ATTACHMENT J4 Responsibility Eval Form.pdf
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- Solicitation number
- N4008521R2534
About this file
This solicitation is for an Indefinite Delivery/Indefinite Quantity (IDIQ) Environmental Multiple Award Contract (MAC) for environmental services and remedial actions. The services will be performed predominately at Naval Station Great Lakes in Illinois and Naval Support Activity Crane in Indiana, as well as other Navy and Marine Corps facilities throughout the United States and territories within the NAVFAC Atlantic Area of Responsibility. The objective is to obtain environmental services and implement remedial actions at contaminated sites regulated under statutes such as CERCLA, RCRA, UST, Clean Water Act, and Clean Air Act. This requirement is set aside 100% for competitive Service Disabled Veteran Owned Small Business firms located in the Midwest region. The performance period is a one-year base period followed by four one-year options, with a maximum aggregate value of $30 million over five years distributed across three to five awards. Individual task orders will range from $50,000 to $250,000.
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ATTACHMENT J-4
RESPONSIBILITY EVALUATION FORM
Offeror: ____________________________________________ Date: __________________
A. NAMES OF OFFICERS, OWNERS OR PARTNERS:
President: ________________________ Vice President: __________________________
Secretary: ________________________ Treasurer:_______________________________
Owner or Partners: ___________________________________________________________
B. PERSONS AUTHORIZED TO SIGN OFFERS, MODIFICATIONS AND CONTRACT FOR
COMPANY
Name: __________________________ Official Capacity: ________________________
C. BANKING REFERENCES (Please notify the Point of Contact that we will be calling.)
Name of Bank: _____________________ Point of Contact: _________________________
Address: __________________________ Phone: _________________________________
Email: ___________________________
Checking Account: _____________ Savings Account: ____________ Loan:_____________
D. CREDIT REFERENCES
Firm Name: _________________________ Address: _______________________________
Point of Contact: _____________________ Phone: _________________________________
Email: _____________________________
GOVERNMENT USE
Date account opened: _________________________________________________________
Ratings: __________________ Amount: _______________ Balance: __________________
Comments:___________________________________________________________________________
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