Solicitation_W912WJ-17-Q-0015.pdf

SEE ADDENDUM

(No Collect Calls)

W912WJ-17-Q-0015 20-Dec-2016

b. TELEPHONE NUMBER

978-318-8324

8. OFFER DUE DATE/LOCAL TIME

02:00 PM 28 Dec 2016

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

W912WJ9. ISSUED BY

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

JENNIFER M SAMELA

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

0 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SEE SCHEDULE

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED OR X

SMALL BUSINESSX

WOMEN-OWNED SMALL

BUSINESS (WOSB)

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

U S ARMY ENGR DISTRICT, NEW ENGLAND

696 VIRGINIA RD

CONCORD MA 01742-2751

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE 16. ADMINISTERED BY

SEE SCHEDULE

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

978-318-8207FAX:

TEL: SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL BUSINESS

(EDWOSB)

SIZE STANDARD:

$18M

NAICS:

561720

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF64

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

W912WJ-17-Q-0015

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Job NHL Janitorial Services

FFP

Contractor shall supply all labor, equipment, and materials to perform janitorial services at locations throughout North Hartland Lake in accordance with the attached Performance Work Statement.

Period of Performance: 1 January 2017 through 31 December 2017 FOB: Destination

PURCHASE REQUEST NUMBER: W13G86631908480001

NET AMT

0002 1 Job UVD Janitorial Services

FFP

Contractor shall supply all labor, equipment, and materials to perform janitorial services at locations throughout Union Village Dam in accordance with the attached Performance Work Statement.

Period of Performance: 1 January 2017 through 31 December 2017

PURCHASE REQUEST NUMBER: W13G86631908480002

0003 1 Job OPTION NHL Janitorial Services

FFP

Contractor shall supply all labor, equipment, and materials to perform janitorial services at locations throughout North Hartland Lake in accordance with the attached Performance Work Statement.

Period of Performance: 1 January 2018 through 31 December 2018

0004 1 Job OPTION UVD Janitorial Services

FFP

Contractor shall supply all labor, equipment, and materials to perform janitorial services at locations throughout Union Village Dam in accordance with the attached Performance Work Statement.

Period of Performance: 1 January 2018 through 31 December 2018

0005 1 Job OPTION NHL Janitorial Services

FFP

Contractor shall supply all labor, equipment, and materials to perform janitorial services at locations throughout North Hartland Lake in accordance with the attached Performance Work Statement.

Period of Performance: 1 January 2019 through 31 December 2019

0006 1 Job OPTION UVD Janitorial Services

FFP

Contractor shall supply all labor, equipment, and materials to perform janitorial services at locations throughout Union Village Dam in accordance with the attached Performance Work Statement.

Period of Performance: 1 January 2019 through 31 December 2019

BID SCHEDULE

Office Cleaning US Army Corps of Engineers

North Hartland Lake, North Hartland, VT Union Village Dam, East Thetford, VT

Performance Work Statement

Base Year

ITEM UNIT QTY

UNIT

PRICE

TOTAL

1. North Hartland Lake

EA

2. North Hartland Lake Carpet Cleaning

3. North Hartland Lake Clean walls, windows & doors

4. Union Village Dam

5. Union Village Dam

6. Union Village Dam

North Hartland Lake, North Hartland, VT

Option Year 1

PRICE

TOTAL

North Hartland Lake, North Hartland, VT

Option Year 2

PRICE

TOTAL

ADDITIONAL INFORMATION

PLEASE DIRECT QUESTIONS TO JENNIFER M. SAMELA AT (978) 318‐8324 OR

jennifer.m.samela@usace.army.mil. THE SOLICITATION AND RESULTING CONTRACT SHALL BE THE

GOVERNING DOCUMENT IN ALL CASES.

QUOTES CAN BE FAXED OR E‐MAILED TO JENNIFER M. SAMELA AT (603) 746‐2593 or jennifer.m.samela@usace.army.mil. E‐MAIL IS THE PREFERRED METHOD OF SUBMISSION.

THE BID SCHEDULE FOR THE BASE AND ONE OPTION YEAR MUST BE COMPLETED AND SUBMITTED FOR

A QUOTE TO BE CONSIDERED COMPLETE.

Contractors must be registered in the System for Awards Management at www.SAM.gov (formerly the Central Contractor Registration (CCR) database and the On‐Line Representations and Certifications (ORCA) (see DFARS clause 252.204‐7004 Alt A). Please note that Google and Google Chrome are not supported browsers for SAM registration. Mozilla FireFox, Safari, and Internet Explorer are supported browsers.

