03-1058 � � r
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Presented By:
Council File #
Green Sheet#
� � t�$
3007734
�a -
Referred To: Committee: Date
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RESOLVED, that the proper City officials are hereby authorized and directed to execute a request for proposal
(RFP) for fire protection services with the VA Medical Center as provided by Saint Paul's Department of Fire and
Safety Services; a copy of said proposal is to be kept on file and of record in the O�ce of Financial Services.
Adopted by Council: Date _ //p� ,�', �//�
Adoption Certified by Council Secretary:
L�'�
Requested by Department of:
Fire & Safet Services
By: ,
Approval Recommended by Director of Financial Services:
By:
Fo App ved by City Attorney:
C
By: �
�
Anoro v avor for Submission to
Appro e � y Mayor. Dat�_
B !�''f/t/l�ifA
r �� Green Sheet Green Sheet
Green Sheet Green Sheet Green Sheet Green She �
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Departmenf/office%ouncil: , Date Initiated: v—
FR – F� �3-NO�-o3 Green Sheet NO: 3007734
Contact Person 8 Phone: DeoaRment Sent To Person 1'" V ate
Chief Douglas A. Holton � 0 ire ��
� Assign 1 ire De artment DireMOr
Must Be on Council /\qenda by (Date): Number 2 i Attorne �'��
For
RoUting 3 a or's Oftice Ma odASSistant
� Orde� 4 ouncil
- 5 i Clerk Ci C�erk
Total # of Signature Pages _(Clip All Locations for Signature)
Action Requested:
To approve the attached Council Resolution authorizing the Depazhnent of Fire and Safety Services to submit a request for proposal
(RFP) for. fire protection services with the VA Medical Center.
Recommendations: Approve (A) or Reject (R): Personal Service Contracts Must Mswer the Following Questions:
Pianning Commission 1. Has this persoNfirm ever worked under a contract for fhis departmenY?
CIB Committee Yes No �
Civil Service Commission 2. Has this person/firrn ever been a city employee?
, - . - Yes No :
. 3. Dces this personlfirm possess a skill oot nwmally possessed by any
' current city employee? �
Yes No
� Explain all yes ansWers on separate sheet and attach to green sheet
Initiating Problem, issues, Opportunity (Who; What, When, Where, Why):
The City of Saint Paul Depathnent of Fire and Safety Services is proposing to provide fire protecrion response services to the VA
Medical Centex.
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Advanfages lf Approved:
Addirionat revennes will be gzneratedby tfie Saint Paul Department of Fire and Safety Services. ��� �������
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Disadvantapes If Approved: ..
None.
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Disailvantages If Not Approved: � ����
Loss of potenrial revenue for the City of Saint Paul. �� ��
Total Amount of CosURevenue Budgeted: .
Transaction: � . _ , , ,
Fundinp Source: Adivity Number. GL-735-55001 �
Financiai lnformation: -
(Explain)
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�LICITA
DAiE
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TNFnRMATT(1N!`eT T �
COMMERCIAL ITEMS I!�
12.17. 23. 24. & 30
CONTRACT'ING OFFICER (90C) BLDG. 70 ROOM 4G-107 ❑ SEf ASIDE: °/.FOR
VA MEDICAL CENTER � sM,v.i.susm*�ss
ONE VETERANS DRIVE ❑xvszo�
susw�ss
MINNEAPOLIS, MN 55417 p �
wucs: 561990
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i. SOLICR'A110NISSUE
DATE
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HIEF, FISCAL SERVICE
A MEDICAL CENTER
NE VETERANS DRIVE
[INNEAPOLIS, MN 55417
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OF FIRE SUPPRESSION
OVIDE TECFINICAL AND COST PROPOSALS -
E PART III INSTRUCTIONS TO OFFERORS-
ALUATION
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2]a. SOLICITf
276. CONiRA�
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REPRESEKfA7IVE
STANDARD FORM 1449 (�v. azart) BACK
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03-�05?
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PART I-- CONTINUATION OF STANDARD FORM 1449
SOLICITATION/CONTRACT/ORDER FOR CObA�RCZAI, ITEMS
SUPPLIES OR SERVICES AI•ID PRICES/COSTS
This solicitation's "Requirements" - and "Schedule of Items" cover periods of
contract performance as follows:
Section I: Base Year, Calendar Year 2004 Requirements �
Section II: Option to Renew for Calendar Year 2Q05 Requirements
Section IIZ: Option to Renew for Calendar Year 2006 Requirements
Section IV: Option to Renew for Calendar Year 2007 Requirements
Section V: Option to Renew for Calendar Year 2008 Requirements
This solicitation includes options to extend the term of the contract for £our
additional twelve-month periods. Offerors are to provide firm-£ixed pricing
for Schedule of Items, Sections I, II, III, IV and V.
It is desirable that contract seivices commence on January 1, 2004; however, if
al1 administxative preparations for award have not been completed by that date,
contract performance period will be £rom date of award throuqh December 31,
2004.
REQUIREMENTS
In accordance with standard industry practice furnish Fire Suppression and
related safety and rescue services to and at Veterans Affairs Medical Center
(VAMC) and Fort Snelling National Cemetery (FSNC) campuses, Minneapolis,
Minnesota in accordance with the specifications, terms and conditions of this
Request for Proposal.
Contractor will provide monthly RUN DATA indicating how many responses were
made for what reason, i.e. alarm, elevator extrication, hazardous materials,
medical emergency, etc. �
Alarms include coded alarms, vehicle fires, etc.; Hazardous Materials and
standby could include ETO alarms, gasoline leaks from vehicles, confined
space standby, mercury spills, bomb squad standby, etc.
For the period of January 1, 2002 through December 31, 2002, there were 61
tota2 runs by current contractor; this is an average of 5.08 runs/responses
per month or an average o£ 1.17 runs/responses per week. The majority o£ the
calls have been for alaxms and elevator extrications.
Floor plot plans of Building 70 (main Medical Center) and VAMC and FSNC
building plot drawinqs are listed in Part V of the solicitation, they are
available only in hard copv and must be requested by FAX to 612-725-2072.
Upon request, VAMC will express mail drawings overnight-express (or deliver
locally).
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RFP 618-90-04
SCHEDULES OF I '�MC
SECTION I- BASE YEAR� JANUARY 1� 2004 THROUGH� DECEMBER 31, 2004
UNIT
ITEM QTY UNIT PRICE AMOUNT
1. Provide a11 labor, equipment and 12 mo
material necessary for Fire
Suppression Services and related
work to and at VAMC and FSNC.
2. Specify a deduction, if any,
to the contract for use of
VAMC-owned fire truck, 1993
Emergency One, Inc., Model C803
Pumper Fire Truck, capacity
of 1250 GPM with 750 gallon poly
tank, and accessories
1 ea
( 1
Total Monthly Charge $
Total Annual Charge Calendar Year 2004 $
SECTION II - OPTION YEAR 1, JANUARY 1, 2005 TFIl20UGH DECEMBER 31, 2005
ITEM
1. Provide a11 labor, equipment and
material necessary for Fiie
_ Suppression Services and related
work to and at VAMC and FSNC.
2. Speci£y a deduction, if any,
to the contract for use of
VAMC-owned fire truck, 1993
Emergency One, Inc., Model C803
Pumper Fire Truck, capacity
of 1250 GPM with 750 gallon poly
tank, and accessories
UNZT
QTY ONIT PRICE
12 mo
1 ea
q • r�c��y
( )
Total Monthly Charqe $
Total Annual Charge Calendar Year 2005 $
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RFP 618-90-04
SECTION III - OPTION�YEAR 2, JANIJARY 1, 2006 THROUGH DECEMBER 31, 2006
ITEM QTY
1. Provide a11 labor, equipment and 12
material necessaiy_for Fire
Suppression Services and related
work to and at VAMC and FSNC.
2. Specify a deduction, i£ any,
to the contract for use of
VAMC-owned fire truck, 1993
Emerqency One, Inc., Model C803
Pumper Fire Truck, capacity
of 1250 GPM with 750 gallon poly
tank, and accessories
1
UNIT
UNIT -PRICE
mo
ea
AMOUNT
( 1
Total Monthly Charge $
Total Annual Charge Calendar Year 2006 $
SECTION 2V - OPTION YEAR 3, JANUARY 1, 2007 THROUGA DECEMBER 31� 2007
ITEM QTY
1. Provide all labor, equipment arid 12
material necessary for Fire
Suppression Services and related
work to and at VAMC and FSNC.
2. Specify a deduction, if any,
to the contract Por use of
VAMC-owned fire truck, 1993
Emergency One, Inc., Model C803
Pumper Fire Truck, capacity
of 1250 GPM with 750 gallon poly
tank, and accessories
1
UNIT
UNIT PRICE
mo
ea
AMOUNT
( )
Total Monthly Charge $
Total Annual Charge Calendar Year 2007 $
$
03-��5$
. ...���.
SECTION V- OPTION YEAR 4, JANUARY 1, 2008 THROIIGH DECEMBER 31, 2008
ITEM
1. Provide all ].abor, equipment and
material necessary for Fire
Suppression Services and related
work to and at VAMC and FSNC.
UNIT
QTY UNIT PRZCE
12 mo
AMOUNT
2. Specify a deduction, if any,
to the contract for use of
VAMC-owned fire truck, 1993
Emergency One, Inc., Model C803
Pumper Fire Truck, capacity
of 1250 GPM with 750 gallon poly
tank, and accessories
1 ea
( )
Total Monthly Charge $
Total Annual Charge Calendar Year 2007 $
TOTAL CONTRACT CHARGES, ALI, CALENDAg yEAgg $
END OF SCHEDULE OF IT RMC
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RFP 618-90-04
SSATEMENT OF WORK
A�. pLACE OF PEREORMANCE, PERFORMANCE PERIOD� AND REQUIREMENTS:
1. .Contract period wi11 be from date of awazd (estimated to be January 1,
2004) thraugh December 31, 2004 with options to renew £or four (4) additional
12 periods.
2. Veterans Affairs Medical Center (VAMC), One Veterans Drive, Minneapolis,
MN 55417 is a 133.75 acre facility located on a federal campus with 41
buildings. Al1 patient care buildings are fully sprinklered and staff
quarters have been equipped with smoke detectors. Fort Snelling National
Cemetery (FSNC), 7601 34 Avenue South, Minneapolis, MN 55450 is located
three and one-hal£ miles from the VAMC facilities and is a 933 acre,
developed and undeveloped campus, comprised of eight {8) buildings. Only
Building #3002 (Maintenance) is sprinklered. .
3. Contractor shall operate Fire Station facilities to provide Fire
Suppression Services to VAMC and FSNC campus buildings as indicated on
ATTACHMENTS in Part V of this solicitation. Contractor is required to
respond to a11 emergency calls and £ire alarms; provide 24 hours per day,
seven (7)�days per week, 365 days per year coverage under the provisions of a
firm-fixed price contract. The Contractor shall provide and may receive
services under formal mutual aid agreement(s).
4. Contractor to respond within eight (8) minutes of initial call with a
minimum of four (4) Fire Fighters. Contractor must meet requirements of
JCAHO and MP III, Part 3 and OSHA 1910.134. Contractor to provide pre-fire
planning, emergency medical and rescue services, elevator rescue services,
and hazardous material response to Level "A" entry as well as reset alarm
system at conclusion of incident response. "Response Time" shall be from the
moment of the alarm initiation until the responding apparatius actually stops
at the scene of the emergency incident.
5. Contractor to provide all manpower, equipment, supplies, and facilities.
No existing VAMC/FSNC facilities will be provided the successful Contractor.
6. Contractor shall ensure that adequate staffing levels are maintained at
a.tl times. Al2 respondinq Fire Fiqhters shall meet the minimvm NFPA
requirements for the position they hold, as well as be qualified at the
HazMat Technician level.
7. Contractor to provide and maintain pumping apparatus meeting the criteria
of National Fire Protection Association (NEPA) 1901, Standard for Pumger Fire
Apparatus and be capable of response at all times as required.
8. Fire Suppression: Contractor shall ensure that all Fire Department
operations are conducted in a safe manner and that all Fire Fighters are
knowledgeable in Fire Fighter Occupational Safety and Health Administration
(OSHA) and NFPA practices. Contractor sha11 comply with all provisions of
NFPA 1001, 1002, 1021, 1500, 1582, 472, 473 Standard on Fire Department
Occupational Safety and Aealth.
The Contractor shall use all available resources to safeguard human life and
property, and control and suppress all fires at VAMC, Minneapolis. The
Contractor shall maintain a fire watch on a11 structural fires and wild land
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03 1058
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fires following suppression until there is no possibility that a rekindle may
occur. The Contractor shall overhaul and perform salvage operations during
and following a fire in accordance with accepted practices as described in
the appropriate IFSTA Manuals. -
9. Contractor to provide and maintain an operational communications system
ufilizing radio equipment and telephone as necessary. Provide radio and
telephone communications procedural instruction for routine and emergency
use. The procedures shall be submitted to the Contracting Officer's
Technical Representative (COTR).for approval after award.
S0. Contractor to maintain Mutual Aid Radio Frequencies in all responding
Eire Department radios. The Contractor shall request Mutual Aid from Fire
Departments covered under Contractor's Mutual Aid agreements or contracts
when any fire or emergency situation is beyond the control of the Contzactor-
operated Fire Department.
11. Contractor and his/her employees shall become acquainted with and obey
all government regulations as posted and as requested by the VAMC Contracting
Officer's Technical Representative (COTR) when on facility campuses.
The Contractor shall �maintain an updated pre-£ire plan of the entire
contract-covered campuses following the procedures contained in International
Fire Service Training Association (IFSTA) Manual, "Fire Department Company
Officer." The Contractor sha11 conduct an initial and -periodic company
inspection to establish and update the pre-fire plan as needed. The pre-fire
plan shall be located on the responding apparatus for quick reference during
emergency calls. The pre-fire plan shall include, but is not limited to, the
following information:
a. VAMC will provide a site plan identifying the names and locations of
buildings, roads, fire hydrant locations, water mains, and property
boundaries at the VAMC, Minneapolis; Contractor to maintain and update as
necessary.
b. VAMC will provide an individual plan for each building showing
occupancy type, floor plan of each level or floor plan of each level or
floor, locations of utility shutdown, fire protection, system controls (i.e.
alarm annunciators, £ire sprinkler systems, Fire Department connections,
standpipe riser connections), locations of-any hazardous material storage,
anfl any potential £or life safety hazards; Contractor to maintain and update
as necessary. VAMC's Facilities Engineering Management Service staff will
provide assistance to the successful Contractor to locate above systems
control locations.
- c. A listing of telephone numbers and radio frequencies o£ persons or
departments that may be required for assistance. The list would include
VAMC/FSNC Police and Security Service, Facilities Engineering Management,
Boiler Plant Operator, and Telephone Operators.
12. Contractor Oversi ht: Contractor will desiqnate in writing a Contract
Manager (Fire Chief or other designee) responsible for the overall management
and coordination of the contract, contractor's work force, and act as the
central point of contact with the government-on matters dealing with the
complete supervision of all Fire Department activities, includinq fire
suppression, personnel training, education, structural fire fighting
operations, and rescue. This written designation shall be submitted to the
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RFP 618-90-04
Contracting OPficer (CO) within 10 days after award of contract. The Fire
Chief (Contract Manager) or alternate shall have £ull authority to act for
the contractor on all contractual matters relating to daily operation of this
contract. - �
The Contractor shall provide £or the preparation and submission of reports,
forms, personnel records, training reports, and other data incidental to the
performance of service under -this contract as specified in the contract or
required by the CO/COTR. Contractor will provide Monthly RUN REPORTS with
details indicatina r.ateaori.es o£ soeci£ic runs, i.e. £ire alarm, elevator
The Contractor shall assume full responsibility for the protection of its
personnel furnishing services under this contract in accordance with the
Contractor's personnel policy. To carry out this responsibility, the
Contractor shall provide worker's compensation, professional liability
insurance, health examinations, income tax withholding, social security
payments, �vacation and sick leave compensation. Such personnel shall not be
considered VAMC employees for any purpose.
13. Contractor Supervision: �The Contractor, as a result of this contractual
obligation to supervise the personnel furnished and oversee the quality of
their performance, is responsible £or all performance o£ work required by
this contract.
A11 Contractor employees shall be identified by a distinctive name
plate, emblem, or patch attached in a prominent place to an outer garment.
14. 5ecurity Requirements: The Contractor shall establish and implement
methods of ensuring that keys issued to the Contractor by the government are
not lost nor used by unauthorized persons. Keys issued to�the Contractor by
the government shall not be duplicated. The Contractor shall establish and
implement methods to ensure that lock combinations are not revealed to
unauthorized persons. These control methods shall be included in the quality
control plan.
The Contractor shall immediately notify the COTR of lost or duplicated keys.
In the event that keys are lost, the government, at its option, wi11
replace the affected locks or perform re-keying. In this case, the total
cost of re-keying or replacement shall be deducted from the monthly payment
due the contractor. In the event that a master key is lost or duplicated,
all locks and keys for that system will be replaced by the government and
tot'al cost shall be deducted from the monthly payment due.
The Contractor shall not permit unauthorized entry by persons into a fire
damaged building until the security of the building is turned over to the
appropriate VAMC authority.
15_ Property and Equipment Loss or Damage: A11 tasks accomplished by
Contractor personnel will be performed to preclude damage or disfigurement of
government-owned furnishings, fixtures, equipment, and architectural or
buildinq structures. The Contractor shall be responsible for all damages to
real and/or personal property or injuries to persons that occur as a result
of his/her actions or negligence.
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RFP 618-90-04 ,
The Contractor wi11 perform� repairs or replace government-owned eqaipment,
fixtures furnishings, architectural or building structures to their
previously existing condition and at his/her own expense when the CO/COTR
determines damage to be Contractor-caused.
When the Contractor has caused damage or loss of government equipment and/or
when performance is determined unsatis£actory, the COTR will prepare and
issue a Contract Discrepancy Report (CDR) through the Contracting Officer
(CO). The government reserves the right to hold the Contractor liable £or
losses sustained by the government as the direct consequence of a failure to
furnish the required personnel or services.
VAMC-owned 1993 Fire Truck (being used by current contractor) may be marked
with Contractor "decals" at contractor's expense.
16. Traininq: The Contractor shall develop and implement a comprehensive
training program to cover all aspects of fire suppression and other tasks.
The training program sha11 include pre-duty training, phase-in training and
refresher-recurring training in accordance with NFPA 1001. The Contractor
shall submit a written schedule to the COTR for approval of a11 training and
the subjects to be covered pzior to the start of work.
17. Quality Control: The Contractor sha11 - establish a complete quality
control program to ensure that a11 services are provided as specified in this
contzact.
18. Government Oversiqht: The contract is under the management of the
Contracting Officer (CO)_ The CO will designate a Contracting Officer's
Technical Representative (COTR) who wil1. represent the government on a day-
to-day basis. The Contracting Officer will advise the Contractor in writing
of the extent of the authority of the COTR. .
19. Government-Furnished Pro ertv: - FIRE ALARM SYSTEM: The government sha11
provide a fire detection and alarm system which meets the requirements o£ a
Centsal Station System as de£ined in NFPA Code 72, Protective Signaling
Systems. The signaling system (alarm system) for this facility shall
communicate directly to a constantly attended location whose purpose is
providing central dispatching services, or, at the Contractor's discretion,
shall transmit directly to the Contractors facility per VA Safety Guidebook.
Costs incurred for this connection and service will be borne by the
Contractor. . _
Signals shall be transmitted from the protected premises using a digital
alarm communicator via phone line to the receiving station indicated above.
�n receipt of fi=e alarm signals any central station will immediately
retransmit those signals to the Contractor.
OTHER A,LARMS: Alarms other than £ire alarms will be� handled, accept in rare
occurrences, by in-house personnel and wi11 not be a part of this contract
(i.e. blood bank alarm, panic alarms, odors, oxygen alarms).
20. Contractor-Furnished Propertv: The - Contractor shall furnish all
materials, equipment and tools necessary to safely and properly perform the
tasks specified. Contractor's equipment shall comply with a11 safety
standards. The Contxactor sha11 provide a11 vehicles required to fulfill the
requirements of this contract. Vehicles shall meet NFPA 1901 Standards and
meet applicable local, State, and Federal safety requirements. Note that
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03-/058
RFP 618-90-04
Contractor will
provide adequate
fire hydrants.
provide Pire hydrant connection adapters as necessary to
hose connections from Contractor's £ire truck to VAMC/FSNC
2i. Emergency Medical Service and Rescue: The Contractor shall have the
equipment and training necessary to respond to requests for emergency medical
aid and rescue. This service shall meet the requirements o£ the local
Emergency Medical Services o£ Hennepin County. Contractor personnel shall be
equipped and trained to at least the EMT-B (Emergency �Medical Technician
Basic) level. This service would be required for, but not limited�to, the
following types of incidents: Trauma victims in case of vehicle accidents,
falls, violent crime, fire, hazardous material exposure, elevator
extrication, confined space extrication, building collapse, or assistance for
persons with medical emergencies that need advanced life support.
22. Hazardous Material Response: The Contractor shall respond to hazardous
material spills when requested. The Contractor shall abide by the provisions
of the Superfund Amendments and Reauthorization Act of 1986 (SARA) and other
Federal, State, and local laws regarding emergency responders at hazardous
material incidents. The Contractor sha11 have an emergency response plan to
handle anticipated hazardous material emergencies as outlined in Title III of
SARA. Contractor personnel shall be trained to at least the Technician Level
as defined in Federal OSHA 1910.120 and NFPA 472, Standard for Pro£essional
Competence of responders to Hazardous Materials Incidents. She Contractor
shall provide Level "A" entry to hazardous materials incidents for
mitigation. The Contractor shall per£orm all clean-up of spills or leaks of
five (5) U.S. gallons or less.
23. Performance Requirements Summarv: The Contractor shall use all available
resources to safeguard human life and property, control and suppress all
fires at the VAMC/FSNC, Minneapolis, MN. Contractor shall:
Receive emergency calls
Dispatch emergency equipment
Issue evacuation alerts -
Respond to fire calls (Pire, smoke, alarms, auto extrication)
neterm3ne cause and origin o£ odors (rarely, but upon reque�
- Respond to medical emergencies
Respond to hazardous materials (HazMat) incidents (leaks, spills,
Determine cause and origin o£ HazMat indcident
Perform Level "A" Entry as required
Perform confined space rescue
Perform elevator extrication
Respond to suicide stand-by incidents (aiding VAMC police who
first responder)
Have mutual aid response policy in place
vapors)
will be
(Normally, all odor "alarms" will be handled internally by VAMC personnel for
resolution. VAMC personnel are responsible for fire code inspections and
enforcement.l
B. APPI,ICABLE REGULATIONS, STANDARDS� CODES AND MANCTALS
1. The £ollowing apply, as specified, to the requirements of the contract:
a. Federal Occupational Safety and Health Association (OSHA).
11
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RFP 618-90-04
b. National Fire Codes (NFPAJ.
c. International Fire Service Training,Association (IFSTA) Manuals.
d. VA Manual: MP III, Part III.
e. Joint Commission Accreditation for Hospitals Organization
f. VAMC fire suppression/fire safety policies -
_ g. Life Sa£ety Code, 2000 edition
The publications are incorporated by reference into this contract and are
supplemental to this specification. These publications are available for
inspection in Acquisition and Material Management Service (AMMS), Room 4G-
107, Building �70, upon,request, up to the time of date for receipt of
offers. The Contractor is to maintain on file at his/her own expense the
current and latest edition of, each applicable publication. The Contracting
Officer will provide the successful Contractor with current VA publications
(i.e. fire suppression/fire safety).
2. Insurance: Contractor must have insurance coverage whereby he/she
undertakes to indemni£y or guarantee against loss by specified contingency or
peril. Contractor shall have at the very least the minimum amount o£
insurance mandated by governing State laws for this operation. Present a
copy of insurance coverage to the Contrahting O£ficer upon receipt oP award.
3. Correspondence: All correspondence relative this contract sha11 bear
the contract and purchase order numbers. . -
4. A11 re£erences, any drawings or blueprints £urnished are for informational
purposes only. Such references do not necessarily indicate that locations or
function designations will remain stable; they may be changed by VAMC or FSNC
Director. Changes will be coordinated with the Contractor by the Contracting
Officer prior to the initiation of such changes in order to ensure adequate
contractual coverage.
C. GENERAI+ INE'ORMATION
1. VA Medical Center, Bldg. 70, was occupied in June, 1988. This building
has several fire prevention mechanisms - it is fully sprinklered and has a
smoke controlled zoning system which puts the zone in alarm and in exhaust
while pressurizing'surrounding zones (all smoke detectors were replaced in
B1dg. 70 in 2002). There are full alarms and automatic door closures for
containment of any £ire that may occur. There is a na smoking policy for all
buildings. �
For Bldg. 70, from initial occupancy in 1988- through 1999, only two (2)
actual fires with smoke or flames have occurred - a mattress set on fire by a
patient in a seclusion room, and one in the Cafeteria kitchen, both of which
were suppressed by on-site first responders. There have been no fires with
flames during the preceding contract period of 1999 through 2003. There have
been no actual fires at the National Cemetery in the last 15-year period.
The Cemetery campus is located 3.2 miles from the medical center.
END OF STATEMENT OF WORK
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3
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��� � �E•� � � d
CONTRACT ADMINISTRATION DATA
l. PAYMENT�
(a) Payment will be made in arrears upon receipt of a properly prepared
invoice. - -
(b) Invoices shall be submitted in the ORIGINAL ONLY, unless otherwise
specified, and shall contain the following information: contract number,
order number, item(s) number(s), description of services, sizes, quantities,
unit prices and extended totals.
(c) Submit invoices to the�following payment office: -
Chief, Fiscal Service (618/04)
VA Medical Center
One Veterans Drive
. Minneapolis, MN 55417
(d) Prior to payment,'the accuracy of each invoice will be certified by the
Contracting Officer's designated representative. �
2. A11 contract administration matters will be handled by the following
individuals:
a. CONTRACTOR:
T elephor.e :
Faxcimile:
E-mai1:
b. GOVERNMENT: Contractinq Officer (90C)
V A Medical Center
One Veterans Drive
Minneapolis, MN 55417
Tel: 612-725-2188
Fax: 612-725-2072
3. CONTRACTOR'S REMITTANCE ADDRESS
Offeror shall indicate the address to which Government checks shall be mailed
for payment of invoices submitted under any resultant contract:
ADDRESS:
Respondents shall indicate their Federal Ta�ayer ldentification Number:
OFFERORS MVST COMPLETE AND RETURN ALL INFORMATION DESIGNATED SN 52.212-1�
INSTRUCTIONS TO OFE'ERORS - COML�RCIAL ITEMS, PARAGRAPH "b", P.t�7D COMPLETE
52.212-3, OFFEROR REPRESENTATIONS AND CERTIFICATIONS - COfIl�RCIAL ITEMS PRIOR
TO THE TIME SPECIFIED IN BLOCK 8 OF SF 1449 IN ORDER TO BE CONSIDERED EOR
AWARD.
13
j�3 •� O sg RFP 618-90-04 R
DUNS NUMBER: Please provide the Dun and Bradstreet Number assigned to your
firm in the space provided below: - _
DUNS#
ACFQIOWLEDGMENT OF AMENDMENTS: The of£eror acknowledges receipt of amendments
to the Solicitation numbered and dated as follows: -
AMENDMENT NUMBER DATE
Sealed offers for £urnishing the supplies or services in the Schedule will be
received at the address specified in Block 9 of SF 1449, or if handcarried,
to the address shown in Block 15, until the date and time specified in Block
8. CAUTION - LATE Submissions, Modifications, and Withdrawals: See
provision 52.212-1. All offers are subject to all terms and conditions of
this solicitation.
Electronic offers will not be accepted.
Office of Inspector General of the Department of Health and Human Services
(IG/HHS) has made a determination that prior to obligating 'VA contracts,
purchase orders, task and delivery orders, and purchase cards orders gaid
with VA health care funds may not be entered into with any individual; entity
or organization that has been listed on the HHS/OIG Exclusionary List. VA
does not have the burden of defending the merits o£ the HHS/OZG decision
established under �42 U.S.C. 1320a-7.
The Government may award a contract on the basis of initial of£ers received,
without discussions. Therefore, each initial of£er should contain the
offeror's best terms from a cost/price and technical stanrlpoint. The
Government will award a single aggregate contract contingent upon best value
and the offeror's ability to meet a11 requirements.
END OF CONTRACT ADMINISTRATION DATA
END OF PART I.
14
�
03'/0� �
RFP 618-90-04
PART II - CONTRACT TERMS AND COHIJITIONS
52.212-4 CONTRACT TERMS AND CONDITIONS - COMMERCIAL ZTEMS. (OCT 2003)
(a) Inspection/Acceptance. The Contractor shall only tender for accegtance
those items that conform to the requirements of this contract. The Government
reserves the right to inspect or test any supplies or services that have been
tendered £or acceptance. The Government may require repair or replacement o£
noncon£orming supplies or reperformance of nonconforming services at no
increase in contract price. The Government must exercise its post-acceptance
rights -
(1) Within a reasonable time after the defect was discovered or should
have been discovered; and -
(2) Before any substantial change occurs in the condition of the item, unless
the change is due to the defect in the item.
(b) Assignment. The Contractor or its assignee �may assign its rights to
receive payment due as a result of performance o£ this contract to a bank,
trust company, or other financing institution, including any Federal lending
agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727).
However, when a third party makes payment (e.q., use of the Governmentwide
commercial purchase card), the Contractor may not assiqn its rights to
receive payment under this contract.
(c) Changes. Changes in the terms and conditions of this contract may be made
only by written agreement of the parties.
(d) Disputes. This contract is subject to the Contract Disputes Act�of 1978,
as amended (41 U.S.C. 601-613). Failure of the parties to this contract to
reach agreement on any request for equitable adjustment, claim, appeal or
action arising under or relating to this contract shall be a dispute to be
resolved in accordance with the clause at FAR 52.233-1, Disputes, which is
incorporated herein by reference. The Contractor shall proceed diligently
with performance of this contract, pending final resolution of any dispute -
arisinq under the contract. � � '
(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated
herein by reference.
(f) Excusable delays. The Contractor sha11 be liable for default unless
nonperformance is caused by an occurrence beyond the reasonable control of
the Contractor and without its fault or negligence such as, acts of God or
the public enemy, acts of the Government in either its sovereign or
contractual capacity, fires, £loods, epidemics, quarantine restrictions,
strikes, unusually severe weather, and delays of common carriers. The
Contractor shall noti£y the Contracting Officer in writing as soon as it is
reasonably possible after the commencement of any excusable delay, setting
forth the full particulars in connection therewith, shall remedy such
occurrence with all reasonable dispatch, and shall promptly give written
notice to the Contracting Officer of the cessation of such occurrence.
(g) Invoice.
EE
�3���8 RFP618-90-04 �
(1) The Contractor sha11 submit an.original invoice and three copies
(or electronic invoice, if authorized) to the address designated in the
contract to receive invoices. An invoice must include -
(i) Name and address o£ the Contractor;
(ii) Invoice date and number;
�(iii) Contract number, contract Iine item number and, if
applicable, the order number; .
(iv) Description, quantity, unit of ineasure, unit price and
extended price of the items delivered;
(v) Shipping number and date of shipment, including the bi11 of
lading number and weight of shipment if shipped on Government bill of lading;
(vi) Terms of any discount for prompt payment o£fered;
(vii) Name and address of official_to whom payment is to be sent;
- (viii) Name, title, and phone number of person to notiEy in event
of defective invoice; and �
(ix) Taxpayer ldentification Number (TIN). The Contractor sha11
include its TIN on the invoice only if required elsewhere in this contract. �
(x) Electronic funds transfer (EFT) banking information.
(A) The Contractor shall include EFT banking information on
the invoice only if required elsewhere in this contract.
(B) If EET banking in£ormation is not required to be on the
invoice, in order for the invoice to be a proper invoice, the Contractor
shall have submitted correct EFT bankincj information in accordance with the
applicalale solicitation provision, contract clause (e.g., 52.232-33, Payment
by Electronic Funds Transfer - Central Contractor Registration, or 52.232-34,
Payment by Electronic Funds Transfer - Other Than Cent=al Contractor
Registration), or applicable agency procedures.
(C) EFT banking information is not required if the
Government waived the requirement to pay by EFT.
(2) Invoices will be handled in accordance with the Prompt Payment Act
(31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment
regulations at 5 CFR part 1315. .
(h) Patent indemnity. The Contractor shall indemniPy the Government and its
officers, employees and agents against liability, including costs; for actual
or alleged_diiect or contributory infringement of, or inducement to infringe,
any United States or foreign patent, trademark or copyright, arising out of
the per£ormance of this contract, provided the Contractor is reasonably
notified of such claims and proceedings.
(i) Payiaent.-(1) Items accepted. Payment shall�be made for items accepted by
the Government that have been delivered to the delivery destinations set
forth in this contract. -
�
03 -lo�P
RFP 618-90-04
(2) Prompt payment. The Goveinment will make payment in accordance with
the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5
CFR part 1315. . -
(3) EZectronic Funds Transfer (EFTJ. If the Government makes payment by
EFT, see 52.212-5(b) for the appropriate EFT clause.
(4J -Discount. In connection with any discount offered for early
payment, time shall be computed from the date of the invoice. For the purpose
of computing the discount earned, payment -shall be considered to have been
made on the date which appears on the payment check or the specified payment
date if an electronic funds transfer payment is made.
(5) Ovespayments. If the Contractor becomes aware of a duplicate
contract financing or invoice payment or that the Government has otherwise
overpaid on a contract financing or invoice payment, the Contractor shall
immedia'tely notify the Contracting Officer and request instructions for
disposition of the overpayment.
(j) Risk of loss. Unless the contract specifically provides otherwise, risk
of loss or damage to the supplies provided under this contract shall remain
with the until, and shall pass to the Government upon:
(1) Delivery of the supplies to a carrier, if transportation is f.o.b.
origin; or -
(2) .Delivery of the supplies to the Government at the destination
specified in the contract, if transportation is f.o.b. destination.
(k) Taxes. The contract price includes all applicable Federal, State, and
local taxes and duties.
(1) Termination for the Government's convenience. The Government reserves the
riqht to terminate this contract, or any part hereof, for its sole
convenience. In the event of such termination, the Contractor shall
immediately stop all work hereunder and shall immediately cause any and all
of its suppliers and subcontractors to cease work. Subject to the terms of
this contract, the Contractor shall be paid a percentage of the contract
price re£lecting the percentage o£ the work performed prior to the notice of
termination, plus reasonable charges the Contractor can demonstrate to the
satisfaction of the Government using its standard record keeping system, have
resulted from the termination. The Contractor shall not be required to comply
with the cost accounting standards or contract cost principles for this
purpose. This paragraph does not give the Government any right to audit the
Contractor's records. The Contractor shall not be paid for any work performed
or costs incurred which reasonably could have been avoided.
(m) Termination for cause. The Government may terminate this contract, or any
part hereof, for cause in the event of any default by the Contiactor, or if
the Contractor fails to comply with any contract terms and conditions, or
£ails to provide the Government, upon request, with adequate assurances of
future performance. In the event of termination for cause, the Government
shall not be liable to the Contractor for any amount for supplies or services
not accepted, and the Contractor shall be liable to the Government for any
and a11 rights and remedies provided by law. If it is determined that the
Government improperly terminated this contract for default, such termination
shall be deemed a termination for convenience.
17
a3 _ � v 5 g RFP 618-90-04 •
(n) Title. Unless specified elsewhere in this contract, title to items
furnished under this contract shall: pass to the Government upon acceptance,
regaidless of when or where the Government takes physical�possession.
(o) Warranty. The Contractor warrants and implies that the items delivered
hereunder are merchantable and fit for_ use for the particular purgose
described in this contract. -
(p) Limitation of liability. Except as otherwise provided by an express
warranty, the Contractor will not be liable to the Government £or
consequential damages resulting from any defect or deficiencies in accepted
items.
(q) Other compliances. The Contractor shall comply with all applicable
Federal, State and local laws, executive orders, rules and regulations
applicable to its performance under this contract.
(r) Compliance with laws unique to Government contracts. The Contractor
agrees to comply with 31 U.S.C. 1352 relating to limitations on the use of
appropriated funds to influence certain Federal �contracts; 18 U.S.C. 431
relating to officials not to benefit; 40 U.S.C. 327, et seq„ Contract Work
Hours and Safety Standards Act; 41 U.S.C. 51-58, Anti-Kickback Act of 1986;
41 U.S.C. 265 and 10 U.S.C. 2409 relating to whistleblower protections; 49
U.S.C. 40118, F1y American; and 41 U.S.C. 423 relating to procurement
integrity. .
(s) Order of precedence. Any inconsistencies in this solicitation or contract
shall be resolved by giving precedence in the following order:
(1) The schedule of supplies/services. � ,
(2) The 14ssignments, Disputes, Payments, Invoice, Other Compliances,
and Compliance with Laws Unique to Government Contracts paragraphs of this
clause.
(37 The clause at 52.212-5.
. (4) Addenda to this solicitation os contract, including any license
agreements for computer software.
(5) Solicitation provisions if this is a solicitation.
(6) Other paragraphs of this clause.
(7) The Standard Form 1449.
(8) Other documents, exhibits, and attachments.
(9) The specification. _
(t) Central Contractor Registration (CCR). (1) Unless exempted by .an_addendum
to this contract, the Contractor is responsible during performance and
through final payment o£ any contract for the accuracy and completeness of
the data within the CCR database, and for any liability resulting from the
Government's reliance on inaccurate or incomplete data. To remain registered
in the CCR database after the initial registration, the Contractor is
required to review and update on an annual basis from the date of initial
�3
U3-/o5�
RFP 618-90-04 .
registration or subsequent updates its information in the CCR database to
ensure it is current, accurate and complete. Updating information in the CCR
does not alter the terms and conditions �of this contract an@ is not a
substitute for a properly executed contractual document.
� (2)(i) If a Contractor has legally changed its business name, "doing
business as" name, or division name (whichever is shown on the contract), or
has transfesred the assets used in performing the contract, but has not
completed the necessary requirements regarding novation -and change-of name
agreements in FAR Subpart 42.12, the Contractor shall provide the responsible
Contracting Officer a minimum of one business day's written notification o£
its intention to (A) change the name in the CCR database; (B) comply with the
reguirements of Subpart 42.12; and (C) agree in writing to the timeline and
procedures specified by the responsible Contracting Officer. The Contractor
must provide with the noti£ication sufficient documentation to support the
legally changed name.
(ii) I£ the Contractor fails to comply with the requirements of
paragraph (t)(2)(i) of this clause, or fails to perform the agreement at
paragraph (t)(2)(i)(C) of this clause, and, in the absence .of a properly
executed novation or change-of name agreement, the CCR information that shows
the Contractor to be other than the Contractor indicated in the contract will
be considered to be incorrect information within the meaning of the
"Suspension of Payment" paragraph of the electronic funds transfer (EFT)
clause of this contract.
(3)� The Contractor shall not chanqe the name or address £or EFT
payments or manual payments, as appropriate, in the CCR record to reflect an
assignee for the purpose of assignment ,
of claims (see Subpart 32.8, Assignment of Claims). Assignees sha11 be
separately registered in the CCR database. Information provided to the
Contractor's CCR record that indicates payments, including those made by EFT,
to an ultimate recipient other than that'Contractor will be �considered to be
incorrect information within the meaning of the "Suspension of payment"
paragraph of the EFT clause of this contract.
(4) Offerors and Contractors may obtain information on registration and
annual con£irmation requirements via the internet at http://www:ccr.gov or by
calling 1-888-227-2423 or 269-961-5757.
(End of clause) . ,
ADDENDA TO 52.212-4� CONTRFaCT TERMS AND CONDITIONS - CObA1ERCIAL ITEMS
52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) �
This contract incorporates one or more clauses by reference, with the same
£orce and effect as if they were� given in full text. Upon request, the
Contracting Officer will make their £ull text available. Also, the full text
o£ a clause may be accessed electronically at this/these address(es):
FAR www.arnet.gov/£ar/
VAAR www.va.gov/oa&mm/vaar/index.htm
(end of clause)
19
o3'toSB
(A) E'EDERAL ACQUISITION REGULATIONS (4$ CFR CHAPTER 1):
52.232-18 AVAILABILITY OF FONDS.
52.232-19 AVAILABLITY OF FUNDS FOR THE NEXT FISCAL YEAR
(Funds are not currently available beyond 9/30/04)
52.232-38 SUBMISSION OF ELECTRONIC FUNDS TRANSFER INEORMATION
WITH OFFER - -
52.237-2 PROTECTION OF GOVERNMENT BUILDINGS, EQUIPMENT AND
VEGETATION � -
52.237-3 CONTINUITY OF SERVICES - .
(B) VETERANS AFFAIRS ACQUISITION REGULATIONS (48 CER CHAPTER 8):
852.203-71 DISPLAY OF VA AOTLINE POSTER
852-211-75 TECHNICAL INDUSTRY STANDARDS
852.237-70 CONTRACTOR RESPONSIBILITIES.
852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS.
852.270-4 COMMERCIAL ADVERTISING.
52.204-7 CENTRAL CONTRACTOR REGISTRAT�ION (OCT 2003)
RFP 618-90-04 �
APR 1984
APR 1984
MAY 1999
APR 1984
JAN 1991
DEC 1992
APR 1984
APR 1984
APR 1984
NOV 1984
(a) De£initions. As used in this clause- . .
"Central Contractor Registration (CCR) database" means the primary
Government repository for_Contractor information required for the conduct of
business with the Government.
"Data Universal Numbering System (DUNS) number^ means the 9-digit
number assigned by Dun and Bradstreet, Inc. (D&B) to identify unique business
entities. �
"Data Universal Numbering System +4 (DUNS+4) number" means the DUNS
number assigned by D&B plus a 4-character suffix that may be assigned by a
business concern. (D&B has no affiliation with this 4-character su££ix.) This
4-character suffix may be assigned�at the disczetion of the business concern
to establish additional CCR records for identifying alternative Electronic
Funds Transfer (EFT} accounts (see the FAR at Subpart 32.11) for the same
parent concern.
"Registered in the CCR database" means that-
(1� The Contractor has entered all mandatory information, including
the DUNS number or the DUNS+4 number, into the CCR database; and �
(2) The Government has validated a11 mandatory data fields and has
marked the record "Active".
(b) (1) By submission of an offer, the offeror acknowledges the
requirement that a prospective awardee shall be registered in the CCR
database prior to award, during performance, and throuqh final payment of any
contract, basic agreement, basic ordering agreement, or blanket purchasing
agreement resulting from this solicitation. �
(2) The offeror shall enter, in the block with its name and address
on the cooer page of its offer, the annntation "DUNS" or "DUNS +4" followed
by the DUNS or DUNS +4 number that identifies the offeror's name and address
exactly as stated in the offer. The DUNS number will be used by the
Contracting Officer to verify that the offeror is registered in the CCR
database.
(c) If the offeror does not have a DUNS number, it should contact Dun
and Bradstreet directly to obtain one._
(1) An of£eror may obtain a DUNS number-
(i) IP located within the United States, by calling Dun and
Bradstreet at 1-866-705-5711 or via the Internet at http://www.dnb.com; or
f►�li
03-/OS?
,
�•. : •� ��
(ii) If located outside the United States, by contacting the
local Dun and Bra�dstreet office. _ �
�(2) The_ o££eror should be prepared to provide the following
in£ormation: - - -- - - � -
(i) Company legal business.
- (ii) Tradestyle, doing business, or other name by which your
entity is commonly recognized.
(iii) Company Physical_Street Address, City, State, and Zip
Code.
(iv) Company Mailing Address, .City, State and Zip Code (if
separate from physical).
(v) Company Telephone Number.
(vi) Date the company was started.
(vii) Number of employees at your location.
(viii) Chief executive officer/key manager.
� (ix) Line of business (industry).
(x) Company Headquarters name and address (reporting
relationship within your entity).
(d) If the Offeror does not become registered in the CCR database in the
time prescribed by the Contracting Officer, the Contracting Officer wi11
proceed to award to the next otherwise successful registered Offeror.
. (e) Processing time, which normally takes 48 hours, should be taken into
consideration when registering. Offerors who are not registered should
consider applying for registration immediately upon receipt of this
solicitation.
(f) The Contractor is responsible for the accuracy and completeness of
the data within the CCR database, and for any liability resulting from the
Government's reliance on inaccurate or incomplete data. To remain registered
in the CCR database after the initial reqistration, the Contractor is
required to review and update on an annual basis fzom the date of initial
registration or subsequent updates its information in the CCR database to
ensure it is current, accurate and complete. Updating information in the CCR
does not alter the terms and conditions of this contract and is not a
substitute for a properly executed contractual document.
(g) (1) (i) If a Contractor has Iegally changed its business name,
"doing business as" name, or division name (whichever is shown on the
contract), or has transferred the assets used in performing the contract, but
has not completed the necessary requirements reqarding novation and change-
of-name agreements in Subpart� 42.12, the Contractor shall provide the
responsible Contracting Officer a minimum of one business day's written
notification of its intention to (A) change the name in the CCR database; (B)
comply with the requirements of Subpart 42.12 of the FAR; and (C) agree in
writing to the timeline and procedures specified �by the responsible
Contracting Officer. The Contractor must provide with the notification
sufficient documentation to support the legally changed name. "
(ii) If the Contractor fails to comply with the requirements of
paragraph (g)(1)(i) of this clause, or fails to perform the agreement at
paragraph (g)(1)(i)(C) of this clause, and, in the absence of a properly
executed novation or change-of-name agreement, the CCR information that shows
the Contractor to be other than the Contractor indicated in the contract will
be considered to be incorrect information within' the meaning of the
"Suspension of Payment" paragraph of the electronic funds transfer (EFT)
clause of this contract.
(2) The Contractor shall not change the name or address for EFT
payments or manual payments, as appropriate, in the CCR record to reflect an
assignee for the purpose of assignment of claims (see FAR Subpart 32.8,
Assignment of Claims). Assignees shall be separately registered in the CCR
21
v3-to58
RFP 618-90-04
database. Information provided to the Contractor's CCR record that indicates
payments, including those made_ by EFT, to an ultimate recipient other than
that Contractor will be considered to be incorrect information within the
meaning of the "Suspension of payment" paragraph of the EFT clausz of this
contract. - -
ih) Offerors and Contractors may obtain information on registration and
annual confirmation requirements via the internet at http://www.ccr.gov or by
calling 1-888-227-2423, or 269-961-5757.
52.217-8 Option to Extend Services (Nov 1999)
The Government may require continued performance of any services within the
limits and at the rates specified in the contract. These rates may be
adjusted only as a result o£ revisions to prevailing labor rates provided by
the Secretary of Labor. The option provision may be exercised more than once,
but the total extension o£ performance hereunder shall not exceed 6 months.
The Contracting Officer may exercise the option by written notice to the
Contractor within 30 days of contract expiration. - �
(End of clause)
52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT. (MAR 2000)
(a) The Government may extend the term of this contract by written notice to
the Contractor within the time specified in the contract; provided that the
Government gives the Contractor a preliminary written notice of its intent to
extend at least 30 days before the contract expires. The preliminary notice
does not commit the Government to an extension.
(b) If the Government exexcises this option, the extended contract shall be
considered to include this option clause. - .
(c) The total duration of this contract, including the exercise of any
options under this clause, shall not exceed the time speci£ied in the
contract.
(end o£ clause)
52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IM
STATUTES OR
(a) The Contractor shall comply with the following federal Acquisition
Regulation Clause (FAR), which is incoxporated in this contract by reference,
to implement provisions of law or Executive orders applicable to acquisitions
of commercial items: 52.233-3, Protest after. Award (AUG 1996) (31U.S.C.
3553).
(b) The Contractor shall comply with the FAR clauses in this paragraph (b)
t'hat the Contracting Officer has indicated as being incorporated in this
contract by reference to implement provisions of law or Executive orders
applicable to acquisitions of commercial items:
(Contracting Officer must check as appropriate.)
X (1) 52.203-5, Restrictions on Subcontractor Sales to the Government (JUL
1995), with Alternate I(OCT 1995) (41 II.S.C. 253g and 10 U.S.C. 2402).
22
03-/O5�
,
RFP 618-90-04
N/A (2) 52.219-3, Notice of HUBZone Small Business Set-Aside (JAN 1999)
(15 U.S.C. 657a).
X (3) 52.219-4, Notice Price Evaluation Preference for HUBZOne Small
Business Concerns (JAN 1999) (if the offeror elects to waive the preference,
it sha11 so indicate in its offer) (15U.S.C_ 657a). �
N/A (4)(i)52.219-5, Very Small Business Set-Aside (JUNE 2003) (Pub. L.
103-403, section 304, Small business Reauthorization and Amendments Act of
1994).
N/A (ii) Alternate I(MP.R 1999) of 52.219-5
N/A (iii) Alternate II (JUNE 2003j of 52.219-5.
N/A (5)(i) 52.219-6, Notice of Total Small Business Set-Aside (JUNE 2003)
(15 U.S.C. 644). -
N/A (ii) Alternate I(OCT 1995) of 52.219-6
N/A (6)(i) 52.2'_9-7, Notice of Partial Small Business Set-ASide (JUNE
2003) (15 U.S.C. 644).
N/A (ii) Alternate I(OCT 1995) of 52.219-7
X (7)(i) 52.21h-8, Utilization of Small Business Concerns (OCT 2000J (15
U.S.C. 637 (d)(2) and (3)}.
X (8)(i) 52.219-9, Small Business Subcontracting Plan (JAN 2002) (15
U.S.C. 637(d)(4)).
N/A (ii) Alternate I(OCT 2001) of 52.219-9
N/A (iii) Alternate II (OCT 2001) of 52.219-9.
N/A (9) 52.219-1�, Limitations on Subcontracting (DEC 1996) (15 U.S.C.
637(a) (14)). . �
X (10)(i) 52.219-23, Notice of Price Evaluation Adjustment for Small
Disadvantaged Business Concerns (JUNE 2003) (Pub. L. 103-355, section 7102,
and 10 U.S.C. 2323) (if the offeror elects to waive the adjustment, it shall
so indicate in its offer).
N/A (ii) Alternate I(JUNE 2003) of 52.21°-23.
X (11) 52.219-25, Small Disadvantaged Business Participation Program--
Disadvantaged Status and Reporting (OCT 1999) (Pub. L. 103-355, section 7102,
and 10 U.S.C. 2323).
N/A (12) 52.219-25, Sma11 Disadvantaged Business Participation Program--
Incentive Subcontracting (OCT 2000J (Pub. L. 103-355, section 7102, and 10
U.S.C. 2323).
X (13) 52.222-3, Convict Labor (JUNE 2003) (E.O. 11755).
N/A (14) 52.Z22-19, Child Labor-Cooperation with Authorities and Remedies
(SEP 2002) (E.O. 13126)
X_ (15) 52.222-2?, Prohibition oP Segregated Facilities (FEB 1999).
23
a3 - /058
RFP 618-90-04
X_ (16) 52.222-26, Equa1 Opportunity (APR 2002) (E.O. 11246).
X (17) 52.222-35, Equal Opportunity for Special Disabled Veterans,
Veterans of the Vietnam Era, and Other Eligible Veterans (DEC 2001) (38
U.S.C. 4212). . ' _ � - -
X (18J 52.222-36, Affirmative Action for Workers with Disabilities (JUN
1998) (29 U.S.C. 793).
X (19J 52.222-3'., Employment Reports on Special Disabled Veterans,
Veterans of the Vietnam Era, and Other Eligible Veterans (DEC 2001) (38
U.S.C. 4212). .
N/A (20)(i) 52.223-9, Estimate of Percentage of Recovered Material Content
for EPA-Designated Products (AUG 2000) (42 U.S.C. 6962(c)(3)(A)(ii)). -
N/A (ii) Alternate I(AUG 2000) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)).
N/A (21) s2.225-1, Buy American Act -- Supplies (JUNE 2003) (41 U.S.C.
l0a-lOd). '
N/A (22)(i) 52.225-3, Buy American Act - North American Free Trade
Agreement - Israeli Trade Act (JONE 2003) (41 U.S.C. l0a-lOd, 19 U.S.C. 3301
note, 19 U.S.C. 2112 note). � - -
N/A (ii) Alternate I(MAY 2002) of 52.225-3.
N/A (iiij Alternate II (MAY 2002)0£ 52.225-3.
X (23) 52.225-5, Trade Agreements (OCT 2003) (19 U.S.C. 2501, et seq., 19
U.S.C. 3301 note).
X (24) 52.225-13, Restriction� on Certain Foreign Purchases (OCT 2003)
(E.o.s, proclamations, and statutes administered by the OPfice o£ Foreign
Assets Control of the Department of the Treasury). ,
N/A (25) 52.225-15, Sanctioned European Union Country End Products (FEB
2000)(E.O. 12849).
N/A (26) 52.225-16, Sanctioned European Union Country Services (FEB 2000j
(E.O. 12849).
N/A (27) 52.232-29, Terms for Financing of Purchases of Commercial Items
(FEB 2002) (41 U.S.C. 255(f), 10 U.S.0 2307(f)).
N/A (28) 52.232-30, Installment Payments for Commercial Items (OCT 1995)
(41 U.S.C. 255(f), 10 U.S.C. 2307(f)).
X (29) 52.232-33, Payment by Electronic Funds Transfer-Central Contractor
Registration (OCT 2003) (31 U_S.C. 3332).
X_ (30) 52.232-34, Payment by Electronic Funds Transfer-Other Than Central
Contractor Registration (MAY 1999) (31 U.S.C. 3332).
N/A (31) 52.232-36, Payment by Third Party (MAY 1999} (31 U.S.C. 3332).
24
� • 03-10�8
. .
. ..:•��-
N/A (32) �2.239-1, Privacy or Security Sa£eguards (AUG 1996) (5 U.S.C.
552a).
N/A (33)(i) 52.2�7-c�, Preference £or Privately Owned U:S.-Flag Commercial
Vessels (APR 2003) (46 U.S.C. Appx 1241 and 10 U.S.C. 2631). �
N/A (ii) Alternate Z(APR 1984) of 52.247-64.
(c) The Contractor shall comply with the FAR clauses in this paragraph (c),
applicable to-commercial services� that the Contracting Officer has indicated
as being incorporated in this contract by reference to implement provisions
of law or Executive orders applicable to acquisitions o£ commercial items:
(Contracting Officer check as appropriate.)
X (1) 52.222-41, Service Contract Act of 1965, As Amended (MAY 1989) (41
U.S.C. 351, et seq.). �
X (2) 52.222-42, Statement of Equivalent Rates for Federal Iiixes (MAY
1989) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.).
X (3) 52_222-43, Fair Labor Standards Act and Service Contract Act -
Price Adjustment (Multiple Year and Option Contracts) (MAY 1989) (29 U.S.C.
206 and 41 U.S.C. 351, et seq.).
N/A (4) 52.222-44, Fair Labor Standards Act and Service, Contract Act -
Price Adjustment (FEB 2002) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.).
N/A (5) 52.222-47, SCA Minimum Wages and Fringe Benefits Applicable to
Successor Contract Pursuant to Predecessor Contractor Collective Bargaining
Agreement (CBA) (MAY 1989) (41 U.S.C. 351, et seq.).
(d) Comptroller General Examination of Record. The Contractor shall conply
with the provisions of this paragraph �(d) if this contract was awarded using
other than sealed bid, is in excess of the simplified acquisition threshold,
and does not contain the clause at 52.215-2, Audit and Records - Negotiation.
(1) The Comptroller General of the United States, or an authorized
representative of the Comptroller General, shall have access to and right to
examine any of the Contractor's directly pertinent records involving
transactions related to this contract. �
(2) The Contractor shall make available at its offices at all
reasonable times the records, materials, and other evidence for examination,
audit, or reproduction, until 3 years after final payment under this contract
or for any shorter period specified in FAR Subpart 4.7, Contractor Records
Retention, of the other clauses of this contract. If this contract is
completely or partially terminated, the records relating to the work
terminated sha11 be made available for 3 years after any resulting final
termination settlement. Records relating to appeals under the disputes clause
or to litigation or the settlement of claims arising under or relating to
this contract sha]:l be made available until such appeals, litigation, or
claims are finally resolved.
(3) As used in this clause, records include books, documents,
accounting procedures and practices, and other data, regardless of type and
regardless of form. This does not require the Contractor to create or
�7
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RFP 618-90-04
maintain any record that the Contractor does not maintain in the ordinary
course of business or pursuant to a provision of law._ , �
(e)(1) Notwithstanding the requirements of the clauses in.paragraphs (a),
(b) , (c) or (d) of this clause, the Contractor is not required to Plow down
any FAR clause,� other than those in paragraphs (i) through (vi) of this
paragraph in a subcontract for commercial items. Unless othexwise indicated
below, the extent of the flow down shall be required by the clause-
(i) 52.219-8, Utilization of Small Business Concerns (OCT 2000) (15
U.S.C. 637(d)(2) and (3)), in a11 subcontracts that offer further
subcontracting opportunities. If the subcontract (except subcontracts to
small business concerns) exceeds $5000,000 ($1,000,000 for construction of
any public facility), the subcontractor mnst include 52.219-8 in lower tier
subcontracts that offer subcontracting opportunities.
(ii) 52.222-26, Equal Opportunity (APR 2002) (E.O. 11246);
(iii) 52.222-35, Equal Opportunity for Special Disabled Veterans,
Veterans of the Vietnam Era, and Other Eiigible Veterans (DEC 2001) (38
U.S.C. 4212); , .
(iv) 52.222-36, A€firmative Action for Workers caith Disabilities (JUNE
1998) (29 U.S.C. 793);
(v) 52.222-41, Service Contract �ACt of 1965, as Amended (MAY 1989),
flow down required for a11 subcontracts subject to the Service Contract Act
of 1965 (41 U.S.C. 351, et seq.). �
(vi) 52.247-64, Preference for Privately-Owned U.S.- Flag Commercial
Vessels (APR 2003) (46 Q.S.C. Appx 1241 and 10 U.S.C. 2631) F1ow down
required in accordance with paragraph (d) of FAR clause 52.247-64.
(2) Whi1e not required, the contractor may include in its subcontracts
for commercial items a minimal number of additional clauses necessary to
satisfy its contractual obligations. - �
(End of clause) - ,
ADDENDA TO CONTRACT TERMS ANI� CONDITIONS REQUIRED TO IMPLEMENT STATOTES OR
EXECUTIVE.ORDERS - COMMERCIAI, ITEMS. .
Reference 5.2.212-5 paragraph (b)(3) - 52.219-4, Notice of Price Evaluation
Preference for HUBZone Sma11 Business Concerns (JAN 1999) (if the offeror
elects to waive the preference, it shall so indicate in its of£er) (15U.S.C.
657a). Evaluation adjustment: o£fers will be evaluated by adding a factor of
10°s.
--End.Addenda to FAR Clause.52.212-5 paragraph (b)(3).
Reference 52.212-5 paragraph (b)(10)(i) - 52.2i9-23, Notice of Price
Evaluation Adjustment for Small Disadvantaged Business Concerns .(JUNE 2003)
(Pub. L. 103-355, section 7102, and 10 U.S.C. 2323) (if the offeror elects to
waive the adjustment, it shall so indicate in its offer). Evaluation
adjustment: offers wi11 be evaluated by adding a factor of 10�:
--End Addenda to FAR clause 52.212-5 paragraph (b)(10)(i)
.
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03-/058
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Reference 52.212-5 paragraph (c)(2) - 52.222-42, Statement of Equivalent
Rates for- Federal Hires (MAY 1989) (29 U.S.C. 206 and 41 U.S.C. 351, et
seq.). The following is £or Information Only; it is not a waqe determination
but identifies the classes o£ service employees expected to be employed under
the contract and states the-wages and fringe benefits payable to each if they
were employed-by the contracting agency:
Employee Class Monetary Waqe-Fringe Benefits
Fire Fighter $15/16 with 25$ fringe*
*This is "base" hourly rate only; does not include stand-by, FSLA, 12 hour
shi£t differential, or premium pays usually af£orded a Fire Eighter.
--End Addenda to FAR clause 52.212-5 paragraph (c)(2)
END PART II
2�
03��� �
RFP 618-90-04
PART III - INSTRUCTIONS TO OFFERORS
52.212-1 INSTRUCTIONS TO OFFERORS - COMMERCIAL ITEMS. (OCT 2003)
(a) North American Industry Classification System (NAICS) code and sma11
business size standard. The NAICS code and small business size standard for
this acquisition appear in Block 10 of the solicitation cover sheet (SF
1449). However, the small business size standard £or a concern which submits
an offer in its own name, but which proposes to furnish an item which it did
not itself manufacture, is 500 employees.
(b) Submission of offers. Submit signed and dated offers to the office
specified in this solicitation at or before the exact time specified in this
solicitation. Offers may be submitted on the SF 1449, letterhead stationery,
or as otherwise specified in the solicitation. As a minimum, offers must show
(1) The solicitation number;
(2) The time specified in the solicitation for receipt of offers;
(3) The name, address, and telephone number of the offeror;
(4) A technical description of the items being offered in sufficient
detail to evaluate compliance with the requirements in the solicitation. This
may include product literature, or other documents, if necessary;
(5) Terms of any express warranty;
(6) Price and any discount terms;
(7) "Remit to" address, if different than mailing address;
(8) A completed copy of the representations and certifications at FAR
52.212-3:
(9) Acknowledgment of Solicitation Amendments;
(10) Past performance information, when included as an evaluation
factor, to include recent and relevant contracts for the same or similar
items and other references (including contract numbers, points o£ contact
with telephone numbers and other relevant information); and
(11) If the offer is not submitted on the SF 1449, include a statement
specifying the extent of agreement with all terms, conditions, and provisions
included in the solicitation. Of£ers that fail to £urnish required
representations or information, or reject the terms and conditions of the
solicitation may be excluded from consideration.
(c) Period for acceptance of offers. The offeror agrees to hold the prices in
its offer firm for 30 calendar days from the date specified for receipt of
o£fers, unless another time period is specified in an addendum to the
solicitation.
(d) Product samples. When required by the solicitation, product samples shall
be submitted at or prior to the time specified for receipt of offers. Unless
9
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03 -1058
RFP 618-90-04
otherwise.specified in this solicitation, these samples shall be submitted at
no expense to the Government, and returned"_at the sender's request and
expense, unless they are destroyed during preaward testing.
(e) Multiple� offers. Offerors are encouraged to submit multiple offers
presenting alternative terms and conditions or commercial items for
satisfying the requirements of this solicitation. Each offer submitted will
be evaluated separately. - - _
(f) Late submissions, modifications, revisions, and withdrawal of offers.
(1)� Offerors are responsible for submitting offers, and any
modifications, revisions, or withdrawals, so as to reach the Government
office designated in the solicitation by the time specified in the
solicitation. If no time is specified in the solicitation, the �time for
receipt is 4:3D p.m., local time, for the designated Government office on the
date that offers or revisions are due.
(2)(i) Any offer, modification, revision, or withdrawal of an of£er
received at the Government office designated in the solicitation after the
exact time specified for receipt of offers is "late" and wi11 not be
considered unless it is received before award is made, the Contracting
Officer determines that accepting the late offer would not unduly delay the
acquisition; and --
(A) If it was transmitted through by electronic commerce
method authorized by the solicitation, it was received at the initial point
of entry to the Government infrastructure not later than 5:00 p.m. one
working day prior to the date specified for receipt o£ offers; or
(B) There is acceptable evidence to establish that it was
received at the Government installation designated.for.receipt of offers and. ��
was under the Government's control prior to the time set for receipt of �'
o£fers; or
(C) If this solicitation is a request £or proposals, it
was the only proposal received.
(ii) Aowever, a late modification of an otherwise successful
offer, that makes its terms more favorable to the Government, wi11 be
considered at any time it is received and may be accepted.
(3) Acceptable evidence to establish the time of receipt at the
Government installation includes the time/date stamp of that installation on
the o£fer wrapper, other documentary evidence of receipt maintained by the
installation, or oral testimony or statements of Government personnel.
(4) If an emergency or unanticipated event interrupts normal
Government processes so that offers cannot be received at the Government
o£fice designated for receipt of offers by the exact time specified in the
solicitation, and urgent Government requirements preclude amendment of the
solicitation or other notice of an extension of the closing date, the time
specified for receipt of offers will be deemed to be extended to the same
time of day specified in the solicitation on the first work day on which
normal Government processes resume.
29
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RFP 618-90-04
(5) Offers may be withdrawn by written notice received at any time
before the exact time set for receipt of offers. Oral offers in response to
oral solicitations may be withdrawn orally. If the solicitation authorizes
facsimile offers, offers may be withdrawn via facsimile received at any time
before the exact time set for receipt of offers, subject to the conditions
specified in the solicitation concerninq•facsimile offers. An offer may be
withdrawn in person by an offeror or its authorized representative i£, before
the exact time set £or receipt of offers, the identity of the person
requesting withdrawal is established and the person signs a receipt for the
o£fer.
(g) Contract award (not applicable to Invitation for Bids). The Government
intends to evaluate offers and award a contract without discussions with
offerors. Therefore, the offeror's initial offer should contain the offeror's
best terms from a price and technical standpoint. However, the Government
reserves the right to conduct discussions if later determined by the
Contracting Officer to be necessary. The Government may reject any or all
offers if such action is in the public interest;.accept other than the lowest
offer; and waive informalities and minor irregularities in offers received.
(h) MuZtiple awards. The Government may accept ariy item or group of items of
an offer, unless the offeror qualifies the offer by specific limitations.
Unless otherwise provided in the Schedule, offers may not be submitted for
quantities less than those specified. The Government reserves the right to
make an award on any item for a quantity less than the quantity of£ered, at
the unit prices offered, unless the offeror specifies otherwise in the offer.
(i) AvailabiZity of reqvirements documents clted in the solicitation. (1)(i)
The GSA Index of Federal Specifications, Standards and Commercial Item
Descriptions, FPMR Part 101-29, and copies of speci£ications, standards, and
commercial item descriptions cited in this solicitation may be obtained for a
fee�by submitting a request to: GSA Federal Supply Service, Specifications
Section, Suite 8100, 470 L'Enfant Plaza, SW, Washington, DC 20407, Telephone
(202)619-8925, Facsimile (202)619-8978. (ii) If the General Services
Administration, Department of Agriculture, or Department of Veterans Affairs
issued this solicitation, a single copy of specifications, standards, and
commercial item descriptions cited in this solicitation may be obtained free
of charge by submitting a request to the addressee in paragraph (i)(1)(i) of
this provision. Additional copies will be issued for a fee.
(2) The DOD Index of Speci£ications and Standards (DODISS) and
documents listed in it may be obtained £rom the: Department of Defense
Single Stock Point (DoDSSP), Building 4, Section D, 700 Robbins Avenue,
Philadelphia, PA 19111-5094, Telephone (215)697-2667/2179, Facsimile (215)
697-1462. -
(i) Automatic distribution may be obtained on a subscription basis.
(ii) Order forms, pricing information, and customer support information may
be obtained -(A) By telephone at (215) 697-2667/2179; or (B) Through
the DoDSSP Internet site at http://dodssp.daps.mil. �
(3) Nongovernment (voluntary) standards must be obtained from the
organization responsible for their preparation, publication or maintenance.
(j) Data Universal Numbering System (DUNS) Number.,
h
[cZ17
♦
�J ���� a
RFP 618-90-04
(Applies�to all offers exceeding $25,000, and of£ers of $25,000 or less if
the solicitation requires the Contractor to be registered in the Central
Contractor Registration (CCR) database. The offeror sha11 enter, in the block
with its name and address on the cover page of its offer, the annotation
"DUNS" or "DUN5+4" followed by the DUNS or DUNS+4 number that identifies the
o£feror's name and address. The DONS+4 is the DUNS number plus a?-character
suffix that may be assigned at the discretion of the offeror to establish
additional CCR records for identifying alternative Electronic Funds Transfer
(EFT) accounts (see FAR Subpart 32.11) £or the same parent concern. If the
o£fexor does not have a DUNS number, it should contact Dun and Bradstreet
directly to obtain one. An offeror within the United States may contact Dun
and Bradstreet by calling 1-866-705-5711 or via the internet at
http://www.dnb.com. An of£eror located outside the United States must contact
the local Dun and Bradstreet office for a DUNS number.
(k) Central Contractor Registration. Unless exempted by an addendum to this
solicitation, by submission of an -of£er, the offeror acknowledges the
requirement that a prospective awardee shall be registered in the CCR
database prior to award, during performance and through final payment of any
contract resulting from this solicitation. If the 0££eror does not become
registered in the CCR database in the time prescribed by the Contracting
Officer, the Contracting Officer will- proceed to award to the next otherwise
successful registered Offeror. Offerors may obtain information on
registration and annual confirmation requirements via the intexnet at
http://www.ccr.gov or by calling 1-888-227-2423 or 269-961-5757.
(End of provision)
ADDENDA TO 52.212-1, INSTRUCTIONS TO OFFERORS - COMI�RCIAL IT RMC
52.233-2 SERVICE OF PROTEST. (AUG 1996)
(a) Protests, as defined in section 33.101 of the Federal Acquisition
Regulation, that are filed directly with an ager.cy, and copies of any-
protests that are filed with the General Accounting OfPice (GAO), shall be
served on the Contracting Officer (addressed as follows) by obtaining written
and dated acknowledgment of .receipt from the Contracting Officer (90C), VA
Medical Center, One Veterans Drive, Minneapolis, MN 55417. -
(b) The copy of any protest shall be received in the office designated
above within one day of filing a protest with the GAO.
(end of provision) �
852.233-70 PROTEST CONTENT. (JAN 1998) �
(a) Any protest filed by an interested party shall:
(1) Include the name, address, fax number, and telephone number of the
protester;
(2) Identify the solicitation and/or contract number;
(3) Include an original signed by the protester or the protester's
representative, and at least one copy;
31
03 -I oS �
RFP 618-90-04
(4) Set forth a detailed statement o£ the legal and factual grounds of
the protest, including a description of resulting prejudice to the protester,
and provide copies of relevant siocuments;
(5) Specifically request a ruling of the individual �upon whom the
protest is served; �
(6) State the form of relief requested; and � _
(7) Provide a11 information establishing the timeliness of the protest.
(b) Failure to comply with the above may result in dismissal of the protest
without further consideration.
(End of Provision)
852.233-71 ALTERNATE PROTEST PROCEDURE. (JAN 1998)
As an alternative to filing a protest with the contracting officer, an
interested party may file a protest with the Deputy Assistant Secretary for
Acquisition and Materiel Management, Acquisition Administration Team,
Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC,
20420, or, for solicitations issued by the Office of Facilities Management,
the Chief Facilities Management Officer, Office of Facilities Management, 810
Vermont Avenue, NW, Washington, DC 20420. The protest will not be considered
if the interested party has a protest on the same or similar issues pending
with the contracting officer.
ADDENDA TO 52.212-1 INSTRUCTIONS TO OFFERORS - EVPS.UATION
The Contractor must submit a Technical Proposal and a Cost Proposal for
evaluation. The Technical Pr000sal must provide sufficient information to
demonstrate the corporate capabilities, service providers, other resources,
and� approach to satisfactorily perform the work detailed in Part I. It must
minimally address the following: � _
APPROACH TO PERFORMANCE:
1. Quality of Offeror's £acilitv: include a description of the facility to
be utilized, location, security, applicable insurance; statement(s) of
meeting response time requirement to incidents and accomplishing basic
requirements (i.e., staffing levels, equipment available and/or dedicated)
a. Evidence of qualified personnel to service the contract, technical
expertise/knowledge; years of experience; availability of labor Porce and
various equipment � .
b. Management capabilities: evidence of corporate experience, start-up
and phase-in schedules, management plans and procedures for logistical and
administrative support �
c. Scope of training in place, continuing competency and efficiency
training, orientation to VAMC/FSNC campuses, etc. Address frequency, ground
operations, pre-fire planning, emergency procedures, medical and HazMat
training, etc.
d. Quality control procedures to ensure contractual requirements are met.
32
03 -1 b58
. ..:���.
e. If Offeror/Contractor desires the use of government-owned 1993 Fire
Truck, you may wish to indicate how contractor would utilize same.
PAST PERFORMANCE
1. Identify past performance of. contracts (State, City and/or Fede*al) of
similar size and scope; include information that depicts contract response
times, comp2iance and ef£iciency. Address availability and use of Mutual Aid
Agreements.� Address communication centers; priority, i£ any, of calls
(police, fire, various - alarms); and back up to alarm assignments - who
responds, etc:). � �
PRICE
Contractor to provide a monthly charge to the Government that will be charged
to provide all labor, materials and equipment for Fire Suppression and
related services as addressed in the Statement of Work.
Contractor to.provide a deduct, if any, to the contract if mutually agreed by
the Contractor and Government that the existing Fire Truck wi11 be available
to the Contxactor for use during the period of the contract. Contractor
would accept sole responsibility for all maintenance. The Fire Truck would
remain Government-owned and be returned in good operational condition to the
Government upon expiration of the contract.
52.212-2 EVALUATION--COMMERCIAL ITEMS. (JAN 1999
(a) The Government will award a contract resulting from this solicitation to
the responsible offeror whose offer conforming to the solicitation will be
most advantageous to the Govexnment, price and othex factors consideied. The
following factors shall be used to evaluate offers and are listed in
descending order of importance:
(1) Technical capability of the services offered to meet the
Government requirements;
(2) Past performance;
(3) Price; and
(4) Small Disadvantaged Business Participation (SDB) evaluation
factor. Credit under this £actor is not available to an SDB concern
unless it specifically waives the price evaluation adjustment as
indicated in FAR clause 52.219-23
total SDB percent participation of total value of of£er by
SDB prime contractors
total percent of participation of total value of offer by SDB
subcontractors
total dollar value of SDB participation (subcontractor and
prime contractors.
Technical, past performance and SDB Pactor, when combined, are approximately
equal to cost or price.
33
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RFP 618-90-04
(b) Options. The Government wi11 evaluate offers for award purposes by
adding the total price for al1 options to the total price for the basic
requirement. The Government may determine that an offer is unacceptable if
the option prices are significantly unbalanced. Evaluation of options sha11
not obligate the Government �o exercise the option(s). �
(c) A written notice of award or acceptance of an offer, mailed or otherwise
furnished to the successful offeror within the time for acceptance specified
in the offer, shall result in a binding contract without further action by
either party. Before the offer's specified expiration time, the Government
may accept.an offer (or part of an offer), whether or not there are
negotiations after its receipt, unless a written notice of withdrawal is
received before award.
(End of Provision)
END PART I2I
•
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03 -! 058
. . . : �� ��
PART 2V - OFFEROR
AND-CERTIFICATIONS
52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS - COMMERCIF�T, ITEMS. (JUNE
2003)
(a) Defixritions. As used in this provision:
"Emeiging sma11 business" means�a small business concern whose size is no
greater than 50 percent of the numerical size standard for the NAICS code
designated.
"Forced or indentured child labor" means all work or service --
(1) Exacted Prom any person under the age of 18 under the menace of any
penalty £or its nonperformance and for which the worker does not offer
himself voluntarily; or
(2) Performed by any person under the age o£ 18 pursuant to a contract
the enforcement of which can be accomplished by process or penalties.
"Serviae-disabled veteran-owned small business conCern" -
(1) Means a small business concern -
. (i) Not less than 51 percent of whieh 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 cas� of a
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), w-ith a disability thet is�service-connected, as defined in 38 U.S.C.
101 (16) .
"Small business concern" means a concern, including its aPfiliates, that is
independently owned and operated; not dominant in the field of operation in
which it is bidding on Government contracts, and quali£ied as a small
business under the criteria in 13 CFR Part 121 and size standards in this
solicitation.
"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
35
03 -/058
RFP 618-90-04
least 51 percent of �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.
(b) Taxpayer ldentification Number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701).
(Not applicable if the offeror is required to provide this in£ormation to a
central contractor registration database to eligible for award.)
(1) All offerors must submit the in£ormation required in paragraphs
(b)(3) through (b)(5] of this provision to comply with debt collection
requirements 31 U.S.C. 7701(c) and 3325(d), reporting requirements of 26
U.S.C. 6041, 6041A, and 6050M, and implementing regulations -issued by the
Internal Revenue Service (IRS). _
(2) The TIN may be used by the Government to collect and report on
any delinquent amounts arising out of the offeror's relationship with the
Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject to
the payment reporting requirements described in FAR 4.904, the TIN provided
hereunder may be matched with IRS recoxds to verify the accuracy.of the
o£feror's TIN.
(3) Taxpayer ldentification Number (TIN).
TIN:
TIN has been applied for.
_ TIN is not required because:
Offeror is a nonresident alien, foreign corporation, or
foreign partnership that does not have income e£fectively connected with the
conduct of a trade or business in the United States and does not have an
oPfice or place of business or a fiscal-paying agent in the United States;
government;
Government.
Offeror is an agency or instrumentality of a foreign
Offeror is an agency or instrumentality of the Federal
(4) Type of organization.
Sole proprietorship;
Partnership;
Corporate entity (non tax-exempt);
Corporate entity (tax-exempt);
�
a3-/o5�'
I2FP 618-90-04
� Government entity (Federal, State, or local);
Foreign government; � �
International_organization per 26 CFR 1.6049-4;
Other
(5) Common parent.
Offeror is not owned or controlled by a common parent: �
Name and TIN of common parent:
Name
TIN
(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) Sma11 business concern. The offeror represents as part o£ its offer
that it [] is, [] is not a small business concern.
(2) Veteran-owned small business concern. (Complete only if the
of£eror 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 sma11 business concern. (Complete
only if the offeror represented itself as a veteran-owned small business
concern in paiagraph (c) (2) o£ this provision.J The offeror represents as
part of its offer that it [] is, [] is not a service-disabled veteran-owned
small business concern. �
(4J Small disadvantaged business concern. (Complete only if the offeror
represented itsel£ as a small business concern in paragraph (c)(1j of this
provision.) The offeror repxesents, for general statistical purposes, 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 thz 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)(6) and (c)(7) only if this solicitation is
expected to exceed the simplified acquisition threshold.
(6) 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.
37
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RFP 618-90-04
(7) Tie bid priority for labor surplus area concerns. If this is an
invitation for bid, small business offerors may identify the labor suxplus
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:
(8J Small Business Size for the Small Business Competitiveness
Demonstration Proqram and for the Targeted Industry Cateqories under the
Small Business Competitiveness Demonstration Program. (Complete only if the
oPferor has represented itself to be a small business concern under�the size
standards for this solicitation.)
(i) (Complete only for solicitations indicated in an addendum as
being set-aside for emerging small businesses in one o£ the four designated
industry groups (DIGs).) The o£feror represents as part of its offer that it
[] is, [ 7 is not an emerging small business.
(ii) (COmplete only for solicitations indicated in an addendum as
being for one of the targeted industry categories (TICs) or_ £our designated
industry groups (DIGs).) Offeror represents as follows: -
(A) Offeror's number of employees for the past 12 months
(check the Employees column i£ size standard stated in the solicitation is
expressed in terms of number of employees); or
(B) Offeror's average annual gross_ revenue for the last 3
fiscal years (check the Average Annual Gross Number of Revenues column i£
size standaid stated in the solicitation is expressed�in terms o£ annual
receipts).
(Check one of the following):
[
�
[
[
[
�
[
NUMBER OF AVERAGE_ANNUAL GROSS
EMPLOYEES REVENUES
l
�
l
l
l
�
I
50 or fewer
51-100
101-250
251-500
SO1-750
751-1,000
Over 1,000
[ ] $1 million or less
[ J $1,000,001-$2 million
[ ] $2,000,001-$3.5 million
( ] $3,500,001-$5 million
[ ] $5,000,001-$10 million
[ ] $10,000,001-$17 million
[ ] Over $17 million
(9) (Complete only if the solicitation contains the clause at FAR
52.219-23, Notice of Price Evaluation Adjustment for Sma11 Disadvantaged
Business Concerns, or FAR 52.219-25, Small Disadvantaged Business
Participation Program-Disadvantaged Status and Reporting, and the offeror
desires a benefit based on its disadvantaged status.)
-(i) General. The offeror represents that either:
� (A) It [] is, [] is not certified by the Small Business
Administration as a small disadvantaged business concern and identified, on
the date of this representation, as a certified small disadvantaged business
concern in the database maintained by the Small Business Administration (PRO-
38
03 -/os�
RFP 618-90-04
Net), and that no material change in disadvantaged ownership and control has
occurred since its certification, and,. where the concern is owned by one or
more_ individuals claiming disadvantaged status, the net worth of each
individual upon whom the certification is based does not exceed $750,000
after taking into account the applicable exclusions_ set forth at 13 CFR
124.104(c)(2); or.
- - � (B) It [ ] has, [ ] has not submitted a _completed
application to the Small Business Administration or- a Private Certi£ier to be
certified as a sma11 disadvantaged business concern in accordance with 13 CFR
124, Subpart B, and a decision on that application is pending, and that no
material change in disadvantaged ownership and control has occurred since its
application was submitted.�
(ii) Joint Ventures under the Price Evaluation Adjustment for
Small Disadvantaqed Business Concerns. The offeror represents, as part of
its offer, that it is a joint venture that complies with the requirements in
13 CFR 124.1002(f) and that the representation in paragraph (c)(9)(i) of this
provision is accurate for the small disadvantaged business concern that is
participating in the joint venture. (The offeror shall enter the name of the
small disadvantaged business concern that is participating in the joint
venture )•
(10) HUBZone small business concern. (Complete only if the offexor
represented itself as a small business concern in paragraph (c)(1) of this
provision.) The o£feror 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 AUBZOne Small
Business Concerns maintained by the Small Business Administration, and no
material change in ownership and control, principal office, or HUBZone
employee percentage has occurred since it was certified by the Small Business
Administxation in accoxdance with 13 CFR part 126; and
(ii) It [- ] is, [ J is not a joint venture thaE complies with the
requirements of 13 CFR part 126, and the representation in paragraph
(c)(10)(i) of this provision is accurate for the HUBZone small business
concern or concerns that are participating in the joint venture. (The
offeror.shall enter the name or names oP the AUBZone small business concern
or concerns that are participating in the joint venture:
.) Each HUBZone small business concern
participating in the joint venture shall submit a separate signed copy of the
AUBZone representation.
(d) Representations required to implement provisions of Executive Order
11246-
(1) Previous contracts and compliance. The of£eror represents that--
(i) It [] has, [] has not participated in a previous contract
or subcontract subject to the Equa1 Opportunity clause of this solicitation;
and
reports.
(ii) It [] has, [] has not filed all required compliance
(2) Affirmative Action Compliance. The offeror represents that -
�
p3-/058
RFP 618-90-04
(i) It [] has developed and has on file, (] has not developed
and does not have on file, at each establishment, affirmative action programs
required by rules and regulations of the Secretary of Labor (41 CFR parts 60-
1 and 60-2), or
(ii) It (] has not previously had contracts ,subject to the
written affirmative aetion programs requirement of the rules and regulations
of the Secretary of Labor.
(e) Certification Regarding Payments to Influence Federal Transactions (31
U.S.C. 1352). (Applies only if the contract is expected to exceed $100,000.)
By submission of its offer, the offeror certifies to the best of its
knowledge and belief that no Federal appropriated funds have been paid or
wi11 be paid to any person for influencing or attempting to influence an
of£icer or employee of any agency, a Member of Congress, an officer or
employee of Congress or an employee of a Member of Congress on his or her
behalf in connection with the award of any result�ant contract.
(f) Buy American Act Certificate. (Applies only if the clause Federal
Acquisition Regulation (FAR) 52.225-1, Buy American Act �- Supplies, is
included in this solicitation.) _ _ �
(1) She offeror certifies that each end product, except those listed in
paragraph (f)�(2) of this provision, is a domestic end product and that the
offeror has considered components of unknown origin to have been mined,
produced, or manufactured outside the_Onited States. The offeror sha11 list
as foreign end products those end products manu£actured in the United States
that do not qualify as domestic end products. The terms "component,"
"domestic end product," "end product," "foreign end product;" and "United
States" are de£ined in the clause of this solicitation entitled "Buy American
Act-Supplies." .
(2) Foreign End Products;
Line Item No.:
Country of Ori
(List as nece�
(3) The Government will evaluate ofPers in accordance with the policies
and procedures of FAR Part 25.
(g)(1) Buy American Act—North American Free Trade Agreement—Israeli Trade Act
Certificate. (App2ies only if the clause at FAR 52.225-3, Buy American Act—
North American Free Trade Agreement—Israeli Trade Act, is included in this
solicitation.) .
(i) The offeror certifies that each end product,. except those
listed in paragraph (g)(1}(ii) or (g)(1)(iii) of this provision, is a
domestic end product and that the offeror has considered components of
unknown origin to have been mined, prbduced, or manufactured outside the
IInited States. The terms "component," "domestic end product," "end product,"
"foreign end product," and "United States" are defined in the clause of this
solicitation entitled ��Buy American Act—North American Free Trade Agreement—
Israeli Trade Act." �
.�
�3 -1 OS8
RFP 618-90-04
(ii) The o£feror certifies that tfie following supplies are NAFTA
country end products or Israeli end products as defined in the clause of this
solicitation_entitled "Buy American Act-North American Free.Trade Agreement-
Israeli Trade Act": �
NAFTA Country or Israeli End Products
Line Item No.• "
Country of Origin:
(List as necessary) �
(iii) The of£eror shall list those supplies that are foreign end
products (other than those listed in paragraph (g)(1)(ii) of this provision)
as de£ined in the clause of this solicitation entitled "Buy American Act-
North American Free Trade Agreement-ISraeli Trade Act." The offeror shall
list as other foreign end products those end products manufactured in the
United States that do not qualify as domestic end products.
Other Foreign End Products
Line Item No.•
Country of Origin:
(List as necessary)
(iv) The� Government will evaluate offers in accordance with the
policies and procedures of FAR Part 25.
(2) Buy American Act-North American Free Trade Agreement-Israeli Trade
Act Certificate, Alternate I(MAY 2002). If Alternate I to the clause at EAR
52.225-3 is included in this solicitation, substitute the following paragraph
(g)(1)(ii) for paragraph (g)(1)(ii) o£ the basic provision:
(g)(1)(ii) The offeror certifies that the following supplies are
Canadian end products as defined in the clause of this solicitation entitled
"Buy American Act-North American Free Trade Agreement-Israeli Trade Act":
Canadian End Products:
Line Item No.:
(List as necessaryj
(3) Buy American Act-North American Free Trade Agreement-Israeli Trade
Act�Certificate, Alternate II (MAY 2002j. If Alternate IZ to the clause at
FAR 52.225-3 is included in this solicitation, substitute the following
paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:
(g)(1)(ii) The o£feror certifies that the followinq supplies are
Canadian end products or Israeli end products as defined in the clause of
this solicitation entitled "Buy American Act-North American Free Trade
Agreement-Israeli Trade Act": .
Canadian or Israeli End Products
Line Item No.:
Country of Origin:
(List as necessary)
41
03 -t osa
�:��• . : � � �.,
(4) Trade Agreements Certificate. (Applies only if the clause at FAR
52.225-5, Trade Agreements is included in this solicitation.) �
�(i) The offeror certifies that� each end product, except those
listed in paragraph (g)(4)(ii) of this provision, is a U.S.-made, designated
country, Caribbean Basin country, or NAFTA country end product, as defined in
the clause of this solicitation entitled "Trade Agreements."
(ii) The offeror shall list as other end products those end
products that are not U.S.-made, designated country, Caribbean Basin country,
or NAFTA country end products. ,
Other End Products:
Line Item No.:
Country o£ Origin:
(List as necessary)
(iii) The Government will evaluate offers in accordance with the
policies and procedures o£ FAR Part 25. For line items subject to the Trade
Agreements Act, the Government will evaluate offers of U.S.-made, designated
country, Caribbean Basin country, or NAFTA country end products without
regard to�the restrictions of the Buy American Act. The Government will
consider for award only offers of U.S.-made, designated country, Caribbean
Basin country, or NAFTA country end products unless the Contracting Officer
determines that there are no offers for such products or that the offers for
such products are insu££icient to fulfill the requirements of the
solicitation.
(h) Certification Regarding Debarment, Suspension or Ineligibility for Award
(Executive Order 12549). (Applies only if the contract value is expected to
exceed the simplified acquisition threshold.) The offeror certifies, to the
best of its knowledge and belief, that the offeror and/or any_of its
principals - �
( [ l �e, [] are not presently debarred, suspended, proposed for
debarment, or declared ineligible £or the award of contracts by any Federal
agency; and -
(2) [] Have, [] have not, within a three-year period preceding this
of£er, been convicted of or had a civil judgment rendered-against them for:
commission of Praud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a Federal, state or local government
contract or subcontract; violation of Federal or state antitrust statutes
relating to the submission of offers; or commission of embezzlement, theft,
forgery, bribery, £alsi£ication or destruction of records, making false
statements, tax evasion, or receiving stolen property; and _
(3) [ j Are, [} are not presently indicted for, or otherwise
criminally or civilly charged by a Government entity-with, commission o£ any
of these offenses.
(i) Certification Regarding Knowledge of Child Labor for Listed End Products
(Executive Order 13126). [The Contracting Officer must list in paragraph
(i)(1) any end products being acquired under this solicitation that are
included in the List of Products Requiring Contractor Certification as to
Forced or Indentured Child Labor, unless excluded at 22.1503(b).]
42
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�3 �/o��
�
RFP 618-90-04
(1) " Listed end products.�
Listed End Product
Listed Countries o£ Origin
(2) Certification. [If the Contracting Office has identified end
products and countries of oriqin in paragraph (i)(1) of this provision, then
the offeror must certify to either (i)(2)(i) or (i)(2)(ii) by checking the
appropriate block.]
(i) The offeror will not supply any end product listed in
paragraph (i)(1) of this provision that was mined, produced, or manufactured
in the corresponding country as listed for that product.
- (ii) The offeror may supply an end product listed in paragraph
(i)(1) of this provision that was mined, produced, or manufactured in the
corresponding country as listed for that product. The offeror certifies that
it has made a good faith effort to determine whether forced or indentured
child Iabor was used to mine, produce, or manufacture any such end product
furnished under this contract. On the basis of those efforts, the offeror
certifies that it is not aware of any such use of child labor.
(End of provision)
END OF PART IV
43
o3-to$8 . . _
RFP 618-90-04
, PART V- ATTACF�NTS TO THE SOLICITATION
1. "Emergency Response": an overview of manual references for Response tasks
as indicated in Part I, Statement of Work, paragraph A.23 (1 page).
2. Listing of Minneapolis medical center and national cemetery campus
buildings (3 pages)
3. Department of Labor Wage Determination No. 94-2287 (Revision 2&) dated May
30, 2003 and applicable to any resultant contract (9 pages).
4. Plot drawings of Veterans Affairs Medical Center Primary and Secondary
campuses (2 each) - Available in hard copv onlv, request bv Fax to 612-725-
2072.
5. Plot drawing of Fort Snelling National Cemetery campus (1 each) -
Available in hard copy onlv, request bv Fax to 612-725-2072.
6. Hazardous Waste Generator Local Authority Notification Form with footprint
drawings (8'�" x 11") of Basement, Floors 1 through 4- Bldg. 70, medical
center, and an 8'�" x 11",campus d=awing indicating locations of HazMat
storage areas (paint thinners, waste oil, etc.). This attachment also
includes 2003 HazMat Waste Management Plan Summary. Available in hard copy
on1y, request bv Fax to 612-725-2072. (22 pages)
�
O3 /058
,
RFP 618-90-04
F,T'?�',R6E23CY RESPC73SE
Respond to Fire Ca11s MP3 part III 34.OA DM&S Sup.
Smoke NFPA 600: 1-4.4 _ 6-27 Paqe 8
Odor
Alarms
Auto Extrication
*** Respond to Medical Loca1-PO1icy #26 HCMC PORTACAL
Emergencies - NFPA #473
Respond to HazMat Incidents NFPA 901 Chapter 14 NFPA 1991, 1992,
Leaks NFPA 471 A6-4.1.9, 1993, 1999
Spills Chapter 6
Vapors
Level "A" Entry NFPA 472: A4-2.1.3.3
to A4-4.3.2, I992
Chapter 2
Confined Space Rescue OSHA 1910.149 �
Local Policy #33
Elevator Extrication Local Policy #21 �
Suicide Stand-By Local Policy
Mutual Aid Response MP-3 Part III, Para
34.04 H; APPX 4A
� 42 U.S.C. 1856
***Contractor will be asked to provide ambulance/medical response for any
emergency occurring outside of Building 70 VA Medical Center (i.e., parking
lot). However, VAMC does not pay for that ambulance trip; rider pays;
Contractor will not bill VAMC for these services.
END OF ATTACF�IENT #1
45
a3 -� os$
RFP 618-90-04
Minneapolis VAMC
Schedul.e o£ Buildings
Primary Campus
BLDG. NO. DESCRIPTION GSF
9 Regional Medical Education Center 34,568
20 Quarters and Offices 28,818
11 ,Director's Quarters � 4,564
12 Quarter's Duplex 8,687
13 Quarter's Duplex . 8,687
14 Quarter's Duplex 8,687
28 Garage_(8-car) 1,637
47 Transitional Housing 3,600
49 Research Building 45,754
49-A Biomedical Machine Shop 9,105
49-SV SuperVOltage (Underground) 8,936
62 Primary Switchgear Building 880
64 Storage Suilding 384
65 Patient Picnic Pavilion 540
68 Child Day Care/Day Treatment 28,260
69 Energy Center 21,151
70 General Med/Surgical & Admin 1,500,000
71 Storage Building 384
71-A Hazardous Waste 218
71-B _ Hazardous Waste 150
72 Maintenance Garage 10,320
73 Regional Counsel 5,707
74 Fisher House 4,912
23 - Total Buildings Total GSF - 1,735,449
Page 1 of 3
.,
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Minneapolis VAMC
Schedule of Buildings
Secondary Campus
BLDG. NO. DESGRIPTION
RFP 618-90-04
6SF
g9 FSEA Club (Canteen Service� 14,238
210 Storage 9,766
�211 Garage - 19,160
214 Research - Animal Housing 18 ���$
215 � Gas Station � 306
Z1'7 Storage 2, 650
Zlg Warehouse 1,796
219 Warehouse 1,728
Zzp Gas Station (Nieman's) 1,953
222 Office & Warehouse 61,969
223 Fire Station and Warehouse 23,260
224 Shop and Warehouse 13,460
225 Warehouse - 2,201
z27 QuarteYS (DUplex 22?-A & 227-B) - 3,893
ZZg Garage . 1,240
229 Quarters (Fourplex 229a-d) 10,515
Z37 Warehouse 1,908
239 Warehouse 543
18 - Total Buildings Total GSE - 18Q,369
(Note: 12 buildings have been removed/no longer exist on the Secondary
Campus since original procuzement in 1999 of fire suppression services)
Page 2 of 3
47
a3 -� °S $
Fort Snelling
Nati.onal Ce�etEry Campus
Schedule o£ Buildinqs
BLDG. NO.
3W01
3W02
3001
3002
1002
1501
No. A
No. B
8 - Total Buildings
Page 3 of 3
END OF ATTACHMENT #2
S'outh Pump House
North Pump House
Main Storage Building
Maintenance Building
Administration Building
Admin/Conference Building
Committal Shelter North
Committal Shelter South
TOTPS, GSF - 35,388
RFP 618-90-04
GSF
293
1,351
7,154
18,439
2,287
2,314
1,775
1,775
�.j
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l�3 - l058
RFP 618-90-04
REGZSTER,OF WAGE DETERMINATIONS UNDER
- THE SERVICE CONTRACT ACT
of the Secretary of Labor
U.S. DEPARTMENT OF LP.BOR
EMPLOYMENT STANDARDS ADMINISTRATION
WAGE AND HOUR DIVISION
WASHINGTON, D.C. 20210 .._.
�F[.�7
94-2287
Revision No.:
William W.Gross Division o£ Wage Date of Last Revision: OS/30/2003
Director Determinations � _ _ -- -
States: Minnesota, Wisconsin
Area: Minnesota Counties of Anoka, Carver, Chisago, Dakota, Hennepin, Isanti,
Ramsey, Scott, Washington, Wright
Wisconsin Counties of Pierce, Po1k, St Croix
�**Fringe Benefits Required Follow the Occupational Listing**
OCCUPATION CODE - TITLE MINIMUM WAGE RATE ._
01000 - Administrative Support and Clerical Occupations
01011 - Accounting Clerk I 10.83 -
01012 - Accounting C1erk II 12.41
01013 - Accounting Clerk III 14.20 �
01014 - Accounting Clerk IV 16.66
01030 - Court Reporter 16.67
01050 - Dispatcher, Motor Vehicle '16.67 ' . '
01060 - Document Preparation Clerk 14.05
01070 - Messenger (Courier) 10.60
01090 - Duplicating Machine Operator 1z-��
01110 - Film/Tape Librarian 12.87
01115 - General Clerk I. 12.13.
01116 - General Clerk II 13.42
01117 - General Clerk III 14.05
01118 - General Clerk IV 16.59
01120 - Housing Referral Assistant 16.91
01131 - Key Entry Operator Z 12.39
01132 - Key Entry Operator II 13.81
01191 - Order Clerk I 12.40
01192 - Order Clerk II 14.39
01261 - Personnel Assistant (Employment) I 12.57
01262 - Personnel Assistant (Employment) II 14.99
01263 - Personnel Assistant (Employment) III 17.19
01264 - Personnel Assistant (Employment) IV 19.54
01270 - Production Control Clerk 17.25
01290 - Rental Clerk 13.41
01300 - Scheduler, Maintenance 14.71
01311 - Secretary I 14.71
01312 - Seczetary ZI 16.00
01313 - Secretary III 17.96
01314 - Secretary IV 19.47 "
01315 - Secretary V 23.49
01320 - Service Order Dispatcher 15.19
01341 - Stenographer I 13.53
01342 - Stenographer II 15.19
01400 - Supply Technician 19.47
Li!]
�3-lat8
01420 - Survey Worker (Tnterviewer) 15.15
01460 - Switchboard Operator-Receptionist 12.81
01510 - Test Examiner 16.00
01520 - Test Proctor 16.02
01531 - Travel Clerk I 10.15
01532 -- Travel Clerk II . � 10.94
01533 - Travel Clerk IIT - 11.74
01611 - Word Processor I 13.20
01612 - Word Processor II 15.64
01613 - Word Processor III 16.60
03000 - Automatic Data Processing Occupations
03010 - Computer Data Librarian 12.55
03041 - Computer Operator I 14.62
03042 - Computer Operator II 16.52
03043 - Computer Operator III 18
03044 - Computer Operator IV 21.03
03045 - Computer Operator V 23.43
03071 - Computer Programmer I(1) 20.10
03072 - Computer Programmer II (1) 23.54
03073 - Computer Programmer III (1) 26.49
03074 - Computer Programmer IV (1) 27•62
03101 - Computer Systems Analyst I(1) 27.62
03102 - Computer Systems Analyst II �1) Z�•62'
03103 - Computer Systems Analyst III (1) 27.62
03160 - Peripheral Equipment Operator 14.62
05000 - Automotive Service Occupations
05005 - Automotive Body Repairer, Fiberglass 23.66
05010 - Automotive Glass Installer 18.20
05040 - Automotive Worker 18.98
05070 - Electrician, Automotive 19.80
05100 - Mobile Equipment Servicer 16.68
05130 - Motor Equipment Metal Mechanic 20.57
05160 - Motor Equipment Metal Worker 1$•98
05190 - Motor Vehicle Mechanic 19.73
05220 - Motor Vehicle Mechanic Helper 15.92
05250 - Motor Vehicle Upholstery Worker 17.63
05280 - Motor Vehicle Wrecker 18
05310 - Painter, Automotive - 1 $• 99
05340 - Radiator Repair Specialist 1$-79
05370 - Tire Repairer 16.12
05400 - Transmission Repair Specialist 20.57
07000 - Food Preparation and Service Occupations
(not set) - Food Service Worker 9.93
07010 - Baker 13.30
07041 - Cook I 12.22
07042 - Cook II� 13.30
07070 - Dishwasher g•
07130 - Meat Cutter 15.30
07250 - Waiter/Waitress 10.54
09000 - F�rniture Maintenance and Repair Occupations
09010 - Electrostatic Spray Painter 18.83
09040 - £urniture Handler 15.26
09070 - Furniture Refinisher 18.83
09100 - Furniture Refinisher Helper 16.92
09110 - Furniture Repairer, Minor 18.54
09130 - Upholsterer 18.83
11030 - General Services and Support Occupations
� � � �� ��
4 -
50
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03-�oSE'
RFP 618-90-04
11030 - Cleaner, Vehicles -
11060 - Elevator Operator
11090 - Gardener- . -
11121 - House Keeping Aid I
11122 - Aouse Keeping Aid II
11150 - Janitor
11210 - Laborer; Grounds Maintenance
112a0 - Maid or Houseman
11270 - Pest Controller�
11300 - Re£use Collector
11330 - Tractor Operator
11360 - Window Cleaner
12000 - Health Occupations
12020 - Dental Assistant
12040 - Emergency Medical Technician
(EMT)/Paramedic/Ambulance Driver
12071 - Licensed Practical Nurse I
12072 - Licensed Practical Nurse II
12073 - Licensed Practical Nurse III
12100 - Medical Assistant
12130 - Medical Laboratory Technician
12160 - Medical Record C1erk
12190 - Medical Record Technician
12221 - Nursing Assistant I
12222 - Nursing Assistant II
12223 - Nursing Assistant III
12224 - NuYSing Assistant IV
12250 - Pharmacy Technician
12280 - Phlebotomist
12311 - Registered Nurse I
12312 - Registered Nurse II
I2313 - Registered Nurse II, Specialist
12314 - Registered Nurse III
12315 - Registered Nurse III, Anesthetist
12316'- Registered Nurse IV
13000 - In£oxmation and Arts Occupations
9.93
11.42
12.77
9.32
11.42
11.42
11.23
9.32
12.69
11.42
12.25
12.21
14.14
14 .14
11.26
12.64
14.14
12.55
12.64
11.49
13.84
8.57
9.74
10.23
11.33
13.55
12.64
16.52
20.20
20.20
29.45
24.45
29.19
13002 - Audiovisual Librarian 17.58
13011 - Exhibits Specialist I 16.37
13012 - Exhibits Specialist II ZD•99
13013 - Exhibits Specialist-IIT 24.71
13041 - Illustrator I 17.36
13042 - Illustrator II - ZZ•26
13043 - Illustrator III 26.20
13047 - Librarian 22.62
13050 - Library Technician 15.54
13071 - Photographer I 16.96 "
13072 - Photographer II 18.28
13073 - Photographer III 23.44
13074 - Photographer IV Z�•59
13075 - Photographer V 30.45
15000 - Laundry, Dry Cleaning, Pressing and Related Occupations
15010 - Assembler $•
15030 - Counter Attendant $•
15040 - Dry Cleaner 10.65
15070 - Finisher, Flatwork, Machine 8.79
15090 - Presser, Hand $•
15100 - Pxessex, Machine, Drycleaning 8•�9
51
t13-1o5
15130 - Presser, Machine, Shirts 8.79
15160 - Presser, Machine, Wearing Apparel, 8 79
Laundry
15190 - Sewing Machine Operator 11.35
15220 - Tailor 72.07
15250 - Washer, Machine 9.78
19000 - Machine Tool Operation and Repair Occupations
19010 - Machine-Tool Operator (Toolroom) 17.98
19040 - Tool and Die Maker 22.81
21000 - Material Aandling and Packing Occupations
21010 - Fuel Distribution System Operator 18.69
21020 - Material Coordinator 20.31
21030 - Material Expediter 20.31
21040 - Material Handling Laborer 16.04
21050 - Order Fi11er 13.50
21071 - Forklift Operator 16.12
21080 - Production Line Worker (Food 16.40
Processing)
21100 - Shipping/Receiving C1erk 13_92
21130 - Shipping Packer 15.31
21140 - Store Worker I 11.42
21150 - Stock C1erk (Shel£ Stocker; Store 14.37
Worker II)
21210 - Tools and Parts Attendant 16.40
21400 - Warehouse Specialist 18.67
23000 - Mechanics and Mai.ntenance and Repair Occupations
�23010 - Aircraft Mechanic 20.97
23040 - Aircraft Mechanic Helper 16.92
23050 - Aircraft Quality Control Inspector 21.78
23060 - Aiicraft Servicer 18.54
23070 - Aircraft Worker 19.34
23100 - Appliance Mechanic , 20.17
23120 - Bicycle Repairer 17.12
23125 - Cable Splicer 24.27
23130 - Carpenter, Maintenance 20.76
23140 - Carpet Layer 21.25
23160 - Electrician, Maintenance 25.03
23181 - Electronics Technician, Maintenance I - 18.79
23182 - Electronics Technician, Maintenance II 21.10
23183 - Electronics Technician, Maintenance Z3.90
III
23260 - Fabric Worker 18.54
23290 - Fire A1arm System Mechanic 20.97
23310 - Fire Extinguisher Repairer 17.72
23340 - Fuel Distribution System Mechanic 20.97
23370 - General Maintenance Worker 19.34
23400 - Heating, Refrigeration and Air 20 97
Conditioning Mechanic
23430 - Heavy Equipment Mechanic 20.97
23440 - Heavy Equipment Operator 22.18
23460 - Instrument Mechanic 20.97
23470 - Laborer 10.52
23500 - Locksmith 20.17
23530 - Machinery Maintenance Mechanic 20.87
23550 - Machinist, Maintenance 19.98
23580 - Maintenance Trades Helper 14.72
23640 - Millwright 23.07
RFP 618-90-04
52
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a3_lov8
RFP 618-90-04
23700 - Office Appliance Repairer -
23740 - Painter, Aircraft -
23760 - Painter, Maintenance .
23790 Ripefitter, Maintenance -
23800 - P1LUnber, Maintenance -
23820 - Pneudraulic Systems Mechanic
23850 - Riqger
23870 - Scale Mechanic
23890 - Sheet-Meta1 Worker, Maintenance �
23910 - Small Engine Mechanic
23930 - Telecommunication Mechanic I
23931 - Telecommunication Mechanic II
23950 - Telephone Lineman
23960 - Welder, Combination, Maintenance
23965 - We11 Driller
23970 - Woodcraft Worker
23980 - Woodworker
24000 - Personal Needs Occupations
24570 - Child Care Attendant
24580 - Child Care Center Clerk
24600 - Chore Aid
24630 - Homemaker -
25000 - Plant and System Operation Occupations
25010 - Boiler Tender
25040 - Sewage Plant Operator
25070 - Stationary Engineer �
25190 - Ventilation Equipment Tender
25210 - Water Treatment Plant Operator
27000 - Protective Service-Occupations
(not set) - Police Of£icer
27004 - Alarm Monitor
27006 - Corrections Of£icer
27010 - Court Security Officer
27040 - Detention Officer
27070 - Firefighter
27101 - Guard I
27102 - Guard II
28000 - Stevedoring/LOngshoremen Occupations
28010 - Blocker and Bracer
28020 - Hatch Tender
28030 - Line Handler
28040 - Stevedore I
28050 - Stevedore II
29000 - Technical Occupati.ons
2115� - Graphic Artist
29010 - Air Traffic Control Specialist,_ Center
(2)
29011 - Air Traffic Control Specialist, �
Station (2)
29012 - Air Traffic Control Specialist,
Terminal (2)
29023 - Archeological Technician I
29024 - Archeological Technician II
29025 - Archeological Technician III
29030 - Cartographic Technician
29035 - Computer Based Training (CBT)
Specialist/ Instructor
53
20.17
20.17
21.49
25.87
21.72
20.97
23.07
19.34
20.36
19.34
20.97
21.17
20.97
18.70
20.97
20.97
17.72
9.55
13.55
9.32
15.06
20.97
20.17
20.97
16.92
20.17
24.14
13.92
17.05
20.60
19.08
17.79
10.26
14.20
21.30
21.30
21.30
20.54
22.22
24.15
28.98
19.98
22.01
19.12
21.44
26.55
24.14
28.77
a3 -�058
29040 - Civil Engineering Technician 22.14
29061 - Drafter I 13.59
29062 - Drafter II 19.21
29063 - Drafter III 20.69 �
29064 - Drafter IV 26.55
29081 - Engineering Technician I 16.04
29082 - Engineering Technician II 18.94
29083 - Engineering Technician IZI 21.16
29084 - Engineering Technician IV 25.86
29085 - Engineering Technician V 27.42
29086 - Engineering Technician VI 34.43
29090 - Environmental Technician 19.63
29100 - Fliqht Simulator/Instructor (Pi1ot) 28.52
29160 - Instructor 21.12
29210 - Laboratory Technician 16,15
29240 - Mathematical Technician 20,44
29361 - Paralegal/Legal Assistant I 18.48
29362 - Paralegal/Legal Assistant II 23.28 _
29363 - Paralegal/Legal Assistant IZI 24.68
29364 - Paralegal/Legal Assistant ZV 29.93
29390 - Photooptics Technician 24.89
29480 - Technical Writer 25.48
29491 - Unexploded Ordnance (UXO} Technician I 18.42
29492 - Unexploded Ordnance (UXO) Technician - ZZ 2$
II
29493 - Unexploded Ordnance (UXO) Technician 26.71
III
29494 - Unexploded (UXO) Safety Escort 18.42
29495 - Unexploded (UXO) Sweep Personnel i8.42 -
29620 - Weather Observer, Senior (3) 21.24
29621 - Weather Observer, Combined Upper Air 19.37
and Surface Pragrams (3) -
29622 - Weather Observer, Upper Air (3) 19.37
31000 - Transportation/ Mobile Equipment Operation Occupations
31030 - Bus Driver 15.18
31260 - Parkinq and Lot Attendant 8.76
31290 - Shuttle Bus Driver 15.37
31300 - Taxi Driver 12.91
31361 - Truckdriver, Light Truck 14.29
31362 - Truckdriver, Medium Truck 17.92
31363 - Truckdriver, Heavy Truck 18.56
31364 - Truckdriver, Tractor-Trailer 18.30
99000 - Miscellaneous Occupations
99020 - Animal Caretaker 11.12
99030 - Cashier 8.69
99041 - Carnival Equipment Operator 12.15
99042 - Carnival Equipment Rspairer 12.21
99043 - Carnival Worker 9.93
99050 - Desk Clerk 10.62
99095 - Embalmer 19.47
99300 - Lifeguard 10.14
99310 - Mortician 19.47
99350 - Park Attendant (Aide) 12.15
99?00 - Photofinishing Worker (Photo Lab 11.15
Tech., Darkroom Tech)
99500 - Recreation Specialist - 14.71
99510 - Recycling Worker 13.34
RFP 618-90-04
54
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^
M
d3-1o58
RFP 618-90-04
99610 - Sales Clerk
99620 - School Crossing Guard (Ciosswalk
Attendant) - -
99630 - Sport Official
99658 - Survey Party Chief (Chief oE Party)
99659 - Surveying Technician (Instr. -
Person/Surveyor Asst./Instr.)
99660 - Surveying Aide
99690 - Swimming Pool Operator -
99720 - Vending Machine Attendant
99730 - Vending Machine Repairer -
99740 - Vending Machine Repairer Helper
10.14
9.93
10.14
22.13
16.90
14.69
14.63
12.76
14.63
12.76
ALL OCCUPATIONS LISTED ABOVE RECEIVE THE FOLLOWING BENEFITS:
HEALTH & WELFARE: $2.36 an hour or $94.40 a week or $409.07 a month
VACATION: 2 weeks paid vacation after 1 year of service with a contractor or
successor; 3 weeks a£ter 5 years, and 4 weeks after 15 years. Length of
service includes the whole span of continuous service with the present
contractor or successox, whesevex employed, and with- the predecessor
contractors in the performance of similar work at the same Eederal facility.
