Sol_140F0922Q0161.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

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

OFFEROR

FGS

Falls Church VA 22041 5275 Leesburg Pike FWS Goods & Services

0009846420 CODE 16. ADMINISTERED BYCODE

X

X

X

237110

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED ORFGS

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

09/21/2022 1100 ED

09/14/2022

4132538782Ryna Russell (No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

140F0922Q0161

5. SOLICITATION NUMBER

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

1 32 0040593042OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Newington NH 03801-2903 100 Merrimac Drive FWS - Great Bay NWR

15. DELIVER TO

Falls Church VA 22041 5275 Leesburg Pike

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$39.50

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

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 Goods & Services

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.

00010 Decommission 700' Inactive Well (refer to SOW for details)

Attachments:

Synopsis (2 pages); SOW (9 page) Past Experience (2 pages) Terms & Conditions (6 pages) DOL Wage Rates (11 pages)

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

HEREIN, IS ACCEPTED AS TO ITEMS:

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

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

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

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

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

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32 2 of

Combined Synopsis – 140F0922Q0161

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 140F0922Q0161 is issued as a request for quotation (RFQ). The anticipated award date is within 5 days after the close of this announcement.

This solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular FAC Number: 2022-07, Effective Date: 8/10/2022.

This requirement is being solicited as a 100% Small Business Set-Aside. The applicable North American Classification System (NAICS) code is 237110 Water and Sewer Line and Related Structures Construction.

The small business size standard is $39.5 Million.

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

Line-Item Description(s):

Decommission 700’ Inactive Well (refer to SOW for details)

Period of Performance:

Work shall be scheduled and completed no later than November 30, 2022.

Place of Performance:

U.S. Fish & Wildlife Service Great Bay National Wildlife Refuge 100 Merrimac Drive - Newington, NH 03801

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.

In order to be eligible for award, all contractors must have an Active Registration in the System for Award Management (SAM) website https://sam.gov/content/home. Please note, SAM is a free website and there is never a cost to register your entity.

https://www.acquisition.gov/far/ https://sam.gov/content/home

Combined Synopsis – 140F0922Q0161

Prior to or following receipt of an award, the Contractor must register with the U.S. Department of the Treasury's Invoice Processing Platform System (IPP) to submit requests for payment. Refer to Terms and Conditions for details. Please note, IPP is a free website and there is never a cost to complete registration. Invoices for services will be paid after the end of the month of service, advanced payments are not allowed.

Important Submission Dates:

1. 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 Friday, September 16, 2022 at 2:00pm EDT. Please be advised that the government reserves the right to transmit responses to those questions of common interest to all competing schedule contractors through an Amendment to this Solicitation.

Emails must indicate the following in the subject line: Question Submission 140F0922Q0161.

2. 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 Wednesday, September 21, 2022 at 11:00am

EDT.

Emails must indicate the following in the subject line: Quote Submission 140F0922Q0161.

Required Submittal Documents:

Before submitting an offer, please read the entire solicitation package carefully. Offerors responding to this solicitation must submit the following documents:

- SF 30: If applicable, provide signed SF30 document(s) acknowledging any/all Amendment(s)

- Price/Quote: Submit a quote to include your Unique Entity ID, Company Name, Address, Point of Contact (POC), POC email & phone number and total cost. Note: If using a sub-contractor, the name and location of the sub-contractor must be provided

- Past Experience & References: Complete the attached document

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 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) ryna_russell@fws.gov mailto:ryna_russell@fws.gov

Statement of Work

STATEMENT OF WORK

Inactive Well Decommission Project

U.S. Fish & Wildlife Service Great Bay National Wildlife Refuge

100 Merrimac Drive - Newington, NH 03801

1. GENERAL INFORMATION

1.1. Description of Services/Introduction: Great Bay National Wildlife Refuge is seeking a licensed New Hampshire water well contractor to decommission an inactive artesian well.

The contractor shall provide all personnel, equipment, supplies, transportation, tools, materials, supervision, and other items necessary to decommission the well as defined in this Statement of Work (SOW).

1.2. Scope of Work: The Contractor shall decommission an inactive, 700’ deep artesian well which as a well head diameter of six inches (6”). The pump and associated electrical conduits for this well have already been removed. (Refer to attachment 1 for maps)

Project work to include the following:

1. All work shall be done by a licensed New Hampshire water well contractor; proof of current licensed status will be provided to the refuge POC prior to scheduling any work.

