Attachment_C_Forms_to_Return_with_Quote.docx

RFQ # 140P8323Q0011 San Juan Islands NHP FY23 Septic Pumping Services

Contract Price Schedule

INSTRUCTIONS: On 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 and extended prices to whole dollars.

Contract Year

Price Per Gallon

FY23

(Base Year)

FY24

(Option Year 1)

FY25

(Option Year 2)

FY26

(Option Year 3)

FY27

(Option Year 4)

In accordance with FAR clause 52.216-21, Requirements, the gallons pumped per year is estimated; this estimate is not a guarantee and payment will be made for the actual number of gallons pumped. The total contract is not expected to exceed $20,000.00 in the base period or any single ordering period, nor exceed $100,000 for the entire contract period (base period plus all option years).

Relevant Experience The purpose of this form is for the offeror to list construction projects (preferably performed during the past five (5) years) that are similar to the work described in this solicitation. 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 Proposal. Include area codes with all telephone numbers. Type or print legibly.

The Government may contact the entities listed herein to obtain past performance reviews of the offeror’s team. Past performance is a measure of the degree to which the Offeror satisfied its customers in the past and complied with federal, state, and local laws and regulations. The past performance of the offeror, key personnel (if applicable), and proposed subcontractors on projects similar in scope and complexity (i.e. relevant to the current project) will be evaluated in the areas of quality, timeliness, and business relations. 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 offeror 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 offeror’s past performance record.

Name of Contractor/Offeror:

Project Name:

Project Location:

Name of Owner:

Address of Owner:

Telephone Number:

Project Value:

Dates of Construction:

Description of the Project and Scope of Offeror’s Work

Performance Remarks