Attachment_D_Forms_to_Include_with_Quote.docx

SECTION B: Contract Price Schedule, 140P8321Q0077

INSTRUCTIONS: Enter price for all line items; failure to do so may render the offer non-responsive. 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 to whole dollars.

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

Contract Price Schedule

Grand Total

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 2020) 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 the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Items.

(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.

(1) 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. Nothing in the prohibition shall be construed to— (i)Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or (ii)Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) 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, 2020, from entering into a contract or extending or renewing a contract with an entity that uses 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. This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. Nothing in the prohibition shall be construed to— (i)Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or (ii)Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(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—

(1) 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. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds “will” in paragraph (d)(1) of this section; and

(2) After conducting a reasonable inquiry, for purposes of this representation, the Offeror represents that— It ☐ does, ☐ does not use covered telecommunications equipment or services, or use any equipment, system, or service that uses covered telecommunications equipment or services. The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds “does” in paragraph (d)(2) of this section.

(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— (A)The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known);

(B)A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and (C)Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(ii)For covered services— (A)If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or (B)If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(2) Disclosure for the representation in paragraph (d)(2) of this provision. If the Offeror has responded “does” in the representation in paragraph (d)(2) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment— (A)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);

(B)A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and (C)Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(ii) For covered services— (A)If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or (B)If not associated with maintenance, the PSC of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision. (End of provision)

52.204-26 Covered Telecommunications Equipment or Services-Representation (Dec 2019)

(a) Definitions. As used in this provision, “covered telecommunications equipment or services” has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) 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”.

(c) Representation. The Offeror represents that it ☐ does, ☐ 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. (End of provision)

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

Solicitation #140P8321Q0077, Replace Housing Roofs Big Hole NB

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: