W911SA-20-Q-3020_Attachment_1_88th_RD_Universal_Pest_Management_Application_Reporting_Form_V1.5.docx
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- Attached to
- Grounds IL177 3 Multi-Site Locations
- Solicitation number
- W911SA-20-Q-3020
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. Solicitation number W911SA-20-Q-3020 will be issued on or around September 18, 2019 for grounds maintenance at three Illinois locations - Facility IL035 in Lake Forest, Facility IL068 in Machesney Park, and Facility IL131 in Fort Sheridan. The performance period is April 1, 2020 to March 31, 2021 with four one-year option periods. Site visits will be held on specific dates in October 2019 at each location. Written questions must be submitted by October 14, 2019 and vendors should access FBO.gov for solicitation documents and amendments as direct notifications will not be provided. The reporting form requires details of each pest management operation, including date, location, type of application, area treated, pesticide used, applicator information, and comments.
Attachment 1 88th RD Universal Pest Management Application Reporting Form
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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)____________
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