W911SA24Q3076 Attachment 3 - 63d RD Weed Control Form.docx

DOCX document 30 KB Posted

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Grounds Maintenance Services for CL Region 6 in California
Solicitation number
W911SA24Q3076
Issued by

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This document is a form titled "63d RD WEED CONTROL RECORD FORM" to be used for a federal contract opportunity. The form requires the contractor to provide details on the date of application, facility name, type of application, size of area treated, applicator information, herbicide used (including trade name, active ingredient, EPA or state registration number, formulation, quantity applied, and final concentration), and any additional comments. The contractor must also include the signature of the applicator and their certification number. The form indicates that a copy must be attached to the invoice in iRAPT, per requirement 5.3.5 of the Performance Work Statement.

The related federal contract opportunity is a Request for Quotes (RFQ) solicitation number W911SA24Q3076 for Grounds Maintenance Services for CL Region 6 in California, issued by the Department of the Army Materiel Command Mission and Installation Contracting Command Fort McCoy.

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Other files

File Type Posted
W911SA24Q3076 Solicitation.pdf PDF
W911SA24Q3076 Attachment 2 - Deliverables.docx DOCX document
W911SA24Q3076 Attachment 7 - Grounds Service Ticket.docx DOCX document
W911SA24Q3076 Attachment 6 - AT OPSEC.pdf PDF
W911SA24Q3076 Attachment 4 - 63d RD CPMR and Pesticide List.pdf PDF
W911SA24Q3076 Attachment 5 - Grounds Drawings.pdf PDF
W911SA24Q3076 Attachment 1 - Price Schedule - CUI.xlsx XLSX spreadsheet

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63d RD

WEED CONTROL RECORD FORM

Version 1.4; 14 May 2018 A separate form shall be filled out for each operation.

Please print for number 1-8.

1. Date of Application: _________________________

2. Facility Name: ____________________________

3. Type of Application: ________________________________________ (e.g., power spray, manual application etc.)

4. Site Description: ______________________________________ (e.g., lawn, unimproved ground, fence line, parking lot cracks, etc.)

5. Size of Area Treated: _________________________________ [Include unit, SF (square feet), LF (linear feet), AC (acre), CF (cubic feet)]

6. Applicator’s Name: ___________________________________

7. Herbicide Used:

7a. Herbicide Trade Name: ___________________________________

7b. Herbicide Active Ingredient: ________________________________________

7c. EPA or State Reg. #: ________________________________

7d. Formulation: _____________________________________

7d. Quantity of herbicide applied ____________________________ [(include unit, FL (fluid ounce), GA (gallon), ML (milliliter), LT (liter), LB (pound), DR (dry ounce), GR (gram), KG (kilogram)]

7e. Final Concentration Applied (%): _______________________________

8. Additional Comments: (survey results, wind conditions, sanitation deficiencies, etc.)

9. Signature of Applicator: ___________________________________

10. Certification # of Applicator: _______________________________

11. (PWS #5.3.5) Copy of this form attached to invoice in iRAPT on (date): ___________________

File details come from the government source that posted it. Updated .