c.ReturnThisCopy.docx
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- Solicitation number
- AG-04M3-S-12-0039
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C. Return Packet
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|---|---|---|
| b.05-2569.txt | TXT text file | |
| a.AG-04M3-S-12-0039.rtf | RTF text file |
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REQUEST FOR QUOTATION
PAGE OF PAGES
| (THIS IS NOT AN ORDER) |
| THIS RFQ |
| X |
| IS |
| IS NOT A SMALL BUSINESS SET- ASIDE |
| 1 |
| 4 |
| 1. REQUEST NO. |
| 2. DATE ISSUED |
| 3. REQUISITION/PURCHASE REQUEST NO. |
| 4. CERT. FOR NAT.DEF. |
| RATING |
| AG-04M3-S-12-0039 |
| 8/21/2012 |
UNDER BDSA REG. 2
AND/OR DMS REG. 1
| 5a. ISSUED BY |
| 6. DELIVER BY (Date) |
Wallowa-Whitman National Forest 1550 Dewey Ave / P.O. Box 907 Baker City, OR 97814 See Section F
| 5b. FOR INFORMATION CALL (NO COLLECT CALLS) |
| 7. DELIVERY |
FOB DESTINATION
| NAME |
| TELEPHONE NUMBER |
| X |
| OTHER (See Schedule) |
Sue Domina, Contracting Officer
AREA CODE
| NUMBER |
| 9. DESTINATION |
| 541 |
| 523-1263 |
| a. NAME OF CONSIGNEE |
| 8. TO: |
| North Fork John Day Ranger District |
| a. NAME |
| b. COMPANY |
| b. STREET ADDRESS |
| c. STREET ADDRESS |
| c. CITY |
Ukiah
| d. CITY |
| e. STATE |
| f. ZIP CODE |
| d. STATE |
| e. ZIP CODE |
OR
| 10. PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5A ON OR BEFORE CLOSE OF BUSINESS |
| IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in BLOCK 5A. This request does not commit the Government to pay any costs incurred in the preparation of the |
| September 19, 2012 4:30 pm (PT) |
| submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter. |
11. SCHEDULE (Include applicable Federal, State and local taxes)
| ITEM NO. |
| SUPPLIES/SERVICES |
| QUANTITY |
| UNIT |
| UNIT PRICE |
| AMOUNT |
| (a) |
| (b) |
| (c) |
| (d) |
| (e) |
| (f) |
Umatilla National Forest Janitorial Services for the North Fork John Day Ranger District in Ukiah Oregon
This is 100% set-aside for Small Business.
| a. 10 CALENDAR DAYS (%) |
| b. 20 CALENDAR DAYS |
| c. 30 CALENDAR DAYS |
| d. CALENDAR DAYS |
12. DISCOUNT FOR PROMPT PAYMENT
| NUMBER |
| PERCENTAGE |
| NOTE: Additional provisions and representations |
| X |
| are |
are not attached.
| 13. NAME AND ADDRESS OF QUOTER |
| 14. SIGNATURE OF PERSON AUTHORIZED TO |
| 15. DATE OF |
| a. NAME OF QUOTER |
| SIGN QUOTATION |
| QUOTATION |
| b. STREET ADDRESS |
| 16. SIGNER |
| a. NAME (Type or print) |
| b. TELEPHONE |
c. COUNTY
AREA CODE
| d. CITY |
| e. STATE |
| f. ZIP CODE |
| c. TITLE (Type or Print) |
| NUMBER |
NSN 7540-01-152-8084
Previous edition not usable
| 18-121 |
| STANDARD FORM 18 (Rev. 6-95) |
Prescribed by GSA-FAR (48 CFR) 53.215-1(a)
RFQ Services Solicitation No. AG-04M3-S-12-0039 Project: Janitorial Services, Ukiah Oregon Unit: North Fork John Day Ranger District
RETURN THIS COPY
SECTION B - Supplies or Services and Prices/Costs Schedule of Items
ITEM NO.
DESCRIPTION
UNIT OF ISSUE
QTY.
UNIT
PRICE
TOTAL
AMOUNT
| Oct. 15, 2012 – Sept 30, 2013 |
| Month |
| 12 |
| $________ |
| $__________ |
| 2 |
| As Needed Basis – Emergency Cleaning |
| Each |
| 5 |
| $________ |
| $__________ |
Option 1
Oct. 1, 2013 – Sep. 30, 2014
Month
| A |
| As Needed Basis – Emergency Cleaning |
| Each |
| 5 |
| $________ |
| $__________ |
Option
Oct. 1, 2014 – Sep. 30, 2015
Month
| A |
| As Needed Basis – Emergency Cleaning |
| Each |
| 5 |
| $________ |
| $__________ |
Total Quote
SECTION K - Representations, Certifications, and Other Statements of Offerors
452.219-70 Size Standard and NAICS Code Information. (SEP 2001)
The North American Industrial Classification System Code(s) and business size standard(s) describing the products and/or services to be acquired under this solicitation are listed below:
Contract line item(s): All
- NAICS Code 561720
- Size Standard $16.5
NOTE: ALL offerors MUST be registered in the CCR Database and ORCA.
CONTRACTORS: DUNS NO. __________________________________
EMAIL: ___________________________________
52.223-1 Biobased Product Certification. (MAY 2012)
As required by the Farm Security and Rural Investment Act of 2002 and the Energy Policy Act of 2005 (7 U.S.C. 8102(c)(3)), the offeror certifies, by signing this offer, that biobased products (within categories of products listed by the United States Department of Agriculture in 7 CFR part 3201, subpart B) to be used or delivered in the performance of the contract, other than biobased products that are not purchased by the offeror as a direct result of this contract, will comply with the applicable specifications or other contractual requirements.
GOVERNMENT EMPLOYEES, FORMER USDA EMPLOYEES, AND USDA RETIREES
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 to a current Forest Service employee. If so, list employee's name and location. ____________________________________ |
| (e) | The firm |_| is, |_| is not substantially owned or controlled by a former USDA employee or retiree. |
AGAR 452.209 – 70 Representation by Corporations Regarding an Unpaid Delinquent Tax Liability or a Felony Conviction. (FEB 2012)(DEVIATION 2012-01)
(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.
______________________________________ Contractor Name
______________________________________Signature __________________Date
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