Attachment 5 AF APP REQ FOR NS PESTICIDES 2021.pdf

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Attached to
HERBICIDE TREATMENT OF INVASIVE PLANT SPECIES
Solicitation number
FA6703-24-Q-0010
Issued by

About this file

This document is a Request for Quote (RFQ) for herbicide treatment of invasive plant species at Dobbins Air Reserve Base in Marietta, Georgia. The contractor is required to provide all labor, materials, equipment, transportation, reports, and other documentation necessary to perform invasive species management, including foliar spray application and cut stump/vine application of herbicides. The work will be awarded as a firm-fixed price contract with a base year and four one-year option periods. This is a 100% Small Business set-aside with a NAICS code of 541620 - Environmental Consulting Services and a size standard of $19M. A site visit is scheduled for August 16, 2024, and quotes are due by September 4, 2024. Award will be made to the responsive/responsible offeror whose quote is most advantageous to the Government, price and other factors considered.

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Text version

REQUEST FOR APPROVAL OF NON-STANDARD PESTICIDE

Select MAJCOM from dropdown: INSTALLATION:

POINT OF CONTACT: ACTIVITY:

OFFICE SYMBOL:

DSN:

Commercial:

E-MAIL:

POC SIGNATURE

DATE SIGNED

PESTICIDE INFORMATION

TRADE NAME: EPA#

ACTIVE INGREDIENT: SIGNAL WORD:

FORMULATION: CONTAINER SIZE:

QUANTITY REQUESTED: NSN:

TARGET PEST

SPECIES:

JUSTIFICATION STATEMENT (Provide details for need, e.g., reduced cost, pesticide resistance management, improved efficacy):

APPLICATOR INFORMATION (use continuation on reverse if needed)

NAME: DOD/STATE CERTIFICATION NUMBER

MAJCOM PEST MANAGEMENT CONSULTANT APPROVAL

APPROVED w/conditions: (one time only, used by date, or indefinitely) NOT APPROVED (Justification)

MAJCOM CONSULTANT SIGNATURE DATE SIGNED

Select MAJCOM Consultant from dropdown box and e-mail:

AFCEC NON-STANDARD PESTICIDE APPROVAL FORM 20211012

Proposed product use/general application area

Continuation:

AFCEC NON-STANDARD PESTICIDE APPROVAL FORM 20191022

INSTALLATION:
POINT OF CONTACT:
OFFICE SYMBOL:
DSN:
Commercial:
EMAIL:
TRADE NAME:
ACTIVE INGREDIENT:
FORMULATION:
CONTAINER SIZE:
QUANTITY REQUESTED:
NSN:
SPECIES: e.g., broad leaf weeds, bed bugs, German cockroaches, tree of heaven, roof rats
NAMERow1:
DODSTATE CERTIFICATION NUMBERRow1:
NAMERow2:
DODSTATE CERTIFICATION NUMBERRow2:
NAMERow3:
DODSTATE CERTIFICATION NUMBERRow3:
Continuation:
MAJCOM: [ACC]
EPA REGISTRATION #:
SIGNAL WORD: [CAUTION]
Check Box18: Off
Check Box19: Off
Text20:
What do you want to do and where?:
MAJCOM E-mail: [mark.breidenbaugh@us.af.mil]
DATE:
JUSTIFICATION STATEMENT:

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