W9127820R0069 Solicitation.pdf

THIS PROJECT IS ADVERTISED ON AN UNRESTRICTED BASIS

SOLICITATION NO: W9127820R0069

SPECIFICATIONS

FOR

Unit 1 and 2 Install Turbine and Generator Rewind at Philpott Powerhouse

Philpott Powerhouse in Bassett, VA

(Henry County, VA)

THIS IS A CIVIL WORKS PROGRAM PROCUREMENT AND IS NOT FUNDED BY THE DEPARTMENT OF

DEFENSE

“GOOD ENGINEERING RESULTS IN A BETTER ENVIRONMENT”

U.S. ARMY ENGINEER DISTRICT, MOBILE

109 St. Joseph St

Mobile, Alabama 36602

BUILDING STRONG®

This page was intentionally left blank for duplex printing.

Turbine & Unit 1 & 2 Generator Rewind, Philpott Powerhouse, Bassett, VA Solicitation No. W9127820R0069

Page - 1

CHECKLIST FOR PREPARATION OF OFFERS

Before sending your offer to us, review it for the following documents--without these, your offer could be rejected.

Any questions about this solicitation, including technical questions about plans and specifications, shall be submitted via the Bidder Inquiry Portal in ProjNet at https://www.projnet.org. Please refer to Section 01 00 01 paragraph

“REQUESTS FOR INFORMATION”.

This checklist is designed for your convenience to assist you in completing your offer. Its completion does not guarantee that your offer will be acceptable. A complete and acceptable offer is solely the responsibility of the Contractor.

1. Your attention is directed to the following clause:

Section 00 45 00, FAR Clause 52.204-7, “System for Award Management”. LACK OF REGISTRATION IN THE SAM DATABASE WILL RENDER BIDDER INELIGIBLE FOR AWARD. Information on how to register and the time it takes is detailed in the clause.

2. Standard Form 1442 Titled “SOLICITATION, OFFER AND AWARD”

a. Is it signed in Block 20B? Yes (Y)___Not Applicable(NA) ___

b. Have you verified on beta.sam.gov that you have received all Amendments? Have you acknowledged all Amendments using block 19? Y__ NA__

c. Is the complete, correct address of the company printed in Block 14? (ALSO INCLUDE YOUR TIN, DUNS, AND CAGE NUMBERS IN THIS BLOCK) Y__ NA__

d. Are the correct phone numbers, and fax numbers including country codes, included in Block 15? Y__ NA__

e. Is the mailing address of the company is different from the address in Block 14, is the mailing address written in Block 16? (ALSO INCLUDE YOUR EMAIL ADDRESS IN THIS BLOCK) Y__ NA__

f. If you are a Partnership or Joint Venture, have all partners or joint ventures signed in Block 20; or has authority properly been delegated pursuant to the provisions of the solicitation clause entitled JOINT VENTURE BID

REQUIREMENTS? Y__ NA__

g. . If you are a Joint Venture have you submitted your Joint Venture Agreement and taken the other actions necessary to comply with the “Joint Venture Bid Requirement” Clause? Y__ NA__ h.. Is the time you are allowing for acceptance of the offer, the same or longer than the time set out in block

13?. Y__ NA__

3. Representations, Certifications, and Other Statements of the Offeror

Are all of the clauses in this section completed and signed in the appropriate places and returned attached to the offer?

Y__ NA__

4. The Bidding Schedule

a. Is it completely filled out? Y__ NA__

b. It may not be altered either as to quantities or as to items offered. Y__ NA__

c. There can be no language of limitation either as to quantities or as to items offered. Y__ NA__

Page - 2

d. If you corrected your numbers, have you initialed these corrections? Y__ NA__

e. If the bidding schedule has been changed by Amendment, is the bidding schedule that you are submitting from the most recent amendment ? Y__ NA__

f. Do prices for each bid item include all costs, mark-ups and taxes (if any taxes are imposed)? Y__ NA__

g. Is the cost of obtaining your bid and performance guarantee included in the total bid price specified on the bid schedule? Y__ NA__

h. In preparing your bid, remember the Corps does not make advanced payments on its contracts Y__ NA__

5. Pre-award Information- Although not required to be submitted with the solicitation, the pre-award information is necessary for award. A detailed list of this information is found in the Pre-Award Information in Section 01 00 01 of the solicitation.

Submission of this information with your offer will expedite the award process.

a Your latest financial statement Y__ NA__

b. Your present financial commitments Y__ NA__

c. Your banking institutions and financial resources Y__ NA__

All your documents must be in English

Turbine & Unit 1 & 2 Generator Rewind, Philpott Powerhouse, Bassett, VA Solicitation No. W9127820R0069

Turbine and Rewind of Generator Units 1 and 2 W9127820R0069

Philpott Powerhouse, Bassett, VA

TABLE OF CONTENTS

NOTICE TO BIDDERS

SECTIONS

00 11 00

00 12 00

00 21 16

00 45 00

00 70 00

Standard Form 1442 - Solicitation, Offer, and Award

Proposal Data Sheet

Bidding Schedule

Required Forms

Standard Form 24- Bid Bond Standard Form 25 – Performance Bond

Standard Form 25A – Payment Bond

Standard Form 28 – Affidavit of Individual Surety

Standard Form LLL – Disclosure of Lobbying Activities

Proposal Submission Requirements and Instructions

Evaluation Criteria and Basis of Award Instructions to Proposers

Representations and Certifications

Conditions of the Contract

DIVISION 01 – GENERAL REQUIREMENTS & SPECIFICATIONS

01 10 01.00 25 Contract Administration Data

01 10 10.00 25 Contractor’s Operations and Requirements

01 11 00 Summary of Work

01 22 00.00 10 Measurement and Payment

01 23 00 Miscellaneous Hire

01 30 60.00 25 Operations and Maintenance Data

01 30 70 As-Built Records and Drawings

01 32 01.00 25 Project Schedule

01 33 00 Submittal Procedures

01 35 29.00 25 Safety and Occupational Health Requirements

01 42 00 Sources for Reference Publications

01 45 04.00 25 Contractor Quality Control

01 55 10 Contractor Work, Access and Storage Areas

01 57 20.00 25 Environmental Protection

02 82 14.00 10 Asbestos Hazard Control Activities

02 83 13.00 20 Lead in Construction

03 30 53 00 26 Cast – in Place concrete and Foundation

03 60 00 01 26 Concrete Demolition, Repairs of Concrete Surfaces, and Minor Equipment

Foundation

05 05 23.20 26 Pressure Vessel Welding

05 05 33.20 26 Non-Destructive Testing

05 50 03.20 26 Metalwork Fabrication, Machine Work, and Miscellaneous Provisions

09 97 02.00 26 Painting, Hydraulic Structures

13 48 00 00 26 Special Construction

21 20 16 01 26 Fire Suppression

Turbine and Rewind of Generator Units 1 and 2 W9127820R0069

26 05 00.00 26 Basic Electrical Materials and Methods

26 05 19.00 26 Insulated Wire and Cable

41 22 13.76 26 Below the Hook Lifting Devices

42 13 19. 00 26 Surface Air Coolers for Generators

42 13 19 01 26 Thrust Bearing Oil Coolers

48 06 15.12 26 Turbine Oil

48 13 13.00 26 Hydraulic Turbine Design

48 13 13.01 26 Hydraulic Turbine

48 13 13.02 26 Disassembly and Reassembly of Hydraulic Turbine Generator

Units

48 13 13.04 26 Existing Turbine component, Refurbishment and Replacement 48 13 13. 96 26 Generator Thrust Bearing Inspection and Optional Refurbishment

48 13 13 07 26 Guide Bearing Inspection & Refurbishment

48 13 13 08 26 Cavitation and Crack Repair (Optional)

48 13 13.11 26 Miscellaneous Parts, Materials and Services

48 13 13.26 26 Turbine Guide Bearing Lubrication System Rehabilitation

48 13 16.00 26 Rewind of Hydraulic – Turbine Driven Generators

48 13 16.24 26 Generator Brake System Mechanical Work

48 19 26.00 26 Refurbishment of Rotating Exciters

SOLICITATION, OFFER

AND AWARD

(Construction, Alteration, or Repair)

1. SOLICITATION NO.

W9127820R0069

2. TYPE OF

SOLICITATION

SEALED BID (IFB)

NEGOTIATED (RFP)

3. DATE ISSUED

22 May 2020

PAGES OF PAGES

IMPORTANT - The "offer" section on the reverse must be fully completed by offeror.

4. CONTRACT NO. 5. REQUISITION/PURCHASE REQUEST NO. 6. PROJECT NO.

7. ISSUED BY CODE CT 8. ADDRESS OFFER TO

U S ARMY ENGINEER DISTRICT, MOBILE

CONTRACTING DIVISION (CESAM-CT)

(109 ST. JOSEPH ST. 36602) P.O. BOX 2288

MOBILE, AL 36628-0001

SAME AS BLOCK 7

ALL PROPOSALS TO BE SUBMITTED ELECTRONICALLY

9. FOR INFORMATION

CALL :

A. NAME B. TELEPHONE NO. (Include area code) (NO COLLECT CALLS)

SOLICITATION

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

10. THE GOVERNMENT REQUIRES PERFORMANCE OF THE WORK DESCRIBED IN THESE DOCUMENTS (Title, identifying no.,date):

A Firm Fixed Price Contract to perform all work required to rewind two generators and turbine replacement for units 1 & 2, at Philpott Powehouse, Bassett, VA.

The NAICS Code for this project is 237990, and the Small Business Size Standard is $39,500,000.00. This is an unrestricted procurement.

The contractor must be registered on the System for Award Management website (www.sam.gov).

11. The Contractor shall begin performance within _5_________ calendar days and complete it within __*________ calendar days after receiving award, notice to proceed. This performance period is mandatory, negotiable. (See _*TBD by proposal schedule__ .)

12A. THE CONTRACTOR MUST FURNISH ANY REQUIRED PERFORMANCE AND PAYMENT BONDS?

(If "YES," indicate within how many calendar days after award in Item 12B.)

YES NO

12B. CALENDAR DAYS

13. ADDITIONAL SOLICITATION REQUIREMENTS:

A. Sealed offers in original and _0______ copies to perform the work required are due at the place specified in Item 8 by__14:00___ (hour) local time 3 November 2020 (date). If this is a sealed bid solicitation, offers must be publicly opened at that time. Sealed envelopes containing offers shall be marked to show the offeror's name and address, the solicitation number, and the date and time offers are due.

B. An offer guarantee is, is not required.

C. All offers are subject to the (1) work requirements, and (2) other provisions and clauses incorporated in the solicitation in full text or by reference.

D. Offers providing less than 120___________ calendar days for Government acceptance after the date offers are due will not be considered and will be rejected.

NSN 7540-01-155-3212 1442-101 STANDARD FORM 1442(REV. 4-85)

Prescribed by GSA FAR(48 CFR) 53.236-1(e)

00010-1

14. NAME AND ADDRESS OF OFFEROR (Include ZIP Code) 15. TELEPHONE NO. (Include area code)

16. REMITTANCE ADDRESS (Include only if different than Item 14)

CODE FACILITY CODE

17. The offeror agrees to perform the work required at the prices specified below in strict accordance with the terms of this solicitation, if this offer is accepted by the Government in writing within _________ calendar days after the date offers are due. (Insert any number equal to or greater than the minimum requirement

AMOUNTS

18. The offeror agrees to furnish any required performance and payment bonds.

19. ACKNOWLEDGMENT OF AMENDMENTS

(The offeror acknowledges receipt of amendments to the solicitation - give number and date of each)

AMENDMENT NO.

DATE

20A. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER

(Type or print)

20B. SIGNATURE 20C. OFFER DATE

AWARD (To be completed by Government)

21. ITEMS ACCEPTED:

22. AMOUNT 23. ACCOUNTING AND APPROPRIATION DATA

24. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM 25. OTHER THAN FULL AND OPEN COMPETITION PURSUANT TO

10 U.S.C. 2304(c) ( ) 41 U.S.C. 253(c) ( )

26. ADMINISTERED BY CODE 27. PAYMENT WILL BE MADE BY

CONTRACTING OFFICER WILL COMPLETE ITEM 28 OR 29 AS APPLICABLE

28. NEGOTIATED AGREEMENT (contractor is required to sign this document and return _______ copies to issuing office.) Contractor agrees to furnish and deliver all items or perform all work, requisitions identified on this form and any continuation sheets for the consideration stated in this contract. The rights and obligations of the parties to this contract shall be governed by (a) this contract award, (b) the solicitation, and (c) the clauses, representations, certifications, and specifications incorporated by reference in or attached to this contract.

29. AWARD (Contractor is not required to sign this document.) Your offer on this solicitation, is hereby accepted as to the items listed. This award con-summates the contract, which consists of (a) the Government solicitation and your offer, and (b) this contract award. No further contractual document is necessary.

30A. NAME AND TITLE OF CONTRACTOR OR PERSON AUTHORIZED

TO SIGN (Type or print)

31A. NAME OF CONTRACTING OFFICER (Type or print)

30B. SIGNATURE 30C. DATE 31B. UNITED STATES OF AMERICA

BY

31C. AWARD

DATE

00010-2

STANDARD FORM 1442 BACK (REV. 4-85)

BID SCHEDULE

PHILPOTT POWERHOUSE UNITS 1-2

TURBINE-GENERATOR REHABILITATION

Bidder's Name:

Item No Description Est. Qty. UOM Unit Price Amount

BASE WORK:

