W911SA24Q3127 Attachment 5 - 88th RD Universal Pest Management Application Reporting Form.docx

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Grounds Maintenance Services for CO147 in Colorado Springs, CO
Solicitation number
W911SA24Q3127
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The document provided is an 88th Readiness Division Universal Pest Management Application Reporting Form. This form is used to document pest control operations, including the date, location, type of pest control, site description, pest type, area treated, applicator information, pesticide/herbicide details, and any additional comments. The related federal contract opportunity is Solicitation Number W911SA24Q3127 for Grounds Maintenance Services for CO147 in Colorado Springs, CO, issued by the Department of the Army Materiel Command Mission and Installation Contracting Command Fort McCoy. This is a Request for Quotes for the required grounds maintenance services.

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Other files

File Type Posted
W911SA24Q3127 Amendment One (1).pdf PDF
W911SA24Q3127 Attachment 6 - DOD Pesticides List.pdf PDF
W911SA24Q3127 Attachment 1 - Price Schedule - CUI.xlsx XLSX spreadsheet
W911SA24Q3127 Solicitiation.pdf PDF
W911SA24Q3127 Attachment 3 - Drawing.pdf PDF
W911SA24Q3127 Attachment 2 - AT OPSEC.pdf PDF
W911SA24Q3127 Attachment 4 - Grounds Service Ticket.docx DOCX document

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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 .