Sol_140F0621Q0172.pdf

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CODE 18a. PAYMENT WILL BE MADE BY

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17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

F06

LAKEWOOD CO 80228-1807

134 UNION BOULEVARD

LAKE PLAZA NORTH

FWS, DIVISION OF CONTRACTING AND GE

0008349567 CODE 16. ADMINISTERED BYCODE

X

X

X

115310

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED ORF06

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

09/03/2021 1100 ED

08/17/2021

413-253-8782Ryna Russell (No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

140F0621Q0172

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 32 0040546474OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

ULLIN IL 62992-2228

137 RUSTIC CAMPUS DR

FWS CYPRESS CRK NWR

15. DELIVER TO

LAKEWOOD CO 80228-1807

134 UNION BOULEVARD

LAKE PLAZA NORTH

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$8.00

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12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

FWS, DIVISION OF CONTRACTING AND GE

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Legacy Doc #: FWS

00010 Herbicide Application Invasive Species Control (refer to attached documents for details)

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

Ryna Russell

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

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ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

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OFFER

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Prescribed by GSA - FAR (48 CFR) 53.212

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AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

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REF.

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ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

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40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

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STANDARD FORM 1449 (REV. 2/2012) BACK

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ITEM NO.

Attachments:

Synopsis (2 pages)

SOW (8 pages)

Past Experience and References Questionnaire (2 pages)

Terms & Conditions (7 pages)

DOL Wage Rates (11 pages)

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32 2 of

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

Solicitation 140F0621Q0172 is issued as a request for quotation (RFQ). The anticipated award date is within 15 days after the close of this announcement.

This solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2021-06 dated 07/12/21.

This requirement is being solicited as a 100% Small Business Set-Aside. The applicable North American Classification System (NAICS) code is 115310 Support Activities for Forestry. The small business size standard is $8.0 Million.

The Government intends to award a firm fixed price contract resulting from this combined synopsis/solicitation.

Line-Item Description(s):

Herbicide Application – Invasive Species Control

Period of Performance:

Herbicide application shall take place sometime between April 2022 and August 2022.

Location:

Cypress Creek National Wildlife Refuge 0137 Rustic Campus Drive, Ullin, IL 62992

Terms & Conditions:

- The provision at 52.212-1, Instructions to Offerors -- Commercial, applies to this acquisition

- The provision at 52.212-2, Evaluation -- Commercial Items applies to this acquisition (refer to terms and conditions for details)

- Offerors must include a completed copy of the provision at 52.212-3 Offeror Representations and Certifications-Commercial Items and submit with its offer.

- The clause at 52.212-4, Contract Terms and Conditions -- Commercial Items, applies to this acquisition

- The clause at 52.212-5, Contract Terms and Conditions Required to Implement Statutes or Executive Orders -- Commercial Items, applies to this acquisition (refer to terms and conditions for details)

Any additional contract requirement(s) or terms and conditions determined by the contracting officer to be necessary for this acquisition and consistent with customary commercial practices are attached in the Terms & Conditions document.

The full text of the referenced FAR clauses may be accessed electronically at https://www.acquisition.gov/far/ or see terms & conditions attached to the solicitation.

Important Submission Dates & Site Visit Info:

Site Inspection:

Prior to submitting a quote, offerors or quoters are urged and expected to inspect the site where services are to be performed and to satisfy themselves regarding all general and local conditions that may affect the cost of contract performance.

https://www.acquisition.gov/far/

A site visit inspection has been scheduled for Friday, August 27, 2021 at 10:00am EST. The inspection will take place at the Cypress Creek National Wildlife Refuge located at 0137 Rustic Campus Drive in Ullin, Illinois. The POC is Benjamin McGuire, Refuge Manager, 618-634-2231.

Question Submission:

All questions regarding this Solicitation must be submitted in writing to the Contracting Officer, Ryna Russell at ryna_russell@fws.gov no later than Tuesday, August 31, 2021 at 11:00am EST. If necessary, questions received will be answered through an Amendment to this Solicitation.

Emails must indicate the following in the subject line: Question Submission 140F0621Q0172.

Quote Submission:

Quotes (including all required documents) must be transmitted via e-mail to the Contracting Officer, Ryna Russell at ryna_russell@fws.gov, no later than Friday, September 3, 2021 at 11:00am EST.

Emails must indicate the following in the subject line: Quote Submission 140F0621Q0172.

Required Submittal Documents: Offerors responding to this solicitation must submit the following documents:

SF 1449: Provide a completed SF 1449 with signature.

SF 30: If applicable, provide signed amendments (SF30) Price/Quote: Submit a quote to include your DUNS number, Company Name, Address, Point of Contact (POC), POC email & phone number and your price/cost per acre.

Past Experience & References: Complete the attached document Technical Capability: Provide a technical proposal that addresses your experience and understanding of the requirement and your planned approach to achieve the goals as described in the SOW.

Proposals that merely offer to provide supplies or services as described in the SOW will not receive further consideration for award. General statements may be considered less favorably than a more detailed technical proposal.

Your quote will be considered non-responsive and will not be considered if all the above required documents are not completed in full and received as part of your submittal package.

An award will be made to the Contractor whose submittal documents conform to the requirements as described in this solicitation and who, based on a subjective assessment from the Government, offers the best value to include past experience, technical experience and price. The Government reserves the right to award a contract to other than the lowest priced offer if, in its judgment, the past experience and/or technical superiority outweighs the price difference.

Contracting Officer/Office:

Ryna Russell, Contracting Officer U.S. Fish & Wildlife Service Hadley, MA Joint Administrative Operations (JAO) | Acquisition Goods and Services Operations ryna_russell@fws.gov

Attachments:

Synopsis (2 pages) SOW (8 pages) Past Experience and References Questionnaire (2 pages) Terms & Conditions (7 pages) DOL Wage Rates (11 pages) mailto:ryna_russell@fws.gov mailto:ryna_russell@fws.gov mailto:ryna_russell@fws.gov

Statement of Work

STATEMENT OF WORK

Herbicide Application – Invasive Species Control

U.S. Fish and Wildlife Service

Cypress Creek National Wildlife Refuge

Introduction U.S. Fish & Wildlife Service is seeking quotes from qualified/certified Contractors for invasive species control through the application of chemical herbicides on specified areas at Cypress Creek National Wildlife Refuge (CCNWR). Work shall consist of furnishing all necessary equipment, labor, approved herbicide, water (carrier), insurance and supervision necessary to accomplish the specified vegetative control measures.

1. GENERAL

1.1. Scope of Work.

The work to be performed under this Contract shall consist of furnishing all labor, equipment, permits, and materials necessary to supply and perform invasive species herbicide application to control Japanese Chafflower (Achyranthes japonica. Award will be based on the number of acres treated, not to exceed 234 acres, however, due to budget restraints, the actual number of acres may be reduced.

1.2. Period of Performance.

Herbicide application would occur between April 2022 and August 2022. Dates after this window will be considered pending the Refuge Project Coordinator’s approval and evaluation of the onsite conditions.

1.3. General Location.

The contract area is located within Pulaski, Alexander, Union, and Johnson Counties in Southern Illinois within the Cypress Creek National Wildlife Refuge. The Refuge is approximately 40 miles south of Marion, IL.

1.4. Contracting Officer.

The term “Contracting Officer” (CO) means the person executing this contract on behalf of the Government, and any other Service employee who is properly designated by the Contracting Officer.

1.5. Refuge Project Coordinator.

The term “Refuge Project Coordinator” means the Refuge-based staff member assigned to coordinate the herbicide application project. This person will be providing on-site assistance to the Contractor and will be acting in collaboration with the Contracting Officer during the life of the Contract.

2. TREATMENT AREA, CONTROL GOALS AND HERBICIDES

2.1. Location.

The site is within the Cypress Creek National Wildlife Refuge (CCNWR) in Southern Illinois. The Administrative Office for CCNWR is located at 0137 Rustic Campus Drive, Ullin, IL 62992.

2.2. Vegetation Control Objectives.

A minimum of 80% of all of the identified infestations to be treated in the treatment areas will be sprayed with each infestation receiving coverage by foliar spray, to the degree that at least 80% of the live stems yellow prematurely within 2-3 weeks of the spray and die within one of year of treatment, or Contractor will re-apply in the very next year, at his/her expense.

The Refuge Project Coordinator will be responsible for documenting that less than 80% of the area was treated, and notifying the Contractor, as soon as possible after the spraying activity (e.g., will survey the area, take digital photographs).

2.3. Herbicide Selection & Procedure.

The herbicide used shall be an aquatic approved triclopyr amine or glyphosate sprayed as a 2% solution in water. An aquatic approved non-ionic surfactant shall be added to the solution to help herbicide absorption by the plant. Always read and follow the herbicide label. If making applications near standing water, aquatic-safe herbicides and surfactants must be used and an EPA NPDES permit may need to be obtained. Take every precaution to prevent impact to non-target plants in sensitive forestry sites.

