Offeror Submission Form.docx

Offeror Submission Form Name of Offeror

Instructions: The following form is designed to standardize information received during the submission process to evaluate Qualifications of Key Personnel and Recent Relevant Experience. It is the Offeror’s responsibility to fill out this form completely to support the certifications and project experience submitted. Each item listed in the table (matching the basis for award section in the solicitation) must be addressed otherwise the solicitation requirements are not met and a firm may be determined not qualified in the evaluation process.

Qualifications of Key Personnel Note: This table must be completed for ONLY the Principal assigned to each of the roles listed in “a. and b.” below.

a. Coating & Paint Inspector (Principal)

First Name and Last Name

Current Employer *If not in-house personnel, a fully executed Letter of Commitment must be included (in the box to the right, state whether this requirement is needed and has been met; provide the PDF page number where a copy of the letter can be referenced)

Narrative describing at minimum of two (2) years of experience in inspection and testing of coating systems while certified in the following:

1.) Coating Inspector Program (CIP) - Level 2

AND

2.) Supervisor/Competent Person Training for Deleading and Hazardous Coatings Removal (C3) *The Offeror can meet the certification requirement with two individuals; if the Offeror elects to do so, information on both individuals must be submitted and meet the requirements in this paragraph.

Provide a copy of the certifications.

*Insert expiration date in the box on the right for each certificate provided

b. Coating & Paint Inspector (Principal) *Used only if two individuals submitted to meet certification requirement

First Name and Last Name

Current Employer *If not in-house personnel, a fully executed Letter of Commitment must be included (in the box to the right, state whether this requirement is needed and has been met; provide the PDF page number where a copy of the letter can be referenced)

Narrative describing at minimum of two (2) years of experience in inspection and testing of coating systems while certified in the following:

3.) Coating Inspector Program (CIP) - Level 2

AND/OR*

4.) Supervisor/Competent Person Training for Deleading and Hazardous Coatings Removal (C3) *The Offeror can meet the certification requirement with two individuals; if the Offeror elects to do so, information on both individuals must be submitted and meet the requirements in this paragraph.

Provide a copy of the certifications.

*Insert expiration date in the box on the right for each certificate provided

Recent Relevant Experience:

The offeror must submit documentation of a minimum of three (3) and a maximum of six (6) projects that are in-progress or completed in the past 15 years. Any projects submitted beyond six (6) will not be evaluated. To qualify as relevant experience, the project must have involved quality assurance or quality control services for fabrication or repair of steel highway bridges, dam bridges or gates, lock gates, multi-story buildings comprised of steel frames, large storage tanks (greater than 10,000 gallons) or pressure vessels, or steel pipelines.

List all of the projects submitted for consideration as recent relevant experience. Completely fill in a minimum of 3 and a maximum of 6 projects below. If the project did not include, involve or require an item listed, input “N / A” into the box to the right indicating it is “Not Applicable” for that project.

*If experience from a subcontractor is submitted, a letter of commitment from that subcontractor must be provided, or the Government will not include the experience of the subcontractor in the evaluation.

Project #1

Project Name and Location

Contract completion date or scheduled completion date

Name and point of contact of owner (Phone Number and Email Address)

Government contract number (if applicable).

Role the offeror or proposed subcontractor performed during the project (prime or subcontractor)

Overall description of project, highlighting work self-performed

Provide a description of the QA or QC services performed for fabrication or repair work [steel highway bridges, dam bridges or gates, lock gates, multi-story buildings comprised of steel frames, large storage tanks (greater than 10,000 gallons) or pressure vessels, or steel pipelines].

Provide a description of the codes that were followed during fabrication (AWS D1.1, AWS D1.5, SSPC, AMPP, etc.)

Provide a description of the following non-destructive inspection techniques used on the project: visual, dye penetrant, magnetic, particle and/or ultrasonic.

Only three (3) total uses across all submitted similar projects required, demonstrating at least three (3) of the non-destructive inspection techniques

Demonstrate how the project included inspection of bolted connections conforming to the requirements of the American Institute of Steel Construction (AISC) or Research Council on Structural Connections (RCSC).

*Only one (1) of the three (3) to six (6) projects needs to meet this requirement

Demonstrate how the project included quality control or quality assurance activities for the application of steel coating systems.

Demonstrate how the project included quality assurance or quality control of lead paint abatement activities.

Demonstrate how the project included review and evaluation of a contractor or fabricator’s quality control plan.

*Only two (2) of the three (3) to six (6) projects need to meet this requirement

Project #2

Project Name and Location

Contract completion date or scheduled completion date

Name and point of contact of owner (Phone Number and Email Address)

Government contract number (if applicable)

Role the offeror or proposed subcontractor performed during the project (prime or subcontractor)

Overall description of project, highlighting work self-performed

Provide a description of the QA or QC services performed for fabrication or repair work [steel highway bridges, dam bridges or gates, lock gates, multi-story buildings comprised of steel frames, large storage tanks (greater than 10,000 gallons) or pressure vessels, or steel pipelines].

Provide a description of the codes that were followed during fabrication (AWS D1.1, AWS D1.5, SSPC, AMPP, etc.)

Provide a description of the following non-destructive inspection techniques used on the project: visual, dye penetrant, magnetic, particle and/or ultrasonic.

Only three (3) total uses across all submitted similar projects required, demonstrating at least three (3) of the non-destructive inspection techniques

Demonstrate how the project included inspection of bolted connections conforming to the requirements of the American Institute of Steel Construction (AISC) or Research Council on Structural Connections (RCSC).

Demonstrate how the project included quality control or quality assurance activities for the application of steel coating systems.

Demonstrate how the project included quality assurance or quality control of lead paint abatement activities.

Demonstrate how the project included review and evaluation of a contractor or fabricator’s quality control plan.

Project #3

Project Name and Location

Contract completion date or scheduled completion date

Name and point of contact of owner (Phone Number and Email Address)

Government contract number (if applicable)

Role the offeror or proposed subcontractor performed during the project (prime or subcontractor)

Overall description of project, highlighting work self-performed

Provide a description of the QA or QC services performed for fabrication or repair work [steel highway bridges, dam bridges or gates, lock gates, multi-story buildings comprised of steel frames, large storage tanks (greater than 10,000 gallons) or pressure vessels, or steel pipelines].

Provide a description of the codes that were followed during fabrication (AWS D1.1, AWS D1.5, SSPC, AMPP, etc.)

Provide a description of the following non-destructive inspection techniques used on the project: visual, dye penetrant, magnetic, particle and/or ultrasonic.

Only three (3) total uses across all submitted similar projects required, demonstrating at least three (3) of the non-destructive inspection techniques

Demonstrate how the project included inspection of bolted connections conforming to the requirements of the American Institute of Steel Construction (AISC) or Research Council on Structural Connections (RCSC).

Demonstrate how the project included quality control or quality assurance activities for the application of steel coating systems.

Demonstrate how the project included quality assurance or quality control of lead paint abatement activities.

Demonstrate how the project included review and evaluation of a contractor or fabricator’s quality control plan.

Project #4

Project Name and Location

Contract completion date or scheduled completion date

Name and point of contact of owner (Phone Number and Email Address)

Government contract number (if applicable)

Role the offeror or proposed subcontractor performed during the project (prime or subcontractor)

Overall description of project, highlighting work self-performed

Provide a description of the QA or QC services performed for fabrication or repair work [steel highway bridges, dam bridges or gates, lock gates, multi-story buildings comprised of steel frames, large storage tanks (greater than 10,000 gallons) or pressure vessels, or steel pipelines].

Provide a description of the codes that were followed during fabrication (AWS D1.1, AWS D1.5, SSPC, AMPP, etc.)

Provide a description of the following non-destructive inspection techniques used on the project: visual, dye penetrant, magnetic, particle and/or ultrasonic.

Only three (3) total uses across all submitted similar projects required, demonstrating at least three (3) of the non-destructive inspection techniques

Demonstrate how the project included inspection of bolted connections conforming to the requirements of the American Institute of Steel Construction (AISC) or Research Council on Structural Connections (RCSC).

Demonstrate how the project included quality control or quality assurance activities for the application of steel coating systems.

Demonstrate how the project included quality assurance or quality control of lead paint abatement activities.

Demonstrate how the project included review and evaluation of a contractor or fabricator’s quality control plan.

Project #5

Project Name and Location

Contract completion date or scheduled completion date

Name and point of contact of owner (Phone Number and Email Address)

Government contract number (if applicable)

Role the offeror or proposed subcontractor performed during the project (prime or subcontractor)

Overall description of project, highlighting work self-performed

Provide a description of the QA or QC services performed for fabrication or repair work [steel highway bridges, dam bridges or gates, lock gates, multi-story buildings comprised of steel frames, large storage tanks (greater than 10,000 gallons) or pressure vessels, or steel pipelines].

Provide a description of the codes that were followed during fabrication (AWS D1.1, AWS D1.5, SSPC, AMPP, etc.)

Provide a description of the following non-destructive inspection techniques used on the project: visual, dye penetrant, magnetic, particle and/or ultrasonic.

Only three (3) total uses across all submitted similar projects required, demonstrating at least three (3) of the non-destructive inspection techniques

Demonstrate how the project included inspection of bolted connections conforming to the requirements of the American Institute of Steel Construction (AISC) or Research Council on Structural Connections (RCSC).

Demonstrate how the project included quality control or quality assurance activities for the application of steel coating systems.

Demonstrate how the project included quality assurance or quality control of lead paint abatement activities.

Demonstrate how the project included review and evaluation of a contractor or fabricator’s quality control plan.

Project #6

Project Name and Location

Contract completion date or scheduled completion date

Name and point of contact of owner (Phone Number and Email Address)

Government contract number (if applicable)

Role the offeror or proposed subcontractor performed during the project (prime or subcontractor)

Overall description of project, highlighting work self-performed

Provide a description of the QA or QC services performed for fabrication or repair work [steel highway bridges, dam bridges or gates, lock gates, multi-story buildings comprised of steel frames, large storage tanks (greater than 10,000 gallons) or pressure vessels, or steel pipelines].

Provide a description of the codes that were followed during fabrication (AWS D1.1, AWS D1.5, SSPC, AMPP, etc.)

Provide a description of the following non-destructive inspection techniques used on the project: visual, dye penetrant, magnetic, particle and/or ultrasonic.

Only three (3) total uses across all submitted similar projects required, demonstrating at least three (3) of the non-destructive inspection techniques

Demonstrate how the project included inspection of bolted connections conforming to the requirements of the American Institute of Steel Construction (AISC) or Research Council on Structural Connections (RCSC).

Demonstrate how the project included quality control or quality assurance activities for the application of steel coating systems.

Demonstrate how the project included quality assurance or quality control of lead paint abatement activities.

Demonstrate how the project included review and evaluation of a contractor or fabricator’s quality control plan.