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INSTRUCTIONS
INSTRUCTIONS FOR BIDDERS:
| This is the Bidder Response Form for WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response |
| Related Products, Supplies and Service . This is a required document for all bidders responding to SWC WMR001. |
| Bidders must ensure all tabs are thoroughly reviewed and completed. The following are the required tabs for this RFR: |
| · | Instructions | | |
| · | Document Submission Checklist | | |
| · | Bidder Profile & Qualifications | | |
| · | Category Questionnaire(s) (Must fill out for categories that you are bidding on) DELETE CATEGORY TABS THAT YOU ARE NOT BIDDING ON | | |
| | Category 1: Hazardous Waste Collection and Disposal | |
| | | Category 1: List of Facilities |
| | | Category 1: Facility Summary |
| | Category 2: Household Hazardous Waste (HHW) Collection Events | |
| | | Category 2: List of Facilities |
| | | Category 2: Facility Summary |
| | Category 3: Mercury-Containing Products and Batteries Collection and Disposal | |
| | | Category 3: End Market Info |
| | | Category 3: List of Facilities |
| | | Category 3: Facility Summary |
| | Category 4: Sharps Collection and Disposal | |
| | | Category 4: List of Facilities |
| | | Category 4: Facility Summary |
| | Category 5: Medical/Infectious Waste Collection and Disposal | |
| | Category 6: Pharmaceutical Waste Collection and Disposal | |
| | | Category 6: List of Facilities |
| | | Category 6: Facility Summary |
| | Category 7: Electronic Waste (e-waste) Collection and Recycling | |
| | | Category 7: End Market Info |
| | Category 8: Tank Collection and Disposal | |
| | Category 9: Emergency Response Services (ERS) and Immediate Response Action (IRA) | |
| · | Bidder References | | |
| Questions about the bid must be submitted through COMMBUYS using the Q&A feature before the Q&A deadline. |
| See RFR Section 1.3: Estimated Procurement Calendar. |
Failure to provide the requested information may result in your response being disqualified.
Doc Submission Checklist
| WMR001 Bidder Document Submission Checklist |
| Bidders must follow the file naming convention specified in RFR Section 7.2.3: File Naming Conventions. |
| This tab is intended as a guide to assist you in file organization while completing your quote submission. FILES MUST NOT BE PASSWORD PROTECTED and PDF files must be searchable. |
| | Required/Mandatory Documents | | |
| Description Enter in COMMBUYS during upload | File format | File Name Assign when creating files | Document Submitted (Yes/No) | |
| | Company Name Bidder Response Form | .xlsx (Excel Only) | CompanyName_Response.xls |
| | Company Name Bidder Price File | .xlsx (Excel Only) | CompanyName_BidderPriceFile.xls |
| | Company Name SDP Form | .doc | CompanyName_SDPform.doc |
| | Company Name PPD Form | .doc | CompanyName_PPDform.doc |
| | Company Name Certificate of Good Standing from DOR | .doc or PDF | CompanyName_COGS |
| | Company Name Bidder Response Form | .xlsx (Excel Only) | CompanyName_ResponseForm.xlsx |
| | Company Name Bidder Price File | .xlsx (Excel Only) | CompanyName_BidderPriceFile.xlsx |
| | Company Name SDP Form | .doc | CompanyName_SDPform.doc |
| | Company Name PPD Form | .doc | CompanyName_PPDform.doc |
| | Company Name Certificate of Good Standing from DOR | .doc or PDF | CompanyName_COGS |
| | Company Name Certificate of Insurance | .doc or PDF | CompanyName_COI |
| | Company Name CEP Form | .xlsx (Excel Only) | CompanyName_CEPForm |
| | Company Name CEP Form [attachment name] | .doc or PDF or .xlsx | CompanyName_CEPForm_[attachment name] |
| | Additional Documents for Review | .doc or PDF or .xlsx | CompanyName_Additional_DocumentName |
Bidder Profile & Qualifications
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | |
| BIDDER PROFILE AND QUALIFICATIONS | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise |
| | Provide answers by selecting the corresponding red box next to the desired field |
| | Sections left blank without justification will not be considered |
| Bidder Profile | | |
| 1. Bidder Information (provide information below) | | |
| Legal Company Name (same as MA W9): | | Years in Business: |
(Minimum of 3 years required)
| Legal Company Address (Same as MA W9): | Days/Hours of Operation: |
| Company Phone: | Company Website (optional): |
| Company Email: | Number of company locations: |
(New England)
2. Contact Person(s) (provide at least one contact person and list additional contacts where applicable) Awarded Contractors are responsible for reporting quarterly sales and diversity spending as well as ensuring payment of the 1% OSD Administration Fee. Any changes to any Contractor contacts must be communicated to the Category Manager.
