Offer-ReturnPacket.docx

REQUEST FOR QUOTATION

PAGE OF PAGES

AND/OR DMS REG. 1

Colville National Forest 765 South Main Colville, WA 99114 See Section F

Aaron Kretzer, Contracting Officer

Michelle Satterfield, Contracting Officer’s representative

AREA CODE

NUMBER

684-7134 (akretzer@fs.fed.us)

548-2578 (msatterfield@fs.fed.us)

9. DESTINATION

a. NAME OF CONSIGNEE

8. TO:

11. SCHEDULE (Include applicable Federal, State and local taxes)

12. DISCOUNT FOR PROMPT PAYMENT

c. COUNTY

AREA CODE

NSN 7540-01-152-8084

Previous edition not usable

Prescribed by GSA-FAR (48 CFR) 53.215-1(a)

USDA Forest Service

EXPERIENCE QUESTIONNAIRE

(Ref. FSH 6309.31 and 41 USC 11) Instructions: See Box 11, remarks, if extra space is needed to answer any of them below. Mark “X” in appropriate boxes.

1. CONTRACTOR NAME, ADDRESS AND TELEPHONE NUMBER

[ ] 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 in contracting have you or your business had as a (a) prime contractor_____ and/or (b) subcontractor_____

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

CONTRACT AMOUNT

TYPE OF PROJECT

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

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

* If “Yes” to either 8a or 8b specify location(s) and reason(s) why:

9. Organization and work that will be available for this project:

a. (1) Minimum number of employees______ and a (2) Maximum number of employees_______

b. Are employee regularly on you payroll: [ ] Yes [ ] No

c. Specify equipment available for this contract:_________________________________________________________________________

d. Estimated rate of progress below ( such as 20 acres/man/day):

(1) Minimum progress rate:___________ and (2) Maximum progress rate___________

10. List below the experience of the principle individuals of your business:

11. REMARKS - SPECIFY BOX NUMBERS

(Attach sheets if extra space is needed to fully answer any above questions:)

CERTIFICATION

12a. CERTIFYING OFFICAL’S NAME AND TITLE

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.

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.