Attachment 005 Pre-Award Survey Form.docx

ATTACHMENT 005 PRE-AWARD SURVEY

PRE-AWARD SURVEY INFORMATION – Instructions, please complete, save document as a PDF and submit with business entity representative signature. If a check box is required, delete the box and put a text “X” in that space.

1. Summary. The Government reserves the right, prior to making an award, to conduct a pre-award survey of the prospective contractors in order to determine that the contractors can meet the minimum standards for responsible contractors pursuant to FAR 9.106. The pre-award survey may include, but will not necessarily be limited to the following factors:

1.1. Financial Resources such as sufficient working capital to permit performance under the contract for a period of sixty (60) days after the effective date of the contract before reimbursement by the Government;

1.2. Ability to comply with required schedules;

1.3. Past record of integrity;

1.4. Past record of performance; and

1.5. Ability to meet other qualifications and eligibility requirement to receive an award of a contract.

2. Past Performance and Financial References. Pursuant to FAR 9.104-1 General Standards, a contractor responsibility determination will be performed.

Please provide at least one (1) and up to three (3) performance references, for work the same as or similar to the work set forth in this solicitation, and one (1) financial reference in the spaces provided below. The performance references can consist of companies for which you have recently performed work. References must be of comparable magnitude and similar in nature to the work required under this solicitation. The financial reference should be your financial institution.

2.1 Performance References:

Name:

Address:

Phone:

Email:

Contract Number:

Amount:

Description:

Name:

Address:

Phone:

Email:

Contract Number:

Amount:

Description:

Name:

Address:

Phone:

Email:

Contract Number:

Amount:

Description:

2.2 Financial Reference:

Pursuant to FAR 9.104-3(a) To be determined responsible, a prospective contractor must- Have adequate financial resources to perform the contract, or the ability to obtain them.

The Contractor shall be responsible to write a Letter addressed to their Financial Institution giving authorization release standing information only to the Contracting Officer and/or Contract Specialist, 2150 Centre Avenue Building D, Fort Collins CO 80526. A signed copy of the Letter shall be submitted with the proposal. The Government will only inquire that the Contractor is a member in good standing. The Government will not request any financial or account information. Offerors that fail to provide a copy of this letter will be found non-responsive and not eligible for award.

3. Solicitation Representations – For FAR References see Acquisition.gov for full context.

3.1. Provision at FAR 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment.

The Offeror represents that—

(1) It □ will, □ will not provide covered telecommunications equipment or services to the Government in the performance of any contract, subcontract or other contractual instrument resulting from this solicitation. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds "will" in paragraph (d)(1) of this section; and

(2) After conducting a reasonable inquiry, for purposes of this representation, the Offeror represents that—

It □ does, □ does not use covered telecommunications equipment or services, or use any equipment, system, or service that uses covered telecommunications equipment or services. The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds "does" in paragraph (d)(2) of this section.

3.2. Provision at FAR 52.222-22 Previous Contracts and Compliance Reports.

The offeror represents that-

It □ has, □ has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation;

It □ has, □ has not filed all required compliance reports; and

Representations indicating submission of required compliance reports, signed by proposed subcontractors, will be obtained before subcontract awards.

3.3. Statement confirming review of Section H.15 BIOBASED PRODUCTS REQUIREMENTS. *[insert business entity name] has reviewed solicitation section H.15 BIOBASED PRODUCTS REQUIREMENTS.”

3.4. Provision at FAR 52.209-7 Information Regarding Responsibility Matters.

The offeror □ has □ does not have current active Federal contracts and grants with total value greater than $10,000,000.

3.5. Statement confirming compliance with the clause at AGAR 452.228-71 Insurance Coverage, see section H.1.

*[insert business entity name] can present evidence to show, as a minimum, the amounts of insurance coverage indicated by the clause at AGAR 452.228-71 Insurance Coverage.

3.6. Statement confirming compliance with the clause at FAR 52.219-14(e)(3) and (4) Limitations on Subcontracting. “(3) General construction, it will not pay more than 85 percent of the amount paid by the Government for contract performance, excluding the cost of materials, to subcontractors that are not similarly situated entities. Any work that a similarly situated entity further subcontracts will count towards the prime contractor's 85 percent subcontract amount that cannot be exceeded; or (4) Construction by special trade contractors, it will not pay more than 75 percent of the amount paid by the Government for contract performance, excluding the cost of materials, to subcontractors that are not similarly situated entities. Any work that a similarly situated entity further subcontracts will count towards the prime contractor's 75 percent subcontract amount that cannot be exceeded.”

Similarly situated entity, as used in this clause, means a first-tier subcontractor, including an independent contractor, that—

(1) Has the same small business program status as that which qualified the prime contractor for the award (e.g., for a small business set-aside contract, any small business concern, without regard to its socioeconomic status); and

(2) Is considered small for the size standard under the North American Industry Classification System (NAICS) code the prime contractor assigned to the subcontract.

*[insert business entity name] has reviewed the Limitations on Subcontracting clause and the offer is compliant with the requirements.

3.7. Statement confirming review and capability to meet the Contractors Key Personnel with special qualifications indicated in in Attachment 002 Section 7.0.

*[insert business entity name] can provide:

“ a qualified Carrier chiller and Johnson Controls technician/engineer, with experience to perform the repair/upgrades for Carrier chiller and JCI Metasys system utilized at NBAF.”

Signature/Date of Business Entity Representative