2.4. Minimizing Impacts to Non-Target Species.

No spraying shall be performed when wind speeds exceed specifications listed on the herbicide label, or wind directions are likely to result in drift to non-target areas or public use areas. There will be zero tolerance for direct spray or drift of herbicides into non-target vegetation or on adjacent property. No spraying shall be performed if more than ten percent (10%) chance of rain is forecast for the day of application or for the twenty-four (24) hour period following the planned application.

3. NOTIFICATION OF TREATMENT AND APPLICATION PLAN

3.1. The Contractor shall provide a minimum seventy-two (72) hour notice to the Refuge Project

Coordinator before arriving at the site location for herbicide treatment work. The Refuge Project Coordinator retains the right to determine whether spraying at any time is appropriate, due to weather (including wind) and other considerations.

3.2. Application Plan.

The Contractor shall submit an electronic copy of an application plan to the Refuge Project Coordinator. This plan shall outline the types of herbicides, planned application rates, hyperlinks to MSDSs and labels for each chemical to be used, scanned copies of applicator licenses, and a spill and contamination action plan. Additionally, the Contractor shall certify in writing that all employees engaged in handling, mixing, and spraying herbicides have read the MSDSs, and that personal protective equipment as specified by the MSDSs will be provided to and worn by these persons. Further, one hard copy of the approved plan shall be provided that will include a signed statement by the Contractor that this plan complies with all Federal, State, and local regulations. This plan shall be submitted for review and approval within ten (10) business days of the notice of Contract award and prior to the desired start of work. Government approval of this plan in no way relieves the Contractor of any liability for compliance with all Federal, State, and/or local regulations, should there be omissions/errors within said plan.

3.3. Post-Application Documentation.

The Contractor shall submit a spray log to the Refuge Project Coordinator detailing: day(s) and time(s) sprayed, crew members, volume of chemical applied, application rate, weather conditions (average windspeed, temperature, humidity, cloud cover). The Contractor shall provide GIS data (ESRI shapefiles in unprotected NAD83 format) on all treated areas no later than four weeks after spraying is complete.

4. SAFETY, CERTIFICATION & ENVIRONMENTAL PROTECTION

4.1. OSHA Provisions.

In order to provide safety controls for protection to life and health of employees and other persons, for prevention of damage to property, materials, supplies, and equipment, and for avoidance of work interruptions in the performance of this contract, the Contractor shall comply with all pertinent provisions and guidance issued by the United States Occupational Safety and Health Administration (OSHA), and shall also take or cause to be taken such additional measures necessary for that purpose. Compliance with the provisions of this clause by employees and subcontractors will be the responsibility of the Contractor.

4.2. Hazard Communication:

The Contractor shall implement a hazard communication program in accordance with 29 Code of Federal Regulations (CFR) 1910.1200 or 1926.59. The written hazard communication program shall address, at a minimum, the following: training (to include potential safety and health effects from exposure), labeling, current inventory of hazardous chemicals on site, and the location and use of Material Safety Data Sheets (MSDSs).

4.3. Accident Reporting.

An accident constitutes an incident or act involving the Contractor, which may or may not have caused obvious damage to persons or property. All accidents shall be reported to the Contracting Officer within 24 hours of the occurrence. All serious accidents (those resulting in death or injury requiring medical attention) shall be reported immediately.

4.4. Spills and Accidents.

The Contractor shall have a spill and accident prevention plan in place as part of the Application Plan (see section 3.2). The Contractor shall take all precautions to ensure no herbicide spills or accidents occur. In the event a spill or accident occurs, the Contractor shall immediately notify the Contracting Officer and initiate clean-up procedures in accordance with the herbicide label at no additional expense to the Government. In the case that the services of an outside environmental cleanup company are required, whether called in by the Contractor or initiated due to necessity by the Government, there will be no additional cost to the Government.

4.5. Environmental Protection.

The Contractor shall comply with all Federal, State, and local laws regarding environmental protection. All environmental protection matters shall be coordinated with the Contracting Officer. The Contractor may be inspected by the Contracting Officer, Refuge Project

Coordinator, or other Federal, State, and local officials without notice. Access for inspection shall be granted by the Contractor upon request.

5. LICENSING / CERTIFICATION

5.1. The Contractor or any employees or sub-contractors performing any of the work under this contract shall possess a valid Illinois commercial herbicide applicator's license and shall comply with all Federal, State, and local laws and regulations applicable to the contract work and to the products and materials used by the Contractor in performing that work. Evidence of such licensing shall be submitted in accordance with the "Application Plan" as outlined in Section 3.2. All appropriate certification and licensing required by the Environmental Protection Agency and Illinois Department of Agriculture, pertaining to the use and application of herbicides, shall be the responsibility of the Contractor. Certifications, licenses and/or permits shall be valid for the period of application and available for inspection.

6. CONTRACTOR FURNISHED EQUIPMENT, MATERIALS, AND SUPPLIES

6.1. Supplies and Materials.

The Contractor shall furnish all supplies and materials necessary for this Contract, including, but not limited to herbicide, surfactant, spraying equipment, Personal Protective Equipment (PPE) for Contractor/Contractor’s staff, etc. The Contractor shall maintain all supplies and materials in accordance with the Manufacturer’s recommendations. All PPE shall be maintained in accordance with Manufacturer standards and in accordance with the Occupational Safety and Health Administration (OSHA) standards.

6.2. Utilities.

Water required in the performance of this contract shall be the responsibility of the Contractor. Procurement of and payment for water shall be the exclusive responsibility of the Contractor. No raw water from any lakes, streams, creeks, rivers, or other bodies of water on Refuge property may be used.

6.3. Restrictions.

Any herbicide applied on Government land shall be applied by an Illinois state licensed applicator or operator. No unlicensed worker may handle or apply herbicides on Government lands under this Contract. Only herbicides labeled for General Use may be applied on Government Property, Contractor may not apply herbicides labeled for Restricted Use on Government property. The Contractor shall be responsible for supplying all herbicides, application equipment and applicators for work under this Contract. The Contractor shall not perform any herbicide mixing, storage, or disposal on Government property. In addition, the Contractor shall not dispose or store any herbicide equipment, containers, or packages on Government property. The Contractor shall comply with all herbicide label requirements and restrictions. This includes, but is not limited to drift reduction controls, treated area signage, water use restrictions, and reentry times.

6.4. Permits and Licenses.

The Contractor shall, at his/her own expense, obtain any licenses or permits required for herbicide application. Permits may be required by the State of Illinois, local Counties, etc.

The Contractor shall comply with all current Federal, State, and local laws and regulations and shall comply with any subsequent changes.

6.5. Equipment.

The Contractor shall furnish and maintain sufficient equipment suitable to perform the work, including, but not limited to, spraying equipment. Spraying equipment to be utilized for this Contract includes hand pump sprayers and backpack sprayers. Equipment other than these types must be proposed to and approved by the Refuge Project Coordinator prior to use. All equipment shall be maintained in safe operating condition in accordance with Manufacturer’s recommendations and in accordance with Federal, State, and local requirements.

6.6. Daily Removal.

All Contractor's equipment, materials, and supplies shall be removed from Government property at the end of each working day unless otherwise approved by the Contracting Officer.

6.7. Vehicles.

All vehicles used in performance of this contract shall be clearly marked with an identification sign, placard, magnet, or sticker listing the Contractor’s name, address, and phone number.

6.8. Vehicle Off-Road Use.

The Contractor shall disclose any need to drive off the paved or gravel access roads onto the grass as part of the Application Plan outlined in Section 3.2. Off-road vehicle use must be approved by the Refuge Project Coordinator.

6.9. Unattended Vehicles.

No vehicles shall be left unattended for any extended periods of time (more than a usual period during a standard workday) at any recreation area or elsewhere on Refuge property without prior approval of the Contracting Officer or Refuge Project Coordinator.

6.10. Vehicle Operation.

Vehicles shall be operated in accordance with posted regulations and traffic control signs.

6.11. Measurement and Payment.

Payment will be made per acre treated. Award will be based on price per acres treated, not to exceed 234 acres, however, due to budget restraints, the actual number of acres may be reduced upon award. Acres treated are categorized as follows:

Level of Coverage Term Quantitative Descriptor Percentage of Ground

Coverage by Invasive Species per Acre

Level One (1) Very Light 0% to 20% Level Two (2) Light 20% to 40% Level Three (3) Moderate 40% to 60% Level Four (4) Heavy 60% to 80% Level Five (5) Very Heavy 80% to 100%

See Attachment A for a map with present known acreages and locations by level of coverage.

Please note that the map is subject to change; the Government may request other areas on the Refuge be treated. The requested areas for treatment will be communicated to the Contractor by the Contracting Officer or Refuge Project Coordinator. The Contractor will be required to submit maps with treated areas and associated acreages.

7. PERSONNEL REQUIREMENTS

7.1. Minimum Workforce Requirements.

The Contractor shall provide an adequate number of fully qualified personnel to perform the specified work, properly and efficiently within the time limits specified. If the Contractor is unable to accomplish work in accordance with the requirements of this contract within the times specified, they shall immediately obtain additional personnel as necessary to fulfill the requirements of this contract.

7.2. Employee Conduct.

The majority of work will be performed in areas where the Contractor or his/her employees may interact with the public; thus, the conduct of all employees is critical and will be monitored. The Contractor shall be responsible for ensuring that their employees strictly comply with all Federal and State laws. Any illegal or criminal activity may result in the removal of Contractor employee(s) from the Refuge.

7.3. Alcohol/Controlled Substances.

No alcoholic beverages and/or controlled substances (non-prescription) shall be consumed by the Contractor or employees while completing work for this Contract.

8. POST-AWARD CONFERENCE

8.1. Within ten (10) business days of the award of the Contract, the Contractor shall contact the

Refuge Project Coordinator to arrange a meeting to discuss and develop a mutual understanding of the requirements and details of work. There may also be occasions when subsequent conferences will be called to reconfirm understandings or provide clarifications on contract requirements.

9. LIABILITY OF AND DAMAGES TO THE GOVERNMENT

9.1. Insurance.

The Contractor shall carry liability insurance that will cover the application of herbicides as defined in this specification, as well as any other work performed in accordance with this Contract. A Certificate of Insurance form signed by the insuring agency shall be provided to the Contracting Officer prior to award of the Contract. The Contractor must maintain insurance coverage for the entire Contract period. Any changes in insurance carriers/policies shall be reported to the Contracting Officer.

9.2. Government Liability.

The Government assumes no liability for the Contractors performance of the Contract work.

The Contractor shall hold and save the Government harmless from any and all liability arising from the performance of the Contract.

10. WARRANTY

10.1. Deficient Work.

The Contractor warrants that should the desired results not be achieved, the Contractor will, at no cost to the Government, reapply the herbicide to those areas where targeted invasive vegetative growth continues or recurs. The determination as to the acceptable performance of the Contractor and the need to reapply the herbicides solely rests with the Government, as represented by the Contracting Officer and the Refuge Project Coordinator. A request to re-treat an area may be made either verbally or in writing. A request to re-treat an area will be in the format of a contract modification.

10.2. Damages.

The Contractor is responsible for damages to persons or property, including unreasonable or unnecessary damages to non-target vegetation, within and outside the treatment areas resulting from the performance of the Contract work. Damage costs as determined by the Government will be charged in the form of a fine for the cost of rehabilitation or replacement of the affected resources. Other penalties may be assessed based on Federal, State, and/or local laws. The Contractor is responsible for taking any action necessary to protect all supplies, and property, including material and supplies issued by the Government to accomplish a job, against damage, theft, or loss. The Government assumes no responsibility for loss or damage to any material, supplies, or property after it is received by, or in the possession of the Contractor. Any Government property lost or stolen due to negligence of the Contractor shall be replaced by the Contractor at no cost to the Government.

11. INSPECTION AND ACCEPTANCE

11.1. General.

The work will be conducted under the general direction of the Refuge Project Coordinator and is subject to inspection by appointed inspectors. No inspector is authorized to change any of the specifications without written authorization by the Contracting Officer, nor shall the presence or absence of an inspector relieve the Contractor from any of the requirements of the Contract. Formal acceptance of the Contract will be made by the Contracting Officer for and on behalf of the Government.

11.2. Re-Performance and Re-Inspection.

The Government shall require the Contractor to re-perform any work found to be deficient by the Contracting Officer or Refuge Project Coordinator at no cost to the Government.

Attachment A

Past Experience Questionnaire – 140F0621Q0172

PAST EXPERIENCE & REFERENCES QUESTIONNAIRE

RFQ/Solicitation No. 140F0621Q0172

Herbicide Application – Invasive Species Control Cypress Creek National Wildlife Refuge 0137 Rustic Campus Drive, Ullin, IL 62992

**ALL INFORMATION MUST BE COMPLETED TO BE COMPLIANT WITH SOLICITATION**

Your Company Name:

DUNS#:

Street Address:

City, State and ZIP Code:

POC Name:

POC Phone Number:

POC Email:

Type of Business: Corporation ___ Partnership ___ Sole Proprietor ___ Other ___ (describe)

To receive consideration, complete and submit the information requested below with your quote. If additional space is needed this form may be duplicated as necessary or you can provide your own form.

1) How many years’ experience does your business have in the line of work contemplated by this solicitation? _____.

2) How many years’ experience has your business had as a Prime Contractor _____ or a Sub-contractor

3) Have you ever Failed to Complete any work awarded to you? Yes or No. If “yes” specify reasons why.

4) References and Relevant Past Performance/Experience:

Experience must have been completed within the past three (3) years and be similar in size and complexity to those stated in the Scope of Work. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress

First Contract Reference:

Contract Agency or Company Name:

Contract Number (if applicable):

Total Contract $ Value:

Point of Contact (POC) Name:

POC Telephone #:

POC E-mail address:

Contract Start and End Date:

Scope of Project: (Provide sufficient detail for the Government to perform an evaluation)

Past Experience Questionnaire – 140F0621Q0172

Second Contract Reference:

Total Contract $ Value:

Point of Contact (POC) Name:

POC Telephone #:

POC E-mail address:

Third Contract Reference:

Total Contract $ Value:

Point of Contact (POC) Name:

POC Telephone #:

POC E-mail address:

5) Certification:

I certify that all of the statements made by me are complete and correct to the best of my knowledge and that any persons named as references are authorized to furnish the Government with any information needed to verify my business and employee’s capability to perform this project.

Certifying Official’s Name and Title:

Date:

Terms & Conditions

TERMS & CONDITIONS

DEPARTMENT OF INTERIOR (DOI)

ELECTRONIC INVOICING AND PAYMENT REQUIREMENTS

Invoice Processing Platform (IPP) (April 2013)

Contractor assistance with enrollment can be obtained by contacting the IPP Production Helpdesk via email IPPCustomerSupport@fiscal.treasury.gov or phone (866) 973-3131.

If the Contractor is unable to comply with the requirement to use IPP for submitting invoices for payment, the Contractor must submit a waiver request in writing to the Contracting Officer with its proposal or quotation.

Payment requests must be submitted electronically through the U. S. Department of the Treasury's Invoice Processing Platform System (IPP).

"Payment request" means any request for contract financing payment or invoice payment by the Contractor. To constitute a proper invoice, the payment request must comply with the requirements identified in the applicable Prompt Payment clause included in the contract, or the clause 52.212-4 Contract Terms and Conditions - Commercial Items included in commercial item contracts. The IPP website address is: https://www.ipp.gov

• Under this contract, the following documents are required to be submitted as an attachment to the

IPP invoice: Upload a hardcopy/pdf of your invoice into IPP

The Contractor must use the IPP website to register, access and use IPP for submitting requests for payment. The Contractor Government Business Point of Contact (as listed in SAM) will receive enrollment instructions via email from the Federal Reserve Bank of Boston (FRBB) within 3 - 5 business days of the contract award date. Contractor assistance with enrollment can be obtained by contacting the IPP Production Helpdesk via email IPPCustomerSupport@fiscal.treasury.gov or phone (866) 973-3131.

If the Contractor is unable to comply with the requirement to use IPP for submitting invoices for payment, the Contractor must submit a waiver request in writing to the Contracting Officer with its proposal or quotation.

(End of local Clause)

52.252-1 – Solicitation Provisions Incorporated by Reference (Feb 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this address: https://www.acquisition.gov/browse/index/far

Provisions Incorporated by Reference 52.204-7 System for Award Management (Oct 2018) 52.204-16 Commercial and Government Entity Code Reporting (Aug 2020) 52.204-17 Ownership or Control of Offeror (Aug 2020) 52.204-20 Predecessor of Offeror (Aug 2020) 52.204-22 Alternative Line Item Proposal (Jan 2017) 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or

Equipment (Oct 2020) 52.204-26 Covered Telecommunications Equipment or Services-Representation (Oct 2020) 52.209-2 Prohibition on Contracting with Inverted Domestic Corporations-Representation (Nov 2015) 52.209-11 Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (Feb 2016) 52.212-1 Instructions to Offerors-Commercial Items (Jul 2021) 52.212-3 Offeror Representations and Certifications -- Commercial Items (Feb 2021) 52.219-1 Small Business Program Representations (Nov 2020) 52.222-22 Previous Contracts and Compliance Reports (Feb 1999) https://www.ipp.gov/ mailto:IPPCustomerSupport@fiscal.treasury.gov https://www.acquisition.gov/browse/index/far

52.222-25 Affirmative Action Compliance (Apr 1984) 52.223-1 Biobased Product Certification (May 2012) 52.223-22 Public Disclosure of Greenhouse Gas Emissions and Reduction Goals-Representation (Dec 2016) 52.225-25 Prohibition on Contracting with Entities Engaging in Certain Activities or Transactions Relating to Iran—Representation and Certifications (Jun 2020) 52.237-1 Site Visit (Apr. 1984)

Provisions Incorporated by Text

52.212-2 - Evaluation -- Commercial Items (Oct 2014)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

o Relevant Past Performance (Past Experience and References Questionnaire must be completed) o Technical Capabilities o Price

(b) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).

(c) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of Provision)

52-252-2 - Clauses Incorporated by Reference (Feb 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address: https://www.acquisition.gov/browse/index/far

Clauses Incorporated by Reference 52.204-13 System for Award Management Maintenance (Oct 2018) 52.204-18 Commercial and Government Entity Code Maintenance (Aug 2020) 52.204-19 Incorporation by Reference of Representations and Certifications (Dec 2014) 52.204-25 Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment (Aug 2020) 52.209-10 Prohibition on Contracting with Inverted Domestic Corporations (Nov 2015) 52.212-4 Contract Terms and Conditions -- Commercial Items (Oct 2018) 52.223-2 Affirmative Procurement of Biobased Products Under Service and Construction Contracts (Sept 2013) 52.223-3 Hazardous Material Identification and Material Safety Data (Feb 2021) 52.223-17 Affirmative Procurement of EPA-Designated Items in Service and Construction Contracts (Aug 2018) 52.228-5 Insurance - Work on a Government Installation. (Jan 1997) 52.232-39 Unenforceability of Unauthorized Obligations (Jun 2013) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Dec 2013) 52.237-2 Protection of Government Buildings, Equipment, and Vegetation (Apr 1984) 52.237-3 Continuity of Services (Jan 1991) 52.247-34 F.O.B. Destination (Nov 1991) http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_237.htm#P2_55 https://www.acquisition.gov/browse/index/far http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_237.htm#P2_55

Clauses Incorporated by Text

52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders— Commercial Items (Jul 2021)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements (JAN 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions)).

(2) 52.204-23, Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab and Other Covered Entities (JUL 2018) (Section 1634 of Pub. L. 115-91).

(3) 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment. (AUG 2020) (Section 889(a)(1)(A) of Pub. L. 115-232).

(4) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations

(NOV 2015).

(5) 52.233-3, Protest After Award (AUG 1996) (31 U.S.C. 3553).

(6) 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004) (Public Laws 108-77 and

108-78 ( 19 U.S.C. 3805 note)).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

[Contracting Officer check as appropriate.]

__ (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Jun 2020), with Alternate I (Oct 1995) (41 U.S.C. 4704 and 10 U.S.C. 2402).

__ (2) 52.203-13, Contractor Code of Business Ethics and Conduct (Jun 2020) (41 U.S.C. 3509)).

__ (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009

(June 2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.)

_X_ (4) 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards (Jun 2020) (Pub.

L. 109-282) (31 U.S.C. 6101 note).

__ (5) [Reserved].

__ (6) 52.204-14, Service Contract Reporting Requirements (Oct 2016) (Pub. L. 111-117, section 743 of Div.

C).

__ (7) 52.204-15, Service Contract Reporting Requirements for Indefinite-Delivery Contracts (Oct 2016)

(Pub. L. 111-117, section 743 of Div. C).

__ (8) 52.209-6, Protecting the Government’s Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (Jun 2020) (31 U.S.C. 6101 note).

__ (9) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (Oct 2018) (41

U.S.C. 2313).

__ (10) [Reserved].

__ (11)(i) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (Mar 2020) (15 U.S.C. 657a).

__ (ii) Alternate I (Mar 2020) of 52.219-3.

__ (12)(i) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (Mar

2020) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a).