Provide DUNS number: ___________________________ (telephone 866‐705‐5711 for DUNS) Provide CAGE code: ____________________________ Provide TAX ID: __________________________ Per FAR Clause 52.212‐3 Alt I, the Contractor is required to complete the On‐line Representations and Certifications Application (www.SAM.gov) and paragraph (b) if applicable, OR to complete paragraphs (c) thru (m) of this clause and return with quote.

POTENTIAL QUOTERS ARE NOTIFIED THAT THE BASIS ON WHICH AWARD WILL BE MADE IS

PRICE ALONE.

ALL RESPONSIBLE SOURCES MAY SUBMIT A RESPONSE WHICH, IF TIMELY RECEIVED, MUST

BE CONSIDERED BY THE AGENCY.

INVOICES SHALL BE SENT TO TECHNICAL POINT OF CONTACT.

SECURITY REQUIREMENTS

The contractor and all associated sub-contractors shall receive a brief/training (provided by the RA) on the local suspicious activity reporting program. This locally developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the project manager, security representative or law enforcement entity. This training shall be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance with the results reported to the Technical Point of Contact NLT 5 calendar days after the completion of the training.

The Contractor must pre-screen Candidates using the E-verify Program

(http://www.uscis.gov/e-verify) website to meet the established employment eligibility requirements. The Vendor must ensure that the Candidate has two valid forms of Government issued identification prior to enrollment to ensure the correct information is entered into the E-verify system. An initial list of verified/eligible Candidates must be provided to the Technical Point of Contact no later than 3 business days after the initial contract award.

PERFORMANCE WORK STATEMENT

US Army Corps of Engineers

North Hartland Lake, North Hartland, VT

I. General

1. Scope:

Furnish all labor, materials, and equipment necessary to clean the offices at North Hartland Lake and Union Village Dam. Services are to be provided in accordance with the following specifications and schedule. Moving and replacing of office furniture, equipment, and miscellaneous materials to accomplish the described work shall be the responsibility of the contractor. All work will be completed to the satisfaction of the Technical Point of Contact.

2. Location North Hartland Lake Office is located at 112 Clay Hill Road in North Hartland, Vermont.

Union Village Dam Office is located at 2 Main Street in East Thetford, Vermont.

3. Site Visit:

To arrange a site visit contact the Technical Point of Contact, Park Ranger, Andrew White at:

802-295-2855 or andrew.d.white@usace.army.mil.

4. Schedule:

The period of performance will be from 1 January 2017 through 31 December 2017.

All work is to be completed on the weekends. In addition, the Government may exercise two (2) optional years with the same scope of services. The Optional years would include a period of performance from 1 January 2018 thru 31 December 2018, and 1 January 2019 thru 31 December 2019.

5. Safety All work shall be conducted in accordance with the U.S. Army Corps of Engineers Safety and Health requirements Manual (EM 385-1-1, most recent edition), and all applicable federal, state, and local safety and health requirements. A copy of EM 385-1-1 can be accessed electronically at Headquarters USACE website under publications using the following link:

http://www.publications.usace.army.mil/Portals/76/Publications/EngineerManuals/EM_3 85-1-1.pdf

5.1 Modified Activity Hazard Analysis:

A Modified AHA shall be submitted and must cover all the major phases of work. A major phase of work is defined as an operation involving a type of work presenting hazards not experienced in previous operations or where a new subcontractor or work crew is to perform the work. The analysis shall define all activities to be performed, identify the sequence of work, the specific hazards anticipated, and the control measures to be implemented to eliminate or reduce each hazard to an acceptable level. Work shall not proceed on a phase of work until the AHAs have been accepted by the GDA. A preparatory meeting shall be conducted by the prime contractor to discuss the Modified AHA’s contents with all effected onsite employees. The Modified AHA shall be continuously reviewed and revised to address changing site conditions as appropriate.

The AHA’s shall interface with the Contractor's overall safety and health program.

Emergency Reponses Procedures shall be documented in the Modified AHA and will include a map with directions to the nearest hospital, emergency contact numbers, and onsite First Aid/CPR responders.

5.2 Required Personnel:

The Contractor shall designate one employee as the site’s Competent Person (CP) who is responsible for ensuring a safe environment for all employees. The CP shall be present at the project site and report to the contractor’s upper management. The CP is required to have related construction and/or service experience.

In addition, when emergency medical services are not accessible within 5 minutes of the work location and there are 2 or more workers onsite, at least 2 employees shall be trained in First Aid and CPR. Minimum qualifications are listed in EM 385-1-1, Section 03.A.02.c.

5.3 Accident Reporting:

All accidents and near misses shall be investigated by the Contractor. All work-related recordable injuries, illnesses and property damage accidents (excluding on-the-road vehicle accidents), in which the property damage exceeds $5,000.00, shall be verbally reported to the GDA within 4 hours of the incident. Serious accidents as described in EM 385-1-1 Section 01.D shall be immediately reported to the GDA. ENG Form 3394 shall be completed and submitted to the GDA within five working days of the incident.

The Contractor shall complete the attached “USACE Contractor Monthly Summary Record of Injuries/Illness and Work Hour Exposure” (for prime and its subcontractors) and forward the completed form to the GDA no later than close of business on the 5th calendar day of the following month. The method of transmission by the prime contractor to the GDA shall be electronically.

7. Contractor Conduct Alcohol and firearms are prohibited on project grounds. Contractor and employees must comply with CFR 36 Rules and Regulations.

8. Payment The contractor shall furnish the Technical Point of Contact with one invoice per month, identifying the contract number, stating the amount of services completed during the month, identified by Item Number and quantity. Payment shall be made monthly for the actual services performed at the applicable contract unit price.

II. Technical Requirements

General Provide all equipment, materials, labor, and transportation necessary to clean one (1) office building at North Hartland Lake and one (1) office building at Union Village Dam. Contractor’s work and responsibility shall include, but not be limited to, all job planning, programming, scheduling, administration, inspection, personnel, equipment, vehicles, fuel, materials, supplies, supervision, and quality control necessary to perform the various services required herein.

Materials & Supplies

Provided by Government:

o Toilet tissue o Liquid soap o Trash bags o Paper towels o Potable Water Source

Provided by Contractor:

o Cleaning materials o Disinfectants o Detergents o Vacuum, steam cleaner, ladders, etc.

Environmentally Preferred Products Federal contracts for janitorial services require contractors to use or supply products covered by the following environmental programs:

1. Safer Choice (formerly DfE) - Includes all-purpose and specialty cleaners, hand soaps, odor removers, and more (https://www.epa.gov/saferchoice/products).

2. BioPreferred - Includes air fresheners, cleaners, floor protectors, and more (https://www.biopreferred.gov/BioPreferred/faces/pages/ProductCategories.xhtml).

3. CPG - Includes toilet paper, plastic trash bags, recycling containers, and more (https://www3.epa.gov/epawaste/conserve/tools/cpg/products/index.htm).

Products that are identified as “environmentally preferable”, products that have a lesser or reduced effect on human health and the environment when compared with competing products that serve the same purpose, and bio-based will be selected over those which do not carry such designations. This comparison may consider raw materials acquisition, production, manufacturing, products and chemicals, packaging, distribution, reuse, operation, maintenance, or disposal of the product. The following factors to consider when selecting products include: environmental performance, cost performance, bio-based, recycled content, biodegradability, technical performance, and availability.

Note: The Contractor shall submit one copy of the manufacturer’s Safety Data Sheet for each chemical proposed for use.

Service Description

Office Cleaning: The following services shall be performed as part of the scheduled Office Cleaning:

A. Vacuum all floors, runners, and upholstered chairs.

B. Dust the surfaces of all desks, counters, file cabinets, bookcases, display cabinets, light shades, and other furniture and office machine surfaces.

C. Wash all counters and table tops D. Clean restrooms, scrub and disinfect toilets, urinals, showers, and sinks, wash mirrors, mop floors, and restock paper tissue, soap, and paper towels. Sweep/vacuum and mop all vinyl and tile floors.

E. Mop any vinyl/ tile floors with an approved floor cleaner and water solution.

F. Scrub and disinfect sinks, water fountain, wash mirror and restock towels & soap.

G. Empty all wastebaskets into larger trash bag(s) and put in onsite dumpster.

H. Replace wastebasket liners I. Remove cobwebs from ceilings, corners, etc.

J. All dirtied mop water will be placed in a location identified by the Technical Point of

Contact.

Carpet Cleaning: The following services shall be performed as part of the scheduled Carpet

Cleaning:

A. Carpets shall be freshly vacuumed and free of dust, dirt, and debris prior to steam cleaning.

B. Carpets shall be steam cleaned underneath all items.

C. This may require minimal furniture to be removed from the room.

D. Water or cleaning solution splashed onto doors, walls, baseboards, furniture, or other items within the work area shall be cleaned up.

E. Carpets will be steam cleaned once in the spring, once in the fall, and once during the winter as directed by the technical point of contact.

F. Contractor is to provide the necessary steam cleaning machine.

Washing of Walls, Windows, and Doors : The following services shall be performed as part of the scheduled Washing of Walls, Windows, and Doors:

A. All walls, ceilings, and doors within the office area and overhead garage doors shall be thoroughly cleaned with an approved cleaner twice annually.

B. Washing of the walls, windows, and doors will be completed once in the spring, and once in the fall as directed by the technical point of contact.

C. All windows (interior and exterior), window screens if any, screen doors, and exterior window sills shall be cleaned.

D. The contractor will be responsible for removing, cleaning and reinstalling window screens as needed to perform the required cleaning.

E. The contractor will also be responsible for providing appropriate window cleaning solutions, brushes, squeegees, cloths, ladders and any other such related tools or equipment to properly clean windows at the locations listed in the scope.

Service Location

ITEM NO. 1 – North Hartland Lake Project Office –Office Cleaning (Weekly)

The North Hartland Lake Project Office building is located at 112 Clay Hill Rd. North Hartland, VT and includes the following details:

Single story building Total Floor Space is approximately 2,594 square feet The space includes:

A. Three (3) Offices (carpeted) B. One (1) Entry Room w/ water fountain (carpeted) C. One (1) Common Area/File storage (carpeted) D. One (1) Boiler Room (sheet vinyl flooring) E. One (1) Restroom w/shower (sheet vinyl flooring) F. One (1) Warm Bay Garage w/sink (painted concrete) G. Two (2) Cold Bay Garages (painted concrete) H. Fifteen (15) single & multi pane windows I. Approximately eight (8) trash cans

Cleaning schedule:

A. Weekly for the duration of the contract B. Office is to be cleaned on weekends.

ITEM NO. 2 – North Hartland Lake Project Office – Carpet Cleaning (3 Times Annually)

The contractor shall steam clean the carpeted areas at North Hartland Lake once in the spring, once in the fall, and once during the winter. The date of the cleaning shall be coordinated with the technical point of contact beforehand.

Total Carpeted Floor Space is approximately 900 square feet

ITEM NO. 3 - North Hartland Lake Project Office –Washing Walls, Doors, and Windows (2 Times Annually)

The contractor shall perform the cleaning of the Walls, Doors, and Windows at the North Hartland Lake Project Office once in the spring, and once in the fall. The date of the cleaning shall be coordinated with the technical point of contact beforehand.

Total Office Area is approximately 1,000 Square feet The three (3) Overhead doors are 10’ x 10’ Fifteen (15) single & multi pane windows (some with screens)

Service Location

ITEM NO. 4 – Union Village Dam Project Office – Office Cleaning (Weekly)

The Union Village Dam Project Office building is located at 2 Main St. East Thetford, VT and includes the following details:

Single story building Total Floor Space is approximately 2,345 square feet The space includes:

A. Two (2) Offices (carpeted) B. One (1) Hallway w/water fountain (carpeted) C. One (1) Common Area/File storage (carpeted) D. One (1) Boiler Room w/shower (sheet vinyl) E. One (1) Restroom w/urinal (sheet vinyl) F. One (1) Warm Bay Garage w/sink (concrete) G. Two (2) Cold Bay Garages (concrete) H. Fourteen (14) single & multi pane windows I. Approximately five (5) trash cans

Cleaning schedule:

A. Weekly for the duration of the contract B. Office is to be cleaned on weekends.

ITEM NO. 5 – Union Village Dam Project Office – Carpet Cleaning (3 Times Annually)

The contractor shall steam clean the carpeted areas at Union Village Dam once in the spring, once in the fall, and once during the winter. The date of the cleaning shall be coordinated with the technical point of contact beforehand.

Total Carpeted Floor Space is approximately 400 square feet

ITEM NO. 6 – Union Village Dam Project Office –Washing Walls, Doors, and Windows (2 Times Annually)

The contractor shall perform the cleaning of the Walls, Windows, and Doors at Union Village Dam Project Office once in the spring, and once in the fall. The date of the cleaning shall be coordinated with the technical point of contact beforehand.

Total Office Area is approximately 650 Square feet The three (3) Overhead doors are 10’ x 10’ Fourteen (14) single & multi pane windows (some with screens)

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS UIC

0001 POP 01-JAN-2017 TO

31-DEC-2017

N/A NORTH HARTLAND LAKE PROJ

ANDREW WHITE

PO BOX 55, #112 CLAY HILL ROAD

N. HARTLAND VT 05052-0055

(802) 295-2855

961602

0002 POP 01-JAN-2017 TO

31-DEC-2017

N/A UNION VILLAGE

HEATHER MORSE

2 MAIN STREET

EAST THETFORD VT 05043-9667

978-318-8469

961605

0003 POP 01-JAN-2018 TO

31-DEC-2018

N/A NORTH HARTLAND LAKE PROJ

ANDREW WHITE

PO BOX 55, #112 CLAY HILL ROAD

N. HARTLAND VT 05052-0055

(802) 295-2855

Modified AHA for Service Contracts

Competent Person (Name, Title, Phone Number, & Signature):

Project Name

Contractor Name

Contract Number

Date

EMERGENCY PHONE NUMBERS AND MEDICAL FACILITY MAP

1. Map with Highlighted Route, Address, and Directions:

2. Emergency Phone Numbers:

Contact Phone Number

SIGNATURE SHEET

Name Signature Date Company

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

3. First Aid/CPR certificates, meeting the requirments of EM 385-1-1 Section 03.A.02, have been submitted for two onsite employees:

a. b.

4. Deficiency Log/Corrective Actions: Date Found Date Corrected

Mishap Reporting and Investigation:

a. is responsible for reporting the exposure data (man-hours worked) to the GDA no later than close of business on the 5th calendar day of the following month.

b. All accidents and near misses will be investigated by the Contractor.

All work-related recordable injuries, illnesses and property damage accidents (excluding on-the-road vehicle accidents), in which the property damage exceeds $5,000.00, will be verbally reported to the GDA within 4 hours of the incident. Serious accidents as described in EM 385-1-1 Section 01.D shall be immediately reported to the GDA.

ENG Form 3394 shall be completed and submitted to the GDA within five working days of the incident.

c. is responsible for completing the accident notifications, investigations, and reports.

Month Year

City State

USACE Office Overseeing Work:

Describe The Case

(B1) (B2) (B3) (C) (D) (F)

Project Title

Using these categories, check ONLY the most serious result for each case:

Monthly Record of Work-Related Injuries/Illnesses & Exposure

In accordance with the provisions of EM 385-1-1, Section 01 Program Management, Paragraph 01.D Accident Reporting and Recording, sub-paragraphs 01.D.05, you (the Prime Contractor) shall provide a monthly record of all exposure and accident experience incidental to the work (this includes exposure and accident experience of the Prime Contractor and its sub-contractor(s). As a minimum , these records shall include exposure work hours and a record of occupational injuries and illnesses that include the data elements listed below. Definitional criteria for each data element is found in 29 CFR Part

1904. If the maintenance of OSHA 300 Logs are required by OSHA, most of this information can be obtained from those logs. If data on log provided below is revised after it is submitted to USACE, Contractor shall provide a revised report to the GDA. You must complete the USACE ENG Form 3394, Report of Accident Investigation Report for all recordable accidents. If you're not sure whether a case is recordable, call your local Safety and Occupational Health Office for help.

Contractor Name

USACE PRIME CONTRACTOR

USACE Command

US Army Corps of Engineers

(A) (E)

Contract Number

Classify the case

Check the "injury" column or choose one type of illness:

Identify the person

Enter the number of days the injured or ill worker was:

(G) (H) (I) (J) (K) (L) (1) (2) (3) (4) (5) (6)

0 0 0 0 0 0 0 0 0 0 0 0

Type of Contract (Choose One):

Construction

Opn & Main. Civil Works

Eng. Services Military Programs

Dredging Other

Rsch. & Dev.

Emerg. Opns.

Other

Away from work (days)

In ju ry

Death

Job transfer or restriction

Using these categories, check ONLY the most serious result for each case:

S ki n D is o rd e r

R e sp ir a to ry

C o n d iti on

P ri m e o r

S u b

P o r S

Company Name

A ll o th e r

Ill n e ss e s

On job transfer or restriction (days)

A g e

G e n d e r

Other record-able cases

Remained at work

Date of injury or onset of illness

Check the "injury" column or choose one type of illness:

P o is o n in g

Days away from work

Signature

Certification of Record Name of Person Submit. Record

Job Title (e.g., Welder)

(mo./day)

H e a ri ng L o ss

(M)

Enter the number of days the injured or ill worker was:

FUSRAP

IRP

Year to Date

Ordinance/Expl. Cleanup

Superfund

TYPE OF WORK ACTIVITY (Choose One):

For Government Use Only

Where the event occurred (e.g. Loading dock north end)Date Employee

Began Work on

Job Covered by Contract

Date

Exposure Hours Month

Describe injury or illness, parts of body affected, and object/substance that directly injured or made person ill (e.g. Second degree burns on right forearm from acetylene torch)

Environmental Remed.

___ of ___PageEnvironmental Other

FUDS

0004 POP 01-JAN-2018 TO

31-DEC-2018

N/A UNION VILLAGE

HEATHER MORSE

2 MAIN STREET

EAST THETFORD VT 05043-9667

978-318-8469

0005 POP 01-JAN-2019 TO

31-DEC-2019

N/A NORTH HARTLAND LAKE PROJ

ANDREW WHITE

PO BOX 55, #112 CLAY HILL ROAD

N. HARTLAND VT 05052-0055

(802) 295-2855

0006 POP 01-JAN-2019 TO

31-DEC-2019

N/A UNION VILLAGE

HEATHER MORSE

2 MAIN STREET

EAST THETFORD VT 05043-9667

978-318-8469

CLAUSES INCORPORATED BY REFERENCE

52.204-16 Commercial and Government Entity Code Reporting JUL 2016 52.208-9 Contractor Use of Mandatory Sources of Supply or Services MAY 2014 52.212-4 Contract Terms and Conditions--Commercial Items MAY 2015 52.223-2 Affirmative Procurement of Biobased Products Under Service and Construction Contracts

SEP 2013

52.223-5 Pollution Prevention and Right-to-Know Information MAY 2011 52.225-25 Prohibition on Contracting with Entities Engaging in Certain

Activities or Transactions Relating to Iran-- Representation and Certifications.

OCT 2015

52.232-39 Unenforceability of Unauthorized Obligations JUN 2013 52.232-40 Providing Accelerated Payments to Small Business

Subcontractors

DEC 2013

52.242-15 Stop-Work Order AUG 1989 52.247-34 F.O.B. Destination NOV 1991 252.203-7000 Requirements Relating to Compensation of Former DoD

Officials

SEP 2011

252.203-7002 Requirement to Inform Employees of Whistleblower Rights SEP 2013 252.203-7005 Representation Relating to Compensation of Former DoD

Officials

NOV 2011

252.204-7003 Control Of Government Personnel Work Product APR 1992 252.204-7004 Alt A System for Award Management Alternate A FEB 2014 252.204-7012 Safeguarding Covered Defense Information and Cyber

Incident Reporting

OCT 2016

252.204-7015 Notice of Authorized Disclosure of Information for Litigation Support

MAY 2016

252.223-7006 Prohibition On Storage, Treatment, and Disposal of Toxic or Hazardous Materials

SEP 2014

252.225-7001 Buy American And Balance Of Payments Program-- Basic (Aug 2016)

AUG 2016

252.225-7048 Export-Controlled Items JUN 2013 252.232-7010 Levies on Contract Payments DEC 2006 252.243-7001 Pricing Of Contract Modifications DEC 1991 252.244-7000 Subcontracts for Commercial Items JUN 2013

CLAUSES INCORPORATED BY FULL TEXT

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (OCT 2016)

ALTERNATE I (OCT 2014)

The offeror shall complete only paragraphs (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) Web site located at https://www.sam.gov/portal . If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (s) of this provision.

(a) Definitions. As used in this provision--

Per Court Injunction dated 24 Oct 2016 and OMB memo dated 25 Oct 2016 do not implement the following until further direction.

“Administrative merits determination” means certain notices or findings of labor law violations issued by an enforcement agency following an investigation. An administrative merits determination may be final or be subject to appeal or further review. To determine whether a particular notice or finding is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance.

“Arbitral award or decision” means an arbitrator or arbitral panel determination that a labor law violation occurred, or that enjoined or restrained a violation of labor law. It includes an award or decision that is not final or is subject to being confirmed, modified, or vacated by a court, and includes an award or decision resulting from private or confidential proceedings. To determine whether a particular award or decision is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance.

“Civil judgment” means--

(1) In paragraph (h) of this provision: A judgment or finding of a civil offense by any court of competent jurisdiction.

Per Court Injunction dated 24 Oct 2016 and OMB memo dated 25 Oct 2016 do not implement the following until further direction.

(2) In paragraph (s) of this provision: Any judgment or order entered by any Federal or State court in which the court determined that a labor law violation occurred, or enjoined or restrained a violation of labor law. It includes a judgment or order that is not final or is subject to appeal. To determine whether a particular judgment or order is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance.

Per Court Injunction dated 24 Oct 2016 and OMB memo dated 25 Oct 2016 do not implement the following until further direction.

“DOL Guidance” means the Department of Labor (DOL) Guidance entitled: ``Guidance for Executive Order 13673, `Fair Pay and Safe Workplaces' ''. The DOL Guidance, dated August 25, 2016, can be obtained from www.dol.gov/fairpayandsafeworkplaces.

“Economically disadvantaged women-owned small business (EDWOSB) concern” means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

Per Court Injunction dated 24 Oct 2016 and OMB memo dated 25 Oct 2016 do not implement the following until further direction.

“Enforcement agency” means any agency granted authority to enforce the Federal labor laws. It includes the enforcement components of DOL (Wage and Hour Division, Office of Federal Contract Compliance Programs, and Occupational Safety and Health Administration), the Equal Employment Opportunity Commission, the occupational Safety and Health Review Commission, and the National Labor Relations Board. It also means a State agency designated to administer an OSHA-approved State Plan, but only to the extent that the State agency is acting in its capacity as administrator of such plan. It does not include other Federal agencies which, in their capacity as contracting agencies, conduct investigations of potential labor law violations. The enforcement agencies associated with each labor law under E.O. 13673 are--

(1) Department of Labor Wage and Hour Division (WHD) for--

(i) The Fair Labor Standards Act;

(ii) The Migrant and Seasonal Agricultural Worker Protection Act;

(iii) 40 U.S.C. chapter 31, subchapter IV, formerly known as the Davis-Bacon Act;

(iv) 41 U.S.C. chapter 67, formerly known as the Service Contract Act;

(v) The Family and Medical Leave Act; and

(vi) E.O. 13658 of February 12, 2014 (Establishing a Minimum Wage for Contractors);

(2) Department of Labor Occupational Safety and Health Administration (OSHA) for--

(i) The Occupational Safety and Health Act of 1970; and

(ii) OSHA-approved State Plans;

(3) Department of Labor Office of Federal Contract Compliance Programs (OFCCP) for--

(i) Section 503 of the Rehabilitation Act of 1973;

(ii) The Vietnam Era Veterans' Readjustment Assistance Act of 1972 and the Vietnam Era Veterans' Readjustment Assistance Act of 1974; and

(iii) E.O. 11246 of September 24, 1965 (Equal Employment Opportunity);

(4) National Labor Relations Board (NLRB) for the National Labor Relations Act; and

(5) Equal Employment Opportunity Commission (EEOC) for--

(i) Title VII of the Civil Rights Act of 1964;

(ii) The Americans with Disabilities Act of 1990;

(iii) The Age Discrimination in Employment Act of 1967; and

(iv) Section 6(d) of the Fair Labor Standards Act (Equal Pay Act).

“Forced or indentured child labor” means all work or service—

(1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

“Highest-level owner” means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

“Immediate owner” means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: Ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

“Inverted domestic corporation,” means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C.

395(c).

Per Court Injunction dated 24 Oct 2016 and OMB memo dated 25 Oct 2016 do not implement the following until further direction.

“Labor compliance agreement” means an agreement entered into between a contractor or subcontractor and an enforcement agency to address appropriate remedial measures, compliance assistance, steps to resolve issues to increase compliance with the labor laws, or other related matters.

Per Court Injunction dated 24 Oct 2016 and OMB memo dated 25 Oct 2016 do not implement the following until further direction.

“Labor laws” means the following labor laws and E.O.s:

(1) The Fair Labor Standards Act.

(2) The Occupational Safety and Health Act (OSHA) of 1970.

(3) The Migrant and Seasonal Agricultural Worker Protection Act.

(4) The National Labor Relations Act.

(5) 40 U.S.C. chapter 31, subchapter IV, formerly known as the Davis-Bacon Act.

(6) 41 U.S.C. chapter 67, formerly known as the Service Contract Act.

(7) E.O. 11246 of September 24, 1965 (Equal Employment Opportunity).

(8) Section 503 of the Rehabilitation Act of 1973.

(9) The Vietnam Era Veterans' Readjustment Assistance Act of 1972 and the Vietnam Era Veterans' Readjustment Assistance Act of 1974.

(10) The Family and Medical Leave Act.

(11) Title VII of the Civil Rights Act of 1964.

(12) The Americans with Disabilities Act of 1990.

(13) The Age Discrimination in Employment Act of 1967.

(14) E.O. 13658 of February 12, 2014 (Establishing a Minimum Wage for Contractors).

(15) Equivalent State laws as defined in the DOL Guidance. (The only equivalent State laws implemented in the FAR are OSHA-approved State Plans, which can be found at www.osha.gov/dcsp/osp/approved_state_plans.html).

Per Court Injunction dated 24 Oct 2016 and OMB memo dated 25 Oct 2016 do not implement the following until further direction.

“Labor law decision” means an administrative merits determination, arbitral award or decision, or civil judgment, which resulted from a violation of one or more of the laws listed in the definition of ``labor laws''.

“Manufactured end product” means any end product in product and service codes (PSCs) 1000-9999, except—

(1) PSC 5510, Lumber and Related Basic Wood Materials;

(2) Product or Service Group (PSG) 87, Agricultural Supplies;

(3) PSG 88, Live Animals;

(4) PSG 89, Subsistence;

(5) PSC 9410, Crude Grades of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metal Materials.

“Place of manufacture” means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

“Restricted business operations” means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate—

(1) Are conducted under contract directly and exclusively with the regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended.

Sensitive technology—

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically—

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3) of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)).

“Service-disabled veteran-owned small business concern”—

(1) Means a small business concern—

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16).

“Small business concern” means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation.

“Small disadvantaged business concern, consistent with 13 CFR 124.1002,” means a small business concern under the size standard applicable to the acquisition, that--

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by--

(i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13.CFR 124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

“Subsidiary” means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

“Veteran-owned small business concern” means a small business concern—

(1) Not less than 51 percent of which is owned by one or more veterans(as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

(2) The management and daily business operations of which are controlled by one or more veterans.

“Women-owned business concern” means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of the its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

“Women-owned small business concern” means a small business concern --

(1) That is at least 51 percent owned by one or more women or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and

(2) Whose management and daily business operations are controlled by one or more women.

“Women-owned small business (WOSB) concern eligible under the WOSB Program (in accordance with 13 CFR part 127),” means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States.

(b)

(1) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications posted on the SAMwebsite.

(2) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through https://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of this offer that the representation and certifications currently posted electronically at FAR 52.212- 3, Offeror Representations and Certifications—Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs ___ . [Offeror to identify the applicable paragraphs at (c) through (s) of this provision that the offeror has completed for the purposes of this solicitation only, if any.

These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer. Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted electronically on

SAM.]

(c) Offerors must complete the following representations when the resulting contract is to be performed in the United States or its outlying areas. Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that it [ ___ ] is, [ ___ ] is not a small business concern.

(2) Veteran-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it [ ___ ] is, [ ___ ] is not a veteran-owned small business concern.

(3) Service-disabled veteran-owned small business concern. [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it [ ___ ] is, [ ___ ] is not a service-disabled veteran-owned small business concern.

(4) Small disadvantaged business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.]The offeror represents that it [ ___ ] is, [ ___ ] is not, a small disadvantaged business concern as defined in 13 CFR 124.1002.

(5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.]The offeror represents that it [ ___ ] is, [ ___ ] is not a women-owned small business concern.

Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold.

(6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that—

(i) It [ ___ ] is, [ ___ ] is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: ___ .] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation.

(7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that—

(i) It [ ___ ] is, [ ___ ] is not an EDWOSB concern, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: ___ .] Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.

(8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ___ ] is, a women-owned business concern.

(9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price:

(10) HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that--

(i) It [ ___ ] is, [ ___ ] is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with 13 CFR part 126; and

(ii) It [ ___ ] is, [ ___ ] is not a HUBZone joint venture that complies with the requirements of 13 CFR part 126, and the representation in paragraph (c)(10)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZone joint venture.