Attachments_AG-3K25-S-17-0010.pdf

PDF 14 MB Posted Aug 21, 2017

Attached to: Fire Alarm Detection System Replacement at the National Agricultural Library (NAL) Beltsville, MD
Solicitation number: AG-3K25-S-17-0010
Issued by: Department of Agriculture Agricultural Research Service

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Attachments AG-3K25-S-17-0010

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AG-3K25-S-17-0010_Amd_000002.pdf	PDF	Sep 7, 2017
site_visit_attendees_8-28-17.pdf	PDF	Aug 30, 2017
Cover_Sheet_AG-3k25-S-17-0010_NAL_FIRE_SYSTEM_v3.docx	DOCX document	Aug 30, 2017
Sol_AG-3K25-S-17-0010_Amd_000001.pdf	PDF	Aug 30, 2017
Sol_AG-3K25-S-17-0010.pdf	PDF	Aug 21, 2017

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Administrator

D:20050417122542- 04'00'

D:20050426092953- 04'00'

U.S. DEPARTMENT OF AGRICULTURE • AGRICULTURAL RESEARCH SERVICE

IMPORTANT: Read instructions on reverse before completing this form.

DESCRIPTION OF BRANCH OF WORK

PROGRESS SCHEDULE

SCHEDULE OF PAYMENTS

(Use in conjunction with ARS Form 372)

Value

Percent of work

DATE

Completed this period

Previously Completed

Total Completed

Start

Complete

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

Following items to be used for Change Orders, Amendments, and other.

24.

25.

26.

27.

28.

29.

30.

31.

TOTAL

CONTRACT NO.

AMOUNT

STARTING DATE

COMPLETION DATE

PROJECT

LOCATION

CONTRACTOR'S NAME & ADDRESS (Include Zip code)

REMARKS

CONTRACTOR'S SIGNATURE

DATE

CONTRACTING OFFICER'S APPROVAL

DATE

Form ARS-371 (11/84) Previous edition may be used.

USDA-ARS

CONSTRUCTION PROGRESS AND PAYMENT SCHEDULE

CALENDAR DAYS

This form was electronically produced by USDA/ARS/OCIO/ADB.

INSTRUCTIONS FOR COMPLETION OF FORM ARS - 371

The construction Progress - Payment Schedule shall be submitted within 14 calendar days after the date of receipt of Notice to Proceed.

This form is required even though partial payments are not requested. If partial payments arerequested, a copy of the approved Form ARS-371 must accompany each Payment Request (FormARS-372), and Columns E, F, and G must be filled in according to the work completed.

Complete blocks entitled: Contract Number, Amount, Calendar Days, Starting Date, Completion Date, Project, Location, and Contractor's Name and Address.

Complete Column A, Value, indicating a complete breakdown of each branch of work in dollar value.

Complete Column B, Percent of Work, showing the percentage of each branch of work in relation to the whole project.

Complete Columns C and D to show the approximate dates each branch of work will begin and be completed. Final completion date in Column D must not exceed the completion date at the top of the form.

Contractor shall sign the form at the bottom and submit to the Contracting Officer for his approval. An approved copy will be returned to the Contractor for his file.

Form ARS-371 (Reverse) ffSignImage01:

ffSignImage02:

Enter starting date using format MM/DD/YYYY.:

Enter completion date using format MM/DD/YYYY.:

Date. C. Start. Line 1.:

D. Completed. Line 1.:

Date. C. Start. Line 2.:

D. Completed. Line 2.:

Date. C. Start. Line 3.:

D. Completed. Line 3.:

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Date. C. Start. Line 30.:

D. Completed. Line 30.:

Date. C. Start. Line 31.:

D. Completed. Line 31.:

Amount.:

Schedule of payments. E. Completed this period. Line 1.:

F. Previously completed. Line 1.:

G. Total completed. Line 1.:

Schedule of payments. E. Completed this period. Line 2.:

F. Previously completed. Line 2.:

G. Total completed. Line 2.:

Schedule of payments. E. Completed this period. Line 3.:

F. Previously completed. Line 3.:

G. Total completed. Line 3.:

Schedule of payments. E. Completed this period. Line 4.:

F. Previously completed. Line 4.:

G. Total completed. Line 4.:

Schedule of payments. E. Completed this period. Line 5.:

F. Previously completed. Line 5.:

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F. Previously completed. Line 8.:

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F. Previously completed. Line 10.:

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G. Total completed. Line 12.:

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F. Previously completed. Line 13.:

G. Total completed. Line 13.:

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F. Previously completed. Line 14.:

G. Total completed. Line 14.:

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G. Total completed. Line 24.:

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G. Total completed. Line 26.:

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F. Previously completed. Line 27.:

G. Total completed. Line 27.:

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F. Previously completed. Line 28.:

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F. Previously completed. Line 30.:

G. Total completed. Line 30.:

Schedule of payments. E. Completed this period. Line 31.:

F. Previously completed. Line 31.:

G. Total completed. Line 31.:

Total completed this period.:

Total previously completed.:

Total completed.:

Calendar days.:

Progress schedule. A. Value. Line 1.:

B. Percent of work. Line 1.:

Progress schedule. A. Value. Line 2.:

B. Percent of work. Line 2.:

Progress schedule. A. Value. Line 3.:

B. Percent of work. Line 3.:

Progress schedule. A. Value. Line 4.:

B. Percent of work. Line 4.:

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B. Percent of work. Line 5.:

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B. Percent of work. Line 6.:

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B. Percent of work. Line 9.:

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B. Percent of work. Line 10.:

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B. Percent of work. Line 14.:

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B. Percent of work. Line 20.:

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B. Percent of work. Line 21.:

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Progress schedule. A. Value. Line 30.:

B. Percent of work. Line 30.:

Progress schedule. A. Value. Line 31.:

B. Percent of work. Line 31.:

Total value.:

Total percent of work.:

Construction progress and payment schedule. Contract number.:

Project.:

Location.:

Contractor's name and address (Include zip code.):

Description of branch of work. Line 1.:

Description of branch of work. Line 2.:

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Description of branch of work. Line 30.:

Description of branch of work. Line 31.:

Remarks.:

Click to return to catalog:

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Administrator

D:20050417122932- 04'00'

D:20050426102902- 04'00'

CONTRACTOR'S REQUEST FOR PAYMENT TRANSMITTAL

CONTRACT NO.

PROJECT

LOCATION

PARTIAL PAYMENT NO.

REQUISITION NO.

FOR PERIOD BEGINNING

ENDING

FINAL PAYMENT

ITEM

AMOUNT

1. Amount of original contract

2. Change orders and/or amendments

3. Total adjusted contract prices

4. Value of work completed to end of period

5. Value of material stored at the site (Itemize below)

6. Total value of work completed and stored material (Line 4 plus Line 5).

8. Total due contractor thru end of this period

9. Less previous requests

10. Net amount due contractor this payment

7. Less

MATERIAL STORED AT THE SITE (See Item 5 above)

Description

Value

CONTRACTOR'S CERTIFICATION OF PAYMENT

By signing this request for payment, I certify that I have made payment from the proceeds of prior payments, and that I will make timely payment from the proceeds of this payment, of amounts due my subcontractors and suppliers in accordance with my contractual arrangements with them.

SIGNATURE OF CONTRACTOR'S AUTHORIZED REPRESENTATIVE

RECOMMENDED FOR PAYMENT (Signature of EPM, COR, CM or A.E. as ppropriate)

CONCUR (Signature of EPM or COR as appropriate)

DATE SIGNED

Form ARS-372 (11/84) Replaces SEA-372 (1/79) which may be used.

USDA-ARS

This form was electronically produced by USDA/ARS/OCIO/ADB.

% retainage ffSignImage01:

ffSignImage02:

ffSignImage03:

Check if Final payment.: 0

Enter date for period beginning using format MM/DD/YYYY.:

Enter date for period ending using format MM/DD/YYYY.:

Item. 1. Amount of original contract.:

Item 2. Change orders and / or amendments.:

Item 3. Total adjusted contract prices.:

Item 4. Value of work completed to end of period.:

Item 5. Value of material stored at the site (Itemize below).:

Item 6. Total value of work completed and stored material (Line 4 plus Line 5). Value of material stored at the site (Itemize below).:

Item 7. Enter Percent retainage.:

Item 7. Less indicated percentage retainage.:

Item 8. Total due contractor thru end of this period.:

Item 9. Less previous requests.:

Item 10. Net amount due contractor this payment.:

Value. Line 1.:

Value. Line 2.:

Value. Line 3.:

Value. Line 4.:

Value. Line 5.:

Value. Line 6.:

Value. Line 7.:

Value. Line 8.:

Value. Line 9.:

Value. Line 10.:

Value. Line 11.:

Value. Line 12.:

Value. Line 13.:

Value. Line 14.:

Value. Line 15.:

Value. Line 16.:

Value. Line 17.:

Value. Line 18.:

Contractor's request for payment transmittal. Enter contract number.:

Partial payment number.:

Project.:

Requisition number.:

Location.:

Description. Line 1.:

Description. Line 2.:

Description. Line 3.:

Description. Line 4.:

Description. Line 5.:

Description. Line 6.:

Description. Line 7.:

Description. Line 8.:

Description. Line 9.:

Description. Line 10.:

Description. Line 11.:

Description. Line 12.:

Description. Line 13.:

Description. Line 14.:

Description. Line 15.:

Description. Line 16.:

Description. Line 17.:

Description. Line 18.:

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UserName: Richard T Stevens sessioncookie: 5EE57F3651A194D0C1F8EF5FA8D8CE418134079C29C14B2CD15CD8E4CDB4B430D83001055FF352CB56C7192B7905F3646623C6608706C8D5BB97011F3B1FC56749B93A87D4249481 fscSubmitURL: https://reeforms.ars.usda.gov/REEForms/ffSubmitXFA.asp?id=5EE57F3651A194D0C1F8EF5FA8D8CE418134079C29C14B2CD15CD8E4CDB4B430D83001055FF352CB56C7192B7905F3646623C6608706C8D5BB97011F3B1FC56749B93A87D4249481

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General Decision Number: MD170058 08/18/2017 MD58

Superseded General Decision Number: MD20160058

State: Maryland

Construction Type: Building

County: Prince George's County in Maryland.

BUILDING CONSTRUCTION PROJECTS (does not include single family homes or apartments up to and including 4 stories).

Note: Under Executive Order (EO) 13658, an hourly minimum wage of $10.20 for calendar year 2017 applies to all contracts subject to the Davis-Bacon Act for which the contract is awarded (and any solicitation was issued) on or after January 1, 2015. If this contract is covered by the EO, the contractor must pay all workers in any classification listed on this wage determination at least $10.20 (or the applicable wage rate listed on this wage determination, if it is higher) for all hours spent performing on the contract in calendar year 2017.

The EO minimum wage rate will be adjusted annually. Additional information on contractor requirements and worker protections under the EO is available at www.dol.gov/whd/govcontracts.

Modification Number Publication Date 0 01/06/2017 1 01/13/2017 2 04/21/2017 3 05/05/2017 4 05/26/2017 5 06/09/2017 6 07/14/2017 7 07/21/2017 8 07/28/2017 9 08/18/2017

ASBE0024-007 10/01/2016

Rates Fringes

ASBESTOS WORKER/HEAT & FROST

INSULATOR........................$ 35.03 15.32

Includes the application of all insulating materials, protective coverings, coatings and finishes to all types of mechanical systems

ASBE0024-010 10/01/2016

ASBESTOS WORKER: HAZARDOUS

MATERIAL HANDLER (Removal of hazardous material from ceilings, floors, mechanical

8/21/2017https://www.wdol.gov/wdol/scafiles/davisbacon/MD58.dvb?v=9 systems, and walls)..............$ 22.36 6.79

BRMD0001-006 04/30/2017

TILE SETTER......................$ 27.44 11.44

BRMD0001-011 04/30/2017

BRICKLAYER (Excluding Pointing, Caulking and Cleaning)........................$ 30.91 10.24

BRMD0001-012 04/30/2017

MASON - STONE....................$ 36.91 16.55

BRMD0001-013 04/30/2017

TERRAZZO WORKER/SETTER...........$ 28.19 11.44

CARP0177-011 05/01/2017

CARPENTER (Including Acoustical Ceiling Installation, Drywall Hanging, Metal Stud Installation and Form Work)......$ 28.36 11.53

CARP0219-001 04/01/2016

MILLWRIGHT.......................$ 32.04 9.93

ELEC0026-021 09/05/2016

ELECTRICIAN (Communication and Sound Equipment).............$ 27.55 10.20

ELEC0026-022 06/05/2017

ELECTRICIAN (Including low voltage wiring for and installation of alarms, HVAC controls)........................$ 44.65 16.74+a a.PAID HOLIDAYS: New Year's Day, Inauguration Day, Martin Luther King Jr.'s Birthday, Memorial Day, Independence Day, Labor Day, Veterans' Day, Thanksgiving Day, the day after Thanksgiving Day and Christmas Day.

ELEV0010-001 01/01/2017

ELEVATOR MECHANIC................$ 42.79 31.585+a+b

a. PAID HOLIDAYS: New Year's Day, Memorial Day, Independence Day, Labor Day, Veterans' Day, Thanksgiving Day, Christmas Day and the Friday after Thanksgiving.

b. VACATIONS: Employer contributes 8% of basic hourly rate for 5 years or more of service; 6% of basic hourly rate for 6 months to 5 years of service as vacation pay credit.

ENGI0077-017 05/01/2013

POWER EQUIPMENT OPERATOR:

Backhoe.....................$ 32.40 8.45+a Bulldozer...................$ 31.65 8.45+a

a. PAID HOLIDAYS: New Year's Day, Inaugural Day, Decoration Day, Independence Day, Labor Day, Martin Luther King's Birthday, Veterans' Day, Thanksgiving Day, Friday after Thanksgiving and Christmas Day.

IRON0005-005 06/01/2016

IRONWORKER, STRUCTURAL AND

ORNAMENTAL.......................$ 30.85 19.435

IRON0201-006 05/01/2016

IRONWORKER, REINFORCING..........$ 27.90 19.13

LABO0657-021 06/01/2015

LABORER (Common or General)......$ 14.93 7.31 LABORER: Mason Tender - Cement/Concrete..................$ 22.63 7.31 LABORER: Pipelayer..............$ 22.63 7.31

PAIN0051-014 06/01/2017

GLAZIER

Glazing Contracts $2 million and under...........$ 25.74 11.55 Glazing Contracts over $2 million.....................$ 29.87 11.55

PAIN0051-019 06/01/2017

PAINTER

Brush, Roller, Spray and Drywall Finisher/Taper......$ 25.06 9.66 Industrial..................$ 30.90 10.49

PLAS0891-005 07/01/2016

PLASTERER........................$ 28.83 6.05

PLAS0891-006 02/01/2017

CEMENT MASON/CONCRETE FINISHER...$ 27.65 10.08

PLAS0891-008 08/01/2016

PLASTERER (Fireproofing Including Sprayer, Mixer, and Handler) Handler.....................$ 16.50 4.89 Mixer/Pump..................$ 18.50 4.89 Sprayer.....................$ 23.00 4.89

* PLUM0005-010 08/01/2017

PLUMBER..........................$ 41.67 17.60+a

a. PAID HOLIDAYS: Labor Day, Veterans' Day, Thanksgiving Day and the day after Thanksgiving, Christmas Day, New Year's Day, Martin Luther King's Birthday, Memorial Day and the Fourth of July.

* PLUM0602-011 08/01/2017

PIPEFITTER (Including HVAC Pipe and System Installation)....$ 40.69 21.07+a

a. PAID HOLIDAYS: New Year's Day, Martin Luther King's Birthday, Memorial Day, Independence Day, Labor Day, Veterans' Day, Thanksgiving Day and the day after Thanksgiving and Christmas Day.

ROOF0030-016 05/01/2016

ROOFER...........................$ 28.75 11.74

SFMD0669-001 04/01/2017

SPRINKLER FITTER (Fire Sprinklers)......................$ 34.40 19.24

SHEE0100-015 07/01/2017

SHEET METAL WORKER (Including HVAC Duct Installation)..........$ 40.27 18.74+a

a. PAID HOLIDAYS: New Year's Day, Martin Luther King's Birthday, Memorial Day, Independence Day, Labor Day, Veterans Day, Thanksgiving Day and Christmas Day

SUMD2010-092 08/04/2010

LABORER

Grade Checker...............$ 16.00 2.90 Landscape...................$ 9.23 0.00 Mason Tender - Brick........$ 13.28 2.95 Mason Tender - Stone........$ 14.03 0.00 Mason Tender for Pointing, Caulking and Cleaning.......$ 14.15 0.00 Mortar Mixer................$ 16.61 9.08

