Attachment D Pre-Award Survey 8-13-10.docx

Solicitation W912DR-10-R-0107, Attachment D, Pre-Award Survey

PRE-AWARD SURVEY

PRE-AWARD SURVEY OF PROSPECTIVE PRIME CONTRACTORS

SERVICE CONTRACTS

1. It is the general policy of the Department of Defense that contracts shall be awarded only to contractors determined to be responsible in accordance with Part 9 of the Federal Acquisition Regulation (FAR).

2. No contract shall be awarded to any person or firm unless the Contracting Officer first makes an affirmative determination that the prospective contractor is responsible within the meaning of the FAR, Part 9.

3. Before making a determination of responsibility, the Contracting Officer shall have in his/her possession or obtain information sufficient to satisfy himself/herself that a prospective contractor currently meets the minimum FAR Part 9 standards.

4. In order to make the required determination and also to expedite the contract award, the following information must be submitted by the Contractor:

a. Complete SF 140, Preaward Survey of Prospective Contractor

b. Latest Financial Statements. If the financial statement is more than 60-days old, submit a certificate stating that the firm’s financial condition is substantially the same, or, if not the same, state the changes that have taken place.

c. Provide letters from Banks or other financial institutions with which the contractor conducts business. The letters should contain information about your firm’s accounts, loans, lines of credit, etc., providing information leading to a determination that your firm is “Responsible” as defined in the Federal Acquisition Regulation, Part 9, “has the financial resources to perform the contract or the ability to obtain them." The Government is interested in financial stability, timely payments, the length and nature of the relationship between the firm and the financial institution, etc., which reveals the firm’s financial ability to perform the contract. The letters should also provide the name and telephone number of the bank representative the Government may contact.

5. Be sure to include in your Pre-award Survey, information on any contract you have had with the Baltimore District, Corps of Engineers, within the last 12-months.

THESE DOCUMENTS SHALL BE TREATED BY THE GOVERNMENT AS CONFIDENTIAL.

SERVICE CONTRACTOR DATA - EXISTING COMMITMENTS

Provide a list of the service contracts your firm currently has under way and for which you are presently low bidder but have not yet received an award. For each contract or prospective contract listed, provide the following information:

Contract Number:

Amount:

Description of Work:

For Whom Performed Name Of Organization:

Point of Contact:

Telephone Number for Contact:

SERVICE CONTRACTOR DATA – COMPLETED CONTRACTS

Provide a list of the major contracts your firm has completed within the past three years. For each contract listed, provide the following information:

Contract Number:

Amount:

Description and Location of Work:

Percent Subcontracted:

For Whom Performed Name of Organization:

Point of Contact:

Telephone Number for Contact:

SERVICE CONTRACTOR DATA – FACILITIES AND EQUIPMENT

Provide a list of the equipment and facilities owned for performing the work and its present status as to whether or not it is committed to existing contracts. For each listed item, provide the following information:

Description:

Quantity:

Condition:

Years of Service:

Present Status:

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PREAWARD SURVEY OF PROSPECTIVE CONTRACTOR

(GENERAL)

1. SERIAL NO. (For surveying activity use) OMB NO.: 9000-0011 Expires: 07/31/2010

Public reporting burden for this collection of information is estimated to average 24 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat (VRS), Office of Federal Acquisition and Regulatory Policy, GSA, Washington, DC 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0011), Washington, DC 20503.

SECTION I - REQUEST (For Completion by Contracting Office)

3. SOLICITATION NO. 4. TOTAL OFFERED PRICE

5. TYPE OF CONTRACT

6B. TELEPHONE NO. (Include AUTOVON, WATS, or FTS, if available) 7B. FIRM'S CONTACT 7C. TELEPHONE NO. (with area code)

8. WILL CONTRACTING OFFICE PARTICIPATE IN SURVEY?

YES NO

9. DATE OF REQUEST 10. DATE REPORT REQUIRED

11. PROSPECTIVE CONTRACTOR REPRESENT THAT IT

SMALL BUSINESS CONCERN.

IS, IS NOT A

12. WALSH-

HEALY

CON

ACT

(Check applicable box(es))

A. IS NOT APPLICABLE

B. IS APPLICABLE AND PROSPECTIVE CONTRACTOR

REPRESENTS HIS CLASSIFICATION AS:

MANUFACTURER REGULAR DEALER

OTHER (Specify)

15A. NAME OF REQUESTING ACTIVITY CONTRACTING OFFICER 14B. POINT OF CONTACT 14C. TELEPHONE NO. (with area code)

15B. SIGNATURE

15C. TELEPHONE NO. (Include AUTOVAN, WATS or FTS, if available)

16A. NAME OF CONTACT POINT AT REQUESTING ACTIVITY (If different from Item 15A)

17. RETURN PREAWARD SURVEY TO THIS ADDRESS:

ATTN:

16B. TELEPHONE NO. (Include AUTOVON, WATS, or FTS, if available)

SECTION II - DATA (For Completion by Contracting Office) 18A.

ITEM

NO.

18B. NATIONAL STOCK NUMBER

(NEW) AND NOMENCLATURE

18C. TOTAL

QUANTITY

18D. UNIT

PRICE

18E. DELIVERY SCHEDULE

(a) (b) (c) (d) (e)

SOLICITED

OFFERED

STANDARD FORM 1403 (REV. 9-88)

Prescribed by GSA FAR (48 CFR) 53.209-1(a)

AUTHORIZATION FOR LOCAL REPRODUCTION

Previous edition is usable.

2. NAME AND ADDRESS OF SURVEYING ACTIVITY

6A. NAME AND ADDRESS OF SECONDARY SURVEY ACTIVITY

(For surveying activity use)

7A. NAME AND ADDRESS OF PROSPECTIVE CONTRACTOR

13. NAME AND ADDRESS OF PARENT COMPANY (If applicable)

14A. PLANT AND LOCATION (If different from Item 7, above)

SECTION III - FACTORS TO BE INVESTIGATED

21. IS THIS A SHORT FORM PREAWARD REPORT? (For completion by surveying activity)

YES NO

22. IS A FINANCIAL ASSISTANCE PAYMENT PROVISION IN THE

SOLICITATION? (For completion by contracting activity)

YES

A. COMPLETE AWARD

B. PARTIAL AWARD

C. NO AWARD

(Quantity )

25A. NAME AND TITLE OF SURVEY APPROVING OFFICIAL 25B. TELEPHONE NO.

25C. SIGNATURE 25D. DATE

STANDARD FORM 1403 (REV. 9-88) BACK

23. REMARKS (For Contracting Activity Use)

SECTION IV - SURVEYING ACTIVITY RECOMMENDATIONS

24. RECOMMEND

NO

19. MAJOR FACTORS CHK.

(a)

SAT.

(b)

UN-

(c)

A. TECHNICAL CAPABILITY

B. PRODUCTION CAPABILITY

C. QUALITY ASSURANCE CAPABILITY

D. FINANCIAL CAPABILITY

E. ACCOUNTING SYSTEM

CHK.

(a)

(b)

UN-

(c)

20. OTHER FACTORS

(Provide specific requirements in Remarks)

A. GOVERNMENT PROPERTY CONTROL

B. TRANSPORTATION

C. PACKAGING

D. SECURITY

E. SAFETY

F. ENVIRONMENTAL/ENERGY CONSIDERATION

G. FLIGHT OPERATIONS/FLIGHT SAFETY

H. OTHER

(Specify)

PREAWARD SURVEY OF PROSPECTIVE CONTRACTOR (GENERAL)

1. SERIAL NO. (For surveying activity use)

OMB NO.: 9000-0011 Expires: 07/31/2010

Public reporting burden for this collection of information is estimated to average 24 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat (VRS), Office of Federal Acquisition and Regulatory Policy, GSA, Washington, DC 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0011), Washington, DC 20503.

SECTION I - REQUEST (For Completion by Contracting Office)

3. SOLICITATION NO.

4. TOTAL OFFERED PRICE

5. TYPE OF CONTRACT

6B. TELEPHONE NO. (Include AUTOVON, WATS, or FTS, if available)

7B. FIRM'S CONTACT

7C. TELEPHONE NO. (with area code)

8. WILL CONTRACTING OFFICE PARTICIPATE IN SURVEY?

YES

NO

9. DATE OF REQUEST

10. DATE REPORT REQUIRED

11. PROSPECTIVE CONTRACTOR REPRESENT THAT IT

SMALL BUSINESS CONCERN.

IS,

IS NOT A

12. WALSH- HEALY

CON

ACT

(Check applicable box(es))

A. IS NOT APPLICABLE

B. IS APPLICABLE AND PROSPECTIVE CONTRACTOR REPRESENTS HIS CLASSIFICATION AS:

MANUFACTURER

REGULAR DEALER

OTHER (Specify)

15A. NAME OF REQUESTING ACTIVITY CONTRACTING OFFICER

14B. POINT OF CONTACT

14C. TELEPHONE NO. (with area code)

15B. SIGNATURE

15C. TELEPHONE NO. (Include AUTOVAN, WATS or FTS, if available)

16A. NAME OF CONTACT POINT AT REQUESTING ACTIVITY (If different from Item 15A)

17. RETURN PREAWARD SURVEY TO THIS ADDRESS:

ATTN:

16B. TELEPHONE NO. (Include AUTOVON, WATS, or FTS, if available)

SECTION II - DATA (For Completion by Contracting Office)

18A.

ITEMNO.

18B. NATIONAL STOCK NUMBER

(NEW) AND NOMENCLATURE

18C. TOTAL

QUANTITY

18D. UNIT

PRICE

18E. DELIVERY SCHEDULE

(a)

(b)

(c)

(d)

(e)

SOLICITED

OFFERED

SOLICITED

OFFERED

SOLICITED

OFFERED

SOLICITED

OFFERED

SOLICITED

OFFERED

SOLICITED

OFFERED

SOLICITED

OFFERED

SOLICITED

OFFERED

STANDARD FORM 1403 (REV. 9-88) Prescribed by GSA FAR (48 CFR) 53.209-1(a)

AUTHORIZATION FOR LOCAL REPRODUCTION Previous edition is usable.

2. NAME AND ADDRESS OF SURVEYING ACTIVITY

6A. NAME AND ADDRESS OF SECONDARY SURVEY ACTIVITY (For surveying activity use)

7A. NAME AND ADDRESS OF PROSPECTIVE CONTRACTOR

13. NAME AND ADDRESS OF PARENT COMPANY (If applicable)

14A. PLANT AND LOCATION (If different from Item 7, above)

SECTION III - FACTORS TO BE INVESTIGATED

21. IS THIS A SHORT FORM PREAWARD REPORT? (For completionby surveying activity)

YES

NO

22. IS A FINANCIAL ASSISTANCE PAYMENT PROVISION IN THE SOLICITATION? (For completion by contracting activity)

YES

A. COMPLETE AWARD

B. PARTIAL AWARD

C. NO AWARD

(Quantity

25A. NAME AND TITLE OF SURVEY APPROVING OFFICIAL

25B. TELEPHONE NO.

25C. SIGNATURE

25D. DATE

STANDARD FORM 1403 (REV. 9-88) BACK

23. REMARKS (For Contracting Activity Use)

SECTION IV - SURVEYING ACTIVITY RECOMMENDATIONS

24. RECOMMEND

NO

19. MAJOR FACTORS

CHK. (a)

SAT. (b)

UN- SAT. (c)

A. TECHNICAL CAPABILITY

B. PRODUCTION CAPABILITY

C. QUALITY ASSURANCE CAPABILITY

D. FINANCIAL CAPABILITY

E. ACCOUNTING SYSTEM

CHK. (a)

SAT. (b)

UN- SAT. (c)

20. OTHER FACTORS

(Provide specific requirements in Remarks)

A. GOVERNMENT PROPERTY CONTROL

B. TRANSPORTATION

C. PACKAGING

D. SECURITY

E. SAFETY

F. ENVIRONMENTAL/ENERGY CONSIDERATION

G. FLIGHT OPERATIONS/FLIGHT SAFETY

H. OTHER (Specify)

1. SERIAL NUMBER (For surveying activity use).:

3. SOLICITATION NUMBER.:

7B. FIRM'S CONTACT.:

6B. TELEPHONE NUMBER (Include AUTOVON, WATS, or FTS, if available).:

15A. NAME OF REQUESTING ACTIVITY CONTRACTING OFFICER.:

17. ATTENTION::

18A. ITEM NUMBER. LINE 8 OF 8.:

18B. NATIONAL STOCK NUMBER (NEW) AND NOMENCLATURE.:

18C. TOTAL QUANTITY. OFFERED.:

18C. TOTAL QUANTITY. SOLICITED.:

18E. DELIVERY SCHEDULE. (a).:

18E. DELIVERY SCHEDULE. (b).:

18E. DELIVERY SCHEDULE. (c).:

18E. DELIVERY SCHEDULE. (d).:

18E. DELIVERY SCHEDULE. (e).:

15C. TELEPHONE NUMBER (Include AUTOVAN, WATS or FTS, if available).:

17. RETURN PREAWARD SURVEY TO THIS ADDRESS::

7C. TELEPHONE NUMBER (with area code).:

14B. POINT OF CONTACT.:

14C. TELEPHONE NUMBER (with area code).:

5. TYPE OF CONTRACT.:

2. NAME AND ADDRESS OF SURVEYING ACTIVITY.:

7A. NAME AND ADDRESS OF PROSPECTIVE CONTRACTOR.:

13. NAME AND ADDRESS OF PARENT COMPANY (If applicable).:

14A. PLANT AND LOCATION (If different from Item 7, above).:

16A. NAME OF CONTACT POINT AT REQUESTING ACTIVITY (If different from Item 15A).:

16B. TELEPHONE NUMBER (Include AUTOVON, WATS, or FTS, if available).:

6A. NAME AND ADDRESS OF SECONDARY SURVEY ACTIVITY (For surveying activity use).:

4. TOTAL OFFERED PRICE.:

18D. UNIT PRICE.:

21. IS THIS A SHORT FORM PREAWARD REPORT? (For completion by surveying activity). YES.: 0

21. IS THIS A SHORT FORM PREAWARD REPORT? (For completion by surveying activity). YES.: 0

21. IS THIS A SHORT FORM PREAWARD REPORT? (For completion by surveying activity). NO.: 0

21. IS THIS A SHORT FORM PREAWARD REPORT? (For completion by surveying activity). NO.: 0

11. PROSPECTIVE CONTRACTOR REPRESENT THAT IT IS A SMALL BUSINESS CONCERN.: 0

12. WALSH- HEALY CON ACT (Check applicable box(es)). A. IS NOT APPLICABLE.: 0

12. WALSH- HEALY CON ACT (Check applicable box(es)). B. IS APPLICABLE AND PROSPECTIVE CONTRACTOR REPRESENTS HIS CLASSIFICATION AS:: 0

12. WALSH- HEALY CON ACT (Check applicable box(es)). B. IS APPLICABLE AND PROSPECTIVE CONTRACTOR REPRESENTS HIS CLASSIFICATION AS: MANUFACTURER.: 0

12. WALSH- HEALY CON ACT (Check applicable box(es)). B. IS APPLICABLE AND PROSPECTIVE CONTRACTOR REPRESENTS HIS CLASSIFICATION AS: REGULAR DEALER.: 0

12. WALSH- HEALY CON ACT (Check applicable box(es)). B. IS APPLICABLE AND PROSPECTIVE CONTRACTOR REPRESENTS HIS CLASSIFICATION AS: OTHER (Specify).: 0

OTHER (Specify).:

11. PROSPECTIVE CONTRACTOR REPRESENT THAT IT IS NOT A SMALL BUSINESS CONCERN.: 0

9. DATE OF REQUEST. Enter 2 digit month, 2 digit day and 4 digit year.:

10. DATE REPORT REQUIRED. Enter 2 digit month, 2 digit day and 4 digit year.:

25C. SIGNATURE. Digital Signature.:

25C. SIGNATURE. This is a protected field.:

19. MAJOR CAPABILITY. A. TECHNICAL CAPABILITY. CHECK (a).: 0

19. MAJOR CAPABILITY. A. TECHNICAL CAPABILITY. SATISFACTORY (b).: 0

19. MAJOR CAPABILITY. A. TECHNICAL CAPABILITY. UNSATISFACTORY (c).: 0

19. MAJOR CAPABILITY. B. PRODUCTION CAPABILITY. CHECK (a).: 0

19. MAJOR CAPABILITY. B. PRODUCTION CAPABILITY. SATISFACTORY (b).: 0

19. MAJOR CAPABILITY. B. PRODUCTION CAPABILITY. UNSATISFACTORY (c).: 0

19. MAJOR CAPABILITY. C. QUALITY ASSURANCE CAPABILITY. CHECK (a).: 0

19. MAJOR CAPABILITY. C. QUALITY ASSURANCE CAPABILITY. SATISFACTORY (b).: 0

19. MAJOR CAPABILITY. C. QUALITY ASSURANCE CAPABILITY. UNSATISFACTORY (c).: 0

19. MAJOR CAPABILITY. D. FINANCIAL CAPABILITY. CHECK (a).: 0

19. MAJOR CAPABILITY. D. FINANCIAL CAPABILITY. SATISFACTORY (b).: 0

19. MAJOR CAPABILITY. D. FINANCIAL CAPABILITY. UNSATISFACTORY (c).: 0

19. MAJOR CAPABILITY. E. ACCOUNTING SYSTEM. CHECK (a).: 0

22. IS A FINANCIAL ASSISTANCE PAYMENT PROVISION IN THE SOLICITATION? (For completion by contracting activity). YES.: 0

22. IS A FINANCIAL ASSISTANCE PAYMENT PROVISION IN THE SOLICITATION? (For completion by contracting activity). NO.: 0

19. MAJOR CAPABILITY. E. ACCOUNTING SYSTEM. SATISFACTORY (b).: 0

19. MAJOR CAPABILITY. E. ACCOUNTING SYSTEM. UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). A. GOVERNMENT PROPERTY CONTROL. CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). A. GOVERNMENT PROPERTY CONTROL. SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). A. GOVERNMENT PROPERTY CONTROL. UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). B. TRANSPORTATION. CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). B. TRANSPORTATION. SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). B. TRANSPORTATION. UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). C. PACKAGING. CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). C. PACKAGING. SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). C. PACKAGING. UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). D. SECURITY. CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). D. SECURITY. SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). D. SECURITY. UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). E. SAFETY. CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). E. SAFETY. SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). E. SAFETY. UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). F. ENVIRONMENTAL/ENERGY CONSIDERATION. CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). F. ENVIRONMENTAL/ENERGY CONSIDERATION. SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). F. ENVIRONMENTAL/ENERGY CONSIDERATION. UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). G. FLIGHT OPERATIONS/FLIGHT SAFETY. CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). G. FLIGHT OPERATIONS/FLIGHT SAFETY. SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). G. FLIGHT OPERATIONS/FLIGHT SAFETY. UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). UNSATISFACTORY (c).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). CHECK (a).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). SATISFACTORY (b).: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). UNSATISFACTORY (c).: 0

24. RECOMMEND. A. COMPLETE AWARD.: 0

24. RECOMMEND. B. PARTIAL AWARD.: 0

24. RECOMMEND. C. NO AWARD.: 0

20. OTHER FACTORS (Provide specific requirements in Remarks). H. OTHER (Specify). Line 6 of 6.:

25A. NAME AND TITLE OF SURVEY APPROVING OFFICIAL.:

24. RECOMMEND. B. PARTIAL AWARD. QUANTITY.:

25B. TELEPHONE NUMBER.:

23. REMARKS (For Contracting Activity Use).:

25D. DATE OF SIGNATURE. Enter 2 digit month, 2 digit day and 4 digit year.: