RETURN_PACKAGE.pdf

AG-435H-S-16-0011

Chattahoochee NF

BRRD Road Maintenance 2016

REQUEST FOR QUOTATION PAGE OF PAGES

(THIS IS NOT AN ORDER) THIS RFQ XXX IS IS NOT A SMALL BUSINESS SET- ASIDE 1 11

1. REQUEST NO. 2. DATE ISSUED REQUISITION/PURCHASE REQUEST NO. 4. CERT. FOR NAT.DEF. RATING

AG-435H-S-16-0011 03/31/2016 791797 UNDER BDSA REG. 2

AND/OR DMS REG. 1

5a. ISSUED BY 6. DELIVER BY (Date) Chattahoochee National Forest Attn: Lori Austad 1755 Cleveland HWY Gainesville, GA 30501

See Contract Time

223 Days

5b. FOR INFORMATION CALL (NO COLLECT CALLS) 7. DELIVERY FOB DESTINATION NAME TELEPHONE NUMBER X OTHER (See Schedule)

Lori Austad, CO

AREA CODE

NUMBER

297-3055

9. DESTINATION

Bryan Bell, COR 706 745-6928 Ext. 103 a. NAME OF CONSIGNEE

8. TO: Sec. C - Location & Description

a. NAME b. COMPANY b. STREET ADDRESS

c. STREET ADDRESS c. CITY

d. CITY e. STATE f. ZIP CODE d. STATE e. ZIP CODE

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS (Date)

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

April 22, 2016 at 4:30 PM EDT e-mail to laustad@fs.fed.us

Fax Copies will not be Accepted 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)

ROAD MAINTENANCE 2016 LOCATED ON THE

BLUE RIDGE RANGER DISTRICT, UNION,

FANNIN, DAWSON, LUMPKIN & GILMER

COUNTIES, GA

DUNS#____________________________

NAICS 237310

All Contractors must be registered in SAM.gov prior to award.

Small Business Set Aside

Total from Section B

Please read through the entire solicitation

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) mailto:laustad@fs.fed.us

PART I-SECTION B-PAY ITEMS

Chattahoochee National Forest, Blue Ridge Ranger District, Union, Fannin, Dawson, Lumpkin & Gilmer Counties GA.

Performance Period: May 23, 2016 – December 31, 2016

Award of optional maintenance items will be based upon prices submitted and funds available at the time of award and during the performance period. The USFS may also choose to supplement the maintenance schedules below with additional roads and maintenance activities from the attached Road List, Exhibit C, in Section J – also dependent upon funds available at the time of need.

