Attachment_5_Forms_to_Return_with_Quote.docx

PRICE SCHEDULE

The contractor shall factor the lump sum price to include all labor, tools, equipment, materials, mobilization-in, mobilization-out, insurance, contract administration, project management, overhead and profit (applicable to prime contractor subcontractor) necessary for completing all work. All work shall be performed in accordance with the awarded contract terms and clauses, including the attached Dept. of Labor Davis-Bacon Act wage rates and project Specifications.

The Quoter shall submit a price for the line items below. Failure to do so may render the quote ineligible. For these two lump-sum-priced line items, provide the total price only. If no specific line item exists for a portion of the work, include the costs in a related item. In case of errors in summations, the total of the corrected amounts govern. Round totals to whole dollars. The Government anticipates being able to evaluate solely based upon the prices quoted. However, the Government is requesting as part of filling in prices below to also submit supporting price breakdown that includes labor detail such as job categories/titles, hourly rates, and number of hours, as well as Quoter’s unit price per SF for the grading portion of the project. Award will be made to one contractor in accordance with Sections L and M.

Complete this page and return with other documents described in Section L.

Business Name:

Address:

SAM UEI:

Phone:

Submitted by – Printed Name:

Submitted by – Signature:

Date:

Solicitation no. 140P82425Q0059– Attachment no. 5, Forms to Returm with Quote (8/12/25) Regrade road, clean out culverts, Oregon Caves National Monument (ORCA)

Relevant Experience READ CAREFULLY: The purpose of this form is for the quoter to list construction projects (preferably performed during the past five (5) years) that are similar to the work described in this solicitation and from whom the government may gather past performance information. The number of projects listed shall not exceed ten (10) and shall be numbered consecutively, beginning with the most recent project. Use this form to address your familiarity with the Scope of Work described in the plans and specifications and with the capability criteria described in the Request for Quote.

It is especially important that the offeror disclose instances in which their past performance may be considered by others to be less than fully satisfactory. The quoter should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the quoter’s past performance record.

Name of Quoter:

Project Name:

Project Location:

Name of Owner:

Email Address of Owner:

Phone Number of Owner:

Project Value:

Dates of Construction:

DESCRIPTION OF THE PROJECT AND SCOPE FO QUOTER’S WORK

PERFORMANCE REMARKS

Technical Approach Provide a brief work plan describing your approach to the project that demonstrates your understanding of the requirements and the capabilities and experience you bring to it. Include, for example, number of workers (by job classification) and tentative work schedule, phasing the work, equipment you expect to use.

K.2 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (NOV 2021)

This section requires contractor to fill in and submit with quote unless the offeror has already responded “does not” in Paragraphs (c)(1) and (c)(2) of 52.204–26, Covered Telecommunications Equipment or Services—Representation (OCT 2020) in SAM. Quoter shall refer to Attachment no. 3, “Forms to Submit with Quote” to fill in this provision.

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Products or Commercial Services. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision— Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition.

(c) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM) ( https://www.sam.gov) for entities excluded from receiving federal awards for "covered telecommunications equipment or services".

(d) Representation. The Offeror represents that—

(e) Disclosures.

(1) Disclosure for the representation in paragraph (d)(1) of this provision. If the Offeror has responded "will" in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(ii) For covered services—

(i) For covered equipment—

(ii) For covered services—