B08_Solicitation_Attach_3_-_Technical_and_Financial_Capability_Statement.pdf

P17PS03020 ATTACHMENT 3

TECHNICAL & FINANCIAL CAPABILITY STATEMENT

Before awarding any Government contract, the Contracting Officer must determine that a proposed contractor is responsible. As used here, the term “responsible” means the Contracting Officer can reasonably expect satisfactory contract performance. A proposed contractor must have or be able to obtain (1) adequate financial resources, (2) be able to comply with the required or proposed delivery or performance schedule, (3) have a record of satisfactory performance , (4) have a satisfactory record of integrity and business ethics, (5) have the necessary organization, experience & technical skills needed, (6) have or be able to obtain production and technical equipment & facilities needed, and (7) be otherwise qualified and eligible to receive an award under applicable laws and regulations. The following information is needed for this determination and will be treated as confidential. The proposed contractor must demonstrate responsibility to the full satisfaction of the Contracting Officer. If the information is not provided or is incomplete the Contracting Officer may not be able to find a proposed contractor responsible.

* * Sign this form in all places indicated and attach copies of documents requested! * *

1. FINANCIAL: PROVIDE INFORMATION ABOUT THE FINANCIAL POSITION OF YOUR FIRM.

a. CONTRACT FINANCING IS NOT AUTHORIZED UNDER THIS SOLICITATION. THEREFORE; DO YOU HAVE, OR ARE YOU ABLE TO OBTAIN, ADEQUATE FINANCIAL RESOURCES TO PROVIDE AND PERFORM ALL

REQUIREMENTS OF THIS CONTRACT? [___] YES [___] NO EXPLAIN:

b. DO YOU HAVE OR ARE YOU ABLE TO OBTAIN THE INSURANCE, AND THE BONDING AND/OR PAYMENT

PROTECTION AS MAY BE REQUIRED FOR THIS CONTRACT? [___] YES [___] NO

c. LIST YOUR BUSINESS’ BANK/FINANCIAL INSTITUTION, AND SURETY INFORMATION.

NAME PHONE/FAX NO COMPLETE ADDRESS AND ZIP CODE TYPE ACCOUNT

2. BUSINESS ACTIVITIES: ON A SEPARATE PAGE, LIST ANY CONTRACTS THAT YOU HAVE HAD

WITH GOVERNMENT AGENCIES. AT A MINIMUM, INCLUDE THE FOLLOWING FOR EACH CONTRACT LISTED:

(i) The name of the Agency.

(ii) Location where work was performed.

(iii) A reference point of contact, phone number, e-mail address.

(iv) Brief description of the work performed and dollar value.

(v) Date and duration of the contract.

3. TECHNICAL CAPABILITY / PAST PERFORMANCE: ON A SEPARATE PAGE, PROVIDE

DETAILS ON AT LEAST THREE (3) CURRENT OR PAST PERFORMANCE REFERENCES WHERE QUOTER HAS PROVIDED BULK FUELS AND MADE DELIVERIES ON A REOCCURRING BASIS TO COMMERICAL AND/OR NON-COMMERCIAL ENTITIES WITHIN THE PAST THREE (3) YEARS. AT A MINIMUM, PROVIDE THE

FOLLOWING FOR EACH REFERENCE:

(i) Business/Organization/Private entity Name and Address

(ii) A Reference Point of Contact

(iii) Telephone and Email Address of Point of Contact

(iv) Description of Product and Estimated Quantity

(v) Dates/Length of Business Relationship

4. AUTHORIZATION FOR RELEASE OF INFORMATION: ENTER INFORMATION, SIGN & DATE.

I authorize all of the listed references to release financial or business data or records to the National Park Service (NPS) upon request.

Name & Title of Quoter:_________________________________________________________

Signature: _______________________________________________ Date: _______________

5. ABILITY TO COMMENCE PERFORMANCE: IT IS ANTICIPATED THE CONTRACT WILL BE

AWARDED IN LATE OCTOBER 2017. IF YOUR FIRM IS AWARDED THE CONTRACT, CAN DELIVERY BEGIN

WITHIN FOURTEEN (14) CALENDAR DAYS AFTER CONTRACT HAS BEEN AWARDED?

[___] YES [___] NO IF NO, EXPLAIN.

6. ABILITY TO COMPLETE PERFORMANCE: I UNDERSTAND THAT DELIVERY OF PRODUCT IS TO

BE MADE WITHIN TWO (2) BUSINESS DAYS FROM THE DATE ORDERS HAVE BEEN PLACED BY THE GOVERNMENT. BUSINESS DAYS ARE CONSIDERED TO BE MONDAY THROUGH FRIDAY. LEGAL FEDERAL

HOLIDAYS ARE NOT CONSIDERED A BUSINESS DAY. VENDOR IS ABLE TO MEET THIS DELIVERY

REQUIREMENT.

[___] YES [___] NO IF NO, EXPLAIN.

7. RELATIONSHIP WITH THE GOVERNMENT: IS THE OWNER OR ANY OFFICIAL OF THE FIRM AN

EMPLOYEE OF THE U.S. GOVERNMENT OR AN IMMEDIATE FAMILY MEMBER RESIDING IN THE SAME

HOUSEHOLD OF SUCH PERSON?

[___] YES [___] NO IF YES, EXPLAIN. INCLUDE NAME, POSITION HELD, RELATIONSHIP

8. RESOURCES: DO YOU HAVE OR ARE YOU ABLE TO OBTAIN THE PERSONNEL, EQUIPMENT,

MATERIALS, AND SOURCES REQUIRED FOR TIMELY AND COMPLETE PERFORMANCE OF THIS CONTRACT IF

AWARD IS MADE TO YOUR FIRM?

[___] YES [___] NO IF YOU DO NOT ALREADY HAVE ALL OF THE RESOURCES AVAILABLE,

EXPLAIN YOUR STRATEGY OR PLAN FOR ACQUIRING THEM? (USE ADDITIONAL PAGES IF NEEDED)

9. PERSONNEL:

a. ON A SEPARATE PAGE: PROVIDE A BRIEF RESUME OF THE KEY INDIVIDUAL FROM YOUR FIRM WHO WILL OVERSEE THE CONTRACT. GIVE NAME, POSITION, EXPERIENCE, & OTHER QUALIFICATIONS.

b. ON A SEPARATE PAGE: IF PRODUCT WILL BE PROVIDED AND DELIVERED BY A SUBCONTRACTOR(S), PROVIDE NAME OF COMPANY, ALONG WITH A CAPABILITIES STATEMENT OF THE

COMPANY’S EXPERIENCE AND COMPETENCIES.

10. SAFETY / ACCIDENT PREVENTION AND COMMUNICATION PLANS: CONTRACTORS MUST

BE COMMITTED TO PROVIDING A SAFE AND HEALTHFUL WORK ENVIRONMENT FOR ALL OF ITS EMPLOYEES AND OTHERS THAT MAY WORK, VISIT OR ENTER THE WORK SITE. CONTRACTORS ARE TO MANAGE AND CONDUCT BUSINESS OPERATIONS IN A MANNER THAT OFFERS MAXIMUM PROTECTION TO EACH AND EVERY EMPLOYEE AND ANY OTHER PERSON THAT MAY BE AFFECTED BY CONTRACTOR’S OPERATIONS.

THE CONTRACTOR SHALL MAKE EVERY EFFORT TO PROVIDE A WORKING ENVIRONMENT THAT IS FREE FROM ANY RECOGNIZED OR POTENTIAL HAZARD AND ALLOCATE AND PROVIDE ALL RESOURCES NEEDED TO PROMOTE AND EFFECTIVELY IMPLEMENT ITS SAFETY / ACCIDENT PREVENTION AND COMMUNICATION

PLANS.

[___] YES [___] NO QUOTER DOES HAVE A SAFETY / ACCIDENT PREVENTION PROGRAM AND

COMMUNICATIONS PLAN POLICY IN PLACE WHICH ADDRESSES THE WORK RELATED TO THE HANDLING, DELIVERY AND DISPENSING OF THE PRODUCT REQUIRED BY THE CONTRACT.

Name & Title of Quoter:_________________________________________________________

Signature: _______________________________________________ Date: _______________

11. OTHER AUTHORITIES: DUE TO THE URGENCY WHICH MAY EXIST IN MAKING A RESPONSIBILITY

DETERMINATION, IF YOU ARE UNABLE TO BE IMMEDIATELY REACHED TO PROVIDE ADDITIONAL

INFORMATION OR CLARIFICATION OF YOUR RESPONSES SUBMITTED ON THIS FORM OR REGARDING YOUR QUOTE SUBMITTAL, ARE THERE ANY OTHER INDIVIDUALS WHO HAVE THE AUTHORITY TO RESPOND ON

BEHALF OF YOU OR YOUR FIRM? [___] YES [___] NO IF YES, PROVIDE THEIR NAME(S),

POSITION, AND CONTACT INFORMATION. ALSO INDICATE IF THE INDIVIDUAL(S) HAS AUTHORITY TO SIGN AND/OR ACT ON YOUR OR YOUR FIRM’S BEHALF REGARDING ANY FOLLOW-ON CONTRACT ACTION OR

ACTIVITIES WHICH MAY RESULT.

12. CERTIFICATIONS: READ CAREFULLY THEN COMPLETE INFORMATION REQUESTED BELOW.

I certify that the information provided is true and may be relied upon in determining my responsibility. If the information is incorrect, incomplete, unable to be validated, or misleading, I understand and agree that sufficient basis exists to determine my quote nonresponsive, and/or me nonresponsible for the performance of the contract; or, if the contract has been awarded, to terminate the contract for cause based upon fraud or misrepresentation in its inception.

COMPLETE BUSINESS ______________________________ NAME & TITLE ______________________________

NAME AND ADDRESS: OF QUOTER:

_______________________________ DUNS #: _____________________________

PHONE NUMBER: _______________________________ SIGNATURE: _____________________________

FAX NUMBER: _______________________________ DATE: _____________________________

E-MAIL ADDRESS: _______________________________