Base Bid Items 1: Union County

Pay Item Description Pay Unit

Method of Measurement

Estimated Quantity

Unit Price

Total Price

210 (01) Blading Aggregate Surfaced Roads

Mile AQ 6

220 (01) Spot Surfacing, Crushed Aggregate, GDOT GAB

Compaction A

Ton VQ 630

220 (02) Spot Surfacing, Crushed Aggregate, GDOT # 4 Stone, Compaction A

Ton VQ 270

230 (01) Clean and Reshape Drainage Structures

Mile AQ 6

Bid Item 1 Total

Base Bid Items 2: Lumpkin and Dawson Counties

Pay Item Description Pay Unit

Method of Measurement

Estimated Quantity

Unit Price

Total Price

210 (01) Blading Aggregate Surfaced Roads

Mile AQ 6.4

220 (01) Spot Surfacing, Crushed Aggregate, GDOT GAB

Compaction A

Ton VQ 810

220 (02) Spot Surfacing, Crushed Aggregate, GDOT # 4 Stone, Compaction A

Ton VQ 450

230 (01) Clean and Reshape

Mile AQ 6.4

Bid Item 2 Total

Base Bid Items Grand Total $____________________

Option Bid Items 1: Union County

Pay Item Description Pay Unit

Method of Measurement

Estimated Quantity

Unit Price

Total Price

210 (01) Blading Aggregate Surfaced Roads

Mile AQ 17.3

220 (01) Spot Surfacing, Crushed Aggregate, GDOT GAB

Compaction A

Ton VQ 1350

220 (02) Spot Surfacing, Crushed Aggregate, GDOT # 4 Stone, Compaction A

Ton VQ 450

230 (01) Clean and Reshape

Mile AQ 17.3

Option Bid Items 1 Total

Option Bid Items 2: Fannin and Gilmer Counties

Unit

Method of Measurement

Estimated Quantity

Unit Price

Total Price

210 (01) Blading Aggregate Surfaced Roads

Mile AQ 10.2

220 (01) Spot Surfacing, Crushed Aggregate, GDOT GAB

Compaction A

Ton VQ 900

220 (02) Spot Surfacing, Crushed Aggregate, GDOT # 4 Stone, Compaction A

Ton VQ 270

230 (01) Clean and Reshape

Mile AQ 10.2

Option Bid Items 2 Total

Option Bid Items 3: Lumpkin and Dawson

Unit

Method of Measurement

Estimated Quantity

Unit Price

Total Price

210 (01) Blading Aggregate

Surfaced Roads Mile AQ 2.0

220 (01) Spot Surfacing, Crushed Aggregate, GDOT GAB

Compaction A

Ton VQ 180

220 (02) Spot Surfacing, Crushed Aggregate, GDOT # 4 Stone, Compaction A

Ton VQ 90

230 (01) Clean and Reshape

Mile AQ 2.0

Option Bid Items 3 Total

Option Bid Items Grand Total $____________________

* Method of Measure:

CC – Contract Quantity – will not be field measured

VQ – Vehicle Quantity – measured by weight tickets

AQ – Actual Quantities – These quantities are determined from measurements of completed work.

LSQ – Lump Sum Quantities – will not be field measured

PART IV--REPRESENTATIONS AND INSTRUCTIONS

SECTION K--REPRESENTATIONS, CERTIFICATIONS, AND

OTHER STATEMENTS OF OFFERORS OR RESPONDENTS

NOTE: Offerors should address questions concerning VETS-100 reporting and reporting requirements to the Office of Veterans Employment and Training Services offices at the following address:

U. S. Department of Labor VETS-100 Reporting 4200 Forbes Blvd., Suite 202 Lanham, MD 20703 Telephone: (301) 306-6752

Website: www.vets100.cudenver.edu Reporting Questions: HelpDesk@vets100.com

Reporting Verification: Verify@vets100.com

K.1 AGAR 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 Items --NAICS Code 237310 --Size Standard $36.5 million

The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees.

K.2 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (JAN 2014)

(a)(1) The North American Industry Classification System (NAICS) code for this acquisition is 237310 (2) The small business size standard is $36.5 million 3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees. (b)(1) If the provision at 52.204-7, System for Award Management, is included in this solicitation, paragraph (d) of this provision applies.(2) If the provision at 52.204-7 is not included in this solicitation, and the offeror is currently registered in the System for Award Management (SAM), and has completed the Representations and Certifications section of SAM electronically, the offeror may choose to use paragraph (d) of this provision instead of completing the corresponding individual representations and certifications in the solicitation. The offeror shall indicate which option applies by checking one of the following boxes:[ ] (i) Paragraph (d) applies.[ ] (ii) Paragraph (d) does not apply and the offeror has completed the individual representations and certifications in the solicitation.(c)(1) The following representations or certifications in SAM are applicable to this solicitation as indicated:(i) 52.203-2, Certificate of Independent Price Determination.This provision applies to solicitations when a firm-

FAC 2005–72 JANUARY 1, 2014

SUBPART 52.2—TEXT OF PROVISIONS AND CLAUSES 52.204-8 52.2-12.1 fixed-price contract or fixed-price contract with economic price adjustment is contemplated, unless— (A) The acquisition is to be made under the simplified acquisition procedures in Part 13;(B) The solicitation is a request for technical proposals under two-step sealed bidding procedures; or(C) The solicitation is for utility services for which rates are set by law or regulation. (ii) 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. This provision applies to solicitations expected to exceed $150,000.(iii) 52.204-3, Taxpayer Identification. This provision applies to solicitations that do not include the provision at 52.204-7, System for Award Management.(iv) 52.204-5, Women-Owned Business (Other Than Small Business). This provision applies to solicitations that—(A) Are not set aside for small business concerns;

(B) Exceed the simplified acquisition threshold; and (C) Are for contracts that will be performed in the United States or its outlying areas. (v) 52.209-2, Prohibition on Contracting with Inverted Domestic Corporations— Representation. This provision applies to solicitations using funds appropriated in fiscal years 2008, 2009, 2010, or 2012.

