SF1449_highlited_solicitation.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

BOISE ID 83709

1249 S VINNELL WAY STE 200

ATTN DONNA BIXLER

DONNA BIXLER

0258 CODE 16. ADMINISTERED BYCODE

X

X

X

561720

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR0261

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

02/06/2017 1500 MT

01/20/2017

208-373-4133DONNA BIXLER

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

AG-0261-S-17-0014

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 68834082OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

USDA FOREST SERVICE

PAYETTE NATIONAL FOREST

500 E WHITELY

COUNCIL ID 83612-9999

15. DELIVER TO

BOISE ID 83709

1249 S VINNELL WAY STE 200

ATTN DONNA BIXLER

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$18.00

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

DONNA BIXLER

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

2017 Janitorial Service for Council Ranger District.

CONTRACTOR IS REQUIRED TO BE REGISTERED IN SAM

PRIOR TO AWARD.

See attached for documents to submit with your quote.

Make sure NAICS code 561720 is referenced in your SAM registration.

Quotes may be mailed to: drbixler@fs.fed.us (Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

DONNA R. BIXLER

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

DUNS NO.:___________________

E-MAIL:_____________________

Contact person Diane J Davis: 208-253-0123

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Period of Performance: 03/01/2017 to 02/28/2022

001 BASE YEAR - COUNCIL RD JANITORIAL SERVICES March 12 MO

2017 - FEB 28, 2018

Product/Service Code: S201

Product/Service Description: HOUSEKEEPING-

CUSTODIAL JANITORIAL

002 OPTION YEAR 1 - COUNCIL RD JANITORIAL SERVICES 12 MO

March 1, 2018- FEB 28, 2019

Product/Service Code: S201

Product/Service Description: HOUSEKEEPING-

CUSTODIAL JANITORIAL

003 OPTION YEAR 2 - COUNCIL RD JANITORIAL SERVICES 12 MO

March 1, 2019 - FEB 29, 2020

Product/Service Code: S201

Product/Service Description: HOUSEKEEPING-

CUSTODIAL JANITORIAL

004 OPTION YEAR 3 - COUNCIL RD JANITORIAL SERVICES 12 MO

March 1, 2020 - FEB 28, 2021

Product/Service Code: S201

Product/Service Description: HOUSEKEEPING-

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

682 of

1, ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 68

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

AG-0261-S-17-0014

CUSTODIAL JANITORIAL

005 OPTION YEAR 4 - COUNCIL RD JANITORIAL SERVICES 12 MO

March 1, 2021 - FEB 28, 2022

Product/Service Code: S201

Product/Service Description: HOUSEKEEPING-

CUSTODIAL JANITORIAL

The "Submit Invoice-to" address for USDA orders is the Department of Treasury's Invoice

Processing Platform (IPP). The contractor must follow the instructions on how to register and submit invoices via IPP as prescribed in the previous communications from USDA and Treasury.

All invoices are to be submitted via the electronic Invoice Processing Platform. This is a mandatory requirement initiated by the U.S.

Department of Treasury and you can find more information at this website https://www.ipp.gov/index.htm. Please make sure that your company has registered at https://www.ipp.gov/vendors/enrollment-vendors.htm to establish your account.

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

AG-0261-S-17-0014 2017 COUNCIL JANITORIAL SVC. PNF

Contract Terms and Conditions

ADDENDUM TO FAR CLAUSE 52.212-4, CONTRACT TERMS AND CONDITIONS-

COMMERCIAL ITEMS (INCORPORATED BY REFERENCE ON STANDARD FORM 1449)

The Following are added to the terms and conditions in FAR 52-212-4

CLAUSES INCORPORATED BY REFERENCE

52.204-9 Personal Identity Verification of Contractor Personnel (Jan 2011)

52.223-2 Affirmative Procurement of Biobased Products Under Service and Construction Contracts (Sep 2013)

52.223-17 Affirmative Procurement of EPA-Designated Items in Service and Contruction Contracts (May 2008)

52.237-2 Protection of Government Buildings, Equipment, and Vegetation (Apr 1984)

52.232-18 Availability of Funds (APR 1984)

52.232-40 Providing Accelerated Payments to Small Business Subcontractors. (Dec 2013)

CLAUSES INCORPORATED BY FULL TEXT

52.252-2 Clauses Incorporated by Reference (Feb 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): http://farsite.hill.af.mil

(End of Clause)

52.217-8 -- Option to Extend Services. (Nov 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 5 calendar days of expiring contract.

(End of Clause)

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52.217-9 -- Option to Extend the Term of the Contract. (Mar 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within 1 day; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 10 calendar days before the contract expires.

The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 5 years.

(End of Clause)

52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders -- Commercial Items (Mar 2016)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (Nov 2015)

(2) 52.233-3, Protest After Award (AUG 1996) (31 U.S.C. 3553).

(3) 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004) (Public Laws 108-77, 108-78 (19 U.S.C. 3805 note)).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the contracting officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41 U.S.C. 4704 and 10 U.S.C. 2402).

(2) 52.203-13, Contractor Code of Business Ethics and Conduct (Oct 2015) (41 U.S.C. 3509).

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(3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (Jun 2010) (Section 1553 of Pub L. 111-5) (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009).

X (4) 52.204-10, Reporting Executive compensation and First-Tier Subcontract Awards (Oct 2015) (Pub. L. 109-282) (31 U.S.C. 6101 note).

(5) [Reserved]

(6) 52.204-14, Service Contract Reporting Requirements (Jan 2014) (Pub. L.

111- 117, section 743 of Div. C).

(7) 52.204-15, Service Contract Reporting Requirements for Indefinite- Delivery Contracts (Jan 2014) (Pub. L. 111-117, section 743 of Div. C).

X (8) 52.209-6, Protecting the Government’s Interest When Subcontracting with

Contractors Debarred, Suspended, or Proposed for Debarment (Oct 2015) (31 U.S.C.

6101 note).

(9) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (Jul 2013) (41 U.S.C. 2313).

(10) [Reserved]

(11) (i) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (Nov 2011) (15 U.S.C. 657a).

(ii) Alternate I (Nov 2011) of 52.219-3.

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(12) (i) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (Oct 2014) (if the offeror elects to waive the preference, it shall so indicate in its offer)(15 U.S.C. 657a).

(ii) Alternate I (Jan 2011) of 52.219-4.

(13) [Reserved]

X (14) (i) 52.219-6, Notice of Total Small Business Aside (Nov 2011) (15 U.S.C. 644).

(ii) Alternate I (Nov 2011).

(iii) Alternate II (Nov 2011).

(15) (i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C.

644).

(ii) Alternate I (Oct 1995) of 52.219-7.

(iii) Alternate II (Mar 2004) of 52.219-7.

(16) 52.219-8, Utilization of Small Business Concerns (Oct 2014) (15 U.S.C.

637(d)(2) and (3)).

(17) (i) 52.219-9, Small Business Subcontracting Plan (Oct 2015) (15 U.S.C. 637 (d)(4)).

(ii) Alternate I (Oct 2001) of 52.219-9.

(iii) Alternate II (Oct 2001) of 52.219-9.

(iv) Alternate III (Oct 2015) of 52.219-9.

(18) 52.219-13, Notice of Set-Aside of Orders (Nov 2011) (15 U.S.C. 644(r)).

(19) 52.219-14, Limitations on Subcontracting (Nov 2011) (15 U.S.C. 637(a)(14)).

(20) 52.219-16, Liquidated Damages—Subcontracting Plan (Jan 1999) (15 U.S.C.

637(d)(4)(F)(i)).

(21) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set- Aside (Nov 2011) (15 U.S.C. 657f).

X (22) 52.219-28, Post Award Small Business Program Rerepresentation (Jul 2013) (15 U.S.C. 632(a)(2)).

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(23) 52.219-29, Notice of Set-Aside for, or Sole Source Award to, Economically Disadvantaged Women-Owned Small Business Concerns (Dec 2015) (15 U.S.C.

637(m)).

(24) 52.219-30, Notice of Set-Aside for, or Sole Source Award to, Women-Owned Small Business Concerns Eligible Under the Women-Owned Small Business Program (Dec 2015) (15 U.S.C. 637(m)).

X (25) 52.222-3, Convict Labor (June 2003) (E.O. 11755).

(26) 52.222-19, Child Labor—Cooperation with Authorities and Remedies (Feb 2016) (E.O. 13126).

X (27) 52.222-21, Prohibition of Segregated Facilities (Apr 2015).

X 28) 52.222-26, Equal Opportunity (Apr 2015) (E.O. 11246).

_ (29) 52.222-35, Equal Opportunity for Veterans (Oct 2015) (38 U.S.C. 4212).

X (30) 52.222-36, Equal Opportunity for Workers with Disabilities (Jul 2014) (29 U.S.C. 793).

(31) 52.222-37, Employment Reports on Veterans (Feb 2016) (38 U.S.C. 4212).

(32) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (Dec 2010) (E.O. 13496).

_X (33) (i) 52.222-50, Combating Trafficking in Persons (Mar 2015) (22 U.S.C.

chapter 78 and E.O. 13627).

(ii) Alternate I (Mar 2015) of 52.222-50, (22 U.S.C. chapter 78 and E.O. 13627).

(34) 52.222-54, Employment Eligibility Verification (Oct 2015). (E. O. 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.)

(35) (i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA- Designated Items (May 2008) (42 U.S.C. 6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

(ii) Alternate I (May 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

(36) (i) 52.223-13, Acquisition of EPEAT® -Registered Imaging Equipment (Jun 2014) (E.O.s 13423 and 13514

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(ii) Alternate I (Oct 2015) of 52.223-13.

(37) (i) 52.223-14, Acquisition of EPEAT® -Registered Television (Jun 2014) (E.O.s 13423 and 13514).

(ii) Alternate I (Jun 2014) of 52.223-14.

(38) 52.223-15, Energy Efficiency in Energy-Consuming Products (Dec 2007) (42 U.S.C. 8259b).

(39) (i) 52.223-16, Acquisition of EPEAT® -Registered Personal Computer Products (Oct 2015) (E.O.s 13423 and 13514).

(ii) Alternate I (Jun 2014) of 52.223-16.

X (40) 52.223-18, Encouraging Contractor Policies to Ban Text Messaging while Driving (Aug 2011) (E.O. 13513).

(41) 52.225-1, Buy American--Supplies (May 2014) (41 U.S.C. chapter 83).

(42) (i) 52.225-3, Buy American--Free Trade Agreements--Israeli Trade Act (May 2014) (41 U.S.C. chapter 83, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C. 3805 note, 19 U.S.C. 4001 note, Pub. L. 103-182, 108-77, 108-78, 108-286, 108-302, 109-53, 109-169, 109-283, 110-138, 112-41, 112-42, and 112-43).

___ (ii) Alternate I (May 2014) of 52.225-3.

(iii) Alternate II (May 2014) of 52.225-3.

(iv) Alternate III (May 2014) of 52.225-3.

(43) 52.225-5, Trade Agreements (Feb 2016) (19 U.S.C. 2501, et seq., 19 U.S.C.

3301 note).

X (44) 52.225-13, Restrictions on Certain Foreign Purchases (Jun 2008) (E.O.’s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury).

(45) 52.225-26, Contractors Performing Private Security Functions Outside the United States (Jul 2013) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 U.S.C. 2302 Note).

(46) 52.226-4, Notice of Disaster or Emergency Area Set-Aside (Nov 2007) (42 U.S.C. 5150).

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X

(47) 52.226-5, Restrictions on Subcontracting Outside Disaster or Emergency Area (Nov 2007) (42 U.S.C. 5150).

(48) 52.232-29, Terms for Financing of Purchases of Commercial Items (Feb 2002) (41 U.S.C. 4505), 10 U.S.C. 2307(f)).

(49) 52.232-30, Installment Payments for Commercial Items (Oct 1995) (41 U.S.C.

4505, 10 U.S.C. 2307(f)).

X (50) 52.232-33, Payment by Electronic Funds Transfer— System for Award Management (Jul 2013) (31 U.S.C. 3332).

(51) 52.232-34, Payment by Electronic Funds Transfer—Other Than System for Award Management (Jul 2013) (31 U.S.C. 3332).

(52) 52.232-36, Payment by Third Party (May 2014) (31 U.S.C. 3332).

__ (53) 52.239-1, Privacy or Security Safeguards (Aug 1996) (5 U.S.C. 552a).

(54) (i) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx 1241(b) and 10 U.S.C. 2631).

(ii) Alternate I (Apr 2003) of 52.247-64.

(c) The Contractor shall comply with the FAR clauses in this paragraph (c), applicable to commercial services, that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or executive orders applicable to acquisitions of commercial items:

(1) 52.222-17, Nondisplacement of Qualified Workers (May 2014) (E.O. 13495)

X (2) 52.222-41, Service Contract Labor Standards (May 2014) (41 U.S.C. chapter 67.).

X (3) 52.222-42, Statement of Equivalent Rates for Federal Hires (May 2014) (29 U.S.C. 206 and 41 U.S.C. chapter 67).

This Statement is for Information Only It is not a Wage Determination

Employee Class Monetary Wage— Fringe Benefits

Janitor, WG-02 Laborer, WG-02

$14.60 $14.60

__ (4) 52.222-43, Fair Labor Standards Act and Service Contract Labor Standards -- Price Adjustment (Multiple Year and Option Contracts) (May 2014) (29 U.S.C.206 and 41 U.S.C. chapter 67).

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(5) 52.222-44, Fair Labor Standards Act and Service Contract Labor Standards -- Price Adjustment (May 2014) (29 U.S.C. 206 and 41 U.S.C. chapter 67).

(6) 52.222-51, Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment-- Requirements (May 2014) (41 U.S.C.

chapter 67).

(7) 52.222-53, Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services--Requirements (May 2014) (41 U.S.C. chapter 67).

X (8) 52.222-55, Minimum Wages Under Executive Order 13658 (Dec 2015) (E.O.

13658).

(9) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (May 2014) (42 U.S.C. 1792).

(10) 52.237-11, Accepting and Dispensing of $1 Coin (Sep 2008) (31 U.S.C. 5112(p)(1)).

(d) Comptroller General Examination of Record The Contractor shall comply with the provisions of this paragraph (d) if this contract was awarded using other than sealed bid, is in excess of the simplified acquisition threshold, and does not contain the clause at 52.215-2, Audit and Records -- Negotiation.

(1) The Comptroller General of the United States, or an authorized representative of the Comptroller General, shall have access to and right to examine any of the Contractor’s directly pertinent records involving transactions related to this contract.

(2) The Contractor shall make available at its offices at all reasonable times the records, materials, and other evidence for examination, audit, or reproduction, until 3 years after final payment under this contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the other clauses of this contract. If this contract is completely or partially terminated, the records relating to the work terminated shall be made available for 3 years after any resulting final termination settlement. Records relating to appeals under the disputes clause or to litigation or the settlement of claims arising under or relating to this contract shall be made available until such appeals, litigation, or claims are finally resolved.

(3) As used in this clause, records include books, documents, accounting procedures and practices, and other data, regardless of type and regardless of form. This does not require the Contractor to create or maintain any record that the Contractor does not maintain in the ordinary course of business or pursuant to a provision of law.

(e)

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(1) Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c) and (d) of this clause, the Contractor is not required to flow down any FAR clause, other than those in this paragraph (e)(1) in a subcontract for commercial items. Unless otherwise indicated below, the extent of the flow down shall be as required by the clause—

(i) 52.203-13, Contractor Code of Business Ethics and Conduct (Oct 2015) (41 U.S.C. 3509).

(ii) 52.219-8, Utilization of Small Business Concerns (Oct 2014) (15 U.S.C.

637(d)(2) and (3)), in all subcontracts that offer further subcontracting opportunities. If the subcontract (except subcontracts to small business concerns) exceeds $700,000 ($1.5 million for construction of any public facility), the subcontractor must include 52.219-8 in lower tier subcontracts that offer subcontracting opportunities.

(iii) 52.222-17, Nondisplacement of Qualified Workers (May 2014) (E.O. 13495).

Flow down required in accordance with paragraph (1) of FAR clause 52.222-17.

(iv) 52.222-21, Prohibition of Segregated Facilities (Apr 2015).

(v) 52.222-26, Equal Opportunity (Apr 2015) (E.O. 11246).

(vi) 52.222-35, Equal Opportunity for Veterans (Oct 2015) (38 U.S.C. 4212).

(vii) 52.222-36, Equal Opportunity for Workers with Disabilities (Jul 2014) (29 U.S.C. 793).

(viii) 52.222-37, Employment Reports on Veterans (Feb 2016) (38 U.S.C. 4212).

(ix) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (Dec 2010) (E.O. 13496). Flow down required in accordance with paragraph (f) of FAR clause 52.222-40.

(x) 52.222-41, Service Contract Labor Standards (May 2014), (41 U.S.C. chapter 67).

(xi) _X (A) 52.222-50, Combating Trafficking in Persons (Mar 2015) (22 U.S.C. chapter 78 and E.O. 13627).

(B) Alternate I (Mar 2015) of 52.222-50 (22 U.S.C. chapter 78 E.O.

13627).

(xii) 52.222-51, Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements (May 2014) (41 U.S.C. chapter 67.)

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(xiii) 52.222-53, Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services--Requirements (May 2014) (41 U.S.C. chapter 67)

(xiv) 52.222-54, Employment Eligibility Verification (Oct 2015) (E. O. 12989).

(xv) 52.222-55, Minimum Wages Under Executive Order 13658 (Dec 2015).

(xvi) 52.225-26, Contractors Performing Private Security Functions Outside the United States (Jul 2013) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 U.S.C. 2302 Note).

(xvii) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations.

(May 2014) (42 U.S.C. 1792). Flow down required in accordance with paragraph

(e) of FAR clause 52.226-6.

(xviii) 52.247-64, Preference for Privately-Owned U.S. Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx 1241(b) and 10 U.S.C. 2631). Flow down required in accordance with paragraph (d) of FAR clause 52.247-64.

(2) While not required, the Contractor may include in its subcontracts for commercial items a minimal number of additional clauses necessary to satisfy its contractual obligations.

(End of Clause)

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TABLE OF CONTENTS

STATEMENT OF WORK

NOTICE OF NON-EMPLOYEE IDENTITY SYSTEM REQUIREMENT (NEIS)

NEIS PII SHEET

WAGE DETERMINATION

WORKMAN’S COMP INFO

FIRE REQUIREMENTS

PAST PERFORMANCE QUESTIONNAIRE

PAST PERFORMANCE REFERENCES

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JANITORIAL SERVICES - COUNCIL RANGER DISTRICT

PAYETTE NATIONAL FOREST

I. GENERAL REQUIREMENTS

A. SCOPE OF CONTRACT

It is the purpose of this contract to secure janitorial services at the Forest Service office located in Council, Idaho. The Contractor shall furnish all labor, equipment, supervision, transportation, supplies (except those designated as Government-furnished), and incidentals to perform all work necessary as specified herein.

B. LOCATION AND DESCRIPTION

The following is a list of building locations:

Council Ranger District – 2092 Highway 95 Council Ranger District Fitness Ctr. - 500 E. Whitely Ave., Building #1323 Council Community Visitor Center - Corner of E. Whitely Ave. and Highway 95

Additional information pertinent to each building is contained in this package after general and special requirements.

C. GOVERNMENT FURNISHED PROPERTY

The Government shall deliver to the Contractor the following materials, supplies, property, or services (hereinafter referred to as "Government-furnished property"). The Contractor shall be liable for all loss or damage of such delivered Government-furnished property until completion and final acceptance of work required under this contract. If the Government fails to make timely delivery of such Government-furnished property suitable for its intended use, and upon written request from the Contractor, the Contracting Officer shall make an equitable adjustment of contract delivery or performance dates or contract price, or both, pursuant to the "Changes" Clause of the contract.

The Government shall supply all paper towels, toilet tissue, trash can liners, trash bags, liquid soap for dispensers and provide storage space for all Contractor's materials and equipment required on the job.

The Government shall also supply all necessary electricity and water needed for the Contractor's performance on the job.

One building key, janitorial closet key, and paper product dispenser keys will also be furnished for each building.

D. DELIVERIES OR PERFORMANCE

The period of performance is from March 1, 2017, through February 28, 2022.

The contract period shall be for a 12-month period beginning March 1, 2017; however, at the option of the Government, the contract may be renewed for additional one-year periods, not to exceed four renewal periods, at the quoted terms and same conditions. The Government will notify the Contractor of its intent to renew not less than 60 calendar days prior to the expiration of the current contract period. Subsequent one-year renewal periods will begin March 1 and end February 28.

EVALUATION OF OPTIONS (JUL 1990)

Except when it is determined in accordance with FAR 17.206(b) not to be in the Government’s best interests, the Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basis requirement.

Evaluation of options will not obligate the Government to exercise the options(s).

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II. SPECIAL CONTRACT REQUIREMENTS

A. GENERAL

Quality cleaning will be required, including full performance of all specified daily services on the first official working day of the contract.

The Contractor shall submit a list of all persons employed under the contract. This list will include individual tours of duty (such as 5:30 p.m. - 12:00 Midnight) and scheduled work assignments, including days of the week by building.

A fully qualified force shall be maintained throughout the contract period. All personnel will receive close and continuing first-line supervision.

The Contractor shall see that every new employee shows to Forest Service designated personnel, personal identification (i.e., driver's license, social security card, etc.) prior to start of work. If an employee is found to be unsuitable, and dismissed from duty, that employee will not be permitted to enter the buildings.

The Contractor shall prohibit employees from disturbing papers on desks, opening desk drawers or cabinets, or using telephone or office equipment designated for official Government use only.

The Contractor shall require employees to comply with the instruction pertaining to conduct and building regulations issued by duly appointed officials.

The Contractor shall service all restrooms to maximum capacity during the last contract day. Dispenser stock of paper supplies and hand soap remaining at end of contract period shall not be removed.

B. SCHEDULE OF WORK

To facilitate contract administration and inspection by designated Representatives:

The Contractor will be required, five days after the contract starting date, to submit the name, location, and availability of his/her representatives.

The Contractor shall meet with the Contracting Officer and/or designated Representative, prior to commencement of work, for the purpose of reviewing the work requirements and cleaning methods proposed by the Contractor. Cleaning supplies and equipment must be pre-approved by the Contracting Officer and/or designated Representative.

The Contractor will be required to submit the following information within five days after contract start date:

- A plan containing the layout of all daily cleaning assignments, including policing, and

- An annual schedule of all periodic cleaning by dates and areas.

This information shall be kept current and shall be displayed in a location where it may be readily observed and checked.

The Contractor shall keep the Government provided storage space for bulk supplies and equipment in a neat and orderly condition.

Failure to keep any of the storage areas in a clean condition may result in the withdrawal of the privilege of using them, or the Contracting Officer may have them cleaned and deduct the cost from Contractor's payment.

The Government will not be responsible for damage to the Contractor's stored supplies, materials, equipment, or the Contractor's employees' personal belongings brought into the buildings.

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C. PAYMENT

Payment shall be made monthly upon submission of an invoice for services performed. All invoices shall be submitted as instructed by the Contracting Officer.

III. ADDITIONAL INFORMATION - ALL BUILDINGS CLEANING REQUIREMENTS

A. FLOOR MAINTENANCE

1. General: For all operations where furniture and equipment must be moved, no chairs, wastepaper baskets, or other similar items shall be stacked on desks, tables, or window sills. Upon completion of work, all furniture and equipment must be returned to its original position.

2. Baseboards, walls, furniture, and equipment shall in no way be splashed, disfigured, or damaged during cleaning operations.

3. Contractor will insure that the quarterly waxing of non-carpeted floors maintains its luster until the next waxing. Black scuff marks shall be lifted from non-carpeted floors with each cleaning.

B. CARPET MAINTENANCE

The rug or carpet area is to be vacuumed to remove surface dirt, dust, and litter. (Surface dirt referred to is any visible foreign matter found on the floor, rug, or carpet surface.) Soiled areas will be spot cleaned.

C. MISCELLANEOUS

1. Toilets. Special attention shall be given to floors around urinals and commodes for disinfecting and elimination of odors and stains and to provide a uniformly clean appearance throughout.

2. Showers. Floors and stalls shall be cleaned and disinfected to eliminate bacteria buildup, soap and mineral buildup and odors. Shower mats shall be cleaned and disinfected weekly.

3. Dusting. Dust shall not be removed from spot to spot, but removed directly from the areas in which it lies by the most effective means - appropriately treated dusting cloths, vacuum tools, etc. When doing high cleaning, dust shall not be allowed to fall from high areas onto furniture and equipment below. The following conditions shall exist after the completion of each dusting task:

a. There shall be no dust streaks.

b. Corners, crevices, molding, and ledges shall be free of all dust and cobwebs.

c. There shall be no oils, spots, or smudges on dusted surfaces caused by dusting tools.

4. Damp-wiping. This task consists of using a clean damp cloth or sponge to remove all dirt, spots, streaks, and smudges from walls, glass, and other specified surfaces and then drying to provide a polished appearance. The wetting solution shall contain an appropriate cleaning agent. When damp-wiping in toilet areas, a multi-purpose (disinfectant-deodorizing) cleaner shall be used.

5. Bright Metal Polishing. Bright metal polishing may be performed by damp-wiping and drying with a suitable cloth if a polished appearance is to be obtained; however, if a polished appearance cannot be produced, the Contracting Officer's Representative shall be contacted for direction as to use of an appropriate metal polish.

6. Policing. This requirement includes performance of the following tasks at the stated frequencies:

a. Picking up and removing from inside the building all paper, trash, empty bottles, and other discarded materials.

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b. Picking up and removing from areas inside the building wads of gum, spots of tar, and other foreign substances.

c. Tidying up drinking fountains and glass surfaces, mopping up wet areas caused by spillages, accidents, and inclement weather.

7. Porcelain Cleaning. Porcelain fixtures (drinking fountains, wash basins, urinals, toilets, etc.) shall be clean and bright.

There shall be no dust, spots, stains, rust, green mold, encrustation, or excess moisture.

a. Walls and floors adjacent to fixtures shall be free of spots, drippings, and water marks.

b. Drinking fountains shall be kept clean, disinfected, and free of trash, ink, coffee grounds, etc., and nozzles free from encrustations.

8. Spot Cleaning. Following this cleanup operation, smudges, marks, or spots shall be removed from the designated areas without causing unsightly discoloration.

IV. CONTRACT REQUIREMENTS

A. COUNCIL RANGER DISTRICT OFFICE

This is a one-story building which was built in 2006. The building consists of approximately 9,995 square feet, of which approximately 7,800 square feet is carpeted. There are three entrances.

All services will be performed twice weekly (Wednesday and Week-end) from October 1 through May 31 and September 1 through 30; and three times weekly (Tuesday, Thursday, and Week-end) from June 1 through August 31.

1. EACH WORK DAY:

a. Restrooms

*Floors shall be swept and wet-mopped or scrubbed utilizing a cleaner-disinfectant. The floors shall be clean and free of dirt, water streaks, mop marks, string, gum, grease, tar, etc., and present an overall appearance of cleanliness. All surfaces shall be dry and the corners clean.

*Water closets, seats, and urinals shall be washed and sanitized utilizing a cleaner-disinfectant; seats shall be left in a raised position. Fixtures and metal surfaces shall be clean and bright; there shall be no dust, spots, stains, rust, encrustation, excess moisture, or water rings.

*Traps shall be maintained free from odor at all times

*All washbasins shall be thoroughly cleaned.

*Showers shall be cleaned and disinfected.

*All mirrors, shelving, dispensers, chromium fixtures, and piping shall be damp-wiped and polished dry.

*Window sills, ledges, grills and stall partitions shall be dusted.

*Countertops shall be damp wiped and sanitized.

*Wall surfaces, doors, window frames, sills, and waste receptacles shall be spot cleaned, removing smudges, marks, or spots without causing unsightly discoloration.

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*Paper towel waste receptacles shall be emptied prior to the building occupants' official starting time.

*Toilet paper, towel, and other dispensers shall be damp cleaned and polished.

*Paper towels, hand soap, and toilet paper dispensers shall be filled. Soap dispensers shall be maintained in an operative condition at all times.

*Floor drains, where applicable, shall be disinfected.

b. Entrances, Lobbies, and Corridors

Floors shall be vacuumed as specified under Floor Maintenance. Window sills will be cleaned as necessary or weekly. All surfaces within approximately 70 inches from the floor shall be dusted; metal and wood surfaces polished; walls spot cleaned;

and glass surfaces cleared of smudges, fingerprints, water spots, etc.

c. Floor Maintenance

Main corridors, entrances, lobbies, conference rooms, offices, and work areas will be vacuumed. Carpets will be spot cleaned on a daily basis.

d. Disposal Service

Waste contained in all wastepaper baskets or items marked "trash" shall be emptied. Trash shall be deposited in the dumpster as identified by COR. Plastic liners will be used in all trash receptacles.

e. Dusting

Furniture, equipment, ledges, window sills shall be dusted. Countertops and tables in reception area, mail/copy room, conference room, offices, and work areas will be damp wiped to remove dust, coffee rings, smudges, etc.

2. MONTHLY SERVICES

a. Restrooms

The full surface area of all stall partitions, doors, window frames, walls, and sills shall be thoroughly damp-wiped once on last work day of every month utilizing a multipurpose (disinfectant-deodorizer) cleaner. All dirt, dust, water stains, spots, streaks, and smudges shall be removed from the surfaces.

b. All wastepaper receptacles shall be damp-wiped inside and out utilizing a cleaner-disinfectant.

c. Damp mop all non-carpeted floors using neutral cleanser in proper solution to remove dirt without disturbing waxed surface.

Buff to restore luster of wax.

d. All telephones shall be wiped down and disinfected to eliminate germs.

e. Vacuum all fabric chairs and spot clean where necessary.

3. QUARTERLY SERVICES - December, March, June, September

a. Thoroughly scrub all tile and linoleum covered floors and rewax and buff. There shall be no evidence of gum, rust, or scuff marks. There shall be no buildup in corners or crevices. Walls, baseboards, and other surfaces shall be free of finish residue.

Floors shall be free of streaks, mop strand marks, and skipped areas.

b. Carpeted entrances, lobbies, and corridors will be shampooed quarterly.

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4. SEMI-ANNUALLY - May, October

a. Dust venetian blinds, walls, overhead pipes, air vents, molding, doors, door jams, etc., that must be reached by ladder.

b. Wash windows inside and out.

5. ANNUALLY - July

a. Wash screens on all windows.

b. Wash light covers inside and out.

