Attachement 12. = QVL Application Form as of 6.1.2023.docx

DEPARTMENT OF TRANSPORTATION

FEDERAL AVIATION ADMINISTRATION

6973GH-20-R-00040 QVL APPLICATION FORM as of 06.01.2023

Type of Acquisition: Firm Fixed Price Construction Contract Project Type: Qualified Vendors List (QVL) for Unstaffed Infrastructure Sustainment (UIS) facilities on and off airport operating areas.

Location: Various locations throughout the United States of America

The information provided herein will be used for evaluation purposes. Applicants must ensure that the information provided is accurate and complete. If a question is not applicable, indicate such rather than not responding to the question. Failure to be truthful or complete the application may result in your firm’s submittal being rejected as non-responsive.

· Date of Application:

· Contractor Name:

· Contractor Address:

· Contractor Principle Office Location:

· UEI (Unique Identifier in SAM.gov)

· Name/Title of Primary Contact:

· Primary Contact Telephone and e-mail address:

· Based on the geographic description (Eastern Region, Central Region, Western Region) as defined under Section F.1: Areas of Interest in the SIR, please indicate which geographic area(s) and/or state(s) within the service area(s) your firm would be willing to do the construction work in. (Geographical election must be indicated on the application, or it is assumed that the Applicant will work in all geographic areas.)

· This Application form is for construction services for the following construction categories: (Applicants will only submit 1 application form for multiple categories listed below. However, each category must have 2 completed past performance survey forms in their bid package. See Relevant Experience and Relevant Past Performance in section M.2 of the SIR for more details)

· Please mark each category your company would like to be considered for.

· Antenna Tower Installation/Replacements

· HVAC Installation/Replacements

· Roof Replacements

· Stair Installation/Replacements

· Decking Installation/Replacements

· Access Road Installation/Replacements

· Shelter Installation/Replacements

· Tower Inspections

· Construction Services on NAVAIDS facilities/equipment (examples: MALSR, PAPI, VASI, REIL, ALS, VOR, etc.)

· Construction Services on COMM facilities/equipment (examples: RTR, RCO, RCAG, BUEC, RCLR, RCLT, etc.)

· Remediation Services (Lead based paint encapsulation/asbestos abatement)

· Fencing Installation/Repair

· Paving Installation/Repair

· Painting

· Electrical

· Marine Construction

· RELEVANT EXPERIENCE – Before completing the Past Performance Survey Form, please read SIR Section M.2 Evaluation Criterion No. 1, which outlines what the FAA expects in terms of Experience.

1. For the applicants supporting documentation, the Past Performance Survey Form must be utilized instead of SIR Attachment 09 Past Performance Experience Information Form. The applicant is to complete page 1 and then send the survey to their past performance POC to complete the survey on pages 2-4. Two Past Performance surveys are to be filled out for each construction category that the applicant is applying for and returned with the application form (for example, if an applicant is applying for the HVAC category, then the past experience must be on HVAC work). Start with FAA or other federal government contracts. Then, use state/local government contracts or private sector contracts to show capabilities. If the Past Performance Surveys are not included with your application package, your application will not be evaluated.

2. Additional Experience-related Questions:

a. Have you or your organization performed a contract on the grounds of an active airport? What type of work was completed at the airport?

b. If so, what was the airports name and the state the airport was located.

c. Is your company capable of passing a background check to gain access to airports and/or military bases if needed?

· RELEVANT PAST PERFORMANCE – Before completing the Past Performance Survey Form, please read SIR Section M.2 Criterion No. 2, which outlines what the FAA expects in terms of Past Performance.

1. Additional Past Performance-related Questions:

a. Have you ever failed to complete any contract awarded to you? (If yes, please explain. Include contact information of project owner.)

b. Is your organization (or the officers of your organization) a party to any pending or outstanding claims, judgments, arbitrations, or litigation? If so, please explain.

c. In the past five years has the applicant firm or any of its affiliate firms been the subject of any of the following actions by any government agency (If yes, please explain):

i. Been suspended, debarred, disqualified, had a pre-qualification status revoked or otherwise been declared ineligible to bid?

ii. Been denied a contract despite being the low bidder for any other reason?

iii. Been in default on any contract?

iv. Had a contract terminated (T4D or T4C)?

v. Been given an unsatisfactory performance rating or deemed a poor performer (by letter or formal proceeding)?

vi. Been investigated by the Department of Labor?

vii. Cited for non-payment of proper wages or fringe benefits to any employee(s)

1. If yes, was restitution made in full?

If you have answered yes for any part of the questions above, on a separate word document, please identify:

(1) The agency;

(2) The contract number,

(3) The date of the action;

(4) A brief description of the action; and

(5) Agency contact information.

· Capability Statement - Applicants must submit their company’s capability statement. The capability statement should include the following:

· Type of service provided your firm.

· Number of years in business

· Geographic area where your company can provide services.

· Previous experience for work involving similar scope.

· No Pricing Information shall be submitted within the capability statement.

OTHER INFORMATION:

The following questions are not used for qualifying the applicant, and are for informational purposes only to assist the FAA in the solicitation process for future requirements.

1. Please identify any construction-related licenses that your firm holds, and indicate which states to which they apply.

2. Is there a minimum or maximum amount of contract award your firm will accept? If so, please state your limitations.