2. Cut drilled well below grade. Decommission the well with approved materials to close and plug the well. The ground area at the well site shall be restored with topsoil.

3. The Contractor shall be responsible for strict compliance with decommissioning procedures as listed in the State of New Hampshire Department of Environmental Services Fact Sheet to include using the acceptable grout and fill materials used for sealing wells. (Refer to attachment 2, Environmental Fact Sheet).

4. An Abandoned Well Registration Report shall be filed with the State of New Hampshire.

(Refer to section 7.1 for details).

5. The Contractor shall be responsible for strict compliance with all provisions of Occupational Safety and Health Administration (OSHA) requirements 29 CFR1910 and 29 CFR 1926 for the duration of this contract.

6. After completion of the work, prior to de-mobilization, the Contractor shall remove all equipment, trash and/or debris from the project site.

2. LOCATION / PLACE OF PERFORMANCE

2.1. Location:

Great Bay National Wildlife Refuge, 100 Merrimac Drive - Newington, NH 03801

The well-head is located within a section of the refuge that is closed to the public, but easily accessed from refuge roads.

3. PERIOD OF PERFORMANCE

3.1. Work shall be scheduled and completed no later than November 30, 2022.

4. WORK SCHEDULE:

4.1. Hours of Operation: The contractor will be performing work independently, in an outside setting that is accessible from 7:30 a.m. to 4:30 p.m. All access will be coordinated with the Refuge Point of Contract as listed in Section 5.

For safety reasons, the refuge is closed to all public access during the refuge deer shotgun hunt on November 17, 2022, and November 18, 2022. The Contractor will not be granted access to work on these two days.

4.2. Federal Legal Holidays: Whenever scheduled services fall on a federal holiday, the services will be performed on the previous or following working day. In no event will the Contractor change the work schedule without the prior consent of the Contracting Officer (CO) or Technical Coordinator.

Federal Legal Holidays: New Year’s Day, Martin Luther King's Birthday, Presidents Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, Christmas Day.

When a holiday falls on Saturday or Sunday, it is observed on the adjacent Friday or Monday, respectively. In addition to the holidays listed above, the Contractor agrees to observe leave days or closures designated by Federal Statute, Executive Order, or Presidential Proclamation.

5. POST AWARD CONFERENCE / REFUGE POINT OF CONTACT

5.1. Within five (5) days after contract award, the Contractor shall contact the below Refuge Point of Contract to arrange a meeting to discuss and develop a mutual understanding of the requirements, and to arrange a schedule for the work to be completed.

POC: Sharon Ware, Deputy Refuge Manager at 978-270-8440 or Sharon_ware@fws.gov.

6. LIABILITY OF AND DAMAGES TO THE GOVERNMENT

6.1. Government Liability: The Government assumes no liability from the Contractor's 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.

6.2. Responsibility for Damages: The Contractor is responsible for all damages to persons and property resulting from performance of the contract work.

7. DELIVERABLES – ABANDONED WELL REGISTRATION REPORT

7.1. Deliverables:

7. An Abandoned Well Registration Report shall be filed with the New Hampshire State Water Well Board, P.O. Box 95, Concord, NH, within 30 days of completion of work. Note, Contractor will not be paid for services until this report is submitted. (Refer to attachment 3, Abandoned Well Registration Report)

A copy of this report shall also be emailed to the Refuge POC.

mailto:Sharon_ware@fws.gov

8. QUALITY CONTROL/QUALITY ASSURANCE:

8.1. Any inspection by the Government shall be conducted in a manner consistent with commercial practice. The Government may conduct quality assurance for its benefit and has the right to refuse acceptance of nonconforming services. Quality issues with services tendered for acceptance or rejected by the Government shall be resolved in accordance with clause 52.212-4(a) Inspection/Acceptance.

