A10_1-127EAS26Q0006-Att6-KTRKeyPersonnel.doc

DOC document 42 KB Posted

Attached to
Inyo National Forest (NF) Wastewater Treatment Plant (WWTP) Operations (Ops) & Maintenance (Maint)
Solicitation number
127EAS26Q0006
Issued by

About this file

This is a Key Personnel Designation form for USDA Forest Service contract 127EAS26Q0006, which covers Wastewater Treatment Plant Operations and Maintenance services at Inyo National Forest. The form serves as a template for contractors to designate their key personnel and assign contractual authorities to representatives.

The form requires contractors to identify and provide contact information for personnel in the following roles: Contractor Representative, Project Foreman/woman, Project Manager, Inspector, and additional positions as needed. The designated Contractor Representative is granted delegation of authority to execute work-related actions including acknowledging Notices to Proceed, processing work suspension and resumption orders, and addressing noncompliance notices. The form provides checkboxes allowing for assignment of additional authorities to the Contractor Representative, including the ability to sign progress payment estimates and invoices, contract modifications, final payment estimates and releases, termination settlement agreements, or full authority in all contractual matters. Completed forms must be submitted to Matthew (Matt) Killian, the Contracting Officer at matthew.killian@usda.gov. This is a template document requiring contractor-specific completion; no pre-filled information is provided in this version.

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Text version

Designation of Representative, CLRD Poudre Steps II Project

DESIGNATION OF REPRESENTATIVE

SOLICITATION NO.

127EAS26Q0006

CONTRACT NO.

PROJECT

Inyo NF WWTP Ops & Maint

UNIT

Inyo National Forest

TO

Matthew (Matt) Killian, Contracting Officer

CONTRACTOR NAME, ADDRESS & POC EMAIL

Contractor Name

Street Address

City, State + Zipcode POC Name, Email

Key Personnel

In accordance with the above specified contract number, the following personnel are assigned to this contract:

Personnel identified herein may hold multiple roles/positions.

Contractor Representative Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Project Foreman/woman Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Project Manager Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Inspector Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Other Title Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Other Title Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Other Title Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here

Designated Representative This delegation extends authority to take any action necessary with respect to the execution of work, including acknowledging receipt of Notice to Proceed, Suspend and Resume Work Orders, and Notices of Noncompliance. The items check below indicates additional authority authorized by this delegation to the key person identified as the Contractor Representative above:

☐ Sign progress payment estimates and invoices.

☐ Sign contract modifications.

☐ Sign final payment estimate and invoice and contract release.

☐ Execute contract termination settlement agreement.

☐ Full authority in all contractual matters.

Name Overwrite Here Title Overwrite Here

File details come from the government source that posted it. Updated .