G_-_Ouote_Return_Sheet.docx

SOLICITATION NO. AG-04GG-S-16-0016 - SUPPLY AND INSTALLATION OF PRECAST CONCRETE VAULT TOILET BUILDING.

QUOTE/RETURN SHEET

OFFEROR INFORMATION

AGAR 452.211-2 Equal Products Offered (NOV 1996) A. Offerors proposing to furnish an “equal” product, in accordance with the “Brand Name or Equal” provision of this solicitation, shall provide the following information for each offered “equal” product:

Contract Line Item Number (if any): _CLIN 1_ Brand name or Equal Product identified by the Government in this solicitation: __________ Offered Product Name: _______________________________________________________ Catalog Description or Part Number:_____________________________________________ Manufacturer's Name: ________________________________________________________ Manufacturer's Address: ______________________________________________________

WARRANTY: _____________________________________________________

DELIVERY TIME: __________________________________________________

B. Offerors are responsible for submitting all additional information on the above products necessary for the Contracting Officer to determine whether the product offered meets the “brand name or equal” product's salient characteristics listed in the solicitation.

The offeror/quoter represents and certifies that -- A. It [ ] is, [ ] is not a current Federal Government employee.

B. It [ ] is, [ ] is not a former USDA employee.

C. It [ ] is, [ ] is not a retired USDA employee. If retired, give date of retirement: _________.

D. It [ ] is, [ ] is not related by blood or marriage to a current Forest Service employee on the __________________ National Forest. If so, list employee's name and location: ________________________.

E. It [ ] is, [ ] is not substantially owned or controlled by a former USDA employee or retiree.

Taxpayer Identification What is your Taxpayer Identification Number? ______________________

Data Universal Numbering System (DUNS) Number Reference Clause 52.212-1, Instructions to Offerors – Commercial Items, paragraph (j). Quoter shall insert their DUNS number: ________________________________________

System for Award Management (SAM) Reference Central Contract Registration (FAR 212-1).

Have you registered in SAM and is your registration valid?

[ ] Yes [ ] No

Online Representations and Certifications Applications (ORCA) Reference clause FAR 52.212-3 (Apr 2016) - Offeror Representations and Certifications – Commercial Items, paragraph Annual Representation and Certifications.

Have you completed the Representations and Certifications in SAM? [ ] Yes [ ] No

AGAR 452.209-70 REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID DELINQUENT TAX LIABILITY OR A FELONY CONVICTION (DEVIATION 2012-01) ALTERNATE 1 (FEB 2012)

(a) Awards made under this solicitation are subject to the provisions contained in the Consolidated Appropriations Act, 2012 (P.L. No. 112-74), Division E, Sections 433 and 434 regarding corporate felony convictions and corporate federal tax delinquencies. To comply with these provisions, all offerors must complete paragraph (1) of this representation, and all corporate offerors also must complete paragraphs (2) and (3) of this representation.

(b) The Offeror represents that –

(1) The Offeror is [ ], is not [ ] (check one) an entity that has filed articles of incorporation in one of the fifty states, the District of Columbia, or the various territories of the United States including American Samoa, Federated States of Micronesia, Guam, Midway Islands, Northern Mariana Islands, Puerto Rico, Republic of Palau, Republic of the Marshall Islands, U.S. Virgin Islands. (Note that this includes both for-profit and non-profit organizations.)

If the Offeror checked “is” above, the Offeror must complete paragraphs (2) and (3) of the representation. If Offeror checked “is not” above, Offeror may leave the remainder of the representation blank.

(2) (i) The Offeror has [ ], has not [ ] (check one) been convicted of a felony criminal violation under Federal or State law in the 24 months preceding the date of offer.

(ii) Offeror has [ ], has not [ ] (check one) had any officer or agent of Offeror convicted of a felony criminal violation for actions taken on behalf of Offeror under Federal law in the 24 months preceding the date of offer.

(3) The Offeror does [ ], does not [ ] (check one) have any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability.

Alcohol and Controlled Substances Testing Programs A. Definitions.

“Alcohol and controlled substances testing programs” are employer-based programs required by the Federal Department of Transportation (DOT) to help prevent accidents and injuries resulting from the misuse of alcohol and controlled substances by drivers of commercial motor vehicles. Under the DOT rule establishing these programs, pre-employment, reasonable suspicion, random, post-accident, return-to-duty and follow-up testing using specified procedures are required.

“Commercial motor vehicle” is any vehicle that: (1) has a gross combination weight rating of 26,001 or more pounds inclusive of a towed unit with a gross vehicle weight rating of more than 10,000 pounds; or (2) has a gross vehicle weight rating of 26,001 or more pounds; or (3) is designed to transport 16 or more passengers, including the driver; or (4) is of any size and is used in the transportation of materials found to be hazardous for the purposes of the Hazardous Materials Transportation Act and which require the motor vehicle to be placarded under the Hazardous Materials Regulations.

“Consortium” means an entity, including a group or association of employers or contractors, that provides alcohol or controlled substances testing as required by DOT, and that acts on behalf of the employers.

“DOT” is the United States Department of Transportation who is responsible for administering regulations requiring alcohol and/or drug testing.

“Driver” means any person (including the United States, a State, District of Columbia or a political subdivision of a State) who owns or leases a commercial motor vehicle or assigns persons to operate such a vehicle. The term employer includes an employer's agents, officers and representatives.

“Employer” means any person (including the United States, a State, District of Columbia or a political subdivision of a State) who owns or leases a commercial motor vehicle or assigns persons to operate such a vehicle. The term employer includes an employer's agents, officers and representatives.

B. By submission of its offer, the offeror certifies and agrees that --

1. As an employer, it has implemented and continues to maintain an alcohol and controlled substances testing program in accordance with DOT requirements.

2. As an employer who uses, but does not employ, a driver more than once a year, it has assured itself once every six months that the driver participates in an alcohol and controlled substances testing program that meets DOT requirements.

3. As an employer who employs only himself/herself as a driver, it has implemented an alcohol and controlled substances testing program that includes more persons than himself/herself (e.g., a consortium) as covered employees in the random testing pool.