Attachment C Forms to Return with Quote.docx

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

All work shall be performed in accordance with the attached specifications, drawings, and wage determination. Refer to Definition of Line Items in specifications for details.

CONTRACT PRICE SCHEDULE

All work shall be performed in accordance with the attached specifications and wage determination. All lines are “lump sum” except where noted. Refer to Attachment A Project Specifications for contract line item definitions.

Item 1: Fiber Installation/Conduit

Point of contact name: ______________________________ and e-mail: __________________________

This business’ registration is active in SAM __yes __no (check one).

The representations and certifications in SAM apply to this proposal (see FAR provision 52.204-8(b)(2)): __yes __no.

52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment. (AUG 2019)

(a) Definitions. As used in this provision— Covered telecommunications equipment or services, Critical technology, and Substantial or essential component have the meanings provided in clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition. Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Contractors are not prohibited from providing—

(1) A service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(2) Telecommunications equipment that cannot route or redirect user data traffic or permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(c) Representation. The Offeror represents that— It [ ] will, [ ] will not provide covered telecommunications equipment or services to the Government in the performance of any contract, subcontract or other contractual instrument resulting from this solicitation.

(d) Disclosures. If the Offeror has responded affirmatively to the representation in paragraph (c) of this provision, the Offeror shall provide the following information as part of the offer—

(1) All covered telecommunications equipment and services offered (include brand; model number, such as original equipment manufacturer (OEM) number, manufacturer part number, or wholesaler number; and item description, as applicable);

(2) Explanation of the proposed use of covered telecommunications equipment and services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b) of this provision;

(3) For services, the entity providing the covered telecommunications services (include entity name, unique entity identifier, and Commercial and Government Entity (CAGE) code, if known); and

(4) For equipment, the entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the OEM or a distributor, if known).

Solicitation #140P8320Q0036, Painted Hills Septic John Day Fossil Beds NHM

Relevant Experience READ CAREFULLY: 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.

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

Key Personnel Qualifications READ CAREFULLY: The purpose of this form is for the Offeror to list the qualifications of all key personnel as described in the solicitation.

Experience and qualifications include those developed on previous jobs; jobrelated training courses; certificates and licenses; honors; and specialty skills that are relevant to the proposed project. Provide dates, but do not send documents.

Provide the state in which registration or license is held and the registration or license number. Fill in the information by typing or printing legibly.

NAME OF CONTRACTOR/OFFEROR:

PERSONNEL INFORMATION:

Name:

Job Title:

EDUCATION AND PROFESSIONAL REGISTRATION:

Top Educational Level Obtained:

Year:

Area of Specialization:

Professional Registrations:

EXPERIENCE AND QUALIFICATIONS

List of proposed subcontractors

The purpose of this form is for the Offeror to list the proposed subcontractors who will perform on the contract. Include a brief description of the work they will perform. Fill in the information by typing or printing legibly.

NAME OF CONTRACTOR/OFFEROR:

SUBCONTRACTOR NAME:

DUNS:

Address and website (if applicable):

DESCRIPTION OF PROPOSED SUBCONTRACT WORK:

SUBCONTRACTOR NAME:

DUNS:

Address and website (if applicable):

DESCRIPTION OF PROPOSED SUBCONTRACT WORK:

SUBCONTRACTOR NAME:

DUNS:

Address and website (if applicable):

DESCRIPTION OF PROPOSED SUBCONTRACT WORK:

SUBCONTRACTOR NAME:

DUNS:

Address and website (if applicable):

DESCRIPTION OF PROPOSED SUBCONTRACT WORK:

Subcontractor Reference READ CAREFULLY: The purpose of this form is for the offeror to provide references for key subcontractors identified in the Instructions, Conditions, and Notices to Offerors (Section L) who are considered critical to the successful accomplishment of the project. Use as many sheets as necessary. These subcontractor references should include additional relevant projects similar to the work described in the plans and specifications. Include area codes with all telephone numbers. Fill in the information by typing or printing legibly.

SUBContractor (PROPOSED):

ADDRESS:

Project Name:

Name of Owner:

Location:

Prime Contractor

Telephone Number:

Subcontract $ Value:

Dates of Construction:

Dates of Construction:

Description & Scope of Work specific areas of experience (SEE INSTRUCTIONS FOR THE SUBMISSION OF OFFERS AND OTHER INFORMATION – capability CRITERIA):

General References READ CAREFULLY: The purpose of this form is for the offeror to provide the Government with general references in the spaces provided as described in the Instructions, Conditions, and Notices to Offerors (Section L). Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

It is especially important that the offeror disclose instances in which their relationships with the references may be considered 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. Provide explanations on separate sheets as necessary.

Name of Contractor/Offeror:

Surety

Name of Surety:

Address of Surety:

Name of Agent:

Telephone Number:

Corporate Bank

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

Corporate Bank

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

Insurance Company

Name:

Address:

Name of Agent:

Telephone Number:

Types of Policies: