W911SA25QA042 Attachment 9 - 88th RD Universal Pest Management Application Reporting Form.docx
DOCX document 31 KB Posted
- Attached to
- Grounds Maintenance Services at IA033 Des Moines, IA Federal contract opportunity
- Solicitation number
- W911SA25QA042
About this file
This is a pest management application reporting form template that must be completed by contractors performing pest control services for the 88th Readiness Division. The form requires detailed documentation of each pest management operation, including the date, location (indoor/outdoor), facility details, type of control operation, site description, target pest, and area treated. Contractors must provide specific information about pesticides/herbicides used, including trade names, active ingredients, EPA registration numbers, formulations, amounts used, concentrations, and total active ingredients applied.
The form is an attachment to solicitation W911SA25QA042 for Grounds Maintenance Services at Des Moines, IA, which will be issued February 13, 2025. The contract period is April 1, 2025 to March 31, 2026, with four option years and a six-month extension option. A site visit is scheduled for February 18, 2025 at 10:00 AM CT, with questions due February 19, 2025. The contracting agency is the Army Materiel Command Mission and Installation Contracting Command at Fort McCoy, and the place of performance is 6511 Chaffee Rd, Des Moines, IA.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| W911SA25QA042 Solicitation.pdf | ||
| W911SA25QA042 Attachment 3 - PRS.xlsx | XLSX spreadsheet | |
| W911SA25QA042 Attachment 6 - Price Schedule CUI.xlsx | XLSX spreadsheet | |
| W911SA25QA042 Attachment 8 - Sample Service Ticket.docx | DOCX document | |
| W911SA25QA042 Attachment 2 - AT-OPSEC.pdf | ||
| W911SA25QA042 Attachment 5 - Wage Determination Log.docx | DOCX document | |
| W911SA25QA042 Attachment 4 - Deliverables.docx | DOCX document | |
| W911SA25QA042 Attachment 7 - Drawing.pdf | ||
| W911SA25QA042 Attachment 10 - DOD Pesticides List.pdf | ||
| W911SA25QA042 Attachment 1 - PWS.docx | DOCX document |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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 .