Attachment_4_F15PS00263.pdf

Attachment 4

INSTRUCTIONS TO OFFEROR(S) - Proposal Documents for Solicitation # F15PS00263

1. All questions shall be in writing. Questions may be e-mailed to chris_murphy@fws.gov.

2. Proposals must be received at this office no later than April 14, 2015, 5:00pm Eastern Time.

Proposals must be submitted to Christopher Murphy at the following address: u.s. Fish and Wildlife Service, 300 Westgate Center Drive, Hadley, MA 01035-9589. Proposals may also be emailed to chris_murphy@fws.gov.

3. It is the contractor's responsibility that proposals submitted, regardless of the method of transmission, are received in this office prior to the time and date for receipt of proposals.

4. It is MANADTORY that the contractor complete registration in the System for Award

Management (SAM) at https://www.sam.gov/portal/public/SAMI to be eligible award.

5. Contractor shall complete and submit the following attached items along with detailed price and equipment proposal, as their proposal package:

1. Standard Form 1442

2. Blank Bond Forms - Bid Bond, Performance Bond, and Payment Bond

3. Past Performance Survey (include information for similar type of work)

Award shall be made to a single offeror whose proposal represents the best value to the Government.

Complete this set only and return to :

u.S. Fish and Wildlife Service Contracting and General Services 300 Westgate Center Drive Hadley, MA 01035-9589

Attn: Christopher Murphy https://www.sam.gov/portal/public/SAMI mailto:chris_murphy@fws.gov mailto:chris_murphy@fws.gov

SOLICITATION, OFFER,

AND AWARD

(Construction, Alteration, or Repair)

1. SOLICITATION NO.

F15PS00263

2. TYPE OF SOLICITATION

OSEALED BID (IFB)

Ii] NEGOTIATED (RFP)

3. DATE ISSUED

03/10/2015

IMPORTANT •• The "offer" section on the reverse must be fully completed by offeror.

4. CONTRACT NO. 5. REQUISITIONIPURCHASE REQUEST NO. 6. PROJECT NO.

0040194908

7. ISSUED BY CODE 8. ADDRESS OFFER TOF05

FWS, DIVISION OF CONTRACTING AND GE

300 WESTGATE CENTER DRIVE

HADLEY MA 01035-9589

9. FOR b. TELEPHONE NO. (Include area code) (NO COLLECT CALLS)

INFORMATION

CALL:

Murphy 413-253-8235

SOLICITATION

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder."

1O. THE GOVERNMENT REQUIRES PERFORMANCE OF THE WORK DESCRIBED IN THESE DOCUMENTS (Title, identifYing no., date)

The U.S. Fish and Wildlife Service, Northeast 5, is issuing a Request for

Proposal (RFP) for Replacement of (Snare Meadow) Water Control Structure at the

Moosehorn National Wildlife Refuge located in (Washington Co.), Maine. The work under this contract includes furnishing labor, equipment, supplies, tools, heavy equipment, and materials to demolish one water control structure and culvert, and install new water control structure and overflow spillway.

Estimated Price Range: Between $100,000. and $250,000.

Department of Labor Wage Rate: General Decision Number: ME150016

Time for Completion: One Hundred and Twenty (120) Calendar Days After Notice To

Proceed

Bonds: 100% Performance and 100% Payment

Offer Guarantee: 20% of Proposal Amount

USE COPIES ENTITLED "INSTRUCTION TO OFFERORS/PROPOSAL DOCUMENTS" WHEN SUBMITTING

Continued ...

11. The Contractor shall begin performance 10 calendar days and complete it w~hin 120 calendar days after receiving o award, [l notice to proceed. The performance period is [lmandatory onegotiable.

12b. CALENDAR DAYS

12a. THE CONTRACTOR MUST FURNISH ANY REQUIRED PERFORMANCE AND PAYMENT BONDS?

(If "YES", indicate within how many calendar days afteraward in I~m 12b.) 10

13. ADDITIONAL SOLICITATION REQUIREMENTS:

04/14/2015 (date). If this is a sealed bid solicitation, offer. will be publicly opened at thet time. Sealed envelopes containing offers shell be marked to show the offeror's name and address, the solicitation number, and the date and time offers are due.

a. Sealed offers in original and copies to perform the work required are due at the place specified in Item aby (hour) local time

b. An offer guarantee lRl is, 0 is not required.

c. All offers are subject to the (1) work requirements, and (2) other provisions and clauses incorporated in the solicitation in full text or by reference.

d. Offers providing less than 60 calendar days for Government acceptance after the date offers are due will not be conSidered and will be rejected.

NSN 7540-01-155-3212 STANDARD FORM 1442 (Rev. 4-85) Prescribed by GSA FAR(48 CFR) 53.236-1 (d)

OFFER (Muot be fully completed by_Of)

14. NAME AND ADDRESS OF OFFEROR (1_ ZIPCoda) 15. TELEPHONE NO. (lncluda ""'. C<Jde)

16. REMITTANCE ADDRESS (Inc/uds only /fIJi_than Ilem 14.)

CODE FACILITY CODE

17. The offeror .gr.... to perfOrm the wort< required at the prices specified below in strict accordance wfth tho terms o!this solleR.tion, ffthis offer Is accepted by the Gow;mment In writing within _______calendar days after the date offers are due. (lnserl any number equal to or greater than the minimum requlremenlstated in 110m 13d. Failure 10 inserlany number means the offeror aooepls the minimum in item 13d.)

AMOUNTS ~I

18. Th. off.ror .gr.... to fUrnish any required performance .nd payment bonds.

19. ACKNOWLEDGEMENT OF AMENDMENTS

(The offeror acknowledges re~pt ofamendments to tho solicitation - give number end dote ofeach)

AMENDMENT NO.

DATE.

20•. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER (TYpe or print) 20b. SIGNATURE 20e. OFFER DATE

AWARD (To be completed by Govemment)

21. ITEMS ACCEPTED:

Continued ...

22. AMOUNT 123. ACCOUNTING AND APPROPRIATION DATA

24. SUBMIT INVOICES TO ADDRESS SHOWN IN 5. OTHER THAN FULL AND OPEN COMPETITION PURSUANT TO (4 copies unloss otharwtse spoc/filId) D 10 U.S.C. 2304(e) D 41 U.S.C.253(e)

26. ADMINISTERED BY CODE II,.;F:..0;:,.;;5___________--i 7. PAYMENT WILL BE MADE BY

FWS, DIVISION OF CONTRACTING AND GE

300 WESTGATE CENTER DRIVE

HADLEY MA 01035-9589

CONTRACTING OFFICER WILL COMPLETE ITEM 28 OR 29 AS APPLICABLE

D 28. NEGOTIATED AGREEMENT D29.AWARD

(Conltactor is required to sign this document and return ____ copies to Issuing olffee.) (Conltactor is not required to sign this dOCument.)

Ccnltactrlt 09""'" to furniSh end dellvor .11 //ems or perform all work requirements I_HIied on this fonn and any conlinuat/on sheels foJ' the considarelton stated in this conltact. Tho \'bur offer on this sollclt."on Is hl1t&by acceptad as 10 the //ems listed. This e_consummates rightS end obIIglltions Of the parties to this conl1act shall be gouomod by (a) this the conltact, which consists of(a) the Government soI_tion end your offer, and (b) this conl1act award.

conl1act a_. (b) the soIicitotion, end (e) the cteu..., r&presontatfons, No further contractual document Is necessalY.

30e. NAME AND TITLE OF CONTRACTOR OR PERSON AUTHORIZED TO SIGN (Type or print) 31a NAME OF CONTRACTING OFFICER (Type orprint)

Christopher Murphy 3Ob. SIGNATURE 31c.DATE30C.DATE 31b. UNITED STATES OF AMERICA

BY

STANDARD FORM 1442 (REV. 4-85) BACK

ERENCE NO. OF DOCUMENT BEING CONTINUED

CONTINUATION SHEE 5PS00263 3

NAME OF OFFEROR OR CONTRACTOR

ITEM NO.