6. MISCELLANEOUS DUTIES

a. Area around entrances and walkways shall be picked up to remove papers, cigarette butts, trash, and discarded material on a monthly basis.

b. During nonwinter seasons, sidewalks and entrance ways outside of buildings will be cleared of dirt, dust, leaves, and debris at end of shift.

B. COUNCIL RANGER DISTRICT FITNESS CENTER

This building (#1323) is located in the Forest Service Compound west of the office building on E. Whitely Ave. The area to be cleaned is at the south end of the building and consists of two restrooms with water closets, lavatories, and shower facilities and approximately 300 square feet of vinyl-covered flooring and 300 square feet of carpeting.

All services will be provided twice weekly (Wednesday and Week-ends) from October 1 through May 31 and September 1 through 30; and three times weekly (Tuesday, Thursday, and Week-ends) from June 1 through August 31.

1. EACH WORK DAY

a. Sweep, wet mop, and scrub all floors utilizing a cleaner-disinfectant. The floors shall be clean and free of dirt, water streaks, mop marks, string, gum, grease, tar, scuff marks, etc., and present an overall appearance of cleanliness. All surfaces shall be dry and the corners clean.

b. Wash basins shall be thoroughly cleaned.

c. Water closets, seats, and urinals shall be washed and sanitized utilizing a cleaner-disinfectant; seats shall be left in a raised position. Fixtures and metal surfaces shall be clean and bright; there shall be no dust, spots, stains, rust, encrustation, excess moisture, or water rings.

d. Showers shall be washed and sanitized to prevent mildew and bacteria buildup.

e. Fitness equipment shall be wiped down and disinfected to avoid dust buildup and eliminate germs.

f. Drinking fountain shall be kept clean, disinfected, and free of trash, ink, water spots, etc., and nozzles free from encrustations.

g. Counter/table tops shall be damp wiped and sanitized.

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2. MONTHLY

a. Shower curtains shall be cleaned and disinfected.

b. Matted area is to be cleaned to remove surface dirt, dust, and litter. (Surface dirt referred to is any visible foreign matter.) Soiled areas will be spot cleaned.

c. Fitness equipment will be cleaned to remove surface dirt, dust, and litter.

3. QUARTERLY SERVICES - December, March, June, September

a. Thoroughly scrub all tile and linoleum covered floors and rewax and buff. There shall be no evidence of gum, rust, or scuff marks. There shall be no buildup in corners or crevices. Walls, baseboards, and other surfaces shall be free of finish residue.

Floors shall be free of streaks, mop strand marks, and skipped areas.

4. SEMI-ANNUALLY - May, October

a. Clean outside windows.

b. Spot clean walls to remove smudges, marks, or spots without causing unsightly discoloration.

5. ANNUALLY - July

a. Wash screens on all windows.

b. Wash light covers inside and out.

C. COUNCIL COMMUNITY VISITOR CENTER

This building is located on the corner of E. Whitely Ave. and Highway 95. The areas to be cleaned are the restrooms, which are approximately 72 square feet each and consist of a water closet, lavatory, and basin; Visitor Center main office; and the dispatch office located on the right at the east end of the hallway. Countertops shall be damp wiped and sanitized.

All services will be provided twice weekly (Wednesday and Week-ends) from October 1 to May 30 and Sept 1 to 30; and three times weekly (Tuesday, Thursday, and Week-ends) from June 1 through August 31.

1. EACH WORK DAY

a. Sweep, wet mop, and scrub all floors utilizing a cleaner- disinfectant. The floors shall be clean and free of dirt, water streaks, mop marks, string, gum, grease, tar, scuff marks, etc., and present an overall appearance of cleanliness. All surfaces shall be dry and the corners clean.

b. Wash basins shall be thoroughly cleaned.

c. Water closets, seats, and urinals shall be washed and sanitized utilizing a cleaner-disinfectant; seats shall be left in a raised position. Fixtures and metal surfaces shall be clean and bright; there shall be no dust, spots, stains, rust, encrustation, excess moisture, or water rings.

d. Waste contained in all wastepaper baskets or items marked "trash" shall be emptied. Trash shall be deposited in the dumpster as identified by COR. Plastic liners will be used in all trash receptacles.

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e. Furniture shall be dusted to avoid buildup.

f. Fitness equipment shall be wiped down and disinfected to avoid dust buildup and eliminate germs.

2. MONTHLY

Vacuum/dust all chairs and spot clean as necessary.

3. QUARTERLY SERVICES - December, March, June, September

a. Thoroughly scrub all tile and linoleum covered floors and rewax and buff. There shall be no evidence of gum, rust, or scuff marks. There shall be no buildup in corners or crevices. Walls, baseboards, and other surfaces shall be free of finish residue.

Floors shall be free of streaks, mop strand marks, and skipped areas.

4. SEMI-ANNUALLY - May, October

a. Dust venetian blinds, walls, overhead pipes, air vents, molding, doors, door jams, etc., that must be reached by ladder.

b. Wash windows inside and out.

5. ANNUALLY - July

a. Wash screens on all windows.

b. Wash light covers inside and out.

D. MISCELLANEOUS DUTIES - ALL BUILDINGS

In addition to the work specified above, the following additional duties shall be performed in conjunction with the cleaning operation:

1. Closing windows, turning off lights and fans when not in use.

2. Insuring that the building is locked and secured after completion of work.

3. Notify COR of any leaks, questionable odors, potential maintenance problems, and any unusual situations.

4. Notify COR when government-furnished supplies are low, giving ample notice to restock without running out.

5. Janitorial services are to be performed after 5:30 p.m. or as agreed upon with the COR for a minimum disturbance to employees during working hours. Services performed on Sunday or holidays may be scheduled during convenient hours for the Contractor.

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Notice of Non – Employee Identity System (NEIS) Requirement

In accordance with the Homeland Security Presidential Directive 12 (HSPD-12) contractors who meet one of three criteria may need a LincPass to access USDA systems and/or facilities. It has been determined performing services under this contract meets the terms of one of the criteria, which is:

“Applicant requires unescorted access in MC (Mission Critical) or NCR (National Capital Region) areas (or as determined by particular agency’s local risk assessment)”

More information on the HSPD-12 can be found at: http://hspd12.usda.gov/about.html

This following is standard protocol of the Homeland Security/USDA HSPD–12 Information specifications for all employees, Federal and Non-Federal, prior being authorized access and entrance of Federal buildings before and after business hours and access to Federal computers.

This contract requires the contractor to work unescorted in this agencies, U.S. Forest Service, buildings and/or other facilities. The normal work hours for this contract are designated in the Statement of Work.

Therefore the contractor and contractor personnel will have to comply with the following steps upon notification of award:

(a) The Contractor will contact the Contracting Officer (CO) or NEIS Sponsor, Diana Early at 208-373-4134 to inform them of the city/address where the personnel who will perform on the contract are located to determine the closest PII station. This will give the contractor information for evaluation of costs involved obtaining access permission.

(b) The Contractor and all personnel shall be required to apply for and go through the NEIS LincPass interview and assignment of badge.

(c) The Contractor is required to fill out a PII Form (Personal Identification Information) for all employees’ assigned to this contract. See attached sample of the PII Form is attached for informational purposes only, unless notified of award. The Contractor should consider contingencies during this process, as alternates who normally would not work in the facility might need a pass in case of an illness or other absence

(d) After PII Forms are forwarded to the NEIS Sponsor each individual will be prompted via email, for an interview appointment with the LincPass station personnel. It will be the Contractors responsibility to travel to the closest PII station from their work location for an interview. This could be anywhere from five miles to two hundred miles of travel and time.

(e) Once the interview is complete the employee will return without the LincPass. Within four

(4) to six (6) weeks the employee will be notified through e-mail that their LincPass has been

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(f) It is then the responsibility of the Contractor and all employees to keep this card safe.

(g) During the term of contract if any employee is suspended, laid off, or terminated it is the Contractor’s responsibility to inform the CO the same day actions is taken. Retrieval of LincPass card should also be the same day, but card shall be relinquished to the CO within two (2) weeks.

In the case of a suspension due to an illness which will last more than three (3) weeks, notify the CO, NEIS Sponsor, or CO Designee (COR, etc.) and retrieve the LincPass. When the employee returns to work, immediately notify the CO, NEIS Sponsor, or CO Designee (COR, etc.) for reinstatement in the system.

(h) Cards are not personal property, but are the property of the Federal Agency. At completion of the contract, through expiration or termination all cards issued will be relinquished to the CO, NEIS Sponsor, or CO Designee (COR, etc.).

(i) For return of LincPasses being relinquished they can be done in the following ways:

a. Through the mail, they are required to be accomplished through Certified Mail – Return Receipt Requested.

b. In person to the CO, NEIS Sponsor, or CO Designee (COR, etc.). When doing it in this manner, be sure to get a signed receipt.

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NEIS PII SHEET

The Contracting Officer Representative (COTR)/Program Manager for one of your organization's Federal government contracts/agreements has determined by agency Risk Assessment that a performing contractor on the contract requires a LincPass. The information collected on this Personal Identity Information (PII) sheet is required for LincPass sponsorship. This information is to be collected and transmitted in accordance with The Privacy Act of 1974. For details on the Privacy Act of 1974, visit this website: http://www.usdoj.gov/oip/.

Instructions: Enter the information below for the applicant. Enter the applicant's complete name and address as it appears on their government-issued ID, such as a driver’s license or passport. If the information doesn’t match, the non-employee will encounter problems during the enrollment process and may have to reapply.

All fields are required to be completed Name:

First, Middle (if any), Last, Suffix (if any).

Use what it looks like on your state ID or passport!

Social Security Number Date of Birth (mm/dd/yyyy)

Gender Existing Background Investigation?

Yes/No/Don’t Know. If yes, enter the agency that conducted the investigation (e.g. USDA, Treasury, etc).

Government Employee (which agency?)

Email Address (business email preferred) This is required for enrolment notification. If the applicant does not have a business email address, enter the address of the person who will manage enrolment activities, e.g.

Security Officer or Supervisor.

Country of Citizenship Non-Employee Type:

Select one: Contractor, Volunteer, Intern, Fellow, or Affiliate Work Phone Federal Emergency Response Official:

Yes/No. If yes, explain the applicant’s designation, e.g., “Continuity Coordinator.”

Note:…