W911SA22Q3005 Attach. 1 - 88th RD Universal Pest Mgmt App. Reporting Form.docx
DOCX document 22 KB Posted
- Attached to
- Grounds Services IL079; Elwood, IL
- Solicitation number
- W911SA22Q3005
About this file
This document contains a federal contract opportunity solicitation for grounds services and a universal pest management application reporting form template. The solicitation W911SA22Q3005 will be issued on May 16, 2022 via SAM.gov for grounds services at one location in Elwood, Illinois. The performance period is July 1, 2022 through June 30, 2023 with four option years and a six month option to extend services. A site visit will be held on May 19, 2022. Written questions are due by May 20, 2022. The reporting form template requires information on pest management operations including date, location, type of operation, site description, pest, area treated, applicator name, pesticide/herbicide used, EPA registration number, quantity applied, and comments.
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Other files
| File | Type | Posted |
|---|---|---|
| W911SA22Q3005 Solicitation Amendment 0001.docx | DOCX document | |
| W911SA22Q3005 Solicitation.docx | DOCX document | |
| W911SA22Q3005 Attach. 5 - Price Schedule (Blank).xlsx | XLSX spreadsheet | |
| W911SA22Q3005 Attach. 3 - AT OPSEC (CUI).pdf | ||
| W911SA22Q3005 Attach. 2 - Drawings.pdf | ||
| W911SA22Q3005 Attach. 4 - 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 .