Attachment 10. QVL Application Form as of 6-5-2025.docx

DEPARTMENT OF TRANSPORTATION

FEDERAL AVIATION ADMINISTRATION

6973GH-25-R-00167 QVL APPLICATION FORM as of 6-5-2025

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 and other countries

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:

· Unique Entity Number No. (UEI Number 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. If the past performance surveys are not received in the application package, the application will not be reviewed. See Relevant Experience and Relevant Past Performance in section M.2 of the SIR for more details)

· Antenna Tower Installation/Replacements

· HVAC Installation/Replacements

· Roof Replacements

· Stair Installation/Replacements

· Decking Installation/Replacements

· Access Road Installation/Replacements

· Tower Structure Inspections

· Shelter Installation/Replacements

· Shelter Purchases (Shelter Manufacturers Only)

· Electrical

· Paving Installation/Repair

· Fencing Installation/Repair

· Painting

· Remediation Services

· Geotechnical Surveys

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

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

· 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 08 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.

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?

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.