Attachment 11. = QVL Application Form.docx

DEPARTMENT OF TRANSPORTATION

FEDERAL AVIATION ADMINISTRATION

QVL APPLICATION FORM

Type of Acquisition: Firm Fixed Price Construction Contract Project Type: Qualified Vendors List (QVL) for AJW-242 Unstaffed Infrastructure Sustainment (UIS) facilities on and off airport operating areas.

Location: Various locations throughout the United States of America

The information provided herein will be used for evaluation purposes. Please ensure that the information provided is accurate and complete. If a question is not applicable, indicate such rather than not responding to the question. Failure to be truthful or complete the application may result in your firm’s submittal being rejected as non-responsive.

· Date of Application:

· Contractor Name:

· Contractor Address:

· Contractor Principle Office Location:

· Dun & Bradstreet No. (DUNS Number in SAM.gov):

· Name/Title of Primary Contact:

· Primary Contact Telephone and e-mail address:

· Based on the geographic description (Eastern Region, Central Region, Western Region) as defined in the Scope of Work, please indicate which service areas and/or states within the service areas your firm would be willing to do the construction work in.

· This Application form is for construction services for the following: (check one that applies, another application form will have to be filled out if you are applying for multiple construction services)

· Antenna Tower Installation/Replacements

· HVAC Installation/Replacements

· Roof Replacements

· Stair Installation/Replacements

· Decking Installation/Replacements

· Access Road Installation/Replacements

· Shelter Installation/Replacements

· Tower Inspections

· Construction Services on NAVIDS facilities/equipment (examples: MALSR, PAPI, VASI, REIL, ALS, VOR, etc.)

· Construction Services on COMM facilities/equipment (examples: RTR, RCO, RCAG, BUEC, RCLR, RCLT, etc.)

· EXPERIENCE – Before completing the Past Performance Experience Information Form, please read SIR Section M.2 Criterion No. 1, which outlines what the FAA expects in terms of Experience.

1. For your supporting documentation please use SIR Attachment 09: Past Performance Experience Information Form to provide a list of at least two (2) projects and not more than five (5) that demonstrate your firm’s capability to perform the type of services described in the Scope of Work during the past five (5) years. Start with FAA or other federal government contracts. Then, use state/local government contracts or private sector contracts to show capabilities.

2. Additional Experience-related Questions:

a. Have you or your organization performed a contract on the grounds of an active airport?

b. If so, what was the airports name and the state the airport was located.

c. Is your company capable of passing a background check to gain access to airports and/or military bases if needed?

· PAST PERFORMANCE – Before completing the Past Performance Experience Information Form, please read SIR Section M.2 Criterion No. 2, which outlines what the FAA expects in terms of Past Performance.

1. For every example used to support the experience requirement above, Applicant must submit a Past Performance Experience Information form (SIR Attachment 09).

2. Additional Past Performance-related Questions:

a. Have you ever failed to complete any contract awarded to you? (If yes, please explain. Include contact information of project owner.)

b. Is your organization (or the officers of your organization) a party to any pending or outstanding claims, judgments, arbitrations, or litigation? If so, please explain.

c. In the past five years has the applicant firm or any of its affiliate firms been the subject of any of the following actions by any government agency (If yes, please explain):

i. Been suspended, debarred, disqualified, had a pre-qualification status revoked or otherwise been declared ineligible to bid?

ii. Been denied a contract despite being the low bidder for any other reason?

iii. Been in default on any contract?

iv. Had a contract terminated?

v. Been given an unsatisfactory performance rating or deemed a poor performer (by letter or formal proceeding)?

vi. Been investigated by the Department of Labor?

vii. Cited for non-payment of proper wages or fringe benefits to any employee(s)

1. If yes, was restitution made in full?

If you have answered yes for any part of questions above, on a separate piece of paper, please identify:

(1) The agency;

(2) The contract number,

(3) The date of the action;

(4) A brief description of the action; and

(5) Agency contact information.

· Capability Statement - Applicants must submit their company’s capability statement. The capability statement should include the following:

· Type of service provided your firm.

· Number of years in business

· Geographic area where your company can provide services.

· Previous experience for work involving similar scope.

· No Pricing Information shall be submitted within the capability statement.

OTHER INFORMATION:

The following questions are not used for qualifying the applicant, and are for informational purposes only to assist the FAA in the solicitation process for future requirements.

1. Please identify any construction-related licenses that your firm holds, and indicate which states they apply to.

2. Is there a minimum or maximum amount of contract award your firm will accept? If so, please state your limitations.