8.2. All work must meet or exceed all Federal, State and local codes and regulations.

9. ATTACHMENTS:

1. Maps of Refuge and Well Site (2 pages)

2. State of New Hampshire Environmental Fact Sheet DW-GB-1-7 (3 pages)

3. Copy of Abandoned Well Registration Report (1 page) – You can also download the fillable form by clicking the following link: https://onlineforms.nh.gov/app/#/formversion/171cb88a-93f4-4c28- 9907-561dc0dad858?formtag=NHDES-W-03-004 https://onlineforms.nh.gov/app/#/formversion/171cb88a-93f4-4c28-9907-561dc0dad858?formtag=NHDES-W-03-004 https://onlineforms.nh.gov/app/#/formversion/171cb88a-93f4-4c28-9907-561dc0dad858?formtag=NHDES-W-03-004 cwington. NM

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Decommissioning Inactive Wells

New Hampshire regulations require wells that are no longer in use to be properly maintained or be decommissioned (filled-in) by a licensed contractor in an appropriate manner to prevent the entry of contaminants into the groundwater. The responsibility for maintaining a well or decommissioning a well, lies with the well owner. Wells are expensive commodities and are generally an asset to the property even if they are not currently in use as long as they are properly maintained. If it is decided that a well will be of use and will be a water supply at some point, the well is considered active and must be properly maintained. If it is decided that a well has no useful purpose, has no potential future use or has no real value and may constitute a liability, then it should be considered inactive and must be properly decommissioned. State law requires that the decommissioning, also known as sealing, wells is performed by a licensed New Hampshire water well contractor. Licensed water well contractors have the necessary equipment and experience to complete the job safely and properly.

There are very good reasons for well owners to make sure inactive or abandoned wells on their property are properly decommissioned:

Improperly abandoned wells threaten drinking water supplies by providing open conduits into aquifers.

If a drinking water well is being replaced because of water quality problems in the original well, the abandoned well is a direct threat to the new water supply if it is not properly sealed.

Improperly abandoned wells can create a liability problem at the time of property resale or if the well causes contamination in neighboring wells.

Shallow dug wells create a physical hazard simply because of their large diameter and the potential for animals or people to fall into them. Typically, the older fieldstone-lined wells are the most dangerous because many were finished flush to the ground surface and were covered with wooden covers, which are now decayed or non-existent.

The following state laws are relevant to decommissioning of inactive or abandoned wells:

RSA 482-B:15 Maintenance and Repair of Wells and Pumps (Chapter 482-B New Hampshire Water

Well Board) and associated Administrative Rules We 603 Well Maintenance and We 604 Abandonment of Wells.

RSA 485:37 Fencing or Covering and RSA 485:38 Nuisance (Chapter 485 New Hampshire Safe Drinking Water Act).

http://www.gencourt.state.nh.us/rsa/html/L/482-B/482-B-mrg.htm http://www.gencourt.state.nh.us/rsa/html/l/485/485-mrg.htm

ACTIVE WELL MAINTENANCE PROCEDURES

Active wells must be properly maintained; maintenance is the responsibility of the well owner. The following is guidance of how to maintain a well, in terms of proper caps and covers.

Ensure that the well casing and cover are above the land surface (at least 8-inches for private wells) where it is protected from flooding. If the top of the well is below the ground surface, the owner should have the well raised above grade by a licensed water well contractor or pump installer.

Wells with a casing inside diameter of 4-12 inches must be fitted with a well cover that has a screened vent and is sealed (o-ring or gasket) so that contaminants (including unwanted rodents and insects) cannot enter the well accidentally. Electrical conduits that have pulled away from the well cover should be securely and mechanically attached to the well cover.

Wells with a casing inside diameter less than 4 inches must be fitted with a secure cap or plug.

Dug wells should have a concrete cover that is difficult to remove by virtue of its weight to prevent children or unauthorized persons from gaining access to the well. If a well is enclosed by a locked building/structure, covers other than concrete are permitted.

INACTIVE WELL DECOMMISSIONING PROCEDURES

The proper well sealing method depends on the construction of well being decommissioned and if there is known groundwater contamination. Prior to decommissioning remove all pump system equipment and any obstructions that may interfere with the sealing process.

A bedrock well with no known contamination issues shall be filled-in with clean ½ diameter crushed stone, and incorporate 4-foot impervious seal (bentonite chips, cement, grout) every 100 feet. The upper 20 feet must be filled-in with grout to where the casing is cut just below ground surface.

Drilled or wash wells penetrating unconsolidated materials or shallow fractured bedrock with no known contamination should be sealed by filling the screened area and the well casing with sand, gravel washed stone or cement up to 15 feet below grade. The upper 15 feet must be filled-in with grout to where the casing is cut just below ground surface.

Drilled wells that have been contaminated due to a construction deficiency or continue to cause an environmental hazard should be sealed by the pressure grout method. This is done with a conductor pipe, called a tremie pipe, starting at the bottom of the well and slowly raising the conductor pipe toward the top of the well at a rate no faster than the grout material fills and displaces water from the well. The grout mixture used should be a Portland cement mixed with 2 percent to 10 percent high solids bentonite clay according to the correct water-to-cement ratio.

Commercially available premixed bentonite grout designed for sealing wells may also be used.

Point wells or other wells constructed in unconsolidated materials that are 2-inches in diameter or less can be decommissioned by trying to remove the casing from the ground or by filling the well screen and casing with bentonite and cutting the well casing off below grade.

Dug wells should be filled and sealed using clean material that is free of organic matter and is like the natural surrounding materials. Often, locally available fill materials are adequate to complete the job. This material is put into the well up to 2-4 feet below ground surface. The upper 2-4 feet should be filled with impervious material such as clay or hardpan and slightly mounded to promote surface water runoff to flow away from the filled excavation.

Monitoring wells shall be decommissioned based on site specific hydrogeologic and contaminant conditions and site use. Some monitoring wells can be decommissioned by trying to remove the casing from the ground or by filling the well screen and casing with bentonite and cutting the well casing off below grade.

Materials to safely seal a well There are a variety of acceptable grout and fill materials used for sealing wells.

Portland cement, otherwise known as neat cement, mixed with five to six gallons of clean water per

94-pound bag.

Cement-Bentonite grout is a mixture of Portland cement with 2% to 10% bentonite clay mixed according to the proper water-to-cement ratio depending on the percent by weight of bentonite added. This sealant is the recommended material to use when decommissioning a contaminated well because, unlike neat cement that shrinks and can crack upon curing, cement-bentonite grout swells and remains plastic when cured creating a superior seal.

Bentonite chips can be used for filling and sealing wells or portions of wells by applying directly into the well through the top at a rate no greater than three minutes per bag. When hydrated, bentonite chips will swell up to 12 to 13 times their dry volume and effectively seal the well. If the chips are applied at a rate greater than three minutes per bag, bridging can occur within the well and the well will not be filled.

Any well abandonment must be performed by a licensed water well contractors. Homeowners can abandon wells on their own properties, but it must be performed by their own hands and the Water Well Board rules must be followed. An Abandoned Well Registration Report is required to be filed with the Water Well Board within 90 days after a well has been decommissioned.

For Additional Information Please contact the Drinking Water and Groundwater Bureau and the New Hampshire Water Well Board at (603) 271-1974 or waterwellprogram@des.nh.gov or visit our website at www.des.nh.gov.

Note: This fact sheet is accurate as of September 2019. Statutory or regulatory changes or the availability of additional information after this date may render this information inaccurate or incomplete.

https://onlineforms.nh.gov/?formtag=NHDES-W-03-004 mailto:waterwellprogram@des.nh.gov http://www.des.nh.gov/

NHDES-W-03-004

2019-11-22 Page 1 of 1

Well Number:

(FOR CONTRACTOR’S USE)

This report must be submitted to the N.H.

Water Well Board no later than 90 days after the well was decommissioned.

State of New Hampshire Water Well Board

PO Box 95 Concord, NH 03302-0095

603-271-1974

Abandoned Well Registration Report

Identification #:

Latitude:

Longitude:

Please Report Coordinates in:

Map Datum: WGS 84 Position Format: hddd°mm.mmm

Well Owner:

Mailing Address:

Building Contractor:

Mailing Address:

Location of Well (# & Street, Town):

Subdivision Name:

Subdivision Lot #:

Town Tax Map and Lot #:

Type of Well: Drilled in Bedrock Drilled in Gravel Dug Wash/Point

Use Type: Domestic Public Irrigation Commercial Monitoring

Reason for Abandonment: Insufficient Yield Poor Aesthetic Quality Contaminated Disrepair Failed Well Isolation Distances No Longer In Use Other:

Current Status: Decommissioned Not Decommissioned Wellhead Left Above Grade and Covered Date Well was Decommissioned:

Depth of Well: ft.

Static Water Level: ft. below land surface

Casing: Length: ft.

