W911SA-20-Q-3014_Attachment_1_88th_RD_Universal_Pest_Man_App_Reporting_Form.docx

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Attached to
Grounds MN076 Multi-Site with Six (6) Locations
Solicitation number
W911SA-20-Q-3014
Issued by

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This form is used to report pest management operations at 88th Readiness Division facilities. It requires information such as the date, location, type of pest control, site description, pest targeted, area treated, name of applicator, pesticide/herbicide used including trade name, active ingredient, EPA registration number, formulation, quantity applied, and final concentration applied. Comments from the applicator are also included. The applicator must sign the form and include their certification number. A copy is then sent to the 88th PMC.

The related federal contract opportunity is solicitation number W911SA-20-Q-3014 for grounds maintenance services at six locations under the Department of the Army Materiel Command Mission and Installation Contracting Command at Fort McCoy. No other details are provided about required services, response dates, or other contractual terms.

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Attachment 1 88th RD Universal Pest Man App Reporting Form

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Other files

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W911SA-20-Q-3014_Amendment_1.docx DOCX document
W911SA-20-Q-3014_Attachment_5_MN076_Grounds_Price_Schedule.xlsx XLSX spreadsheet
W911SA-20-Q-3014_Attachment_3_MN076_AT-OPSEC.pdf PDF
W911SA-20-Q-3014_Solicitation.docx DOCX document
W911SA-20-Q-3014_Attachment_2_Combined_Grounds_Drawings_MN076_2.pdf PDF
W911SA-20-Q-3014_Attachment_6_SUS_Trifold.pdf PDF
W911SA-20-Q-3014_Attachment_4_Grounds_Service_Ticket.pdf PDF

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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 .