Schedule_of_Items_Experience_Questionnaire_Biobased_Product_Certification.pdf

Solicitation Number AG-03R6-S-17-0045 Flathead National Forest

Supervisor’s Office and Hungry Horse Ranger Station Janitorial Services

SCHEDULE OF ITEMS

Janitorial Services for the Flathead National Forest Hungry Horse Ranger District Administration

Building

Base Year

May 1, 2017 – April 30, 2018

Item

No.

Description Unit Quantity Unit Price Amount

1 General Daily, Weekly, &

Monthly Janitorial Services for the Flathead National Forest

Hungry Horse Ranger District

Administrative Building.

Month 12

2 Services to be paid on a Quarterly basis

2 Clean Light Fixtures

Per

Time

3 Services to be paid on a Biannual basis

3a Window Cleaning/Blinds Per

Time

3b Carpet Cleaning Per

Time

4 Services to be paid on an Annual basis

4a Tile Floor Cleaning

4b Vinyl Floor Cleaning

Total Items 1-4 Total

Solicitation Number AG-03R6-S-17-0045 Flathead National Forest

Option Period 1:May 1, 2018 – April 30, 2019

Item

No.

Description Unit Quantity Unit Price Amount

1 General Daily, Weekly, &

Monthly Janitorial Services for the Flathead National Forest

Hungry Horse Ranger District

Administrative Building.

3 Services to be paid on a Biannual basis

3a Window Cleaning/Blinds Per

Time

3b Carpet Cleaning Per

Time

4 Services to be paid on an Annual basis

4a Tile Floor Cleaning

4b Vinyl Floor Cleaning

Total Items 1-4 TOTAL

Solicitation Number AG-03R6-S-17-0045 Flathead National Forest

Option Period 2: May 1, 2019 – April 30, 2020

TOTAL OF QUOTE FOR BASE PLUS OPTION YEARS $______________

Contractor’s Name: ________________________________________

Address: ________________________________________________

Phone Number: ___________________________________________

Email: __________________________________________________

DUNS Number: __________________________________________

To be considered for award your quote must include the following: Quote submitted on the attached Schedule of Items, Proof of registration in SAM, Experience Questionnaire, Biobased certification, and a site specific Quality Control Plan. Please round your quote to the nearest dollar.

Item

No.

Description Unit Quantity Unit Price Amount

1 General Daily, Weekly, &

Monthly Janitorial Services for the Flathead National Forest

Hungry Horse Ranger District

Administrative Building.

3 Services to be paid on a Biannual basis

3a Window Cleaning/Blinds Per

Time

3b Carpet Cleaning Per

Time

4 Services to be paid on an Annual basis

4a Tile Floor Cleaning Per

Time

4b Vinyl Floor Cleaning Per

Total Items 1-4 TOTAL

Solicitation Number AG-03R6-S-17-0045 Flathead National Forest

USDA Forest Service

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 11, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.

1. Contractor Name, Address, and Telephone Number

2. Submitted to (Office Name and Address)

3. Business [ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual [ ] Non-profit Organization

4. How many years do you or your firm have in the line of work contemplated by this solicitation?

5. How many years experience have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?

6. List below the projects your business has completed within the last three years:

Contract Amount

Type of Project Date Completed

Name, Address, and Telephone No. of Owner/Person to Contact for Project Information

7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

Number

Dollar Amt.

of Award

Name, Address, and Telephone No. of Business/Government Agency Involved

Awarded (Units)

Percent Completed

Date

Complete

8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No 8b. Has work ever been completed by performance bond? [ ] Yes [ ] No 8c. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:

Solicitation Number AG-03R6-S-17-0045 Flathead National Forest

EXPERIENCE QUESTIONNAIRE CONTINUED

9. Employees and equipment that will be available for this project:

a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____

b. Are employees regularly on your payroll: [ ] Yes [ ] No

c. Specify equipment available for this contract:______________________________________________________

d. Estimate rate of progress below (such as 2.0 acres/man/day):

(1) Minimum progress rate:________________ and (2) Maximum progress rate: _________________________

10. List below the experience of the principal individuals of your business. (Who will directly be involved in this contract?)

Individual’s Name Present Position Years of Experience

Magnitude and Type of Work

11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO

SUCCESSFULLY COMPLETE THIS PROJECT.

CERTIFICATION

I certify that all of the statements made by me are complete and correct to the best of my knowledge, and that any persons named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.

12a. CERTIFYING OFFICIAL’S NAME AND TITLE

b. SIGNATURE (Sign in ink) 13. DATE

Solicitation Number AG-03R6-S-17-0045 Flathead National Forest

52.223-1, Biobased Product Certification

The Contractor shall execute the following certification required by the Farm Security and Rural Investment Act of 2002 (7 U.S.C. 8102(c) (3) :

I, ____________(name of certifier), am an officer or employee responsible for the performance of this contract and I hereby certify that biobased products (within categories of products listed by the United States Department of Agriculture in 7 CFR part 2902, subpart B) to be used or delivered in the performance of the contract, other than biobased products that are not purchased by the officer as a direct result of this contract, will comply with the applicable specifications of other contractual requirements.

{Signature of the Officer or Employee}

{Typed Name of the Officer or Employee}

{Title}

{Name of Company, Firm, or Organization}

{Date}