| Name | Phone | Email |
| Primary Account Manager (AM): | | | |
| Primary Reporting Contact (if not AM): | | | |
| Secondary Reporting Contact (if not AM): | | | |
| Primary Admin Fee Contact (if not AM): | | | |
| Secondary Admin Fee Contact (if not AM): | | | |
| Customer Contact (if not AM): | | | |
| 3. Emergency Contact Person (provide a contact who can be available 24 hours a day or as close to 24 hours as possible) | | | |
| Name | Phone | Email |
| Emergency Contact Person: | | | |
| Categories | | | |
| 4. Categories Being Bid (Answer Yes/No or mark "X" Bidder may respond to one or multiple categories) | | | |
| Category 1 – Hazardous Waste Collection and Disposal | | | |
| Category 2 – Household Hazardous Waste (HHW) Collection Events | | | |
| Category 3 – Mercury-Containing Products and Batteries Collection and Disposal | | | |
| Category 4 – Sharps Collection and Disposal | | | |
| Category 5 – Medical/Infectious Waste Collection and Disposal | | | |
| Category 6 – Pharmaceutical Waste Collection and Disposal | | | |
| Category 7 – Electronic Waste (e-waste) Collection and Recycling | | | |
| Category 8 – Tank Collection and Disposal | | | |
| Category 9 –Emergency Response Services (ERS) and Immediate Response Action (IRA) | | | |
| Qualification Specifications and Required Documents with Bid Submission | | | |
Failure to provide may result in disqualification
5. RFR Section 3.1 Company Experience - Bidders must provide detail information regarding their company’s experience as it relates to this RFR. Company Experience question(s) are listed in the applicable Category Questionnaires Tabs.
| 6. RFR Section 3.2 Emergency Response Capabilities and Continuity of Operations Plan (COOP) | |
| RFR Section 3.2 | Indicate whether there is a written Continuity of Operations Plan (COOP) that describes how the company will continue to do business in case of an emergency (see RFR Section 3.3, Emergency Response Capabilities and Continuity of Operations Plan (COOP). This information will not be considered in the evaluation of the response. |
| 7. RFR Section 3.3 Financial stability including bankruptcy, litigation and contract defaults (Provide answers below or reference attachments if provided separately) | |
| RFR Section 3.3.1 | Gross Annual Revenue for FY2024 |
| Gross Annual Revenue for FY2023 |
| Gross Annual Revenue for FY2022 |
| RFR Section 3.3.2 | Bidders must provide a Certificate of Good Standing from the Department of Revenue with their bid submission. |
| RFR Section 3.3.3 | Bidders must provide a list of any bankruptcy, litigation, and contract defaults, such as lawsuits or other claims or charges, against the Bidder related to performance of the services sought under this RFR; if none list as "None". |
| 8. RFR Section 3.4 References and Reference Information and/or Requirements (See Tab "Bidder References") |
| 9. Regulatory Compliance History - Bidders must disclose any past as well as current/open violations of any environmental law or regulation that occurred as a result of an act or omission of the Bidder in the previous 5 years. The list must include past as well as current/open violations. |
| RFR Section 4.1.1.1.6 |
RFR Section 4.1.2.1.6 RFR Section 4.1.3.1.5 RFR Section 4.1.4.1.3 RFR Section 4.1.5.1.3 RFR Section 4.1.6.1.3 RFR Section 4.1.7.1.4 RFR Section 4.1.8.1.5
10. RFR Section 4.7 Insurance - Bidders must submit a Certificate of Insurance (COI) meeting the thresholds listed in RFR Section 4.7.
The policy must identify the Commonwealth of Massachusetts as Certificate Holder. Contact your Insurance Agent for guidance.
| RFR Section 4.7 | Bidders must provide a Certificate of Insurance (COI) |
| 11. Climate and Environmental third-party certifications, licenses , affiliations and/or memberships | |
List all current third-party certifications, licenses , affiliations and memberships of your company or that of your subcontractor if applicable.
List all current third-party Certifications (below)
List all current third-party Licenses (below)
List all current third-party Affiliations (below)
List all current third-party Memberships (below)
| Geographic Service |
| 12. RFR Section 4.3 Geographic Coverage (Provide a Yes/No answer as well as justification if necessary below) |
| It is preferred that bidders offer Statewide coverage. Awarded vendors are required to service any request they receive from the locations in which they are awarded. An Awarded Vendor may be removed from a location if they refuse to service that area on multiple requests. Awarded Bidders may only service locations that they were awarded. It is preferred that bidders offer Statewide service. |
Note: Bidders may be asked to provide separate pricing for each individual county statewide.
| Statewide Coverage |
| Berkshire (Western Mass) |
| Barnstable |
| Bristol |
| Dukes (Islands) |
| Essex |
| Franklin (Western Mass) |
| Hampden (Western Mass) |
| Hampshire (Western Mass) |
| Middlesex |
| Nantucket (Islands) |
| Norfolk |
| Plymouth |
| Suffolk |
| Worcester |
Category 1 Questionnaire
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | |
| RFR Section 4.1.1: Category 1 Hazardous Waste Collection and Disposal | | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise. | |
| Each red box is a response field. For example: | Company Name, Inc. |
| Provide answers by selection the corresponding red box next to the desired field | |
| Sections left blank without justification will not be considered | |
| QUESTIONNAIRE INSTRUCTIONS | |
| Please provide the requested information as they pertain to Section 4.1.1 of the WMR001 RFR. Boxes may be expanded to fit your needs, or a separate attachment may be provided. | |
| QUESTIONS | Use this column for response. Category 1 Bidders must answer all questions. Indicate none or N/A if not applicable |
| Describe your company's experience and expertise within Category 1 - Provide detail information regarding your company’s experience and relevant qualifications and expertise as it relates to this this category. |
| List your company’s past performance in this category. Include at least three (3) examples of previous work, including products and services previously provided to public entities if applicable. |
| Maximum Non-Emergency Response Time. |
Pickup takes place within this time frame.
Category 1 List of Facilities
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response |
| RFR Section 4.1.1: Category 1 Hazardous Waste Collection and Disposal |
| Bidders must respond to all questions in the sections below unless stated otherwise. |
| Hazardous Waste Collection and Disposal Facility Summary |
| Instructions: Please list all Receiving and Destination Facilities your company intends to utilize under this contract. List RCRA and non-RCRA Facilities separately. Add lines to the tables if needed. In addition, please complete a "Facility Summary" Tab for each Receiving and Destination Facility. |
| RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
| Non-RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
Category 1 Facility Summary
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | | |
| RFR Section 4.1.1: Category 1 Hazardous Waste Collection and Disposal | | | |
| Bidders must respond to all questions in the sections below unless stated otherwise. | | | |
| Hazardous Waste Collection and Disposal Facility - Each Receiving or Destination Facility | | | | |
| Instructions: Please complete one worksheet (Basic Info, Permit and License Info, Five-year Environmental Enforcement Summary, Superfund Liability, Facility Insurance) for each Receiving or Destination Facility your company intends to utilize under this contract. Create additional copies of this tab in order to accommodate additional facilities. Also, list all Receiving and Destination Facilities in the "List of Facilities" worksheet. | | | | |
| Basic Information | | | | |
| | Facility Information | | |
| Bidder Company Name | | | | |
| Facility Name | | | | |
| Facility ID number | | | | |
| Full Facility Address (Street, City, State, Zip) | | | | |
| Name of Company Operating the Facility | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone | | | | |
| Facility Operator Contact Email | | | | |
| Name of Property Owner (if different than Operator) | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone (if different from Owner) | | | | |
| Facility Operator Contact Email (if different from Owner) | | | | |
| Wastes Accepted (e.g. organic wastes) | | | | |
| Disposal Method (e.g. waste incineration) | | | | |
| Permit and License Information (add lines if needed) | | | | |
| Permit or License Number | | Permit or License Description (i.e. Activity Covered) | Expiration Date | Issuing Agency |
| Five-year Environmental Enforcement Summary (add lines if needed) | | | | | | |
| Date Issued | Nature of Violation and Location | Permit / License / EPA ID# | Issuing Agency | Type of Action (e.g. NOV, NOCAPA) | Disposition (e.g. settled, no penalty, open) | Penalty Paid |
| Superfund Liability (if any) | |
| Facility Information |
| Site Name | |
| Site ID | |
| Allocated Liability % | |
| Future Remediation Costs | |
| % Covered by Commercial Insurance | |
| Past Unreimbursed Costs | |
| Future Unreimbursed Costs | |
| Facility Insurance | |
| Facility Information |
| Name of Insurer | |
| General Liability Policy Number | |
| Total General Liability Limit | |
| Per Occurrence General Liability Limit | |
| General Liability Policy Expiration Date | |
| Pollution Liability Policy Number | |
| Total Pollution Liability Limit | |
| Per Occurrence Pollution Liability Limit | |
| Pollution Liability Policy Expiration Date | |
| Total Coverage Limit for Pollution Incidents | |
Category 2 Questionnaire
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | |
| RFR Section 4.1.2: Category 2 Household Hazardous Waste (HHW) Collection Events | | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise. | |
| Each red box is a response field. For example: | Company Name, Inc. |
| Provide answers by selection the corresponding red box next to the desired field | |
| Sections left blank without justification will not be considered | |
| QUESTIONNAIRE INSTRUCTIONS | |
| Please provide the requested information as they pertain to Section 4.1.2 of the WMR001 RFR. Boxes may be expanded to fit your needs, or a separate attachment may be provided. | |
| QUESTIONS | Use this column for response. Category 2 Bidders must answer all questions. Indicate none or N/A if not applicable |
| Describe your company's experience and expertise within Category 2 . Provide detail information regarding your company’s experience and relevant qualifications and expertise as it relates to this this category. |
| List your company’s past performance in this category. Include at least three (3) examples of previous work, including products and services previously provided to public entities if applicable. |
| Maximum Non-Emergency Response Time. |
Category 2 List of Facilities
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response |
| RFR Section 4.1.2: Category 2 Household Hazardous Waste (HHW) Collection Events |
| Bidders must respond to all questions in the sections below unless stated otherwise. |
| Hazardous Waste Collection and Disposal Facility Summary |
| Instructions: Please list all Receiving and Destination Facilities your company intends to utilize under this contract. List RCRA and non-RCRA Facilities separately. Add lines to the tables if needed. In addition, please complete a "Facility Summary" Tab for each Receiving and Destination Facility. |
| RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
| Non-RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
Category 2 Facility Summary
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | | |
| RFR Section 4.1.2: Category 2 Household Hazardous Waste (HHW) Collection Events | | | |
