention only

Year:

# Hours Worked:

d) Number of fatalities Year:

# Hours Worked:

9. Explanation for EMR if greater than 1.0 :

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FORM K LOWER-TIER SUBCONTRACTOR SAFETY AND HEALTH HISTORY

1. Lower-Tier Company Name:

2. NAICS Code: 541360-

Geophysical Surveying and Mapping Services

3. Name of General Subcontractor

4. Workers’ Compensation Insurance Carrier letter providing your firm’s Interstate EMR for the three

(3) most recent years. Attach letter and input rates and total hours worked.

Year: EMR:

Year: EMR:

Year: EMR:

5. Use your last year’s OSHA No. 300 Log to fill in number of injuries and illnesses:

a) Number of lost workday cases

Hours Worked:

b) Number of restricted workday cases

c) Number of cases with medical attention only

d) Number of fatalities

6. Number of OSHA Inspections previous 5 years. Year(s):

7. Number of OSHA Citations previous 5 years Type: (De minimus, Serious, Willful, Repeat)

8. Do you have a written safety program? Yes No

9. Have you submitted the safety program to the General Contractor for their approval? Yes No

10. Explanation for EMR greater than 1.0