W911SA25QA090 Attachment 08 88th RD Pest Management Application Reporting Form.docx
DOCX document 31 KB Posted
- Solicitation number
- W911SA25QA090
About this file
This is a pest management application reporting form template that must be completed for each pest control operation performed under the grounds maintenance services contract at NE024 in Elkhorn, NE. The form requires detailed documentation of pesticide/herbicide applications including date, location, type of operation, site description, target pest, area treated, applicator information, and specific product details like trade name, active ingredients, EPA registration, formulation, amount used, and final concentration.
The related contract opportunity (W911SA25QA090) is for grounds maintenance services at the Elkhorn, NE facility, with a performance period from April 1, 2025 to March 31, 2026, plus four 12-month option years. The solicitation will be issued March 4, 2025 through SAM.gov, with questions due by March 12, 2025 at 10:00 AM CDT. Quotes must be emailed to the contracting officer and include a signed SF 1449, completed price schedule, and other required documentation. No site visit is scheduled. The contracting agency is the Army Materiel Command Mission and Installation Contracting Command at Fort McCoy.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| W911SA25QA0900001 Amendment 1.pdf | ||
| W911SA25QA090 Attachment 01 Grounds PWS.docx | DOCX document | |
| W911SA25QA090 Attachment 03 Grounds PRS.xlsx | XLSX spreadsheet | |
| W911SA25QA090 Attachment 04 Grounds Deliverables.docx | DOCX document | |
| W911SA25QA090 Attachment 05 Grounds Price Schedule CUI.xlsx | XLSX spreadsheet | |
| W911SA25QA090 Solicitation.pdf | ||
| W911SA25QA090 Attachment 02 GROUNDS AT-OPSEC.pdf | ||
| W911SA25QA090 Attachment 09 DOD_Pesticides List.pdf | ||
| W911SA25QA090 Attachment 06 Grounds Drawing.pdf | ||
| W911SA25QA090 Attachment 07 Sample Grounds Service Ticket.docx | DOCX document |
On GovTribe
Work with this file
- 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 .