| Bidders must respond to all questions in the sections below unless stated otherwise. | | | |
| Hazardous Waste Collection and Disposal Facility - Each Receiving or Destination Facility | | | | |
| Instructions: Please complete one worksheet (Basic Info, Permit and License Info, Five-year Environmental Enforcement Summary, Superfund Liability, Facility Insurance) for each Receiving or Destination Facility your company intends to utilize under this contract. Create additional copies of this tab in order to accommodate additional facilities. Also, list all Receiving and Destination Facilities in the "List of Facilities" worksheet. | | | | |
| Basic Information | | | | |
| | Facility Information | | |
| Bidder Company Name | | | | |
| Facility Name | | | | |
| Facility ID number | | | | |
| Full Facility Address (Street, City, State, Zip) | | | | |
| Name of Company Operating the Facility | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone | | | | |
| Facility Operator Contact Email | | | | |
| Name of Property Owner (if different than Operator) | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone (if different from Owner) | | | | |
| Facility Operator Contact Email (if different from Owner) | | | | |
| Wastes Accepted (e.g. organic wastes) | | | | |
| Disposal Method (e.g. waste incineration) | | | | |
| Permit and License Information (add lines if needed) | | | | |
| Permit or License Number | | Permit or License Description (i.e. Activity Covered) | Expiration Date | Issuing Agency |
| Five-year Environmental Enforcement Summary (add lines if needed) | | | | | | |
| Date Issued | Nature of Violation and Location | Permit / License / EPA ID# | Issuing Agency | Type of Action (e.g. NOV, NOCAPA) | Disposition (e.g. settled, no penalty, open) | Penalty Paid |
| Superfund Liability (if any) | |
| Facility Information |
| Site Name | |
| Site ID | |
| Allocated Liability % | |
| Future Remediation Costs | |
| % Covered by Commercial Insurance | |
| Past Unreimbursed Costs | |
| Future Unreimbursed Costs | |
| Facility Insurance | |
| Facility Information |
| Name of Insurer | |
| General Liability Policy Number | |
| Total General Liability Limit | |
| Per Occurrence General Liability Limit | |
| General Liability Policy Expiration Date | |
| Pollution Liability Policy Number | |
| Total Pollution Liability Limit | |
| Per Occurrence Pollution Liability Limit | |
| Pollution Liability Policy Expiration Date | |
| Total Coverage Limit for Pollution Incidents | |
Category 3 Questionnaire
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | |
| RFR Section 4.1.3: Category 3 Mercury-Containing Products and Batteries Collection and Disposal | | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise. | |
| Each red box is a response field. For example: | Company Name, Inc. |
| Provide answers by selection the corresponding red box next to the desired field | |
| Sections left blank without justification will not be considered | |
| QUESTIONNAIRE INSTRUCTIONS | |
| Please provide the requested information as they pertain to Section 4.1.3 of the WMR001 RFR. Boxes may be expanded to fit your needs, or a separate attachment may be provided. | |
| QUESTIONS | Use this column for response. Category 3 Bidders must answer all questions. Indicate none or N/A if not applicable |
| Describe your company's experience and expertise within Category 3. Provide detail information regarding your company’s experience and relevant qualifications and expertise as it relates to this this category. |
| List your company’s past performance in this category. Include at least three (3) examples of previous work, including products and services previously provided to public entities if applicable. |
| Maximum Non-Emergency Response Time. |
Category 3 End Market Info
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response |
| RFR Section 4.1.3: Category 3 Mercury-Containing Products and Batteries Collection and Disposal |
| Bidders must respond to all questions in the sections below unless stated otherwise. |
| Mercury-Containing Products End Market Information | |
| Instructions: All Bidders must provide below the saleable end product or recycled end use and the purchasing, processing or recycling facility for each product or component listed below. Additional lines may be added for any material, whether mandatory or desirable (i.e. if glass is being sent to two facilities, the spreadsheet should have two lines with "Glass" in the "Material" column with information on both facilities). "Accepted, Tons" refers to the number of tons of the specific material the end-market company accepted from Bidder in Calendar Year 2024. "Estimated % Exported" refers to the share of the specific material exported by the end-market company in Calendar Year 2024. | |
| Mandatory Materials | | | | | | | | | |
| Material | Subcontractor / Receiving Company Name | City | State | Zip | Contact Name | Contact Email | Phone | Accepted in 2024, Tons | Estimated % Exported in 2024 |
| Reclaimed Mercury | | | | | | | | | |
| Desirable Materials | | | | | | | | | |
| Material | Subcontractor / Receiving Company Name | City | State | Zip | Contact Name | Contact Email | Phone | Accepted in 2024, Tons | Estimated % Exported in 2024 |
| Mercury-phosphor powder | | | | | | | | | |
| Sodium and sodium-bearing components | | | | | | | | | |
| Glass | | | | | | | | | |
| Ferrous Metals | | | | | | | | | |
| Non-Ferrous Metals | | | | | | | | | |
| Non-Mercury Batteries (excluding alkaline)* | | | | | | | | | |
*End-markets may be listed separately for each non-mercury battery type if they are going to different companies.
Category 3 List of Facilities
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response |
| RFR Section 4.1.3: Category 3 Mercury-Containing Products and Batteries Collection and Disposal |
| Bidders must respond to all questions in the sections below unless stated otherwise. |
| Hazardous Waste Collection and Disposal Facility Summary |
| Instructions: Please list all Receiving and Destination Facilities your company intends to utilize under this contract. List RCRA and non-RCRA Facilities separately. Add lines to the tables if needed. In addition, please complete a "Facility Summary" Tab for each Receiving and Destination Facility. |
| RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
| Non-RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
Category 3 Facility Summary
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | | |
| RFR Section 4.1.3: Category 3 Mercury-Containing Products and Batteries Collection and Disposal | | | |
| Bidders must respond to all questions in the sections below unless stated otherwise. | | | |
| Hazardous Waste Collection and Disposal Facility - Each Receiving or Destination Facility | | | | |
| Instructions: Please complete one worksheet (Basic Info, Permit and License Info, Five-year Environmental Enforcement Summary, Superfund Liability, Facility Insurance) for each Receiving or Destination Facility your company intends to utilize under this contract. Create additional copies of this tab in order to accommodate additional facilities. Also, list all Receiving and Destination Facilities in the "List of Facilities" worksheet. | | | | |
| Basic Information | | | | |
| | Facility Information | | |
| Bidder Company Name | | | | |
| Facility Name | | | | |
| Facility ID number | | | | |
| Full Facility Address (Street, City, State, Zip) | | | | |
| Name of Company Operating the Facility | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone | | | | |
| Facility Operator Contact Email | | | | |
| Name of Property Owner (if different than Operator) | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone (if different from Owner) | | | | |
| Facility Operator Contact Email (if different from Owner) | | | | |
| Wastes Accepted (e.g. organic wastes) | | | | |
| Disposal Method (e.g. waste incineration) | | | | |
| Permit and License Information (add lines if needed) | | | | |
| Permit or License Number | | Permit or License Description (i.e. Activity Covered) | Expiration Date | Issuing Agency |
| Five-year Environmental Enforcement Summary (add lines if needed) | | | | | | |
| Date Issued | Nature of Violation and Location | Permit / License / EPA ID# | Issuing Agency | Type of Action (e.g. NOV, NOCAPA) | Disposition (e.g. settled, no penalty, open) | Penalty Paid |
| Superfund Liability (if any) | |
| Facility Information |
| Site Name | |
| Site ID | |
| Allocated Liability % | |
| Future Remediation Costs | |
| % Covered by Commercial Insurance | |
| Past Unreimbursed Costs | |
| Future Unreimbursed Costs | |
| Facility Insurance | |
| Facility Information |
| Name of Insurer | |
| General Liability Policy Number | |
| Total General Liability Limit | |
| Per Occurrence General Liability Limit | |
| General Liability Policy Expiration Date | |
| Pollution Liability Policy Number | |
| Total Pollution Liability Limit | |
| Per Occurrence Pollution Liability Limit | |
| Pollution Liability Policy Expiration Date | |
| Total Coverage Limit for Pollution Incidents | |
Category 4 Questionnaire
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | |
| RFR Section 4.1.4: Category 4 Sharps Collection and Disposal | | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise. | |
| Each red box is a response field. For example: | Company Name, Inc. |
| Provide answers by selection the corresponding red box next to the desired field | |
| Sections left blank without justification will not be considered | |
| QUESTIONNAIRE INSTRUCTIONS | |
| Please provide the requested information as they pertain to Section 4.1.4 of the WMR001 RFR. Boxes may be expanded to fit your needs, or a separate attachment may be provided. | |
| QUESTIONS | Use this column for response. Category 4 Bidders must answer all questions. Indicate none or N/A if not applicable |
| Describe your company's experience and expertise within Category 4. Provide detail information regarding your company’s experience and relevant qualifications and expertise as it relates to this this category. |
| List your company’s past performance in this category. Include at least three (3) examples of previous work, including products and services previously provided to public entities if applicable. |
| Maximum Non-Emergency Response Time. |
Category 4 List of Facilities
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response |
| RFR Section 4.1.4: Category 4 Sharps Collection and Disposal |
| Bidders must respond to all questions in the sections below unless stated otherwise. |
| Hazardous Waste Collection and Disposal Facility Summary |
| Instructions: Please list all Receiving and Destination Facilities your company intends to utilize under this contract. List RCRA and non-RCRA Facilities separately. Add lines to the tables if needed. In addition, please complete a "Facility Summary" Tab for each Receiving and Destination Facility. |
| RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
| Non-RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
Category 4 Facility Summary
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | | |
| RFR Section 4.1.4: Category 4 Sharps Collection and Disposal | | | |
| Bidders must respond to all questions in the sections below unless stated otherwise. | | | |
| Hazardous Waste Collection and Disposal Facility - Each Receiving or Destination Facility | | | | |
| Instructions: Please complete one worksheet (Basic Info, Permit and License Info, Five-year Environmental Enforcement Summary, Superfund Liability, Facility Insurance) for each Receiving or Destination Facility your company intends to utilize under this contract. Create additional copies of this tab in order to accommodate additional facilities. Also, list all Receiving and Destination Facilities in the "List of Facilities" worksheet. | | | | |
| Basic Information | | | | |
| | Facility Information | | |
| Bidder Company Name | | | | |
| Facility Name | | | | |
| Facility ID number | | | | |
| Full Facility Address (Street, City, State, Zip) | | | | |
| Name of Company Operating the Facility | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone | | | | |
| Facility Operator Contact Email | | | | |
| Name of Property Owner (if different than Operator) | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone (if different from Owner) | | | | |
| Facility Operator Contact Email (if different from Owner) | | | | |
| Wastes Accepted (e.g. organic wastes) | | | | |
| Disposal Method (e.g. waste incineration) | | | | |
| Permit and License Information (add lines if needed) | | | | |
| Permit or License Number | | Permit or License Description (i.e. Activity Covered) | Expiration Date | Issuing Agency |
| Five-year Environmental Enforcement Summary (add lines if needed) | | | | | | |
| Date Issued | Nature of Violation and Location | Permit / License / EPA ID# | Issuing Agency | Type of Action (e.g. NOV, NOCAPA) | Disposition (e.g. settled, no penalty, open) | Penalty Paid |
| Superfund Liability (if any) | |
| Facility Information |
| Site Name | |
| Site ID | |
| Allocated Liability % | |
| Future Remediation Costs | |
| % Covered by Commercial Insurance | |
| Past Unreimbursed Costs | |
| Future Unreimbursed Costs | |
| Facility Insurance | |
| Facility Information |
| Name of Insurer | |
| General Liability Policy Number | |
| Total General Liability Limit | |
| Per Occurrence General Liability Limit | |
| General Liability Policy Expiration Date | |
| Pollution Liability Policy Number | |
| Total Pollution Liability Limit | |
| Per Occurrence Pollution Liability Limit | |
| Pollution Liability Policy Expiration Date | |
| Total Coverage Limit for Pollution Incidents | |
Category 5 Questionnaire
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | |
| RFR Section 4.1.5: Category 5 Medical/Infectious Waste Collection and Disposal | | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise. | |
| Each red box is a response field. For example: | Company Name, Inc. |
| Provide answers by selection the corresponding red box next to the desired field | |
| Sections left blank without justification will not be considered | |
| QUESTIONNAIRE INSTRUCTIONS | |
| Please provide the requested information as they pertain to Section 4.1.5 of the WMR001 RFR. Boxes may be expanded to fit your needs, or a separate attachment may be provided. | |
| QUESTIONS | Use this column for response. Category 5 Bidders must answer all questions. Indicate none or N/A if not applicable |
| Describe your company's experience and expertise within Category 5. Provide detail information regarding your company’s experience and relevant qualifications and expertise as it relates to this this category. |
| List your company’s past performance in this category. Include at least three (3) examples of previous work, including products and services previously provided to public entities if applicable. |
| Maximum Non-Emergency Response Time. |
Pickup takes place within this time frame.
| QUESTION - RFR Section 4.1.5.1.3 | Indicate none or N/A if not applicable |
| List any past as well as current/open violations of any environmental law or regulation that occurred at any Receiving and Destination Facility in the previous 5 years. | |
Category 6 Questionnaire
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | |
| RFR Section 4.1.6: Category 6 Pharmaceutical Waste Collection and Disposal | | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise. | |
| Each red box is a response field. For example: | Company Name, Inc. |
| Provide answers by selection the corresponding red box next to the desired field | |
| Sections left blank without justification will not be considered | |
| QUESTIONNAIRE INSTRUCTIONS | |
| Please provide the requested information as they pertain to Section 4.1.6 of the WMR001 RFR. Boxes may be expanded to fit your needs, or a separate attachment may be provided. | |
| QUESTIONS | Use this column for response. Category 6 Bidders must answer all questions. Indicate none or N/A if not applicable |
