Attachment 4 - RFQ Information and General Compliance Worksheet_Bremerhaven TC.xlsx
XLSX spreadsheet 18 KB Posted
- Attached to
- Bremerhaven T&C
- Solicitation number
- HTC71126QE118
About this file
This is a Representation, Certification, and Compliance Worksheet (Attachment 4) for Request for Quote HTC71126QE118 for Tallying and Checking (T&C) services in support of Stevedoring and Related Terminal Services at the port of Bremerhaven, Germany. The contract period of performance extends from September 1, 2026 through August 31, 2031. Offerors must complete detailed company information including CAGE code, SAM registration, tax identification number, IBAN/SWIFT code, and primary/alternate points of contact with contractual authority. Government points of contact are Cassandra Range (Contracting Officer) and Connor Breyer (Contract Specialist) at USTRANSCOM/TCAQ-R, Scott Air Force Base, Illinois.
The worksheet serves as a comprehensive compliance and submission checklist requiring offerors to confirm completion of mandatory contract documentation and representations. Key submission requirements include: active SAM registration with NAICS code 488320; completion of multiple FAR and DFARS certifications regarding telecommunications equipment, responsibility matters, tax compliance, and foreign procurement; submission of a Trafficking in Persons compliance plan; technical submission not exceeding 15 pages; a Mission Essential Plan not exceeding 5 pages; a completed Schedule of Rates with unit prices in two decimal places without formulas; and execution of the Standard Form 1449 with specific blocks completed and signed. All pricing and compliance documentation must reference the current or last amended Schedule of Rates. Proposals are valid for a minimum of 180 calendar days from submission.
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Text version
Sheet1
| RFQ HTC71126QE118 - Attachment 4 |
| SOURCE SELECTION INFORMATION - See FAR 2.101 and 3.104 (When Filled-in, this Document becomes CUI//SP-SSEL) |
| ATTACHMENT 4: RFQ Information and General Compliance Worksheet |
| REQUEST FOR QUOTE: HTC71126QE118 |
| Tallying and Checking (T&C) Bremerhaven |
| Period of Performance: 01 September 2026 through 31 August 2031 |
| Government Points of Contact: |
| Cassandra Range, Contracting Officer |
USTRANSCOM/TCAQ-R
508 Scott Drive, Bldg. 1900W Scott AFB, IL 62225 cassandra.a.range.civ@mail.mil Connor Breyer, Contract Specialist
USTRANSCOM/TCAQ-R
508 Scott Drive, Bldg. 1900W Scott AFB, IL 62225 connor.n.breyer.civ@mail.mil
| GENERAL INFORMATION - Complete the requested information below. | |||
| COMPANY NAME: | |||
| COMPANY ADDRESS: | |||
| COMPANY TELEPHONE NUMBER: | |||
| COMPANY EMAIL ADDRESS: | |||
| BUSINESS SIZE (NAICS 488320): | |||
| CAGE CODE: | |||
| SAM NUMBER: | |||
| TAX IDENTIFICATION NUMBER: | |||
| IBAN/SWIFT CODE: | |||
| REMITTANCE ADDRESS: (Only if remittance address is different, such address must be registered in the System for Award Management (SAM) database, If not mark as N/A) | |||
| PRIMARY POC: To include title and contact information | |||
| (Person/s with authority to make decision and negotiate with respect to the | |||
| proposal and who can obligate your company contractually.) | |||
| ALTERNATE POC: To include title and contact information | |||
| (Person/s with authority to make decision and negotiate with respect to the | |||
| proposal and who can obligate your company contractually.) | |||
| PROMPT PAYMENT DISCOUNT: (If applicable, If not mark as N/A) | |||
| DATE/TIME OF SUBMISSION: | |||
| PROPOSAL VALIDITY DATE: (180 calendar days, at minimum) | |||
| CONTRACT DOCUMENTATION | |||
| GENERAL: | ACTION ITEMS | COMPLETED | COMMENTS |
| Active in SAM (Offeror must be registered as Active in SAM by proposal due date) | |||
| NAICS in SAM contains 488320 | |||
| REPRESENTATIONS AND CERTIFICATIONS (REPS & CERTS): **Please fully complete each action item in the RFQ and acknowledge on Attachment 4, if not in SAM.gov** | ACTION ITEMS | COMPLETED | COMMENTS |
| FAR 52.204-24, Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021). NOTE: FAR 52.204-24 only needs to be completed if FAR 52.204-26 is not completed in SAM.gov, or if the offeror represents it “will” provide or “does” use covered telecommunications equipment. | |||
| FAR 52.209-7, Information Regarding Responsibility Matters (Oct 2018) | |||
| FAR 52.212-3, Offeror Representations and Certifications—Commercial Products and Commercial Services (DEVIATION 2025-O0003 and 2025-O0004) (Mar 2025) | |||
| FAR 52.229-11, Tax On Certain Foreign Procurements Notice & Representation (Jun 2020) NOTE: Offerors representing as a "foreign person" must also submit an IRS Form W-14. | |||
| DFARS 252.204-7017, Prohibition on the Acquisition of Covered Defense Telecommunications Equipment or Services—Representation (May 2021). NOTE: DFARS 252.204-7017 only needs to be completed if DFARS 252.204-7016 is not completed in SAM.gov, or if the offeror represents it “does” provide covered defense telecommunications equipment or services in DFARS 252.204-7016. | |||
| DFARS 252.229-7001, Tax Relief (Apr 2020) | |||
| ANCILLARY DOCUMENTATION | |||
| CERTIFICATION REGARDING | ACTION ITEMS | COMPLETED | COMMENTS |
| TRAFFICKING IN PERSONS (CTIP) | |||
| COMPLIANCE PLAN: | |||
| In accordance with FAR 52.222-56, offerors shall submit an English certification implementing a compliance plan for prohibiting trafficking in person or trafficking-related activities. More details and instructions are found within the aforementioned FAR clause. | |||
| TECHNICAL SUBMISSION | |||
| TECHNICAL WORKSHEET | ACTION ITEMS | COMPLETED | COMMENTS |
| Attachment 5, Technical Worksheet, completed and submitted. | |||
| Technical Worksheet did not exceed the page requirement - 15 pages. | |||
| MISSION ESSENTIAL PLAN | ACTION ITEMS | COMPLETED | COMMENTS |
| Attachment 3, Mission Essential Plan, completed and submitted. | |||
| Mission Essential Plan did not exceed the page requirement - 5 pages. | |||
| PRICE QUOTE, SCHEDULE OF RATES (SOR) | |||
| ACTION ITEMS | COMPLETED | COMMENTS | |
| Attachment 2, Schedule of Rates, completed and submitted on the correct SOR. (If the SOR was Amended, it must be on the last Amended SOR.) | |||
| Unit prices were free of formulas. | |||
| Unit prices were only two decimal places. | |||
| All unit prices were completed for each quantity. | |||
| ACKNOWLEDGMENTS | |||
| SF1449: | ACTION ITEMS | COMPLETED | COMMENTS |
| Completed SF 1449 Block 12 (should be completed even if no discount is offered) | |||
| Completed SF 1449 Block 17a | |||
| Completed SF 1449 Block 30a | |||
| Completed SF 1449 Block 30b | |||
| Completed SF 1449 Block 30c | |||
| Returned signed and dated on the SF 1449 (In doing so, offeror accedes to the contract terms and conditions as written in the RFP, with attachments) | |||
| Completed SF 1449 Block 17b (Only if remittance address is different, such address must be registered in the System for Award Management (SAM) database. | |||
| SF30: | ACTION ITEMS | COMPLETED | COMMENTS |
| Completed SF 30 Block 8 on each SF 30 | |||
| Completed SF 30 Block 15a on each SF 30 | |||
| Completed SF 30 Block 15b on each SF 30 |
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