POINTER, CAULKER, CLEANER,

Includes pointing, caulking, cleaning of existing masonry, brick, stone and cement structures (restoration work); excludes pointing, caulking, cleaning of new or replacement masonry, brick, stone or cement...........................$ 19.14

POWER EQUIPMENT OPERATOR:

Asphalt Roller..............$ 21.35 5.38 Bobcat/Skid Loader..........$ 18.05 8.78 Boom........................$ 21.44 8.29 Crane.......................$ 20.95 6.18 Excavator...................$ 20.00 0.00 Forklift....................$ 16.00 5.12

Gradall.....................$ 20.50 8.42 Grader/Blade................$ 14.50 5.18 Loader......................$ 24.00 5.40 Paver.......................$ 17.47 6.36 Roller excluding Asphalt....$ 17.60 3.88

TILE FINISHER....................$ 17.87 7.32

TRUCK DRIVER

Dump Truck..................$ 15.90 1.12 Tractor Haul Truck..........$ 17.87 9.98

WELDERS - Receive rate prescribed for craft performing operation to which welding is incidental.

Note: Executive Order (EO) 13706, Establishing Paid Sick Leave for Federal Contractors applies to all contracts subject to the Davis-Bacon Act for which the contract is awarded (and any solicitation was issued) on or after January 1, 2017. If this contract is covered by the EO, the contractor must provide employees with 1 hour of paid sick leave for every 30 hours they work, up to 56 hours of paid sick leave each year.

Employees must be permitted to use paid sick leave for their own illness, injury or other health-related needs, including preventive care; to assist a family member (or person who is like family to the employee) who is ill, injured, or has other health-related needs, including preventive care; or for reasons resulting from, or to assist a family member (or person who is like family to the employee) who is a victim of, domestic violence, sexual assault, or stalking. Additional information on contractor requirements and worker protections under the EO is available at www.dol.gov/whd/govcontracts.

Unlisted classifications needed for work not included within the scope of the classifications listed may be added after award only as provided in the labor standards contract clauses (29CFR 5.5 (a) (1) (ii)).

The body of each wage determination lists the classification and wage rates that have been found to be prevailing for the cited type(s) of construction in the area covered by the wage determination. The classifications are listed in alphabetical order of "identifiers" that indicate whether the particular rate is a union rate (current union negotiated rate for local), a survey rate (weighted average rate) or a union average rate (weighted union average rate).

Union Rate Identifiers

A four letter classification abbreviation identifier enclosed in dotted lines beginning with characters other than "SU" or "UAVG" denotes that the union classification and rate were prevailing for that classification in the survey. Example:

PLUM0198-005 07/01/2014. PLUM is an abbreviation identifier of the union which prevailed in the survey for this classification, which in this example would be Plumbers. 0198 indicates the local union number or district council number where applicable, i.e., Plumbers Local 0198. The next number, 005 in the example, is an internal number used in processing the wage determination. 07/01/2014 is the effective date of the most current negotiated rate, which in this example is July 1, 2014.

Union prevailing wage rates are updated to reflect all rate changes in the collective bargaining agreement (CBA) governing this classification and rate.

Survey Rate Identifiers

Classifications listed under the "SU" identifier indicate that no one rate prevailed for this classification in the survey and the published rate is derived by computing a weighted average rate based on all the rates reported in the survey for that classification. As this weighted average rate includes all rates reported in the survey, it may include both union and non-union rates. Example: SULA2012-007 5/13/2014. SU indicates the rates are survey rates based on a weighted average calculation of rates and are not majority rates. LA indicates the State of Louisiana. 2012 is the year of survey on which these classifications and rates are based. The next number, 007 in the example, is an internal number used in producing the wage determination. 5/13/2014 indicates the survey completion date for the classifications and rates under that identifier.

Survey wage rates are not updated and remain in effect until a new survey is conducted.

Union Average Rate Identifiers

Classification(s) listed under the UAVG identifier indicate that no single majority rate prevailed for those classifications; however, 100% of the data reported for the classifications was union data. EXAMPLE: UAVG-OH-0010 08/29/2014. UAVG indicates that the rate is a weighted union average rate. OH indicates the state. The next number, 0010 in the example, is an internal number used in producing the wage determination. 08/29/2014 indicates the survey completion date for the classifications and rates under that identifier.