__ (ii) Alternate I (Mar 2020) of 52.219-4.

__ (13) [Reserved] _X_ (14)(i) 52.219-6, Notice of Total Small Business Set-Aside (Nov 2020) (15 U.S.C. 644).

__ (ii) Alternate I (Mar 2020).

__ (15)(i) 52.219-7, Notice of Partial Small Business Set-Aside (Nov 2020) (15 U.S.C. 644).

__ (ii) Alternate I (Mar 2020) of 52.219-7.

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__ (16) 52.219-8, Utilization of Small Business Concerns (Oct 2018) (15 U.S.C. 637(d)(2) and (3)).

__ (17)(i) 52.219-9, Small Business Subcontracting Plan (Jun 2020) (15 U.S.C. 637(d)(4)).

__ (ii) Alternate I (Nov 2016) of 52.219-9.

__ (iii) Alternate II (Nov 2016) of 52.219-9.

__ (iv) Alternate III (Jun 2020) of 52.219-9.

__ (v) Alternate IV (Jun 2020) of 52.219-9.

__ (18) (i) 52.219-13, Notice of Set-Aside of Orders (Mar 2020) (15 U.S.C. 644(r)).

__ (ii) Alternate I (Mar 2020) of 52.219-13.

__ (19) 52.219-14, Limitations on Subcontracting (Mar 2020) (15 U.S.C. 637(a)(14)).

__ (20) 52.219-16, Liquidated Damages—Subcontracting Plan (Jan 1999) (15 U.S.C. 637(d)(4)(F)(i)).

__ (21) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (Mar 2020)

(15 U.S.C. 657 f).

__ (22) (i) 52.219-28, Post Award Small Business Program Rerepresentation (Nov 2020) (15 U.S.C.

632(a)(2)).

__ (ii) Alternate I (MAR 2020) of 52.219-28.

__ (23) 52.219-29, Notice of Set-Aside for, or Sole Source Award to, Economically Disadvantaged Women- Owned Small Business Concerns (Mar 2020) (15 U.S.C. 637(m)).

__ (24) 52.219-30, Notice of Set-Aside for, or Sole Source Award to, Women-Owned Small Business Concerns Eligible Under the Women-Owned Small Business Program (Mar 2020) (15 U.S.C. 637(m)).

__ (25) 52.219-32, Orders Issued Directly Under Small Business Reserves (Mar 2020) (15 U.S.C. 644(r)).

__ (26) 52.219-33, Nonmanufacturer Rule (Mar 2020) (15U.S.C. 637(a)(17)).

X (27) 52.222-3, Convict Labor (June 2003) (E.O. 11755).

X (28) 52.222-19, Child Labor—Cooperation with Authorities and Remedies (Jan 2020) (E.O. 13126).

X (29) 52.222-21, Prohibition of Segregated Facilities (Apr 2015).

X (30) (i) 52.222-26, Equal Opportunity (Sept 2016) (E.O. 11246).

__ (ii) Alternate I (Feb 1999) of 52.222-26.

__ (31) (i) 52.222-35, Equal Opportunity for Veterans (Jun 2020)(38 U.S.C. 4212).

__ (ii) Alternate I (Jul 2014) of 52.222-35.

_X_ (32) (i) 52.222-36, Equal Opportunity for Workers with Disabilities (Jun 2020) (29 U.S.C. 793).

__ (ii) Alternate I (Jul 2014) of 52.222-36.

__ (33) 52.222-37, Employment Reports on Veterans (Jun 2020) (38 U.S.C. 4212).

__ (34) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (Dec 2010) (E.O.

13496).

X (35)(i) 52.222-50, Combating Trafficking in Persons (Oct 2020) (22 U.S.C. chapter 78 and E.O. 13627).

__ (ii) Alternate I (Mar 2015) of 52.222-50 (22 U.S.C. chapter 78 and E.O. 13627).

__ (36) 52.222-54, Employment Eligibility Verification (OCT 2015). (Executive Order 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.)

__ (37)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA–Designated Items (May 2008) (42 U.S.C. 6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

__ (ii) Alternate I (May 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

__ (38) 52.223-11, Ozone-Depleting Substances and High Global Warming Potential Hydrofluorocarbons

(JUN 2016) (E.O. 13693).

__ (39) 52.223-12, Maintenance, Service, Repair, or Disposal of Refrigeration Equipment and Air Conditioners (JUN 2016) (E.O. 13693).

__ (40)(i) 52.223-13, Acquisition of EPEAT®-Registered Imaging Equipment (JUN 2014) (E.O.s 13423 and 13514).

__ (ii) Alternate I (Oct 2015) of 52.223-13.

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