W911SA25QA076 Attachment 09 - Pest Management Application Reporting Form.DOC
DOC document 31 KB Posted
- Attached to
- Grounds Maintenance Services at MI043 (Multi-Site) Federal contract opportunity
- Solicitation number
- W911SA-25-Q-A076
About this file
This is a pest management application reporting form template that must be completed separately for each pest management operation conducted under the 88th Readiness Division contract. The form requires detailed documentation of pest control activities including the date, location (indoor/outdoor), facility information, type of control operation, site description, target pest, and area treated measurements (in square feet, linear feet, acres, etc.). It also requires comprehensive pesticide/herbicide information including trade names, active ingredients, EPA registration numbers, formulation details, quantity applied, and final concentration rates. The form must be signed by a certified applicator with their certification number and submitted to the 88th PMC.
This form is an attachment to solicitation W911SA-25-Q-A076 for Grounds Maintenance Services at three Michigan locations, to be issued February 5, 2025 by the Department of the Army MICC Fort McCoy. The performance period runs from April 1, 2025 to March 31, 2026 with four option years and a six-month extension option. Quote submissions are due to kayla.j.christian.civ@army.mil by February 13, 2025 at 10:00 AM CST and must include a signed SF 1449, completed price schedule, and other required documentation as specified.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| W911SA25QA076 Attachment 07 - Drawings.pdf | ||
| W911SA25QA076 Attachment 01 - PWS.docx | DOCX document | |
| W911SA25QA076 Attachment 02 - AT-OPSEC Coversheet.pdf | ||
| W911SA25QA076 Attachment 03 - PRS.xlsx | XLSX spreadsheet | |
| W911SA25QA076 Attachment 04 - Deliverables.docx | DOCX document | |
| W911SA25QA076 Attachment 05 - Wage Determination Log.xlsx | XLSX spreadsheet | |
| W911SA25QA076 Solicitation Final.pdf | ||
| W911SA25QA076 Attachment 06 - Price Schedule_CUI.xlsx | XLSX spreadsheet | |
| W911SA25QA076 Attachment 08 - Grounds Service Ticket.docx | DOCX document |
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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: _________________________________________________________ 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 .