0100-0114 SITE WORK AND STRUCTURAL

0101 Site Mobilization and Demobilization 1 Job $ $

0102 Pre-Disassembly Investigation and Measurements

Each

Disassemble Hydraulic Turbine/Generator Unit and Inspect Components

Reassemble Generating Unit with New Runner and Components

Operational Testing After Reassembly of

Generating Unit 2 Each $ $

0106 Painting 2 Each $ $

0107 On-site Lead Based Paint Removal and Disposal 6000 Sq FT $ $

0108 Special Tools, Handling Devices and Scaffolding 1 Job $ $

Furnish New Draft Tube Mandoor and Fasteners, Refurbish Door Frame

0110 Supply 55 Gallons of Makeup Oil 1 Job $ $

Turbine Maintenance Platform (TMP) Mount

Replacement

0112 Below-the-Hook Lifting Devices 1 Job

0115-0159 MECHANICAL WORK

0115 Hydraulic Turbine Design 1 Job $ $

0116 Furnish Francis Turbine Runner 2 Each $ $

0117 Line Bore Wicket Gate Stem Housing 2 Each $ $

0118 Stay Ring Inspection 2 Each $ $

0119 Furnish Stationary Sealing Rings 2 Each $ $

0120 Headcover Refurbishment 2 Each $ $

Turbine Guide Bearing Housing and Support

Refurbishment

0122 Bottom Ring Refurbishment 2 Each $ $

0123 Turbine Air Inlet Valve Refurbishment 2 Each $ $

Furnish All Self-Lubricating Bushings and

Bearing Plates

0125 New Wicket Gates 2 Each $ $

0126 Supply and Install Turbine Shaft Sleeve 2 Each $ $

0127 Spare Turbine Shaft Sleeve 1 Each $ $

0128 Spare Wicket Gate Stem Seal Set 1 Set $ $

0129 Spare Wicket Gate Shear Linkage Set 1 Set $ $

0130 Operating Ring Refurbishment 2 Each $ $

0131 Turbine and Generator Shaft Inspection 2 Each $ $

0132 Machining of Turbine Shaft 2 Each $ $

Supply and Install Main Turbine Shaft Packing

Box Assembly

0134 Thrust Runner Phase 1 Inspection 2 Each $ $

0135 Thrust Bearing Shoes Phase 1 Inspection 2 Each $ $

0136 Guide Bearing Phase 1 Inspection 2 Each $ $

Generator Fire Suppression System Removal, Design, Supply, Install

Wicket Gate Operating Mechanism

Refurbishment

0139 Gate Shaft Refurbishment 2 Each $ $

0140 Furnish Set of Wicket Gate Shear Linkage 2 Set $ $

Refurbish Turbine Guide Bearing Oil

Pumps/Motor System

0142 Replace Generator Air Coolers 2 Set $ $

0143 Spare Generator Air Coolers 1 Set $ $

0144 Refurbish Generator Thrust Bearing Coolers 2 Each $ $

Headcover and Bottom Ring Condensing and

Vacuum Breaker Piping

0146 Provision of Boring Bar 1 Job $ $

Setup for Machining and Machining up to 0.020" of Stay Ring Mounting Flanges

Setup for Machining and Machining up to 0.020" of Curb Ring

0149 Spiral Case Inspection 2 Each $ $

0150 Replace Runner Coupling Fasteners and Key 2 Each $ $

Generator Air Brake and Jacking System

Refurbishment 2 Each $ $

0152 Inspect Generator Brake Rings 2 Each $ $

0153 New Adjustable Eccentric Level Pin Design 2 Each $ $

0154 Runner Display 1 Job $ $

0160-0179 ELECTRICAL WORK

0160 Miscellaneous Electrical Work 2 Each $ $

Furnish and Install Complete Set of Stator Coils, Supplies, and Accessories

Manufacture Prototype Coils Identical to

Production Coils and Perform Prototype Testing

Job

Furnish Production Run Coils For and Perform

Production Run Testing

Job

Reinsulate Field Coils, Furnish Pole Bodies and

Amortisseur Winding, and Install Assembled

Field Poles

0165 Re-Insulate Rotor Field Leads 2 Each $ $

0166 Rotating Exciter Refurbishment 2 Each $ $

0167 Supply Spare Generator Parts 1 Job $ $

0168 Replace Stator Core 2 Each $ $

0169 Remove Stator Winding 2 Each $ $

0170 Inspect, Clean, and Test Rotor 2 Each $ $

0171 Install and Test Stator Winding 2 Each $ $

0172 Perform Special Field Tests 1 Job $ $

TOTAL BASE BID: ____________________________

0201-0235 OPTIONAL WORK

Additional Stay Ring Mounting Surface

Machining 8 Each $ $

0202 Additional Head Cover Flange Machining 2 Each $ $

0203 Additional Bottom Ring Flange Machining 2 Each $ $

0204 Additional Bearing Housing Support Machining 2 Each $ $

0205 Upper Guide Bearing Phase 2 Inspection 3 Each $ $

0206 Lower Guide Bearing Phase 2 Inspection 3 Each $ $

0207 Turbine Guide Bearing Phase 2 Inspection 3 Each $ $

0208 Thrust Bearing Shoes Phase 2 Inspection 3 Each $ $

0209 Thrust Runner Phase 2 Inspection 2 Each $ $

0210 Shipment of Turbine Guide Bearing 3 Each $ $

0211 Refurbish Turbine Guide Bearing 3 Each $ $

0212 Shipment of Upper Guide Bearing 3 Each $ $

0213 Refurbish Upper Guide Bearing 3 Each $ $

0214 Shipment of Lower Guide Bearing 3 Each $ $

0215 Refurbish Lower Guide Bearing 3 Each $ $

0216 Shipment Set of Thrust Bearing Shoes 3 Set $ $

Machining Set of Thrust Bearing Shoes - Babbitt

Face 3 Set $ $

0218 Machining Set of Shoes - Backside 3 Set $ $

0219 Refurbish Set of Thrust Bearing Shoes 3 Set $ $

0220 Shipment of Thrust Bearing Runner 2 Each $ $

0221 Resurfacing Thrust Bearing Runner and Backside 2 Each $ $

Resurfacing Thrust Bearing Runner Running

Surface Only; Runner Separate from Generator

Shaft

Resurfacing Thrust Bearing Runner Running

Surface Only; Runner Mounted on Generator

Shaft

0224 Shipment of Thrust Collar 2 Each $ $

0225 Refurbishment of Thrust Collar 2 Each $ $

0226 Generator Brake Ring Refurbishment 2 Each $ $

0227 Additional Touch Up Painting 500 NTE Sq Ft $ $

0228 Piezometer Tap Inspection and Repair 2 Each $ $

0229 Runner and Thrust Collar Stoning 2 Each $ $

0230 Supply 425 Gallons of Turbine Oil for Unit 1 1 Job $ $

0231 Supply 425 Gallons of Turbine Oil for Unit 2 1 Job $ $

0232 Supply Set of Thrust Bearing Springs 1 Set $ $

0233 New Head Cover 1 Each $ $

0234 Welding Services 300 EST Man Hours $ $

0235 Machinist Hire 400 EST Man Hours $ $

0236 Electrical Hire 200 EST Man Hours $ $

0237 Painter Hire 100 EST Man Hours $ $

0238 Other Skilled Craftsman Hire 200 EST Man Hours $ $

0239 General Laborer Hire 200 EST Man Hours $ $

0240 Liquid Penetrant Method 100 EST Man Hours $ $

0241 Magnetic Particle Method 100 EST Man Hours $ $

0242 Ultrasonic Method 100 EST Man Hours $ $

0243 Radiographic Method 40 EST Man Hours $ $

0244 Thermal Spraying 60 EST Man Hours $ $

0245 Visual Inspection 100 EST Man Hours $ $

0246 Miscellaneous Welding 300 NTE Pounds $ $

TOTAL OF OPTIONS: __________________________

TOTAL BASE + OPTIONS: ______________________

OPTIONAL ITEMS

The Government may require the delivery of the item(s) identified in the Price Schedule as an "(Optional)" item. The quantities for these items may be increased or decreased or the item(s) may not be used at all, at the discretion of the

Government. The unit price or amount of an optional item will remain unchanged whether the quantities are increased or decreased. The Government may exercise an option by written notice to the Contractor commencing from the date of contract award through the date the contract is closed, unless otherwise specified herein. If an optional item is exercised, the contract completion date will not be extended, however, with mutual agreement, the schedule of work may be modified.

Where appropriate, the above may be supplemented by applicable provisions of Part 17, Subpart 17.2, "Options" of the

Federal Acquisition Regulations (FAR). Clauses and/or provisions addressing "Variations in Estimated Quantities" will not apply to these As Needed items.

ESTIMATED ITEM

The quantity for Item's marked EST is estimated and may be increased or decreased at the discretion of the Government.

NOT TO EXCEED

The quantity for Item's marked NTE is the maximum allowed by the Government for that Item without modification to the contract.

NOTES FOR BIDDING SCHEDULES

NOTE NO. 1. To better facilitate the receipt and proposal process, all modifications to proposals are to be submitted on copies of the latest bid schedules as published in the solicitation or the latest amendment thereto. In lieu of indicating additions/deductions to bid items, bidder should state the revised prices for each item. The company name should be indicated on the face of the bidding schedule to preclude being misplaced.

NOTE NO. 2. Bidder must insert a price on all numbered items of the Bidding Schedule. Failure to do so will disqualify the bid.

NOTE NO. 3. If a modification to a bid is submitted and provides for a job adjustment to the total estimated cost, the application of the job adjustment to each unit price and/or job price, in the bid schedule must be stated or, if it is not stated, the bidder agrees that the job adjustment shall be applied on a prorate basis to every bid item in the bid schedule.

NOTE NO. 4. CONDITIONS GOVERNING EVALUATION OF BIDS AND AWARD OF CONTRACT.

Only one contract will be awarded and award will be made on the Base Bid and Options in accordance with FAR Clause 52.217-5 entitled Evaluation of Options (JUL 1990) in Section 00100: INSTRUCTION TO BIDDERS and according to the "Best Value" approach as defined in Section 00 12 00: PROPOSAL EVALUATION CRITERIA, AND BASIS OF AWARD.

The Government may require the delivery of the numbered line items, identified in the schedule as option items, in the quantity and at the price stated in the schedule. Subject to the availability of funds, the Contracting Officer may exercise the option by written notice to the Contractor within 60 days of contract award

END OF BID SCHEDULE

BID BOND

(See instructions on reverse)

OMB Control Number: 9000-0045 Expiration Date: 8/31/2022

PRINCIPAL (Legal name and business address) TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

SURETY(IES) (Name and business address)

PERCENT

OF BID

PRICE

PENAL SUM OF BOND

AMOUNT NOT TO EXCEED

MILLION(S) THOUSAND(S) HUNDRED(S) CENTS

BID IDENTIFICATION

BID DATE INVITATION NUMBER

PRINCIPAL

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1. 2.

2.

3.

3.

(Seal) (Seal) (Seal) Corporate Seal

INDIVIDUAL SURETY(IES)

SIGNATURE(S)

NAME(S)

(Typed)

1.

1.

2.

2.

(Seal) (Seal)

CORPORATE SURETY(IES)

S U

R E

T Y

A

NAME &

ADDRESS

STATE OF INCORPORATION LIABILITY LIMIT ($)

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1.

2.

2. Corporate Seal

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

STANDARD FORM 24 (REV. 8/2016)

Prescribed by GSA - FAR (48 CFR) 53.228(a)

FOR (Construction, Supplies or Services)

OBLIGATION:

We, the Principal and Surety(ies) are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit of liability is indicated, the limit of liability is the full amount of the penal sum.

CONDITIONS:

The Principal has submitted the bid identified above.

THEREFORE:

The above obligation is void if the Principal - (a) upon acceptance by the Government of the bid identified above, within the period specified therein for acceptance (sixty (60) days if no period is specified), executes the further contractual documents and gives the bond(s) required by the terms of the bid as accepted within the time specified (ten (10) days if no period is specified) after receipt of the forms by the principal; or (b) in the event of failure to execute such further contractual documents and give such bonds, pays the Government for any cost of procuring the work which exceeds the amount of the bid.

