Attachments_05-19-2015.pdf

HSCG38-15-Q-301002

ATTACHMENT 1

CERTIFICATE OF CONFORMANCE

CERTIFICATE OF CONFORMANCE IN ACCORDANCE WITH FAR 52.246-15

I certify that on ___________ [insert date], the ______________________________ [insert Contractor’s name] furnished the supplies or services called for by Contract No._____________________ via _____________________________ [Carrier] on _____________________________ [identify the bill of lading or shipping document] in accordance with all applicable requirements. I further certify that the supplies or services are of the quality specified and conform in all respects with the contract requirements, including specifications, drawings, preservation, packaging, packing, marking requirements, and physical item identification (part number), and are in the quantity shown on this or on the attached acceptance document.

DATE OF EXECUTION: ________________________________

SIGNATURE: _______________________________________

TITLE: ____________________________________________

ATTACHMENT 2

U.S. COAST GUARD

COMPONENT REPAIR RECORD

THIS FORM IS USED TO REPORT MAINTENANCE ACTIONS PERFORMED ON COAST GUARD

COMPONENTS BY OVERHAUL/REPAIR FACILITIES.

PART NAME CEI NUMBER SERIAL NUMBER

PART NUMBER: NSN:

THE COMPLETED FORM TO BE PROVIDED TO:

ORIGINAL TO: COPY 1:

ACMS - BLDG 78 PACKAGED WITH THE

USCG AVIATION LOGISTICSS CENTER OVERHAULED/REPAIRED

ELIZABETH CITY, NC 27909-5001 COMPONENT

OVERHAUL/REPAIR FACILITY TO COMPLETE ALL INFORMATION IN DESIGNATED AREA

MANUFACTURER:

TSO : DATE OF MANUFACTURE:

HRS :

THE FOLLOWING NARRATIVE SUMMARIZES THE WORK PERFORMED ON THIS COMPONENT

DURING THE COURSE OF THIS OVERHAUL/REPAIR.

OVERHAUL/REPAIR FACILITY: WORK ORDER NO:

DATE WORK COMPLETED: ITEM BEYOND ECONOMICAL REPAIR: YES NO

THE FOLLOWING MAINTENANCE ACTIONS WERE COMPLIED WITH DURING THE COURSE OF

THIS OVERHAUL/REPAIR.

AUTHORIZED SIGNATURE OR QUALITY ASSURANCE STAMP:

** FOR ACMS CONTRACTOR: DISENROLLED DATA ENTRY DATE **

ATTACHMENT 3

Past Performance Questionnaire (PPQ)

U.S. DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

AVIATION LOGISTICS CENTER

1060 Consolidated Road

ELIZABETH CITY, NC 27909

PAST PERFORMANCE QUESTIONNAIRE (PPQ)

I. INSTRUCTIONS

The company (i.e., contractor) that sent you this questionnaire intends to submit an offer in response to a U.S. Coast Guard solicitation and has identified you as a reference to validate their performance. This PPQ must be completed by the person most familiar with the Contractors’ performance on a present or previous contract and then submitted directly to the U.S.

Coast Guard by the person completing the PPQ. Please DO NOT send the completed PPQ to the Contractor being evaluated.

In addition to this questionnaire, you may receive a follow-up phone call to confirm or clarify information. Your cooperation in this matter is greatly appreciated.

Please submit the completed form to the Contract Specialist, Theresa Alkeus via the following method: (1) E-mail to Theresa.L.Alkeus@uscg.mil Subject Line: HSCG38-15-Q-301002

Please contact the Contract Specialist, Theresa Alkeus at (252)334-5174 if you have any questions.

The completed PPQ is due on or before June 23, 2015, 4:00 PM EST

II. GENERAL INFORMATION

A. PAST PERFORMANCE EVALUATOR & ORGANIZATION/COMPANY INFORMATION

1 Your Name:

2 Your Title:

3 Your Organization/ Company Name:

4 Address:

5 Your Phone Number:

6 Your Fax Number:

7 Your E-mail Address:

8 Date:

9 Your Signature:

B. CONTRACTOR NAME & CONTRACT IDENTIFICATION

1 Name of Contractor being evaluated:

2 Type of Instrument (e.g., Contract, Purchase Order, Task Order, Other):

3 Pricing Type (e.g., Fixed Price, Time & Material, Cost Reimbursement, Other):

4 Contract or Reference Number:

5 Subcontract Number (if applicable):

6 Order Number (if applicable):

7 Role of Contractor (Prime or Sub) (if sub, also provide name of prime)

8 Description of Service/Supply:

9 Competitive (Y/N):

10 Follow-On (Y/N):

11 Date of Award:

12 Initial Contract Dollar Value (w/Options):

13 Final Contract Dollar Value (w/Options):

14 Period of Performance:

15 Place(s) of Performance:

16 Complexity of Work (e.g., difficult, routine):

17 If applicable , type and extent of subcontracting:

Attachment 4

Schedule of Supplies/Services

BASE PERIOD

(From date of award through the following twelve (12) months) (Base Year 1)

Overhaul and repair equipment shown in accordance with (IAW) the Air Force Technical Orders (AFTO) stated and the terms of the Statement of Work (SOW).

CLIN ITEM DESCRIPTION EST

QTY

U/I UNIT

PRICE

(FIXED)

EXTENDED

AMOUNT

0001 Alternating Generator NSN: 6115-00-946-8441, P/N: 2CM353C1P or

P/N: 2CM353C1H.

Overhaul in Accordance with AFTO 8A6-9-5-3 (15 June 2011 Chg 4 - 1 April 2014) 8A6-9-5-4 (30 November 2006 Chg 7 – 1 Apr 2014) OEM: GE Aviation, cage code 07639 Flight Critical

EA

0002 Alternating Generator

NSN: 6115-01-224-5848, P/N: 28B58-9B

Overhaul in Accordance with AFTO 8A6-8-10-3 (1 May 2008 Chg 4 – 15 Apr 2014 8A6-8-10-4 (1 Mar 2010 Chg 2 – 15 Apr 2014 OEM: Honeywell, cage code 64547

Alternating Generator

NSN: 6115-00-678-6319, P/N: 31220-004

Overhaul in Accordance with AFTO 8A6-6-6-3 (30 September 2005 Chg 6 – 15 Apr 8A6-6-6-4 (1 September 2005 Chg 1 – 15 Apr 2014) OEM: Goodrich Corporation, cage code 3CPEO

0004 Evaluation Fee SOW paragraph 6.1.3

TBD

0005 Composite Hourly Labor Rate SOW paragraph 6.1.4

HR

BASE PERIOD ESTIMATED VALUE $_____________________

OPTION PERIOD ONE

(Twelve (12) Month Period following the Base Period (Contract Year 2)

Overhaul and repair equipment in accordance with (IAW) the Air Force Technical Orders

U/I UNIT

PRICE

(FIXED)

EXTENDED

AMOUNT

1001 Alternating Generator NSN: 6115-00-946-8441, P/N: 2CM353C1P or P/N:

2CM353C1H.

Overhaul in Accordance with T.O 8A6-9-5-3 (15 June 2011 Chg 4 - 1 April 2014) 8A6-9-5-4 (30 November 2006 Chg 7 – 1 Apr 2014)

1002 Alternating Generator

NSN: 6115-01-224-5848, P/N: 28B58-9B

Overhaul in Accordance with AFTO 8A6-8-10-3 (1 May 2008 Chg 4 – 15 Apr 2014 8A6-8-10-4 (1 Mar 2010 Chg 2 – 15 Apr 2014

Overhaul in Accordance with AFTO 8A6-6-6-3 (30 September 2005 Chg 6 – 15 Apr 2014 8A6-6-6-4 (1 September 2005 Chg 1 – 15 Apr 2014)

1004 Evaluation Fee

1005 Composite Hourly Labor Rate

OPTION PERIOD ONE ESTIMATED VALUE $______________________

OPTION PERIOD TWO

(Twelve (12) Month Period following the Option Period One

(Contract Year 3) Overhaul and repair equipment in accordance with (IAW) the Air Force Technical Orders

U/I UNIT

PRICE

(FIXED)

EXTENDED

AMOUNT

2001 Alternating Generator NSN: 6115-00-946-8441, P/N: 2CM353C1P or P/N:

2CM353C1H.

Overhaul in Accordance with T.O 8A6-9-5-3 (15 June 2011 Chg 4 - 1 April 2014) 8A6-9-5-4 (30 November 2006 Chg 7 – 1 Apr 2014)

2002 Alternating Generator

NSN: 6115-01-224-5848, P/N: 28B58-9B

Overhaul in Accordance with AFTO 8A6-8-10-3 (1 May 2008 Chg 4 – 15 Apr 2014 8A6-8-10-4 (1 Mar 2010 Chg 2 – 15 Apr 2014

Overhaul in Accordance with AFTO 8A6-6-6-3 (30 September 2005 Chg 6 – 15 Apr 2014 8A6-6-6-4 (1 September 2005 Chg 1 – 15 Apr 2014)

2004 Evaluation Fee

2005 Composite Hourly Labor Rate

OPTION PERIOD TWO ESTIMATED VALUE $______________________

OPTION PERIOD THREE

(Twelve (12) Month Period following the Option Period Two)

(Contract Year 4) Overhaul and Repair equipment in accordance with (IAW) the Air Force Technical Orders (AFTO) stated and the terms of the Statement of Work (SOW).

U/I UNIT

PRICE

(FIXED)

EXTENDED

AMOUNT

3001 Alternating Generator NSN: 6115-00-946-8441, P/N: 2CM353C1P or P/N:

2CM353C1H.

Overhaul in Accordance with T.O 8A6-9-5-3 (15 June 2011 Chg 4 - 1 April 2014) 8A6-9-5-4 (30 November 2006 Chg 7 – 1 Apr 2014)

3002 Alternating Generator

NSN: 6115-01-224-5848, P/N: 28B58-9B

Overhaul in Accordance with AFTO 8A6-8-10-3 (1 May 2008 Chg 4 – 15 Apr 2014 8A6-8-10-4 (1 Mar 2010 Chg 2 – 15 Apr 2014

Overhaul in Accordance with AFTO 8A6-6-6-3 (30 September 2005 Chg 6 – 15 Apr 2014 8A6-6-6-4 (1 September 2005 Chg 1 – 15 Apr 2014)

3004 Evaluation Fee

3005 Composite Hourly Labor Rate

OPTION PERIOD THREE ESTIMATED VALUE $______________________

OPTION PERIOD FOUR

(Twelve (12) Month Period following the Option Period Three

(Contract Year 5- Final Contract Period) Overhaul and repair equipment in accordance with (IAW) the Air Force Technical Orders (AFTO) stated and the terms of the Statement of Work (SOW).

U/I UNIT

PRICE

(FIXED)

EXTENDED

AMOUNT

4001 Alternating Generator NSN: 6115-00-946-8441, P/N: 2CM353C1P or P/N:

2CM353C1H.

Overhaul in Accordance with T.O 8A6-9-5-3 (15 June 2011 Chg 4 - 1 April 2014) 8A6-9-5-4 (30 November 2006 Chg 7 – 1 Apr 2014)

4002 Alternating Generator

NSN: 6115-01-224-5848, P/N: 28B58-9B

Overhaul in Accordance with AFTO 8A6-8-10-3 (1 May 2008 Chg 4 – 15 Apr 2014 8A6-8-10-4 (1 Mar 2010 Chg 2 – 15 Apr 2014

Overhaul in Accordance with AFTO 8A6-6-6-3 (30 September 2005 Chg 6 – 15 Apr 2014 8A6-6-6-4 (1 September 2005 Chg 1 – 15 Apr 2014)

4004 Evaluation Fee

4005 Composite Hourly Labor Rate

OPTION PERIOD FOUR ESTIMATED VALUE $_______________________

TOTAL CONTRACT ESTIMATED VALUE $_______________________