(vi) 52.209-5, Certification Regarding Responsibility Matters. This provision applies to solicitations where the contract value is expected to exceed the simplified acquisition threshold.(vii) 52.214-14, Place of Performance—Sealed Bidding.This provision applies to invitations for bids except those in which the place of performance is specified by the Government. (viii) 52.215-6, Place of Performance. This provision applies to solicitations unless the place of performance is specified by the Government.(ix) 52.219-1, Small Business Program Representations (Basic & Alternate I). This provision applies to solicitations when the contract will be performed in the United States or its outlying areas.(A) The basic provision applies when the solicitations are issued by other than DoD, NASA, and the Coast Guard.(B) The provision with its Alternate I applies to solicitations issued by DoD, NASA, or the Coast Guard.(x) 52.219-2, Equal Low Bids. This provision applies to solicitations when contracting by sealed bidding and the contract will be performed in the United States or itsoutlying areas.

(xi) 52.222-22, Previous Contracts and Compliance Reports. This provision applies to solicitations that include the clause at 52.222-26, Equal Opportunity. (xii) 52.222-25, Affirmative Action Compliance. This provision applies to solicitations, other than those for construction, when the solicitation includes the clause at 52.222-26, Equal Opportunity.(xiii) 52.222-38, Compliance with Veterans’ Employment Reporting Requirements. This provision applies to solicitations when it is anticipated the contract award will exceed the simplified acquisition threshold and the contract is not for acquisition of commercial items.(xiv) 52.223-1, Biobased Product Certification. This provision applies to solicitations that require the delivery or specify the use of USDA–designated items; or include the clause at 52.223-2, Affirmative Procurement of Biobased Products Under Service and Construction Contracts. (xv) 52.223-4, Recovered Material Certification.This provision applies to solicitations that are for, or specify the use of, EPA– designated items. (xvi) 52.225-2, Buy American Act Certificate. This provision applies to solicitations containing the clause at 52.225-1. (xvii) 52.225-4, Buy American Act—Free Trade Agreements—Israeli Trade Act Certificate. (Basic, Alternates I, II, and III.) This provision applies to solicitations containing the clause at 52.225-3.(A) If the acquisition value is less than $25,000, the basic provision applies.(B) If the acquisition value is $25,000 or more but is less than $50,000, the provision with its Alternate I applies.

(C) If the acquisition value is $50,000 or more but is less than $79,507, the provision with its Alternate II applies.

(D) If the acquisition value is $79,507 or more but is less than $100,000, the provision with its Alternate III applies.

(xviii) 52.225-6, Trade Agreements Certificate. This provision applies to solicitations containing the clause at 52.225-5.

(xix) 52.225-20, Prohibition on Conducting Restricted Business Operations in Sudan—Certification. This provision applies to all solicitations.(xx) 52.225-25, Prohibition on Contracting with Entities Engaging in Certain Activities or Transactions Relating to Iran-Representation and Certifications. This provision applies to all solicitations. (xxi) 52.226- 2, Historically Black College or University and Minority Institution Representation. This provision applies to—(A) Solicitations for research, studies, supplies, or services of the type normally acquired from higher educational institutions; and (B) For DoD, NASA, and Coast Guard acquisitions, solicitations that contain the clause at 52.219-23, Notice of Price Evaluation adjustment for Small Disadvantaged Business Concerns.

FAC 2005–72 JANUARY 1, 2014 52.204-9 FEDERAL ACQUISITION REGULATION 52.2-12.2 (2) The following certifications are applicable as indicated by the Contracting Officer:

[Contracting Officer check as appropriate.] __ (i) 52.219-22, Small Disadvantaged Business Status. __ (A) Basic.

__ (B) Alternate I.__ (ii) 52.222-18, Certification Regarding Knowledge of Child Labor for Listed End Products.

__ (iii) 52.222-48, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment Certification.

__ (iv) 52.222-52, Exemption from Application of the Service Contract Act to Contracts for Certain Services– Certification.__ (v) 52.223-9, with its Alternate I, Estimate of Percentage of Recovered Material Content for EPA– Designated Products (Alternate I only).__ (vi) 52.227-6, Royalty Information.__ (A) Basic.__(B) Alternate I.

__ (vii) 52.227-15, Representation of Limited Rights Data and Restricted Computer Software.(d) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through ttps://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of the offer that the representations and certifications currently posted electronically that apply to this solicitation asindicated in paragraph (c) of this provision have been entered or updated within the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201); except for the changes identified below [offeror to insertchanges, identifying change by clause number, title, date].These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer.Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted on SAM.

K.4 52.219-28 POST-AWARD SMALL BUSINESS PROGRAM REREPRESENTATION.

As prescribed in 19.309(d), insert the following clause:

POST-AWARD SMALL BUSINESS PROGRAM REREPRESENTATION (JUL 2013)

(a) Definitions. As used in this clause—

Long-term contract means a contract of more than five years in duration, including options. However, the term does not include contracts that exceed five years in duration because the period of performance has been extended for a cumulative period not to exceed six months under the clause at 52.217-8, Option to Extend Services, or other appropriate authority.

Small business concern means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR part 121 and the size standard in paragraph (c) of this clause. Such a concern is “not dominant in its field of operation” when it does not exercise a controlling or major influence on a national basis in a kind of business activity in which a number of business concerns are primarily engaged. In determining whether dominance exists, consideration shall be given to all appropriate factors, including volume of business, number of employees, financial resources, competitive status or position, ownership or control of materials, processes, patents, license agreements, facilities, sales territory, and nature of business activity.

(b) If the Contractor represented that it was a small business concern prior to award of this contract, the Contractor shall rerepresent its size status according to paragraph (e) of this clause or, if applicable, paragraph (g) of this clause, upon the occurrence of any of the following:

(1) Within 30 days after execution of a novation agreement or within 30 days after modification of the contract to include this clause, if the novation agreement was executed prior to inclusion of this clause in the contract.

(2) Within 30 days after a merger or acquisition that does not require a novation or within 30 days after modification of the contract to include this clause, if the merger or acquisition occurred prior to inclusion of this clause in the contract.

(3) For long-term contracts—

(i) Within 60 to 120 days prior to the end of the fifth year of the contract; and https://www.acquisition.gov/far/current/html/Subpart%2019_3.html#wp1101393 https://www.acquisition.gov/far/current/html/52_217_221.html#wp1135887

(ii) Within 60 to 120 days prior to the date specified in the contract for exercising any option thereafter.

(c) The Contractor shall rerepresent its size status in accordance with the size standard in effect at the time of this rerepresentation that corresponds to the North American Industry Classification System (NAICS) code assigned to this contract. The small business size standard corresponding to this NAICS code can be found at http://www.sba.gov/content/table-small-business-size-standards.

(d) The small business size standard for a Contractor providing a product which it does not manufacture itself, for a contract other than a construction or service contract, is 500 employees.

(e) Except as provided in paragraph (g) of this clause, the Contractor shall make the rerepresentation required by paragraph (b) of this clause by validating or updating all its representations in the Online Representations and Certifications Application and its data in the Central Contractor Registration, as necessary, to ensure that they reflect the Contractor’s current status. The Contractor shall notify the contracting office in writing within the timeframes specified in paragraph (b) of this clause that the data have been validated or updated, and provide the date of the validation or update.

(f) If the Contractor represented that it was other than a small business concern prior to award of this contract, the Contractor may, but is not required to, take the actions required by paragraphs (e) or (g) of this clause.

(g) If the Contractor does not have representations and certifications in ORCA, or does not have a representation in ORCA for the NAICS code applicable to this contract, the Contractor is required to complete the following rerepresentation and submit it to the contracting office, along with the contract number and the date on which the rerepresentation was completed:

The Contractor represents that it o is, o is not a small business concern under NAICS Code 237310 assigned to contract number AG-435H-P-16-00.

[Contractor to sign and date and insert authorized signer’s name and title].

K.5 AGAR 409.471 Solicitation Provision and Contract Clause.

(a) Solicitation Provision. The contracting officer shall insert the provision at 452.209–70, Representation by Corporations Regarding an Unpaid Delinquent Tax Liability or a Felony Conviction, in all solicitations above the micro-purchase threshold, except for those of the Forest Service. For all Forest Service solicitations above the micro-purchase threshold, the contracting officer shall use Alternate 1 of the provision.

Alternate 1 (Feb 2012). The Contracting Officer shall use this alternate for all Forest Service solicitations above the micro-purchase threshold:

(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 http://www.sba.gov/content/table-small-business-size-standards

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.

1. NAME 2. COMPANY

BUSINESS TYPE

[ ] COMPANY [ ] INDIVIDUAL

[ ] CORPORATION

[ ] CO-PARTNERSHIP

[ ] NON-PROFIT ORGANIZATION

3. HOW MANY YEARS DOES YOUR BUSINESS HAVE IN THE

LINE OF WORK CONTEMPLATED BY THIS SOLICITATION?

4. HOW MANY YEARS EXPERIENCE IN CONTRACTING HAS YOUR BUSINESS HAD AS AN (a) PRIME CONTRACTOR __________ AND/OR (b) SUB-CONTRACTOR __________? IS THIS TIME CONCURRENT? ___________ 5a. LIST BELOW SIMILAR PROJECTS YOUR BUSINESS HAS COMPLETED WITHIN THE LAST THREE YEARS:

CONTRACT

AMOUNT

TYPE OF PROJECT DATE

COMPLETED

NAME, ADDRESS & TELEPHONE NUMBER OF

OWNER/PERSON TO CONTACT FOR INFO.

5b. LIST BELOW THE PROJECTS THAT ARE INCOMPLETE:

CONTRACT

NUMBER

DOLLAR AMT.

OF AWARD

NAME, ADDRESS & PHONE NO.

OF AGENCY INVOLVED

PERCENT

COMPLETED

DATE

COMPLETED

UNITS

AWARDED

6a. HAVE YOU EVER FAILED TO COMPLETE ANY WORK AWARDED TO YOU? [ ] YES [ ] NO 6b. HAS WORK EVER BEEN COMPLETED BY PERFORMANCE BOND? [ ] YES [ ] NO 6c. IF “YES” TO EITHER ITEM 6a OR 6b, SPECIFY LOCATION(S) AND REASONS(S) WHY:

7. ORGANIZATION AND WORK THAT WILL BE AVAILABLE FOR THIS PROJECT:

a.(1) MINIMUM NO. OF EMPLOYEES: __________ AND a.(2) MAXIMUM NO. 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: __________

8. LIST BELOW THE EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR BUSINESS:

INDIVIDUALS NAME

PRESENT

POSITION

YEARS

OF EXP.

MAGNITUDE AND TYPE OF WORK

9. REMARKS – SPECIFY BOX NUMBERS (also use this area to address any problems with past performance not noted in item 6):

(attach sheets if extra space is needed)

10. THE BIDDER SHALL INDICATE WHETHER OR NOT HE/SHE HAS EXAMINED THE AREAS FOR WHICH THIS BID

IS SUBMITTED: [ ] YES [ ] NO

IF YES, THE DATE AREA WAS EXAMINED: _________________________

CERTIFICATION: I CERTIFY THAT ALL OF THE

STATEMENTS MADE BY ME ARE COMPLETE AND

CORRECT TO THE BEST OF MY KNOWLEDGE AND

11a. CERTIFYING OFFICIAL’S NAME & TITLE

THAT ANY PERSONS NAMED AS REFERENCES ARE

AUTHORIZED TO FURNISH THE FOREST SERVICE WITH

INFORMATION NEEDED TO VERIFY MY CAPABILITY

TO

11b. SIGNATURE (Sign in ink)

PERFORM THIS PROJECT.

11c. DATE