Attachment B - Contractor Qualification Form Rev. 4.docx

Attachment B - Contractor Qualifications Questionnaire Solicitation # 75N99020R00030 Water Treatment Services for the Central Utility Plant National Institutes of Health Bethesda, Maryland

Name of Offeror: _______________________

A. QUALIFICATIONS:

1. Name and Location of Chemical Production Facilities:

Primary Location No. 1 and miles from NIH: _______ (Owned/Subcontract) Size (Sq. Ft.): ____________ Secondary Location No. 2 and miles from NIH:______(Owned/Subcontract) Size (Sq. Ft.): ____________ Temperature Controlled Warehouse Location No. 3 and miles from NIH: _________________ Size (Sq. Ft.): ____________

If the offeror subcontracts with the chemical production facilities listed above, provide proof of a five (5) year working relationship with the chemical production facility. Each facility must be capable of producing at least 95 % of all products proposed by the Offeror in Attachment A Proposed Chemical Products Form.

2. Provide QA/QC Certifications for Chemical Production Facilities (please provide a copy of all certifications):

ISO Certification: _________________________________________ Provide a copy of the permit with this completed form.

3. On the proposed chemicals please confirm the following:

a. Do any of the proposed cooling tower chemicals or chilled water chemicals contain nitrites, chromates, silicates, or molybdates?

b. Will the contractors provide a 4% non-oxidizing biocide solution to match what we currently use?

c. Will phosphorous based additives in cooling tower and chilled water treatment chemicals have any affect chlorine dioxide ?

4. Does the Water Treatment Chemical Provider own and operate laboratory facilities capable of performing a full range of analytical work, including water analysis, chemical residual levels, deposit analysis, corrosion coupon analysis, microbiological analysis, ion exchange resin, and metallurgical analysis?

5. If the laboratory is not owned and operated by the offeror, demonstrate a five (5) year relationship with the laboratory facility.

6. See Attachment C Laboratory Testing Requirements for Laboratory Requirements. Supply laboratory certifications with this form. Designate whether testing will be performed by the Offeror or a third party laboratory.

7. Can the Offeror supply chemical products to the Government upon 24 hours’ notice? Yes/No

8. Offers proposing a Joint Venture shall provide a detailed accounting of what services and products each partner is supplying. In addition the Joint Venture shall provide the Memo of Understanding (MOU) detailing the relationship and demonstrate a five (5) year working relationship within 300 miles of the NIH Bethesda Campus.

9. Are bulk and neat chemical deliveries handled by the Contractor or subcontractor? Offeror/Subcontractor

a. Name of Subcontractor if Applicable: _____________________________

b. Department of Transportation (DOT) permit for Bulk Delivery of Hazardous Chemicals:

Permit No.: ________________________________ Provide a copy of the permit with this completed form.

c. Delivery Personnel Safety Certification Training:

Hazwoper 40: Yes/No OSHA 30: Yes/No Provide a copy of the certifications with this completed form.

10. Provide facilities where the Offerors deliver a minimum 40,000 gallons of total bulk chemical delivery and 11,000 gallons of total neat delivery annually.

Facility No. 1 ______________________Bulk________gallons Neat _______gallons Facility No. 2 ______________________Bulk________gallons Neat _______gallons Facility No. 3______________________Bulk________gallons Neat _______gallons

11. Experience with Chlorine Dioxide Generation Systems Currently Service: Yes/No Provide 3 sites with a generator which produces approximately 250 pounds per day at a minimum concentration of 2,000 ppm or more.

a. Size of unit and Location: Capacity:__________Location:__________(Leased/Cust Own)

b. Size of unit and Location: Capacity:__________Location:__________(Leased/Cust Own )

c. Size of unit and Location: Capacity:__________Location:__________(Leased/Cust Own)

12. In addition to the Technical Data Sheets, will the Contractor provide additional detailed analysis of proposed chemicals as requested by the Government. Yes/No

13. Provide proof of Commercial General Liability Insurance for an amount not less than $2,000,000/$2,000,000 and attach to

14. Provide example of past approach to transition from an Incumbents chemical products to the Contractor’s chemical products at a similar site with neat and bulk chemical systems (Attach one separate sheet include name of customer and type of facility if not included as a reference in Corporate Experience)

15. Safety A certified safety record shall be provided for the Contractor and any Subcontractors for the past 5 years provide the following information (Attach one separate sheet):

a. Number of employee hours worked from 2016 through 2020

b. Experience Modification Rate per OSHA

c. Number of recordable cases

d. Number of fatalities

e. Occupational Safety and Health Administration (OSHA) experience:

i. Citation Date

ii. Severity

iii. Cited Regulation

iv. Penalty Assessed

f. Provide a copy of the safety information attached at the end of this form.

16. The Offer shall provide the following attachments and number them accordingly

a. If production facility is subcontracted, proof of five (5) year working relationship.

b. Chemical Production Facilities ISO Certificate

c. Laboratory Certifications in Accordance with Attachment C Laboratory Testing Requirements

d. Memo of Understanding and details of what services and product each will provide

e. Permit from Department of Transportation (DOT) permit for Bulk Delivery of Hazardous Chemicals

f. Delivery Personnel Safety Certifications

g. Five Years of Safety Records per Item 10.