QUOTE_SUBMISSION_QUESTIONAIRE.docx

QUOTE SUBMISSION QUESTIONAIRE

☐ Completed Schedule of Services (pages2-4) with proposed pricing for the One-year Base Period and Four (4) one-year option periods. Include separate price schedule for all pest control services

☐ Quoter confirms the attached Performance Work Statement (PWS) has been thoroughly reviewed before submitting a quotation, including Quote Submission Instructions in Section 4.5.1 and Evaluation – Commercial Items in Section 4.3

☐ The active registration in the System for Award Management (SAM) - www.SAM.gov .

☐ Quoter confirms the provision FAR 52.212-3, the annual representations and certifications, has been electronically completed at www.SAM.gov. The complete provision is attached to PWS if not completed in SAM.

☐ Proposed Product/Material Informaiton

☐ Contractor DUNS number is provided:_________________________

Proof of General Insurance, in accordance with FAR 52.228-5;

☐ IS provided (1 page allowed each) OR ☐ CAN be provided before contract award.

Contractor’s Point of Contact (POC) Information is provided:

Name/Position: Email:

Phone: Fax:

☐ The following questions have been answered as provided below (maximum of 1 additional page allowed for each question, if necessary):

1. How will your company handle herbicide, pesticide and fertilizer application services? Specify procedures and typical response time, and how missed services are handled?

2. Do you have any other Job Corp experience? If so, where?

3. Within the past 5 years have you failed to complete any work awarded to you or been terminated for default or breach of contract? If yes, explain.

4. Does your company have a license or equivalent certification and/or documentation to apply pesticides, herbicides and fertilizer in the State of Washington? Is it provided with quote?

5. As required by the USDA - this requirement includes the use of BioBased Products, as identified in Section 3.9 of the Performance Work Statement– please state how this will apply to this requirement, including list of products if applicable. If nothing will be used, please provide a statement as to why.

☐ The following three (3) professional references of similar past work performance is provided:

1. Name: Organization:

Phone: Email:______________________________________

2. Name: Organization:

Phone: Email:______________________________________

3. Name: Organization:

Phone: Email:

☐ I certify that all of the information provided above is complete, true, and correct to the best of my knowledge.

Sign:______________________________________ Date:_______________________________________

AG-82A7-S-15-0070 Herbicide, Pesticide and Fertilizer Services Page 1 of 2