| Describe your company's experience and expertise within Category 6. Provide detail information regarding your company’s experience and relevant qualifications and expertise as it relates to this this category. |
| List your company’s past performance in this category. Include at least three (3) examples of previous work, including products and services previously provided to public entities if applicable. |
| Maximum Non-Emergency Response Time. |
Category 6 List of Facilities
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response |
| RFR Section 4.1.6: Category 6 Pharmaceutical Waste Collection and Disposal |
| Bidders must respond to all questions in the sections below unless stated otherwise. |
| Hazardous Waste Collection and Disposal Facility Summary |
| Instructions: Please list all Receiving and Destination Facilities your company intends to utilize under this contract. List RCRA and non-RCRA Facilities separately. Add lines to the tables if needed. In addition, please complete a "Facility Summary" Tab for each Receiving and Destination Facility. |
| RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
| Non-RCRA Facilities (add lines if needed) | | |
| Facility Name | Facility ID number | Facility Address |
Category 6 Facility Summary
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | | |
| RFR Section 4.1.6: Category 6 Pharmaceutical Waste Collection and Disposal | | | |
| Bidders must respond to all questions in the sections below unless stated otherwise. | | | |
| Hazardous Waste Collection and Disposal Facility - Each Receiving or Destination Facility | | | | |
| Instructions: Please complete one worksheet (Basic Info, Permit and License Info, Five-year Environmental Enforcement Summary, Superfund Liability, Facility Insurance) for each Receiving or Destination Facility your company intends to utilize under this contract. Create additional copies of this tab in order to accommodate additional facilities. Also, list all Receiving and Destination Facilities in the "List of Facilities" worksheet. | | | | |
| Basic Information | | | | |
| | Facility Information | | |
| Bidder Company Name | | | | |
| Facility Name | | | | |
| Facility ID number | | | | |
| Full Facility Address (Street, City, State, Zip) | | | | |
| Name of Company Operating the Facility | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone | | | | |
| Facility Operator Contact Email | | | | |
| Name of Property Owner (if different than Operator) | | | | |
| Facility Operator Contact Name (if different from Owner) | | | | |
| Facility Operator Contact Phone (if different from Owner) | | | | |
| Facility Operator Contact Email (if different from Owner) | | | | |
| Wastes Accepted (e.g. organic wastes) | | | | |
| Disposal Method (e.g. waste incineration) | | | | |
| Permit and License Information (add lines if needed) | | | | |
| Permit or License Number | | Permit or License Description (i.e. Activity Covered) | Expiration Date | Issuing Agency |
| Five-year Environmental Enforcement Summary (add lines if needed) | | | | | | |
| Date Issued | Nature of Violation and Location | Permit / License / EPA ID# | Issuing Agency | Type of Action (e.g. NOV, NOCAPA) | Disposition (e.g. settled, no penalty, open) | Penalty Paid |
| Superfund Liability (if any) | |
| Facility Information |
| Site Name | |
| Site ID | |
| Allocated Liability % | |
| Future Remediation Costs | |
| % Covered by Commercial Insurance | |
| Past Unreimbursed Costs | |
| Future Unreimbursed Costs | |
| Facility Insurance | |
| Facility Information |
| Name of Insurer | |
| General Liability Policy Number | |
| Total General Liability Limit | |
| Per Occurrence General Liability Limit | |
| General Liability Policy Expiration Date | |
| Pollution Liability Policy Number | |
| Total Pollution Liability Limit | |
| Per Occurrence Pollution Liability Limit | |
| Pollution Liability Policy Expiration Date | |
| Total Coverage Limit for Pollution Incidents | |
Category 7 Questionnaire
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | |
| RFR Section 4.1.7: Category 7 Electronic Waste (e-waste) Collection and Recycling | | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise. | |
| Each red box is a response field. For example: | Company Name, Inc. |
| Provide answers by selection the corresponding red box next to the desired field | |
| Sections left blank without justification will not be considered | |
| QUESTIONNAIRE INSTRUCTIONS | |
| Please provide the requested information as they pertain to Section 4.1.7 of the WMR001 RFR. Boxes may be expanded to fit your needs, or a separate attachment may be provided. | |
| QUESTIONS | Use this column for response. Category 7 Bidders must answer all questions. Indicate none or N/A if not applicable |
| Describe your company's experience and expertise within Category 7. Provide detail information regarding your company’s experience and relevant qualifications and expertise as it relates to this this category. |
| List your company’s past performance in this category. Include at least three (3) examples of previous work, including products and services previously provided to public entities if applicable. |
| Maximum Non-Emergency Response Time. |
Pickup takes place within this time frame.
| QUESTION - RFR Section 4.1.7.1.4 | Indicate none or N/A if not applicable |
| List any past as well as current/open violations of any environmental law or regulation that occurred at any Receiving and Destination Facility in the previous 5 years. | |
Category 7 End Market Info
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | | | | | | | |
| RFR Section 4.1.7: Category 7 Electronic Waste (e-waste) Collection and Recycling | | | | | | | | |
| Bidders must respond to all questions in the sections below unless stated otherwise. | | | | | | | | |
| Electronic Waste (e-waste) Collection and Recycling End Market Information | | | | | | | | | |
| Instructions: All Bidders must provide below the saleable end product or recycled end use and the purchasing, processing or recycling facility for each product or component listed below. Additional lines may be added for any material, whether mandatory or desirable (i.e. if plastics are being sent to two facilities, the spreadsheet should have two lines with "Plastics" in the "Material" column with information on both facilities). "Accepted, Tons" refers to the number of tons of the specific material the end-market company accepted from Bidder in Calendar Year 2024. "Estimated % Exported" refers to the share of the specific material exported by the end-market company in Calendar Year 2024. | | | | | | | | | |
| Mandatory/Focus Materials | | | | | | | | | |
| Material | Subcontractor / Receiving Company Name | City | State | Zip | Contact Name | Contact Email | Phone | Accepted in 2024, Tons | Estimated % Exported in 2024 |
| Whole cathode ray tubes (CRTs) | | | | | | | | | |
| Leaded CRT glass | | | | | | | | | |
| Lead-bearing components | | | | | | | | | |
| Items containing PCBs | | | | | | | | | |
| Batteries (excluding alkaline)** | | | | | | | | | |
| Circuit boards** | | | | | | | | | |
| Mercury lights and other mercury containing products** | | | | | | | | | |
| Non-leaded glass | | | | | | | | | |
| Fiberglass residue | | | | | | | | | |
| Plastics | | | | | | | | | |
| Ferrous metals | | | | | | | | | |
| Non-ferrous metals | | | | | | | | | |
| Wiring | | | | | | | | | |
| *There are only three options for the information to be provided in the "Purpose" column: reuse, recycling or disposal. | | | | | | | | | |
| **End-markets may be listed separately for each type of marked products (e.g. each type of mercury-containing product separately if they are going to different companies). | | | | | | | | | |
| Other Materials | | | | | | | | | |
| Material | Subcontractor / Receiving Company Name | City | State | Zip | Contact Name | Contact Email | Phone | Accepted in 2024, Tons | Estimated % Exported in 2024 |
Category 8 Questionnaire
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | |
| RFR Section 4.1.8: Category 8 Tank Collection and Disposal | | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise. | |
| Each red box is a response field. For example: | Company Name, Inc. |
| Provide answers by selection the corresponding red box next to the desired field | |
| Sections left blank without justification will not be considered | |
| QUESTIONNAIRE INSTRUCTIONS | |
| Please provide the requested information as they pertain to Section 4.1.8 of the WMR001 RFR. Boxes may be expanded to fit your needs, or a separate attachment may be provided. | |
| QUESTIONS | Use this column for response. Category 8 Bidders must answer all questions. Indicate none or N/A if not applicable |
| Describe your company's experience and expertise within Category 8. Provide detail information regarding your company’s experience and relevant qualifications and expertise as it relates to this this category. |
| List your company’s past performance in this category. Include at least three (3) examples of previous work, including products and services previously provided to public entities if applicable. |
| Maximum Non-Emergency Response Time. |
Pickup takes place within this time frame.
| QUESTION - RFR Section 4.1.8.1.5 | Indicate none or N/A if not applicable |
| List any past as well as current/open violations of any environmental law or regulation that occurred at any Receiving and Destination Facility in the previous 5 years. | |
Category 9 Questionnaire
| WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | | |
| RFR Section 4.1.9: Category 9 Emergency Response Services (ERS) and Immediate Response Action (IRA) | | |
| Instructions: | Bidders must respond to all questions in the sections below unless stated otherwise. | |
| Each red box is a response field. For example: | Company Name, Inc. |
| Provide answers by selection the corresponding red box next to the desired field | |
| Sections left blank without justification will not be considered | |
| QUESTIONNAIRE INSTRUCTIONS | |
| Please provide the requested information as they pertain to Section 4.1.9 of the WMR001 RFR. Boxes may be expanded to fit your needs, or a separate attachment may be provided. | |
| QUESTIONS | Use this column for response. Category 9 Bidders must answer all questions. Indicate none or N/A if not applicable |
| Describe your company's experience and expertise within Category 9. Provide detail information regarding your company’s experience and relevant qualifications and expertise as it relates to this this category. |
| List your company’s past performance in this category. Include at least three (3) examples of previous work, including products and services previously provided to public entities if applicable. |
| Maximum Emergency Response Time: Contractor is onsite within this time frame. |
Two (2) hours or less is mandatory excluding the Islands. See RFR section 4.1.9.3.1 Emergency Response Services (ERS)
Bidder References
| | | WMR001 Hazardous/Universal, Medical, and Electronic Waste Disposal and Emergency Response | |
| | | RFR Section 3.4: References and Reference Information and/or Requirements | |
| | | INSTRUCTIONS | Each red box is a response field |
| for example: | Company Name, Inc. | | | |
| | | | Provide answers by selecting the corresponding red box next to the desired field |
| | | | Sections left blank without justification will not be considered |
| | Bidder References | | |
| | Bidders must provide 3 business references for each category being bid on. A single business reference may provide multiple references for the bidder when services under multiple categories have been performed. Failure to provide references and valid email addresses may result in disqualification. | | |
It is required that references be:
- Recommended, at least one (1) reference be a Commonwealth of MA Agency or Municipality.
- Recommended, at least one (1) reference be a high-volume order, similar in scope and size to FAC110.
- Under no circumstance may a bidder use a WMR001 SST member as a reference. Any references submitted with a WMR001 SST member will not be considered.
**All eight fields below must be populated** Reference/Entity Company Contact Person (Business) Address Email Address Phone Number Cell Phone Number Description and dates(s) of commodities/services provided Category Pertinent to Reference image1.png image2.png image2.emf