Response_Forms_Only.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

9AC7

REDDING CA 96002

3644 AVTECH PARKWAY SUITE 180

R5 NO-CAL ACQ SERVICE AREA NCASA

USDA FOREST SERVICE

9A29 CODE 16. ADMINISTERED BYCODE

X

X

X

561720

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR9AC7

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

12/08/2016 1400 PT

11/10/2016

530-226-2408SANDRA VINCENT

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

AG-9AC7-S-17-0003

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 34 830323OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

17a. CONTRACTOR/

PLATINA CA 96076

HIGHWAY 36

YOLLA BOLLA RANGER DISTRICT

15. DELIVER TO

REDDING CA 96002

3644 AVTECH PARKWAY SUITE 180

R5 NO-CAL ACQ SERVICE AREA NCASA

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$18.00

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

USDA FOREST SERVICE

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Yolla Bolla Ranger District Shasta-Trinity National Forest

Please provide a quote for the base and option years (see following page).

Period of Performance: 01/01/2017 to 12/31/2018 (Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

SANDRA VINCENT

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

NAME:___________________________________________

ADDRESS:________________________________________

PHONE:__________________________________________

EMAIL:__________________________________________

DUNS # :________________________________________

INVOICES MUST BE PROCESSED THROUGH IPP, THE

INVOICE PROCESSING PLATFORM) AT WWW.IPP.GOV

PAYMENT WILL BE MADE BY EFT (ELECTRONIC FUNDS

TRANSFER) TO THE BANK ACCOUNT SPECIFIED IN THE

CONTRACTOR'S SAM ENTITY

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

001 Base Year: January through December 2017 12 MO $__________ $_________________

Services Twice per Week

Anticipated Award Type: Firm-fixed-price

Period of Performance: 01/01/2017 to 12/31/2017

002 Option Year : January through December 2018 12 MO $__________ $_________________

Services Twice per Week

Anticipated Award Type: Firm-fixed-price

(Option Line Item)

Period of Performance: 01/01/2018 to 12/31/2018

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

34 2 of

Yolla Bolla Ranger Station Janitorial AGAR Provision

AGAR Provision 452.209-70

AGAR 452.209-70 Representation by Corporations Regarding an Unpaid Delinquent Tax Liability or a

Felony Conviction (FEB 2012) -- Alternate I (FEB 2012) (DEVIATION)

(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.

Name of Company:

Name of Company Representative:

Signature of Representative:

Date:

http://www.dm.usda.gov/procurement/policy/docs/USDAFARDeviation03-22-2012Solicitation.pdf

Yolla Bolla Ranger Station Janitorial Response Forms

EXPERIENCE AND PAST PERFORMANCE QUESTIONNAIRE

Instructions: See Box 10, REMARKS, if extra space is needed to answer any items below. Mark "X" in the appropriate spaces. Please list N/A for inapplicable items.

1. Offeror's Name, Address, Email, Telephone Number & DUNS Number 2. Type of Business Name: ____ Company

____ Corporation

____ Non-profit Organization

____ Co-partner

____ Individual

Address:

Email:

Telephone:

DUNS #:

3. How many years of experience do you have in this line of work? ___________________

4. How many years of experience as a prime contractor? _________ Subcontractor? ________

5. List relevant contracts your business has performed with at least one performed in the last three years.

Contract Name Facility Type/Size Service Dates Annual Amount / Description of Services

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 Question 7a. or 7b., please specify location(s) and reason(s):

7. List up to three references for whom your business has performed relevant work:

Contact Name(s) Company Name Project Performed Contact Phone Number(s)

EXPERIENCE AND PAST PERFORMANCE QUESTIONNAIRE

8. Organization that will be available for this project:

a. Minimum No. of employees: _______________ Maximum No. of employees: ________________

b. Are proposed employees regularly on your payroll? ____ YES ____ NO

c. If applicable, specify equipment available for this contract:

9. List the experience of the principal individuals of your business.

Individual's Name Present Position Years Experience Type of Work

10. Remarks:

CERTIFICATION: I certify that all of the statements made above 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.

Signature Title Date

PERFORMANCE OBJECTIVE AREA QUALITY CONTROL PROGRAM

1. Glass Windows, Doors and Counters in

Front Lobby

2. Carpeted Surfaces

3. Non-Carpeted Flooring

4. Drinking Fountains

5. Trash Bins

6. Restrooms

7. Food Service, Break Areas and Hallways

8. All Other Windows, Glass and Plastic

PERFORMANCE OBJECTIVE AREA QUALITY CONTROL PROGRAM

9. Venetian Blinds

10. Walls and High Cleaning Surfaces

(Interior Only)

11. All Furniture

12. External Porches, Benches, Steps, Doors and Walkways

13. Light Bulbs

14. All Other Spaces and Surfaces

Plan to address deficiencies, notify employees of deficiencies in their area of responsibility (if applicable), and ensure corrective action:

Plan to ensure that all issued keys, access cards or identification items are not lost, misplaced, or used by unauthorized persons:

Planned supplies and equipment to be provided and used by the Contractor in the performance of this contract:

Name(s)/Title(s) of person(s) to perform inspection: