Quotedocument.docx

AG-9AC7-S-15-0065 NVUM Survey – Lassen NF

CONTRACTOR QUOTATION

Telephone:

Fax:

Email:

PRICING

Non Price Evaluation Factors: Please include a narrative response to these factors to your quote.

Past Performance: Include information of at least three customers (no more than 6) your business has provided similar services in the last 3 years. Businesses without a record of past performance will receive a neutral rating in this category. Lack of providing references does not automatically result in a neutral rating, a business must provide information about why they lack this information in order to qualify for a neutral rating.

Capability and Experience:

1. Describe other commitments of your firm your capability to meet the specific requirements of this project in addition to your other work.

2. Describe your experience in similar type of survey or data gathering services in either a government or commercial environment Verify your System for Award Management (SAM) Registration is current. No contract can be awarded to a vendor not current this system.

Complete the following representation:

AGAR 452.209 – 70 Representation by Corporations Regarding an Unpaid Delinquent Tax Liability or a Felony Conviction. (DEVIATION 2012-01) (FEB 2012) 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.