W911SA24Q3102 7.5 Attachment 5 - 88th RD Universal Pest Management Application Reporting Form.docx

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Attached to
Grounds Maintenance Services at MT029 Butte, MT
Solicitation number
W911SA-24-Q-3102
Issued by

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This document is the 88th Readiness Division Universal Pest Management Application Reporting Form, which is an attachment to a federal contract opportunity. The form is used to record details of each pest management operation, including the date, location, type of pest control, pests treated, area treated, applicator information, and pesticide/herbicide used.

The related federal contract opportunity is Solicitation W911SA-24-Q-3102 for Grounds Maintenance Services at one location in Montana. The performance period is 1 June 2024 (or subsequent date) to 31 May 2025 with four option years and a six-month option to extend. Quotes are due to the government by the date/time listed in the solicitation in central time. The contractor must submit all required documents with the quote, including a signed SF 1449, completed supplemental information, completed price schedule, and signed amendments. No site visit will be held for this solicitation, and written questions are due by 10:00 AM CST on 9 May 2024.

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Other files

File Type Posted
W911SA24Q3102 Amendment 1.pdf PDF
W911SA24Q3102 7.2 Attachment 2 - MT029 Grounds Drawing.pdf PDF
W911SA24Q3102 7.3 Attachment 3 - MT029 GROUNDS AT-OPSEC Coversheet-Army.pdf PDF
W911SA24Q3102 7.1 Attachment 1 - MT029 Grounds Price Schedule CUI.xlsx XLSX spreadsheet
W911SA24Q3102 7.4 Attachment 4 - 88th RD Grounds Service Ticket.docx DOCX document
W911SA24Q3102 MT029 Solicitation.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 .