(A)

SUPPLIES/SERVICES

(8)

QUANTITY

(C)

UNIT

(D)

UNIT PRICE

(E)

AMOUNT

(F)

00010

OFFERS. OFFEROR MUST SIGN AND RETURN

WITH THEIR PROPOSAL.

Delivery: 08/20/2015 Delivery Location Code: 0008349970

FWS MOOSEHORN NWR

103 HEADQUARTERS ROAD, SUITE 1

BARING ME 04694 US

FOB: Destination Period of Performance: 05/04/2015 to

MSH Snare Mdw Pd repl WCS w spillway

FORM 1442

08/20/2015

OPTIONAL FORM 336 (4-BB)

Sponsored by GSA

NSN 7540·01·152·8067

FAR (46 CFRl 53.11Q

BID BOND

( See instructions on reverse)

DATE BOND EXECUTED (Must not be later than bid opening date)

9000-0045 OMB Number:

Expiration Date: . 6/30/2016

Public reporting burden for this collection of information is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of infonnation, including suggestions for reducing this burden, to the FAR Secretariat (MVR), Federal Acquisition Policy Division, GSA, Washington, DC 20405.

TYPE OF ORGANIZATION (''X'' one)

D INDIVIDUAL D PARTNERSHIP

D JOINT VENTURE D CORPORATION

STATE OF INCORPORATION

PRINCIPAL (Legal name and business address)

SURETY(IES) (Name and business address)

PENAL SUM OF BOND BID IDENTIFICATION

PERCENT AMOUNT NOT TO EXCEED BID DATE INVITATION NO.

OFBID

MILLION (S) THOUSAND(S) HUNDRED(S) CENTSPRICE

FOR (Construction, supplies, or Services)

OBLIGATION

We, the Principal and Surety (ies) are firmly bound to the United States of America (hereinafter call the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jOintly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit of liability is indicated, the limit or liability is the full amount of the penal sum.

CONDITIONS:

The principal has submitted the bid identified above.

THEREFORE:

The above obligation is void if the Principal - (a) upon acceptance by the Government of the bid identified above, within the period specified therein for acceptance (sixty (60) days if no period is specified), executes the further contractual documents and gives the bond(s) required by the terms of the bid as accepted within the time specified (ten (10 days if no period is specified) after receipt of the forms by the principal; or (b) in the event of failure to executes such further contractual documents and give such bonds, pays the Government for any cost of procuring the work which exceeds the amount of the bid.

Each surety executing this instrument agrees that its obligations is not impaired by any extension(s) of the time for acceptance of the bid that the principal may grand to the Government. Notice to the surety (ies) of extensions (s) are waived. However, waiver of the notice applies only to extensions aggregating not more than sixty (60) calendar days in addition to the periods originally allowed for acceptance of the bid.

WITNESS

The principal and Surety (ies) executed this bid bond and affixed their seals on the above date.

PRINCIPAL

SIGNATURE(S)

1.

(Seal)

2.

(Seal)

3.

(Seal) Corporate SealNAME(S) &

TITLE(S)

(Typed)

1. 2. 3.

INDIVIDUAL SURETY(IES)

SIGNATURE(S) 1.

(Seal)

2.

(Seal)

NAME(S)

(Typed)

1. 2.

CORPORATE SURETY(IES)

NAME &

ADDRESS

STATE OF INC.

I

LIABILITY LIMIT ($)

Corporate Seal

:::l en

SIGNATURE(S) 1. 2.

NAME(S)&

TITLE(S)

(Typed)

1. 2.

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 24 (REV. 10/1998)

Pervious edition is usable Prescribed by GSA - FAR (48 CFR) 53.228(a)

NAME & STATE OF INC.

I

LIABILITY LIMIT ($)

III ADDRESS

~ 1. 2. Corporate SIGNATURE(S) Seal

NAME(S) &II)

TlTLE(S)

1. 2.

(Typed)

NAME & STATE OF INC.

I

LIABILITY LIMIT ($)

0 ADDRESS

~ Corporate

~ SIGNATURE(S)

1. 2.

Seal

II) NAME(S) & 1. 2.

TITLE(S)

(Typed)

NAME & STATE OF INC.

I

LIABILITY LIMIT ($)

c

ADDRESS>

I- Corporatew 1. 2.g:; SIGNATURE(S) Seal

II)

NAME(S) & 1. 2.

TITLE(S)

(Typed)

NAME & STATE OF INC.

I

LIABILITY LIMIT ($)

w ADDRESS

~ SIGNATURE(S) 1. 2. Corporate II:: Seal

~ NAME(S) & 1. 2.II)

TITLE(S)

(Typed)

NAME & STATE OF INC.

I

LIABILITY LIMIT ($)

II. ADDRESS

~ SIGNATURE(S)

1. 2. Corporate w SealII::

~ NAME(S) & 1. 2.II)

TITLE(S)

(Typed)

NAME & STATE OF INC.

I

LIABILITY LIMIT ($)

ADDRESS

C)

~ SIGNATURE(S) 1. 2. Corporate II:: Seal

~ NAME(S) & 1. 2.II)

TITLE(S)

(Typed)

INSTRUCTIONS

1. This form is authorized for use when a bid guaranty is required. any deviation from this form will require the written approval of the Administrator of General Services.

2, Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., ab attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. The bond may express penal sum as a percentage of the bid price. In these cases, the bond may state a maximum dollar limitation (e.g., 20% of the bid price but the amount not to exceed dollars).

4. (a) Corporation executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitation listed therein. where more than one corporate surety is involved, their names and address shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY (IES)." In the space designed "SURETY (IES)" on the face of the form, insert only the letter identification of the sureties.

(b) \/\there individual sureties are involved, a completed Affidavit of Individual surety (Standard Form 28), or each individual surety, shall accompany the bond. The Government may require the surety to furnish additional substantiating information concerning its financial capability.

5. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the word" Corporate Seal";

and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals.

6. Type the name and title of each person signing this bond in the space provided.

7. In its application to negotiated contracts. the terms "bid" and "bidder" shall include "proposal" and "Offeror."

STANDARD FORM 24 (REV. 10/1998) BACK

PERFORMANCE BOND

(See instructions on reverse)

DATE BOND EXECUTED (Must be same or/aterthan date of contract)

OMB Number: 9000-0045

Expiration Date: 6/30/2016

PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 60 minutes per response.

including the time for reviewing instructions. searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to U.S. General Services Administration. Regulatory Secretariat (MVCB)/IC 9000-0045, Office of Governmentwide Acquisition PoIicy,1800 F Street.

NW, Washington, DC 20405.

PRINCIPAL (Legal name and business address)

SURETY(IES) (Name(s) and business addressees)

TYPE OF ORGANIZATION ("Xu one)

INDIVIDUAL D PARTNERSHIP

D JOINT VENTURE D CORPORATION

STATE OF INCORPORATION

PENAL SUM OF BOND (whole numbers only) MILLlON(S) ITHOUSANDS IHUNDRED(S) ICENTS

CONTRACT DATE CONTRACT NO.

OBLIGATION

We, the Principal and Surety(ies), are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment ofthe penal sum. we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we the sureties bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit of liability is indicated, the limit of liability is the full amount of the penal sum.

CONDITIONS

The Principal has entered into the contract identified above.

THEREFORE

The above obligation is void if the Principal

(a)(1) Performs and fulfills all the undertaking, covenants, terms, conditions, and agreements ofthe contract during the original term of the contract and any extensions thereof that are granted by the Government, with or without notice of the Surety(ies) and during the life of any guaranty required under the contract, and (2) performs and fulfills all the undertakings, covenants, terms, conditions, and agreements of any and all duly authorized modifications of the contract that hereafter are made. Notice of those modifications to the SuretyQes) are waived.

(b) Pays to the Government the full amount of the taxes imposed by the Government, if the said contract is subject to 41 U.S.C. Chapter 31, Subchapter III, Bonds, which are collected, deducted, or withheld from wages paid by the Principal in carrying out the construction contra!;:t with respect to which this bond is furnished.

WITNESS

The Principal and Surety(ies) executed this performance bond and affixed their seals on the above date.

PRINCIPAL

1. 2. 3.

SIGNATURE(S)

(Seal) (Seal)(Seal)

Corporate

1. 2. 3.NAME(S)& Seal

TITLE(S}

(Typed)

INDIVIDUAL SURETY{IES)

SIGNATURE(S)

1.

(Seal)

2.

{Seal}

NAME{S}

(Typed)

1. 2.

CORPORATE SURETY(IES)

NAME &

ADDRESS

STATE OF INC.

Corporate Seal

~ wa: SIGNATURE(S)

1. 2.

::I t/) NAME(S) &

TITLE(S

(Typed)

1. 2.

I~IABILITY LIMIT ($)

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 25 (REV. 812014)

Previous edition not usable Prescribed by GSA-FAR (48 CFR) 53.228 (b)

CORPORATE SURETY(IES) (Continued)

NAME &

to ADDRESS

SIGNATURE(S)

1. w a:

~ NAME(S) & 1.f/J

TITLE(S)

(Typed)

NAME &

0 ADDRESS

~ 1.

w SIGNATURE(S) a:

~ NAME(S)& 1.

f/J

TITLE(S)

(TYped)

NAME &

C

ADDRESS

~ 1.

w SIGNATURE(S) a:

~ NAME(S) & 1.f/J

TITLE(S)

(Typed)

NAME &

ADDRESS w

~ SIGNATURE(S) 1.w a:

~ NAME(S)& 1.

f/J

TITLE(S)

(Typed)

NAME &

u.. ADDRESS

1.

SIGNATURE(S}

~ NAME(S)& 1.f/J

TITLE(S)

(Typed)

NAME &

ADDRESS

~ SIGNATURE(S} 1.w a:

~ NAME(S)& 1.

f/J

TITLE(S)

(Typed)

STATE OF INC.

2.

2.

STATE OF INC.

2.

2.

STATE OF INC.

2.

2.

STATE OF INC.

2.

2.

STATE OF INC.

2.

2.

STATE OF INC.

2.

2.

ILIABILITY LIMIT ($)

ILIABILITY LI MIT ($)

ILIABILITY LIMIT ($)

ILIABILITY LIMIT ($)

ILIABILITY LIMIT ($)

ILIABILITY LIMIT ($)

Corporate Seal

Corporate Seal

Corporate Seal

Corporate Seal

Corporate Seal

Corporate Seal

RATE PER THOUSAND ($) TOTAL ($)BOND

PREMILIM

INSTRUCTIONS

1. This form is authorized for use in connection with Government contracts. Any deviation from this form will require the written approval of the Adrrinistrator of General Servi03S.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g .• an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm.

partnershiP. or joint venture, or an officer of the corporation invotved.

3. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitation listed therein. Where more than one corporate surety is involved, their names and addresses shall appear in the spaces (Surety A, Surety B. etc.) headed "CORPORATE

SURETY(IES)." In the space deSignated "SURETY(IES)" on the face of the form, insert only the letter identification of the sureties.

(b) Wlere individual sureties are involved. a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety, shall accompany the bond. The Govemment may require the surety to furnish additional substantiating information concerning their financial capability.

4. Corporations executing the bond shall affix their corporate seals.

Individuals shall execute the bond opposite the words "Corporate Seal", and shall affix an adhesive seal if executed in Maine, New I-larrl>shire, or any other jurisdiction requiring adhesive seals.

5. Type the name and title of each person signing this bond in the space provided.

STANDARD FORM 25 (REV. 8/2014) BACK

PAYMENT BOND

(See instructions on reverse)

:~;~?ND EXECUTED (Must be same or later than date of OMB Number: 9000-0045

Expiration Date: 6/30/2016

PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, includin!l suggestions for reducing this burden, to U.S. General Services Administration, Regulatory Secretariat (MVCB)IIC 9000-0045, Office of Governmentwide Acquisition POlicy,1800 F Street, NW, Washington, DC 20405.

PRINCIPAL (Legal name and business address)

SURETY(IES) (Name(s) and business address(es)

TYPE OF ORGANIZATION ("X" one)

D INDIVIDUAL D PARTNERSHIP

D JOINT VENTURE D CORPORATION

STATE OF INCORPORATION

PENAL SUM OF BOND (Whole numbers only) MILLlON(S) THOUSAND(S) IHUNDRED(S) ICENTS

CONTRACT DATE CONTRACT NO.

OBLIGATION:

We, the Principal and Surety(ies), are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jOintly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit is indicated, the limit of liability is the full amount of the penal sum.

CONDITIONS:

The above obligation is void if the Principal promptly makes payment to all persons having a direct relationship with the Principal or a subcontractor of the Principal for furnishing labor, material or both in the prosecution of the work provided for in the contract identified above, and any authorized modifications of the contract that subsequently are made. Notice of those modifications to the Surety(ies) are waived.

WITNESS:

The Principal and Surety(ies) executed this payment bond and affixed their seals on the above date.

PRINCIPAL

SIGNATURE(S)

1.

(Seal)

2.

(Seal)

3.

(Seal) Corporate SealNAME(S)&

TITLE(S)

(Typed)

1. 2. 3.

INDIVIDUAL SURETY(IES)

SIGNATURE(S)

1.

(Seal)

2.

(Seal)

NAME(S)

(Typed)

1. 2.

CORPORATESURETY(lES) oc(

I-w 0:::

NAME &

ADDRESS

STATE OF INC. I~IABILITY LIMIT

Corporate Seal

SIGNATURE(S)

1. 2.

::J m NAME(S)&

TITLE(S)

(Typed)

1. 2.

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 25A (REV. 8/2014)

Previous edition is NOT usable

Prescribed by GSA-FAR (48 CFR) 53.2228(c)

CORPORATE SURETY IES) (Continued)

NAME & STATE OF INC. I~IABILITY LIMIT

IX) ADDRESS

> 1. 2.I- Corporatew SIGNATURE(S) 0:: Seal

::J NAME(S)& 1. 2.U)

TITLE(S)

(Typed)

NAME & STATE OF INC. I ~IABILITY LIMIT

(.) ADDRESS

2. Corporate

0:: Seal ::J 2.U)

NAME & STATE OF INC. I~IABILITY LIMIT

C ADDRESS

~ SIGNATURE(S)

1. 2. Corporate

0:: Seal

::J NAME~S~ & 1. 2.U) TITL ( )

(Typed)

NAME & STATE OF INC. I ~IABILITY LIMIT

W ADDRESS

~ SIGNATURE(S)

1. 2. Corporatew

0:: Seal

::J NAMEJS~& 1. 2.U)

TITL ( )

(Typed)

NAME & INC. I ~IABILITY LIMIT

U. ADDRESS

> 1. 2.I SIGNATURE(S) Corporatew 0:: Seal

::J NAME(S~& 1. 2.U)

TITLE( }

(Typed)

NAME & STATE OF INC. I ~IABILITY LIMIT

C) ADDRESS

> 1. 2. CorporateI SIGNATURE(S)w 0:: Seal

::J NAME(S)& 1. 2.

U) TITLE(S)

(Typed)

INSTRUCTIONS

1. This form. for the protection of persons supplying labor and material. is used when a payment bond is required under 40 U.S.C. Chapter 31.

Subchapter III, Bonds. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g .• an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership. or joint venture, or an officer of the corporation involved.

3. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitation listed therein. Where more than one corporate surety is involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)."

In the space designated "SURETY(IES)" on the face of the form, insert only the letter identification of the sureties.

(b) Where individual sureties are involved. a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety, shall accompany the bond. The Government may require the surety to furnish additional substantiating information concerning their financial capability.

4. Corporations executing the bond shall affix their corporate seals.

Individuals shall execute the bond oppOSite the words "Corporate Seal", and shall affix an adhesive seal if executed in Maine. New Hampshire, or any other jurisdiction requiring adhesive seals.

5. Type the name and title of each person signing this bond in the space provided.

STANDARD FORM 25A (REV. 812014) BACK

Solicitation F15PS00263 page 1 of 5

PAST OR PRESENT PERFORMANCE SURVEY

Your Company Name: ___________________________________

Street Address: ______________________________________

City, State and ZIP Code: _________________________________________

1. GENERAL BUSINESS INFORMATION

Date Firm Organized/Established: ___________

Company President: __________ Vice President: _____________

Dun & Bradstreet Number: ______

Is company a ; Partnership [ ] Separate entity [ ] Division [ ] N/A [ ]

2. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS

Complete and submit the information requested on page 2-4 below on prime contracts or subcontracts completed or in progress. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress.

Solicitation F15PS00263 page 2 of 5

a. First Contract:

Contracting Agency or Company: _____________________

Point of Contact: __________ Telephone Number: ________

Contract Number: ________ContractlSubcontract Amount: $.________

Project Title and Location: _______________________

General Scope of Project: ________________________

Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:

Describe any Work You Subcontracted to Others: ________________

Total Amount of Subcontract(s): $_______

Period of Performance: days

Scheduled Completion Date: ________

Actual Completion Date: _____ Percentage of Work Completed: _______%=0

Were You Terminated? _________________________

Did you use a Quality Control Plan? ____ Did you use a Safety Plan? _______

Quality Control or Safety Problems encountered (if any): _____________

How were the problems resolved? _____________________

Solicitation F15PS00263 page 3 of 5

b. Second Contract:

Contracting Agency or Company: _____________________

Point of Contact: __________ Telephone Number: ________

Contract Number: ________ContractlSubcontract Amount: $________

Project Title and Location:

Your Role (Prime [ 1, Joint Venture [ 1, or Subcontractor [ 1) and the work your firm performed:

Describe any Work You Subcontracted to Others: ________________

Total Amount of Subcontract(s): $_______

Period of Performance: days

Scheduled Completion Date: ________

Actual Completion Date: ______ Percentage of Work Completed: _______°=10

Were You Terminated? _________________________

Did you use a Quality Control Plan? ____ Did you use a Safety Plan? _______

Solicitation F15PS00263 page 4 of 5

c. Third Contract:

Contracting Agency or Company: _____________________

Point of Contact: ___________ Telephone Number: ________

Contract Number: ________ContractlSubcontractAmount: .,.________

P~ectTWeand Location: ______________________~

Your Role (Prime [ ], Joint Venture [ ], or Subcontractor [ ]) and the work your firm performed:

Describe any Work You Subcontracted to Others: ________________

Total Amount of Subcontract(s): $_______

Period of Performance..:...:___.....;d=a=y~s

Scheduled Completion Date: ________

Actual Completion Date: _____ Percentage of Work Completed: _______=

Were You Terminated? _________________________

Did you use a Quality Control Plan? ____ Did you use a Safety Plan? _______

Solicitation F15PS00263 page 5 of 5

4. Certification of Past Performance Information:

Type or Print Information

Name of Survey Preparer ______________Phone:________

E-Mail;____________

Title__________________

Signature_________________

Date____________________