W911SA-21-Q-3006 Attachment 3 Deliverable 88th RD Universal Pest Management Application Reporting Form.docx
DOCX document 22 KB Posted
- Attached to
- Grounds Maintenance for multiple locations in Indiana Federal contract opportunity
- Solicitation number
- W911SA21Q3006
About this file
This document contains a universal pest management application reporting form and details of a related federal contract opportunity for grounds maintenance services. The form requires reporting of date, location, type of pest control operation, site description, pest targeted, area treated, applicator name, pesticide/herbicide used including trade name, active ingredient, EPA registration number, formulation, quantity applied, and final concentration applied. It also includes signature and certification number fields and instructions to send a copy to the 88th PMC.
The grounds maintenance contract opportunity is a non-personnel services contract issued by the Department of the Army Materiel Command Mission and Installation Contracting Command Fort McCoy. It requires grounds maintenance services at four Army Reserve facilities located in Indiana, with site visits scheduled on specified dates and times to the identified locations. Services include mowing, edging, trimming, leaf removal, litter control and other grounds maintenance tasks as defined in the Performance Work Statement.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| W911SA-21-Q-3005 Attachment 4 AT-OPSEC Cover (3 Pages).pdf | ||
| W911SA-21-Q-3006 Attachment 6 SUS Trifold.pdf | ||
| W911SA-21-Q-3006 Attachment 2 Drawings (4 pages).pdf | ||
| W911SA-21-Q-3006 Attachment 1 Price Schedule.xlsx | XLSX spreadsheet | |
| W911SA-21-Q-3006 FINAL solicitation.pdf | ||
| W911SA-21-Q-3006 Attachment 5 Sample Service Ticket.docx | DOCX document |
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Text version
88th Readiness Division
UNIVERSAL PEST MANAGEMENT APPLICATION REPORTING FORM
A separate form shall be filled out for each pest management operation.
Please print for number 1-9.
1. Date of Application: _________________________
2. Location: 2a. Inside or Outside (circle one) 2b. Facility name and/or building #: _______________________________________
3. Type of Pest Control Operation: ______________________________________________ (e.g., baiting, power spray, ULV, manual application of pesticide etc.)
4. Site Description: ______________________________________ (e.g., office, lawn, unimproved ground, fence line, parking lot cracks, etc.)
5. Pest: _________________________________________(rodents, spiders, nates, weeds, etc.)
6. Area Treated: _________________________________ [Include unit, SF (square feet), LF (linear feet), AC (acre), CF (cubic feet), EA (each - for baiting only)]
7. Applicator’s Name: ___________________________________
8. Pesticide/Herbicide Used:
8a. Pesticide/Herbicide Trade Name: _______________________________________ 8b. Pesticide/Herbicide Active Ingredient: ___________________________________ 8c. EPA or Country Reg #: ________________________________________________ 8d. Formulation: _________________________________________________________ 8d. Quantity of pesticide applied: ___________________________________________ [include unit, FL (fluid ounce), GA (gallon), ML (milliliter), LT (liter), LB (pound), DR (dry ounce), GR (gram), KG (kilogram)] 8e. Final Concentration Applied: _______________________________________ (amount of active ingredient per acre/area)
9. Comments: (survey results, wind conditions, sanitation deficiencies, etc.)
10. Signature of Applicator: ____________________________________________
11. Certification # of Applicator: _________________________________________
12. Copy sent to 88th PMC on (date)____________
File details come from the government source that posted it. Updated .