Questionnaire 1 Per â¿¿ and Polyfluoroalkyl Substances.docx

Contracted Laboratory Questionnaire Department of Technology, Management and Budget 2020 Laboratory Testing Services Indefinite-Scope Indefinite-Delivery (ISID)

Per – and Polyfluoroalkyl Substances

INSTRUCTIONS: Firms shall complete the following information in the form provided. A separate sheet may be used if additional space is needed. The Article number(s) the additional information pertains must be included on the separate sheet. Firms are to ensure all questions are answered completely in the most concise way possible to streamline the review process.

ARTICLE 1: BUSINESS ORGANIZATION

1. Business Organization Full Name: Click or tap here to enter text.

Business Organization Street Address: Click or tap here to enter text.

Business Organization Mailing Address: Click or tap here to enter text.

Business Organization Telephone Number: Click or tap here to enter text.

Business Organization E-Mail Address: Click or tap here to enter text.

Business Organization Website Address: Click or tap here to enter text.

Business Organization Point of Contact: Click or tap here to enter text.

Business Organization Point of Contact Email and Phone: Click or tap here to enter text.

SIGMA Vendor ID: Click or tap here to enter text.

If applicable, state the branch office(s), partnering organization or other subordinate element(s) that will perform, or assist in performing, the work: Click or tap here to enter text.

1.2 Check the appropriate status:

|_| Individual firm |_| Association |_| Partnership |_| Corporation, or |_| Combination – Explain: Click or tap here to enter text.

If you operate as a corporation, include the state in which you are incorporated and the date of incorporation: Click or tap here to enter text.

Include a brief description of the Contracted Laboratory’s history: Click or tap here to enter text.

1.3 Can the firm provide an emergency 24/7 contact telephone number and mobilize analytical staff during non-scheduled work hours (i.e., weekends, holidays, evenings) during an emergency situation?

If yes, list accreditations and certifications. Insert copies of accrediations/certifications, showing minimally: accreditation/certification body/agency, date of accreditation/certification, expiration date, methods covered, and parameters covered.

1.5 List the firm’s current capacity for analysis of the following:

per Location Approximate Samples per Day per Location Number of Locations

Method 537.1, 537 Rev 1.1, ASTM D7979

Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.

ARTICLE 2: PRIOR EXPERIENCE

2.1 Indicate any previous and current contract dates for providing Contracted Laboratory services to the Department of Environment, Great Lakes and Energy (EGLE) that you believe best illustrates your firm’s capabilities to provide Contracted Laboratory services.

2.2 Performance Sample Studies

Copies of performance sample studies for water from the provider of the studies for the following;

Provide any analysis of Per- and Polyfluoroalkyl Substances using USEPA methods 537.1, 537 Rev 1.1 and ASTM D7979 for aqueous samples.

NOTE: Other documentation than that provided by the provider of the studies, or edited documentation will not be accepted.

2.3 Provide a copy of the laboratories Quality Assurance Project Plan (QAPP). Please note that individual file size may not exceed 6 MB. The QAPP may be divided into multiple files for submittal.

ARTICLE 3: PERSONNEL STAFFING

3.1 Include an organizational chart.

3.2 Please fill out the following information regarding the personnel your firm considers key to the successful completion of the study or project scope of work:

Key Personnel 1 Name:Click or tap here to enter text. Job Title:Click or tap here to enter text.

Years Experience: Click or tap here to enter text. College Degree(s): Click or tap here to enter text.

Key Personnel 2 Name:Click or tap here to enter text. Job Title:Click or tap here to enter text.

Years Experience:Click or tap here to enter text. College Degree(s):Click or tap here to enter text.

Key Personnel 3 Name:Click or tap here to enter text. Job Title: Click or tap here to enter text.

Years Experience:Click or tap here to enter text. College Degree(s):Click or tap here to enter text.

Key Personnel 4 Name:Click or tap here to enter text. Job Title:Click or tap here to enter text.

Years Experience:Click or tap here to enter text. College Degree(s): Click or tap here to enter text.

Key Personnel 5 Name:Click or tap here to enter text. Job Title:Click or tap here to enter text.

Years Experience: Click or tap here to enter text. College Degree(s):Click or tap here to enter text.

ARTICLE 4: CONSULTANTS / SUBCONTRACTORS

4.1 Specifically, identify any other laboratories/consultants/subcontractors you plan to use for any part of the scope of work (NOTE: If any support must be provided by a laboratory/consultant/subcontractor, said laboratory/consultant/subcontractor must indicate their capability and willingness to carry out the work):

Laboratory/Consultant/Subcontractor 1

Letter of intent provided? |_|Yes |_|No

Letter of intent provided? |_|Yes |_|No

Laboratory/Consultant/Subcontractor 3

Letter of intent provided? |_|Yes |_|No

ARTICLE 5: SPECIAL FACTORS

5.1 Attach a list in table format of all other analyses not included in this Request for Proposal (RFP) with the following information: analysis description, method, matrix, preparation (if appropriate), and cost per sample.

5.2 Include a brief description of your firm’s special qualifications such as awards, recognitions, innovations, etc.

Click or tap here to enter text.

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