Each Surety executing this instrument agrees that its obligation is not impaired by any extension(s) of the time for acceptance of the bid that the Principal may grant to the Government.

Notice to the surety(ies) of extension(s) is waived. However, waiver of the notice applies only to extensions aggregating not more than sixty (60) calendar days in addition to the period originally allowed for acceptance of the bid.

WITNESS:

The Principal and Surety(ies) executed this bid bond and affixed their seals on the above date.

DATE BOND EXECUTED (Must not be later than bid opening date)

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. We estimate that it will take 1 hour to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

JOINT VENTURE

OTHER (Specify)

PARTNERSHIPINDIVIDUAL

CORPORATION

INSTRUCTIONS

1. This form is authorized for use when a bid guaranty is required. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. The bond may express penal sum as a percentage of the bid price. In these cases, the bond may state a maximum dollar limitation (e.g., 20% of the bid price but the amount not to exceed dollars).

4. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitations listed therein. The value put into the LIABILITY LIMIT block is the penal sum (i.e., the face value) of the bond, unless a co-surety arrangement is proposed.

(b) When multiple corporate sureties are involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)." In the space designated "SURETY(IES)" on the face of the form, insert only the letter identifier corresponding to each of the sureties. Moreover, when co-surety arrangements exist, the parties may allocate their respective limitations of liability under the bond, provided that the sum total of their liability equals 100% of the bond penal sum.

(c) When individual sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety, shall accompany the bond.

The Government may require the surety to furnish additional substantiating information concerning its financial capability.

5. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the word "Corporate Seal"; and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals.

6. Type the name and title of each person signing this bond in the space provided.

7. In its application to negotiated contracts, the terms "bid" and "bidder" shall include "proposal" and "offeror."

S U

R E

T Y

B

NAME &

ADDRESS

STATE OF INCORPORATION LIABILITY LIMIT ($)

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1.

2.

2. Corporate Seal

Corporate Seal

LIABILITY LIMIT ($)STATE OF INCORPORATION

2.

2.

1.

1.NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

C

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

D

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

E

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

F

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

G

STANDARD FORM 24 (REV. 8/2016) BACK

PRINCIPAL

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1. 2.

2.

3.

3.

(Seal) (Seal) (Seal) Corporate

Seal

INDIVIDUAL SURETY(IES)

SIGNATURE(S)

NAME(S)

(Typed)

1.

1.

2.

2.

(Seal) (Seal)

CORPORATE SURETY(IES)

S U

R E

T Y

A

NAME &

ADDRESS

STATE OF INCORPORATION LIABILITY LIMIT ($)

SIGNATURE(S)

1.

1.

2.

2. Corporate Seal

STANDARD FORM 25 (REV. 8/2016)

Prescribed by GSA-FAR (48 CFR) 53.228(b)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

PERFORMANCE BOND

(See instructions on reverse)

DATE BOND EXECUTED (Must be same or later than date of contract) OMB Control Number: 9000-0045

Expiration Date: 8/31/2022

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. We estimate that it will take 1 hour to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

PRINCIPAL (Legal name and business address) TYPE OF ORGANIZATION ("X" one)

SURETY(IES) (Name(s) and business address(es)) PENAL SUM OF BOND

MILLION(S) THOUSAND(S) HUNDRED(S) CENTS

CONTRACT DATE CONTRACT NUMBER

STATE OF INCORPORATION

JOINT VENTURE

OTHER (Specify)

PARTNERSHIPINDIVIDUAL

CORPORATION

OBLIGATION:

We, the Principal and Surety(ies), are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit of liability is indicated, the limit of liability is the full amount of the penal sum.

CONDITIONS:

The Principal has entered into the contract identified above.

THEREFORE:

The above obligation is void if the Principal-

(a) (1) Performs and fulfills all the understanding, covenants, terms, conditions, and agreements of the contract during the original term of the contract and any extensions thereof that are granted by the Government, with or without notice of the Surety(ies) and during the life of any guaranty required under the contract, and

(2) Performs and fulfills all the undertakings, covenants, terms, conditions, and agreements of any and all duly authorized modifications of the contract that hereafter are made. Notice of those modifications to the Surety(ies) are waived.

(b) Pays to the Government the full amount of the taxes imposed by the Government, if the said contract is subject to 41 USC Chapter 31, Subchapter III, Bonds, which are collected, deducted, or withheld from wages paid by the Principal in carrying out the construction contract with respect to which this bond is furnished.

WITNESS:

The Principal and Surety(ies) executed this performance bond and affixed their seals on the above date.

NAME(S) &

TITLE(S)

(Typed)

S U

R E

T Y

B

NAME &

ADDRESS

STATE OF INCORPORATION LIABILITY LIMIT ($)

SIGNATURE(S)

1.

1.

2.

2. Corporate Seal

Corporate Seal

LIABILITY LIMIT ($)STATE OF INCORPORATION

2.

2.

1.

1.

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

C

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

D

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

E

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

F

Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

SIGNATURE(S)

NAME &

ADDRESS

S U

R E

T Y

G

BOND

PREMIUM

RATE PER THOUSAND ($) TOTAL ($)

1. This form is authorized for use in connection with Government contracts. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitations listed therein. The value put into the LIABILITY LIMIT block is the penal sum (i.e., the face value) of bonds, unless a co-surety arrangement is proposed.

(b) When multiple corporate sureties are involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)." In the space designated "SURETY(IES)" on the face of the form, insert only the letter identifier corresponding to each of the sureties. Moreover, when co-surety arrangements exist, the parties may allocate their respective limitations of liability under the bonds, provided that the sum total of their liability equals 100% of the bond penal sum.

(c) When individual sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety shall accompany the bond. The government may require the surety to furnish additional substantiating information concerning its financial capability.

4. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the words "Corporate Seal", and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals.

5. Type the name and title of each person signing this bond in the space provided.

STANDARD FORM 25 (REV. 8/2016) BACK

CORPORATE SURETY(IES) (Continued)

NAME(S) &

TITLE(S)

(Typed)

NAME(S) &

TITLE(S)

(Typed)

NAME(S) &

TITLE(S)

(Typed)

NAME(S) &

TITLE(S)

(Typed)

NAME(S) &

TITLE(S)

(Typed)

NAME(S) &

TITLE(S)

(Typed)

Corporate Seal

LIABILITY LIMITNAME &

ADDRESS

NAME(S) &

TITLE(S)

(Typed)

S U

R E

T Y

A

PAYMENT BOND

DATE BOND EXECUTED (Must be same or later than date of contract)

PRINCIPAL (Legal name and business address) TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

MILLION(S)

CONTRACT DATE CONTRACT NUMBER

THOUSAND(S) HUNDRED(S) CENTS

PENAL SUM OF BONDSURETY(IES) (Name(s) and business address(es))

OBLIGATION:

CONDITIONS:

WITNESS:

We, the Principal and Surety(ies), are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit is indicated, the limit of liability is the full amount of the penal sum.

The above obligation is void if the Principal promptly makes payment to all persons having a direct relationship with the Principal or a subcontractor of the Principal for furnishing labor, material or both in the prosecution of the work provided for in the contract identified above, and any authorized modifications of the contract that subsequently are made. Notice of those modifications to the Surety(ies) are waived.

The Principal and Surety(ies) executed this payment bond and affixed their seals on the above date.

PRINCIPAL

INDIVIDUAL SURETY(IES)

CORPORATE SURETY(IES)

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. We estimate that it will take 1 hour to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

OMB Control Number: 9000-0045 Expiration Date: 8/31/2022

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME(S)

(Typed)

SIGNATURE(S)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

1.

(Seal)

(Seal)

2.

(Seal)

(Seal)

3.

2.

2.

2.

2.

2.

3.

(Seal)

1.

1.

1.

1.

1.

STATE OF INCORPORATION

Corporate Seal

STANDARD FORM 25A (REV. 8/2016)

Prescribed by GSA-FAR (48 CFR) 53.2228(c)

JOINT VENTURE

OTHER (Specify)

PARTNERSHIPINDIVIDUAL

CORPORATION

Corporate Seal

Corporate Seal

Corporate Seal

Corporate Seal

Corporate Seal

Corporate Seal

LIABILITY LIMIT

STANDARD FORM 25A (REV. 8/2016) BACK

CORPORATE SURETY(IES) (Continued)

S U

R E

T

B

R E

T

C

R E

T

D

R E

T

E

R E

T Y

F S

U R

E T

Y G

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

2.

1.

1.

1.

1.

1.

1.

1.

1.

1.

1.

1.

1.

STATE OF INCORPORATION LIABILITY LIMIT

2.

2.

LIABILITY LIMIT

2.

LIABILITY LIMIT

2.

2.

STATE OF INCORPORATION

LIABILITY LIMIT

STATE OF INCORPORATION

2.

2.

2.

STATE OF INCORPORATION

LIABILITY LIMIT

STATE OF INCORPORATION

2.

2.

2.

STATE OF INCORPORATION

1. This form, for the protection of persons supplying labor and material, is used when a payment bond is required under 40 USC Chapter 31, Subchapter III, Bonds. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitations listed therein. The value put into the LIABILITY LIMIT block is the penal sum (i.e., the face value) of the bond, unless a co-surety arrangement is proposed.

(b) When multiple corporate sureties are involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)." In the space designated "SURETY(IES)" on the face of the form, insert only the letter identifier corresponding to each of the sureties. Moreover, when co-surety arrangements exist, the parties may allocate their respective limitations of liability under the bonds, provided that the sum total of their liability equals 100% of the bond penal sum.

(c) When individual sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety shall accompany the bond.

The Government may require the surety to furnish additional substantiating information concerning its financial capability.

4. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the words "Corporate Seal", and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals.

5. Type the name and title of each person signing this bond in the space provided.

AFFIDAVIT OF INDIVIDUAL SURETY

STATE OF

COUNTY OF

SS.

I, the undersigned, being duly sworn, depose and say that I am: (1) the surety to the attached bond(s); (2) a citizen of the United States; and of full age and legally competent. I also depose and say that, concerning any stocks or bonds included in the assets listed below, that there are no restrictions on the resale of these securities pursuant to the registration provisions of Section 5 of the Securities Act of 1933. I recognize that statements contained herein concern a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious or fraudulent statement may render the maker subject to prosecution under Title 18, United States Code Sections 1001 and 494. This affidavit is made to induce the United States of America to accept me as surety on the attached bond.

1. NAME (First, Middle, Last) (Type or Print) 2. HOME ADDRESS (Number, Street, City, State, ZIP Code)

3. TYPE AND DURATION OF OCCUPATION 4. NAME AND ADDRESS OF EMPLOYER (If Self-employed, so State)

5. NAME AND ADDRESS OF INDIVIDUAL SURETY BROKER USED

(Number, Street, City, State, ZIP Code)

6. TELEPHONE NUMBER

HOME -

BUSINESS -

7. THE FOLLOWING IS A TRUE REPRESENTATION OF THE ASSETS I HAVE PLEDGED TO THE UNITED STATES IN SUPPORT OF THE ATTACHED BOND:

(a) Real estate (Include a legal description, street address and other identifying description; the market value; attach supporting certified documents including recorded lien; evidence of title and the current tax assessment of the property. For market value approach, also provide a current appraisal.)

(b) Assets other than real estate (describe the assets, the details of the escrow account, and attach certified evidence thereof).

8. IDENTIFY ALL MORTGAGES, LIENS, JUDGEMENTS, OR ANY OTHER ENCUMBRANCES INVOLVING SUBJECT ASSETS INCLUDING REAL ESTATE TAXES DUE AND

PAYABLE.

9. IDENTIFY ALL BONDS, INCLUDING BID GUARANTEES, FOR WHICH THE SUBJECT ASSETS HAVE BEEN PLEDGED WITHIN 3 YEARS PRIOR TO THE DATE OF

EXECUTION OF THIS AFFIDAVIT.

DOCUMENTATION OF THE PLEDGED ASSET MUST BE ATTACHED.

10. SIGNATURE 11. BOND AND CONTRACT TO WHICH THIS AFFIDAVIT RELATES (Where Appropriate)

12. SUBSCRIBED AND SWORN TO BEFORE ME AS FOLLOWS:

a. DATE OATH ADMINISTERED

MONTH DAY YEAR

b. CITY AND STATE (Or other jurisdiction)

Official Sealc. NAME AND TITLE OF OFFICIAL ADMINISTERING OATH

(Type or print)

d. SIGNATURE e. MY COMMISSION

EXPIRES

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

STANDARD FORM 28 (REV. 6/2003)

Prescribed by GSA-FAR (48 CFR) 53.228(e)

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0001.

We estimate that it will take 0.3 hours to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

OMB Control Number: 9000-0001 Expiration Date: 2/28/2021

1. Individual sureties on bonds executed in connection with Government contracts must complete and submit this form with the bond. (See 48 CFR 28.203, 53.228(e).) The surety must have the completed form notarized.

2. No corporation, partnership, or other unincorporated association or firm, as such, is acceptable as an individual surety. Likewise, members of a partnership are not acceptable as sureties on bonds that a partnership or an association, or any co-partner or member thereof, is the principal obligor. However, stockholders of corporate principals are acceptable provided (a) their qualifications are independent of their stockholdings or financial interest therein, and (b) that the fact is expressed in the affidavit of justification. An individual surety will not include any financial interest in assets connected with the principal on the bond that this affidavit supports.

3. United States citizenship is a requirement for individual sureties for contracts and bonds when the contract is awarded in the United States. However, when the Contracting Officer is located in an outlying area or a foreign country, the individual surety is only required to be a permanent resident of the area or country in which the contracting officer is located.

4. All signatures of the affidavit submitted must be originals. Affidavits bearing reproduced signatures are not acceptable. An authorized person must sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of a firm, partnership, or joint venture, or an officer of the corporation involved.

STANDARD FORM 28 (REV. 6/2003) BACK

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden disclosure.)

1. Type of Federal Action:

a.

b.

c.

d.

e.

f.

contract grant cooperative agreement loan loan guarantee loan insurance

2. Status of Federal Action:

a.

b.

c.

bid/offer/application initial award post-award

3. Report Type:

a.

b.

initial filing material change

For Material Change Only:

year quarter date of last report

4. Name and Address of Reporting Entity:

Congressional District, if known:

Prime Subawardee Tier , if known:

5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Congressional District, if known:

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known: 9. Award Amount, if known:

10. a. Name and Address of Lobbying Entity (if individual, last name, first name, MI):

b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI):

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

11. Amount of Payment (check all that apply):

$ actual planned

12. Form of Payment (check all that apply):

a.

b.

cash in-kind; specify: nature value

13. Type of Payment (check all that apply):

a.

b.

c.

d.

e.

f.

retainer one-time fee commission contingent fee deferred other; specify:

14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment indicated in Item 11:

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

15. Continuation Sheet(s) SF-LLL-A attached: Yes No

Information requested through this form is authorized by title 31 U.S.C section 1352. This disclosure of lobbyig activities is a materia representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352 . This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Signature:

Print Name:

Title:

Telephone No.: Date:

Federal Use Only: Authorized for Local Reproduction Standard Form - LLL

Approved by OM 0348-0046

16.

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C.

section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with a covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

Identify the status of the covered Federal action.

Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier.

Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

If the organization filing the report in item 4 checks “Subawardee”, then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known.

Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

Enter the Federal program name or description for the covered Federal action (item 1).