W911SA24Q3041 - Attachment 2 - Pest Management Form.docx

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Attached to
Grounds Maintenance Services at UT003 in Logan, Utah
Solicitation number
W911SA24Q3041
Issued by

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This is a universal pest management application reporting form for the 88th Readiness Division. The form requires applicants to provide details of pest management operations including the date, location, type of control operation, site description, pest targeted, area treated, name of the applicator, trade name and active ingredients of pesticides used, EPA registration number, formulation, quantity applied, and final concentration. Applicators must also provide comments on survey results, wind conditions, sanitation deficiencies, and sign and date the form. A copy of the completed form is to be sent to the 88th PMC on the date indicated.

The related federal contract opportunity is for grounds maintenance services at facility UT003 in Logan, Utah. The solicitation number is W911SA24Q3041 and is being issued by the Department of the Army Materiel Command Mission and Installation Contracting Command at Fort McCoy.

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Other files

File Type Posted
W911SA24Q3041 - Attachment 3 - Drawing.pdf PDF
W911SA24Q3041 - Solicitation.pdf PDF
W911SA24Q3041 - Attachment 4 - AT-OPSEC.pdf PDF
W911SA24Q3041 - Attachment 5 - Service Ticket.docx DOCX document
W911SA24Q3041 - Attachment 1 - Vendor Price Schedule - CUI.xlsx XLSX spreadsheet

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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 .