A UAVG rate will be updated once a year, usually in January of each year, to reflect a weighted average of the current negotiated/CBA rate of the union locals from which the rate is based.

WAGE DETERMINATION APPEALS PROCESS

1.) Has there been an initial decision in the matter? This can be:

* an existing published wage determination

* a survey underlying a wage determination

* a Wage and Hour Division letter setting forth a position on a wage determination matter

* a conformance (additional classification and rate) ruling

On survey related matters, initial contact, including requests for summaries of surveys, should be with the Wage and Hour Regional Office for the area in which the survey was conducted because those Regional Offices have responsibility for the Davis-Bacon survey program. If the response from this initial contact is not satisfactory, then the process described in 2.)

and 3.) should be followed.

With regard to any other matter not yet ripe for the formal process described here, initial contact should be with the Branch of Construction Wage Determinations. Write to:

Branch of Construction Wage Determinations Wage and Hour Division U.S. Department of Labor 200 Constitution Avenue, N.W.

Washington, DC 20210

2.) If the answer to the question in 1.) is yes, then an interested party (those affected by the action) can request review and reconsideration from the Wage and Hour Administrator (See 29 CFR Part 1.8 and 29 CFR Part 7). Write to:

Wage and Hour Administrator U.S. Department of Labor

The request should be accompanied by a full statement of the interested party's position and by any information (wage payment data, project description, area practice material, etc.) that the requestor considers relevant to the issue.

3.) If the decision of the Administrator is not favorable, an interested party may appeal directly to the Administrative Review Board (formerly the Wage Appeals Board). Write to:

Administrative Review Board U.S. Department of Labor

4.) All decisions by the Administrative Review Board are final.

END OF GENERAL DECISION

10. a. Name and Address of Lobbying Registrant:

9. Award Amount, if known:

* Street 1

* City State Zip

Street 2

* Last Name

Prefix * First Name Middle Name

Suffix

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352

Approved by OMB

4040-0013

1. * Type of Federal Action:

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. * Status of Federal Action:

a. bid/offer/application

b. initial award

c. post-award

3. * Report Type:

a. initial filing

b. material change

For Material Change Only:

year quarter date of last report

4. Name and Address of Reporting Entity:

Prime SubAwardee Tier if known:

* Name

* Street 1 Street 2

Congressional District, if known:

6. * Federal Department/Agency: 7. * Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

b. Individual Performing Services (including address if different from No. 10a)

Prefix * First Name Middle Name

* Street 1

Street 2

11.

* Last Name Suffix

Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

* Signature:

*Name: Prefix * First Name Middle Name

* Last Name Suffix

Title: Telephone No.: Date:

Federal Use Only: Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

SFLLL_1_2_P

pward

D:20061124112418- 05'00'

10. a. Name and Address of Lobbying Registrant:

9. Award Amount, if known:$

* Street 1

* City

State

Zip

Street 2

* Last Name

Prefix

* First Name

Middle Name

Suffix

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352

Approved by OMB

4040-0013

1. * Type of Federal Action:

Type of Federal Action: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. This field is required.

Type of Federal Action is required: Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. * Status of Federal Action:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Status of Federal Action is required: Identify the status of the covered Federal action.

3. * Report Type:

Report Type: Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the previously submitted report by this reporting entity for this covered Federal action. This field is required.

For Material Change Only:

year quarter date of last report

4. Name and Address of Reporting Entity:

Reporting Entity: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. This field is required.

Reporting Entity is required: Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

Tier if known:

* Name

* Street 1

Street 2

* City

State

Zip

Congressional District, if known:

* Name

* City

State

* Street 1

Street 2

Zip

6. * Federal Department/Agency:

7. * Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

b. Individual Performing Services (including address if different from No. 10a)

Prefix

* First Name

Middle Name

* Street 1

* City

State

Zip

Street 2

11.

* Last Name

Suffix

* Signature:

*Name:

Prefix

* First Name

Middle Name

* Last Name

Suffix

Title:

Telephone No.:

Date:

Federal Use Only:

Authorized for Local Reproduction

Standard Form - LLL (Rev. 7-97)

XDPFirstField:

Mandatory:

Disclosure Statement: Click the button to read the "Review Public Burden Disclosure Statement".:

Contract: Click if the Type of Federal Action is a contract.:

Grant: Click if the Type of Federal Action is a grant.:

Cooperative Agreement: Click if the Type of Federal Action is a cooperative agreement.:

Loan: Click if the Type of Federal Action is a loan.:

Loan Guarantee: Click if the Type of Federal Action is a loan guarantee.:

Loan Insurance: Click if the Type of Federal Action is a loan insurance.:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Bid, Offer, Application: Click if the Status of Federal Action is a bid, an offer or an application.:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Initial Award: Click if the Status of Federal Action is an initial award.:

Status of Federal Action: Identify the status of the covered Federal action. This field is required.

Post Award: Click if the Status of Federal Action is a post-award.:

Initial Filing: Click if the Report Type is a initial filing.:

Material Change: Click if the Report Type is a material change.:

Year: If this is a follow up report caused by a material change to the information previously reported, enter the year in which the change occurred.:

Quarter: If this is a follow up report caused by a material change to the information previously reported, enter the quarter in which the change occurred.:

Date of last report: Enter the date of the previously submitted report by this reporting entity for this covered Federal action.:

ReportingEntityEntityType:

Prime: Click to designate the organization filing the report as the Prime Federal recipient.:

SubAwardee: Click to designate the organization filing the report as the SubAwardee Federal recipient. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.:

ReportEntityType:

Tier: Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. :

Reporting Entity Organization Name: Enter the name of reporting entity. This field is required.:

Street 1: Enter the first line of the street address for the Reporting Entity. This field is required.:

Street 2: Enter the second line of the street address for the Reporting Entity.:

City: Enter the city of the Reporting Entity. This field is required.:

State: Select the state for the Reporting Entity's address from this pull down menu.:

Zip / Postal Code: Zip Code (or ZIP+4) of the Reporting Entity.:

Congressional District: If known, the Congressional District of the reporting entity. Should be numeric characters.:

Section5Text:

Prime Organization Name: If the organization filing the report in item 4, checks "Subawardee", enter the full name of the prime Federal recipient.:

Street 1: If the organization filing the report in item 4, checks "Subawardee", enter the address of the prime Federal recipient.:

Street 2: If the organization filing the report in item 4, checks "Subawardee", enter the address of the prime Federal recipient.:

City: If the organization filing the report in item 4, checks "Subawardee", enter the city of the prime Federal recipient.:

State: If the organization filing the report in item 4, checks "Subawardee", select the appropriate state from this pull down menu.:

Zip / Postal Code: If the organization filing the report in item 4, checks "Subawardee", enter the zip code.:

Congressional District: If the organization filing the report in item 4, checks "Subawardee", enter the Congressional District of the prime Federal recipient, if known. Should be numeric characters.:

EntityType: Prime

Federal Department/Agency: Enter the name of the Federal Department or Agency making the award or loan commitment. This field is required.:

CFDA/Program Title: Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. :

CFDA Number: Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.:

Federal Action Number: Enter the most appropriate Federal identifying number available for the Federal action, identified in item 1 (e.g., Request for Proposal (RFP) number, invitation for Bid (IFB) number, grant announcement number, the contract, grant, or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001".:

Award Amount: For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment of the prime entity identified in item 4 or 5.:

Prefix: Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Lobbying Registrant.:

First Name: Enter the first name of Lobbying Registrant. This field is required.:

Middle Name: Enter the middle name of Lobbying Registrant.:

Last Name: Enter the last name of Lobbying Registrant. This field is required.:

Suffix: Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Lobbying Registrant.:

Street 1: Enter the first line of street address for the Lobbying Registrant.:

Street 2: Enter the second line of street address for the Lobbying Registrant.:

City: Enter the city of the Lobbying Registrant.:

State: Select the appropriate state of the Lobbying Registrant.:

Zip / Postal Code: Enter the Zip Code (or ZIP+4) of the Lobbying Registrant.:

DataEntered1:

Prefix: Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Individual Performing Services.:

First Name: Enter the first name of the Individual Performing Services. This field is required.:

Middle Name: Enter the middle name of the Individual Performing Services.:

Last Name: Enter the last name of the Individual Performing Services. This field is required.:

Suffix: Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Individual Performing Services.:

Street 2: Enter the second line of street address for the Individual Performing Services.:

City: Enter the city of the Individual Performing Services. :

State: Select the state for the address of the Individual Performing Services from this pull down menu.:

Zip / Postal Code: Enter the Zip Code (or ZIP+4) of the Individual Performing Services.:

Street 1: Enter the first line of street address for the Individual Performing Services.:

DataEntered2:

Prefix: Enter the prefix (e.g., Mr., Mrs., Miss), if appropriate, for the Certifying Official.:

First Name: Enter the first name of Certifying Official. This field is required.:

Middle Name: Enter the middle name of the Certifying Official.:

Last Name: Enter the last name of the Certifying Official. This field is required.:

Suffix: Enter the suffix (e.g., Jr. Sr., PhD), if appropriate, for the Certifying Official.:

Title: Enter the title of the Certifying Official.:

Telephone Number: Enter the telephone number of the certifying official.:

LastField:

Signature: Enter the Signature. This field is required.

Date: Enter the date signed. Enter in the format mm/dd/yyyy. This field is required.:

BID BOND

(See instructions on reverse)

OMB Control Number: 9000-0045 Expiration Date: 7/31/2019

PRINCIPAL (Legal name and business address) TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

SURETY(IES) (Name and business address)

PERCENT

OF BID

PRICE

PENAL SUM OF BOND

AMOUNT NOT TO EXCEED

MILLION(S) THOUSAND(S) HUNDRED(S) CENTS

BID IDENTIFICATION

BID DATE INVITATION NUMBER

PRINCIPAL

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1. 2.

(Seal) (Seal) (Seal) Corporate Seal

INDIVIDUAL SURETY(IES)

NAME(S)

(Seal) (Seal)

CORPORATE SURETY(IES)

NAME &

ADDRESS

STATE OF INCORPORATION LIABILITY LIMIT ($)

2. Corporate

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

STANDARD FORM 24 (REV. 8/2016)

Prescribed by GSA - FAR (48 CFR) 53.228(a)

FOR (Construction, Supplies or Services)

OBLIGATION:

We, the Principal and Surety(ies) are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit of liability is indicated, the limit of liability is the full amount of the penal sum.

CONDITIONS:

The Principal has submitted the bid identified above.

THEREFORE:

The above obligation is void if the Principal - (a) upon acceptance by the Government of the bid identified above, within the period specified therein for acceptance (sixty (60) days if no period is specified), executes the further contractual documents and gives the bond(s) required by the terms of the bid as accepted within the time specified (ten (10) days if no period is specified) after receipt of the forms by the principal; or (b) in the event of failure to execute such further contractual documents and give such bonds, pays the Government for any cost of procuring the work which exceeds the amount of the bid.

Each Surety executing this instrument agrees that its obligation is not impaired by any extension(s) of the time for acceptance of the bid that the Principal may grant to the Government.

Notice to the surety(ies) of extension(s) is waived. However, waiver of the notice applies only to extensions aggregating not more than sixty (60) calendar days in addition to the period originally allowed for acceptance of the bid.

WITNESS:

The Principal and Surety(ies) executed this bid bond and affixed their seals on the above date.

DATE BOND EXECUTED (Must not be later than bid opening date)

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. We estimate that it will take 25 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

JOINT VENTURE

OTHER (Specify)

PARTNERSHIPINDIVIDUAL

CORPORATION

INSTRUCTIONS

1. This form is authorized for use when a bid guaranty is required. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. The bond may express penal sum as a percentage of the bid price. In these cases, the bond may state a maximum dollar limitation (e.g., 20% of the bid price but the amount not to exceed dollars).

4. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitations listed therein. The value put into the LIABILITY LIMIT block is the penal sum (i.e., the face value) of the bond, unless a co-surety arrangement is proposed.

(b) When multiple corporate sureties are involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)." In the space designated "SURETY(IES)" on the face of the form, insert only the letter identifier corresponding to each of the sureties. Moreover, when co-surety arrangements exist, the parties may allocate their respective limitations of liability under the bond, provided that the sum total of their liability equals 100% of the bond penal sum.

(c) When individual sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety, shall accompany the bond.

The Government may require the surety to furnish additional substantiating information concerning its financial capability.

5. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the word "Corporate Seal"; and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring…

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Nov 14, 2017.