Diameter: in. Material:

Method Used for Sealing: Filled with Grout Pressure Grout

Quality of Materials Used (List No. of Units): Neat Cement: Cement/Bentonite Grout:

Premixed Bentonite Grout: Bentonite Chips: Other:

Doing Business As: ____________________________________

Report Filed by (Please sign): ____________________________

Date of Report: _______________________________________

Past Experience Questionnaire

PAST EXPERIENCE & REFERENCES QUESTIONNAIRE

Inactive Well Decommission Project

U.S. Fish & Wildlife Service

100 Merrimac Drive - Newington, NH 03801

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

Your Company Name:

SAM Unique Entity ID (UEI)#:

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: (Sufficient details must be provided for the Government to perform an evaluation)

Past Experience Questionnaire

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

(Nov 2021) 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 Products and Commercial Services (Nov 2021) 52.212-3 Offeror Representations and Certifications -- Commercial Products and Commercial Services (May 2022) 52.219-1 Small Business Program Representations (Nov 2020) 52.222-22 Previous Contracts and Compliance Reports (Feb 1999) 52.222-25 Affirmative Action Compliance (Apr 1984) https://www.ipp.gov/ mailto:IPPCustomerSupport@fiscal.treasury.gov https://www.acquisition.gov/browse/index/far

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)

Provisions Incorporated by Text

52.212-2 - Evaluation -- Commercial Products and Commercial Services (Nov 2021)

(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 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 (Nov 2021) 52.209-10 Prohibition on Contracting with Inverted Domestic Corporations (Nov 2015) 52.212-4 Contract Terms and Conditions -- Commercial Products and Commercial Services (Nov 2021) 52.232-39 Unenforceability of Unauthorized Obligations (Jun 2013) 52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Nov 2021) 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)

Clauses Incorporated by Text

52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders— Commercial Products and Commercial Services (May 2022)

(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 products and commercial services:

(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 (Nov 2021) (Section 1634 of Pub. L. 115-91).

(3) 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment. (Nov 2021) (Section 889(a)(1)(A) of Pub. L. 115-232).

https://www.acquisition.gov/browse/index/far http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/52_237.htm#P2_55

(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 products and commercial services:

[Contracting Officer check as appropriate.]

__ (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Jun 2020), with Alternate I (Nov 2021) (41 U.S.C. 4704 and 10 U.S.C. 2402).

__ (2) 52.203-13, Contractor Code of Business Ethics and Conduct (Nov 2021) (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.)

__ (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. (Nov 2021) (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.

__ (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 (Nov 2021) (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)).

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__ (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 2022) (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.

__ (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 (Nov 2021) (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 (May 2022). (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.

__ (41)(i) 52.223-14, Acquisition of EPEAT®-Registered Televisions (JUN 2014) (E.O.s 13423 and 13514).

__ (ii) Alternate I (Jun 2014) of 52.223-14.

__ (42) 52.223-15, Energy Efficiency in Energy-Consuming Products (May 2020) (42 U.S.C. 8259b).

__ (43)(i) 52.223-16, Acquisition of EPEAT®-Registered Personal Computer Products (OCT 2015) (E.O.s 13423 and

13514).

__ (ii) Alternate I (Jun 2014) of 52.223-16.

X (44) 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving (Jun 2020) (E.O. 13513).

__ (45) 52.223-20, Aerosols (JUN 2016) (E.O. 13693).

__ (46) 52.223-21, Foams (JUN 2016) (E.O. 13693).

__ (47)(i) 52.224-3, Privacy Training (JAN 2017) (5 U.S.C. 552a).

__ (ii) Alternate I (JAN 2017) of 52.224-3.

__ (48) 52.225-1, Buy American—Supplies (Nov 2021) (41 U.S.C. chapter 83).

__ (49)(i) 52.225-3, Buy American—Free Trade Agreements—Israeli Trade Act (Nov 2021) (41 U.S.C. chapter 83, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C. 3805 note, 19 U.S.C. 4001 note, Pub. L. 103-182, 108-77, 108-78, 108- 286, 108-302, 109-53, 109-169, 109-283, 110-138, 112-41, 112-42, and 112-43.

__ (ii) Alternate I (Jan 2021) of 52.225-3.

__ (iii) Alternate II (Jan 2021) of 52.225-3.

__ (iv) Alternate III (Jan 2021) of 52.225-3.

__ (50) 52.225-5, Trade Agreements (Oct 2019) (19 U.S.C. 2501, et seq., 19 U.S.C. 3301 note).

X (51) 52.225-13, Restrictions on Certain Foreign Purchases (Feb 2021) (E.O.’s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury).

__ (52) 52.225-26, Contractors Performing Private Security Functions Outside the United States (Oct 2016) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 U.S.C. 2302 Note).

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