W911SA25QA035 Attachment 9 Pest Management Form.docx

34 KB Posted

Attached to
Grounds Maintenance OH105 Multiple Sites (MS) (OH004, OH044, OH048, OH051, OH094)
Solicitation number
W911SA25QA035
Issued by

About this file

Written by GovTribe AI ·

This is a pest management application reporting form template (Attachment 9) for the 88th Readiness Division's grounds maintenance contract W911SA25QA035. The form is designed to document individual pest control operations and requires detailed information including application date, location details (indoor/outdoor), facility information, type of pest control operation, site description, target pest, and area treated measurements. The form mandates specific documentation of pesticide/herbicide usage, including trade names, active ingredients, EPA registration numbers, formulations, product quantities used (with precise unit measurements), final concentration rates, and total active ingredient amounts. The form must be completed by a certified applicator who must provide their signature, certification number, and submit a copy to the 88th PMC.

This template serves as a documentation requirement for the larger grounds maintenance contract being solicited by the Department of the Army Materiel Command Mission and Installation Contracting Command Fort McCoy for multiple sites in Ohio (OH004, OH044, OH048, OH051, OH094).

View the file

Other files

File Type Posted
W911SA25QA035-0001 Solicitation Amendment.pdf PDF
W911SA25QA035 Attachment 5 Wage Determination Log.xlsx XLSX spreadsheet
W911SA25QA035 Attachment 4 Deliverables.docx DOCX document
W911SA25QA035 Attachment 6 Price Schedule - CUI.xlsx XLSX spreadsheet
W911SA25QA035 Attachment 2 AT OPSEC.pdf PDF
W911SA25QA035 Solicitation.pdf PDF
W911SA25QA035 Attachment 8 Sample Service Ticket.docx DOCX document
W911SA25QA035 Attachment 3 Performance Requirements Summary (PRS).xlsx XLSX spreadsheet
W911SA25QA035 Attachment 7 Grounds Drawings.pdf PDF
W911SA25QA035 Attachment 1 Performance Work Statement (PWS).docx DOCX document
W911SA25QA035 Attachment 10 Approved Pesticides List.pdf PDF
Show all 11

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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: _________________________________(percentage of AI from label) 8e. Amount of Product Used: ___________________________________________ [include unit, FL (fluid ounce), GA (gallon), ML (milliliter), LT (liter), LB (pound), DR (dry ounce), GR (gram), KG (kilogram) AND how much water was added] 8f. Final Concentration Applied: _______________________________________ [amount of ACTIVE INGREDIENT (AI) per area (examples: 1.5 oz/gal, 4lbs/1000 SF] 8g. Total Amount of Active Ingredient applied in this pest management operation: ___________________________________ [in fl oz (if liquid) or weight (if solid)]

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 .