(Reg. 29 CFR 4.173) -
HOLIDAYS: A minimum o£ ten paid holidays per year: New Year's Day, Martin
Luther King Jr.'s Birthday, Washington's BiYthday, Memorial Day, Independence
Day, Labor Day, Columbus Day, Veterans' Day, Thanksgiving Day, and Christmas
Day. (A contractor may substitute for any of the named holidays another day
off with pay in accordance with a plan communicated to the employees
involved.) (See 29 CER 4.174)
THE OCCUPATIONS WHICH HAVE FARENTHE,SES AFTER THEM RECEIVE THE FOLLOWING
BENEFITS (as numbered):
1) Does not apply. to employees employed in a bona fide executive,
administrative, or professional capacity as defined and delineated in 29 CFR
541. (See CFR 4.156) �
2) APPLICABLE TO AIR TRAFFIC CONTROLLERS ONLY - NIGHT DIFFERENTIAL: An
employee is entitled to pay for all work performed between the hours of 6:00
P.M. and 6:00 A.M. at the rate of basic pay plus a night pay di£ferential
amounting to 10 percent of the rate of basic pay.
3) WEATHER OBSERVERS - NIGHT PAY & SUNDAY PAY: If you work at night as part
of a regular tour o£ duty, you will earn a night differential and receive an
additional 10°s of basic pay for any hours worked between 6pm and 6am. I£ you
are a full-time employed (40 hours.a week) and Sunday is part of your
regularly scheduled workweek, you are paid at your rate of basic pay plus a
Sunday premium of 25g of your basic rate for each hour o£ Sunday work which
is not overtime (i.e. occasional work on Sunday outside the normal tour o£
duty is considered overtime woxk). �
HAZARDOUS PAY DIFFERENTIAL: .An 8 percent differential is applicable to
employees employed in a position that represents a high degree of hazard when
working with or in close proximity to ordinance, explosives, and incendiary
materials. This includes work such as screening, blending, dying, mixing, and
pressing of sensitive ordance, explosives, and pyrotechnic compositions such
as lead azide, black powder and photoflash powder. A11 dry-house activities
55
03 -lOSB
RFP 618-90-04
involving propellants or explosives. Deiailitarization, modification,
renovation, demolition, and maintenance operations on sensitive ordnance,
explosives and incendiary materials. All nperations involving regrading and
cleaning of artillery ranges.
A 4 percent differential is applicable to employees employed in a position
that represents a low degree of hazard when working with, or in close
proximity to ordance, (or employees possibly adjacent to) explosives and
incendiary materials which involves potential injury such as laceration of
hands, face, or arms of the employee engaged in the operation, irritation o£
the skin, minor burns and the like; minimal damage to immediate or adjacent
work area or equipment being used. All operations involving, -unloadinq,
storage, and hauling o£ ordance, explosive, and incendiary ordnance material
other than small arms ammunition. These differentials are only applicable to
work that has been specifically designated by the agency for ordance,
explosives, and incendiary material differential pay.
** UNIFORM ALLOWANCE **
If employees are required to wear uniforms in the per£ormance of this
contract (either by the terms of the Government contract, by the employer, by
the state or local� 1aw, etc.), the cost of £urnishing such uniforms and
maintaining (by laundering or dry cleaning) such uniforms is an expense that
may not be borne by an employee where such cost reduces the hourly rate below
that required by the wage determination. The Department of Labor wi11 accept
payment in accordance with the following standards as compliance:
The contractor or subcontractor is required to furnish all employees with an
adequate number of uniforms without cost or to reimburse employees for the
actual cost of the uniforms. In addition, where uniform cleaning and
maintenance is made the responsibility of the employee, aIl contractozs and
subcontractors subject to this wage determination shall (in the absence of a
bona fide collective bargaining agreement providing for a different amount,
or the £urnishing of contraxy affirmative proof as to the actual cost),
reimburse a11 employees for such cleaning and maintenance at a rate of $3.35
per week (or $.67 cents per day). However, in those instances where the
uniforms £urnished are made of "wash and wear" materials, may be routinely
washed and dried with other personal garments, and do not require any special
treatment such as dry cleaning, daily washing, or commercial laundering in
order to meet the cleanliness or appearance standards set by the terms of the
Government contract, by the contractor, by law, or by the nature of the work,
there is no requirement that employees be reimbursed for uni£orm maintenance
costs.
** NOTES APPLYING T6 THIS WAGE DETERMINAPION **
Source of Occupational Title and Descriptions:
The duties of employees under job titles listed are those described in the
"Service Contract Act Directory of Occupations," Fourth Edition, January
1993, as amended by the Third Supplement, dated March 1997, unless otherwise
indicated. This publication may be obtained from the Superintendent of
Documents, at 202-783-3238, or by writing to the Superintendent of Docaments,
U.S. Government Printing Office, Washington, D.C. 20402. Copies of specific
job descriptions may also be obtained from the appropriate contracting
officer.
REQUEST FOR AUTHORIZATION OE ADDITIONAL CLASSIFICATION AND WAGE RATE
{Standard Form 1444 (SF 1444)}
Conformance Process:
The contracting officer shall require that any class of service employee
which is not listed herein and which is to be employed under the contract
(i.e., the work to be performed is not performed by any classification listed
in the wage determination), be classiPied by the contractor so as to provide
a reasonable relationship (i.e., appropriate level o£ skill comparison)
�
r
.� r
�
a3•io58
RFP 618-90-04
between such unlisted classifications and the classifications listed in the
wage determination. Such conformed classes of employees shall be paid the
monetary wages and £urnished the fringe benefits as are determined. Such
conforming process shall be initiated by the contractor prior to the
performance of contract work hy such unlisted class(es) of employees. She
conformed classification, wage rate, and/or fringe benefits shall be
retroactive to the commencement date of the contract. {See Section 4.6
(C)(vi)} When multiple wage determinations are included in a contract, a
separate SF 1444 should be prepared for each wage determination to which a
class(es) is to be conformed.
The process for preparing a conformance request is as follows: �
1) When preparing the bid, the contractor identifies the need for a conformed
occupation(s) and computes a proposed rate(s).
2) After contract award, the contractor prepares a written report listing in
order proposed classification title(s), a Federal grade equivalency (FGE) for
each proposed classification(s), job description(s), and rationale for
proposed wage rate(s), including information regarding the agreement or
disagreement of the authorized representative of the employees involved, or
where these is no authozized representative, the employees themselves. This
report should be submitted to the contracting officer no later than 30 days
a£ter such unlisted class(es) of employees performs any contract work.
3) The contracting officer reviews the proposed action and.promptly submits a
report of the action, together with the agency's recommendations and
pertinent information including the position of the contractor and the
employees, to the Wage and Hour Division, Employment Standards
Administration, U.S. Department of Labor, for review. (See section 4.6(b)(2)
of Regulations 29 CFR Part 4).
4) Within 30 days of receipt, the Wage and Hour Division approves, modifies,
or disapproves the action via transmittal to the agency contracting officer,
or noti£ies the contracting officer that additional time will be required to
process the request.
5) The contracting officer transmits the Wage and Hour decision to the
contractor.
6) The contractor informs the affected employees.
Information required by the Regulations must be submitted on SF 1444 or bond
paper.
When preparing a conformance request, the "Service Contract Act Directory of
Occupations" (the Airectory) should be used to compare job definitions to
insure that duties requested are not performed by a classification already
listed in the wage determination. Remember, it is not the job title, but the
required tasks that determine whether a class is included in an established
wage determination. Conformances may not be used to artificially split,
combine, or subdivide classifications listed in the wage determination.
End of Attachment #3
Request Hard Copy of each Attachment 3, 4 and 5- Fax request to
612-725-2072.
END OF PART V
END OF SOLICITATION
L�
� ,.
D 3 -/ OS8
HAZARI30US VVASTE G�* ?VERATOR LOCAL AL�T':?Q:ZTi'I' l�TOTIFICATi(3�T FQRIVI
� � Hennepia Couuty Environmenta3 Protection Division
To: Police Department Fire Department . Hospital Hennepin County DES
�
From: Company Name Minneanolis VA Medical Center
Address One Veterans Drive
City/ZipCode ��neapolis, MN 55417
CoIItactPerson Evan Smith_ Faciiity �afety Mana eg r
x�
EPAIDNumber L� LL LL� fl LS
To whom ix may concem:
The U.S. Environmental Protection Agency has promnigated regulaiions as required by the Hazardous and Sotid Waste Amendmeflts of
the Resource Conservation and Recovery Acy which govem the 6andlina and diSposal of haTardous wastes.
As part of these rewiadons, genentors of hazardous waste are required to notify ali emergency zesponse personuel that may be called
upo� to provide services. Ihe notification is imended to establish cooperarion ia .r�;,,;,,,;Tng fiazards to human health or to the
environment from asy unplanned release of hazardous a�astes, and request services, if needed, in case an emergency simation azises
invoiving wastes from our facility.
The ro}e of your auiiiority in an emergency iavolving hazardous waste at this location would be in treating emergency conditions or
victims of an emergency In 3i�ht of this, we wouid li3ce to ideatify the following wastes, which are genereted at ovr location, and the
physicai properties andJor healzh hazards w3vch make each of tbese wastes fiazardous:
Basements, 3rd floor storage room, and lst floor.
Temnorary Storage Areas: Building 71A & 718, Building 237, MaintenaaceeG2�age; and
EnerS3* Center.
We appreciate }rour assista�ce in tivs matter aad look forward to any comments you may have regarding this emergency notification plan.
Please conract me at 612-725-2009 ifI can provide fu�erinfo�mation.
Pam RusseZl Industrial Hv¢ienist 10/29/03
Name for Evan Smith, Sa£ety Manager "TiYle� Date
ln order to facilitate eme �ency :esponse, below is a descripaon of facliry entrances and the location of production azeas. A facitity site
plan may also be attac6ed. � - �
Refer to attached sheets: Building 70 Medicai Center; location areas include:
�° �
�
! witfi nurnber indicates stairweii . � . � - �
� elevator � �
- �� D3 -/0$P .
�'m
BI,DG, 70 — VA'Medical Center -
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BASEMENT
;.:
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Front En�ance . . .
. -_ Bldg. 70 YA Medical .
. . - -. . . . . � ' _ - " .- . . co.,rer
■ with number indicaies siairwelt
� elevator .
FIRST FLOOR
. , a3 -/ oS�
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- -. ,. BLDG. 70'- Ve1 i�iedical Center
Front Fnuance . -
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THtRD FL(JOR
g$TLB1S. TO- HENNEPIN COIINTY
- HIiZARDOIIS WASTE IINIT
417 NO�� STH STRES7'
MI=75£AYOLIS, MN 55401-1397
PH= (612J 348-8100
COMPANY SITE NAME: VE��NS AF£ASRS L'IDICAL CENTEit
COMP 1' SZTE CONTACT_ EVAN SNS18
SZTE IqCA3'ION ADD$ESS. 1 VETERAT'S DR .
� Mi27AEAPOLZS MN 55417
SITE EPA IDc MNO-3fi0-090—i95 _ PH: (6i2) 725-2000
E�TA17 SNSTB -
VELERANS A£FAZAS Z�iCA7 C£NTEg
1 vET£RANS DR $ 1375
MINNEF�POLIS MN 55417-2309
PAGE NO: 1
COMPI�NY S+TE ID: 00005079 D5316325
COMPT�NY SST°— SIC: 8062
GEHERATOB S?ZE: St2�
DATE OF PLFiN: 10/29/2002
PLAN DDE DATE: 12/15/2002
o3'la5d'
' _'_""_""_"""' _""' _""' _""""_' _ _"' _' __"' _ _ _' _""' _""_ _""_""""
2003 HAZARDOUS WASTE MAN�4GEMENT PLAN SUMMARY
� ------------------------------------------------------------------------------------
------- =�----------------------
WASSE ZD WASTE NA41E HH' CODE 2002 EST.GENEBATIOS7 UNIT OF MEA3UAE E?A CODE<S)
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95300028 MIXED s-iawrnszxiLE SOLVENTS ' ' ' _�l _ ' ' ' ' ' '��7/°GALS.ONS ' _ ' ' ' ' _ ' D001 F003'/ _ ' _
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TRANSPORTER NAME(S) EPA ID 2IOMBER(5) i LG r_w
gp.F$Ty RLEEN SEi2VICES INC CTG) SCR-000-074-591
DISPOSER NAMELSj EPA ID NOMB£RfS) DISPOSAL PROCIDIIRE
SP.FETY %LEEN INC (BECAT037ICA) ILD-980-502-744 S�RNED AS F[lEL
' ' _ ' _ ' ' ' ' ' ' ' _ ' ' ' ' ' _
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05300029 IIS£D CRANKCA.4£ OIL B1 � GA7,LON5 M100
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DZSPOSER NA.NE(S) �i��.� � ���'�
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05300030 MIxED S7NRE7.�T� ���'S CZ �"� P09PIDS
TRANSPORTER NAt1E(S)
Spp�y yyggg SERVZCES INC (TG)
EPA ID NOPIeER(S)
SCR-000-074-59
DISYOSER NAME(S) £YA ID N[7N.BE8(5) �DISPOSAL PROCIDITRF
SAFETP &LEEN/I�AIDLAW iLD-039-616-677 �`CZN/TgERMN•
SAFE£B KLEEN INC (PECATOA`ICS) ZLS3-980-502-744 INC=N/
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SELF NOT APPLICASL£ INCIN/T�L
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MCES A*OT APPLZCABLE2 SWR 2tF TMT�BAg
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RETRO£IT RECYR.ING ZL7C MNO-000-341-479
GREPS7 LIGHTS RECYQ,ZNG ZSTC MNR-000-1Q7-037
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SII£ERiOR SPECIAL SER02CES/RElROFIT LAMP COLL£CTION NOT APPLICABL83 RECYC/B£NEF IISE
SIIPERSOR SPECIAI. SERVICES I6C WID-988-SS6-543 RECYC/BEN£F DSE
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05311380 SCRAP FILM 82 � pOUNDS DO11
TRANSPORTER RA2.�E(S) EPA ID NOidBER(S)
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05311381 LEAD FOIL 82 1. 0 p09ND5 D008
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RECYCLED VZA SITfi OF C80ICE NOT APPLICABL£ RECYC/BENEF IISE
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05312394 CBLORSNAY'ED SOLV£NTS C1 �8 00 GALLONS F002 D019 D022
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SAFERY XS.EEN SERVICES INC (TG) SCR-000-074-591
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PHa (612) 348-8190 " DATE OF PL2�t7: - 10/29/20D2
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05326502 AEROSOLS . 83 �.�90'' CODNT . D001 .
TRAIiSPORT£FL NAME(S)
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TRHNSPORTER NAME(S) EPA ID N[77tl8ER(5)
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05326508 DEPOd.Z+RIZED PET DZS?ZLLF�TES Cl �8� GPSdANS D001
TRANSPORTER NAME(S)
SAFETY P.LEEN SERVICES INC (TG)
DISPOSER NAME(S)
SAFE37 RLEEN INC (PECATOATICA)
EPA ID NOMBER(5)
SCR-000-074-591
EPA ID T70N•BER(5)
IZ+D-980-SD2-744
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TRANSPORTER NAME(Sj EPA ID NAMBER(S)
SAFETY KLEEN SERVICES INC (TG) SQ2-000-074-591
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417 NORTH 52H STAEET
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EPA ID N[7MB£R(5)
T�'TSP�gT� �'�' � SCR-000-074-591
SAFETY RLEEN SIItVICE9 ZNC (TG)
_ � � ���(s3 DZSPOSAL PROCED9RE
DZSPOSER NAME(S) =yD-980-502-744 B� � �EL
SAFETY RL£EN INC (PECP.TON=f1a)
_ ' ' ' ' ' ' ' ' ' ' ' ' _ _ ' ' _ _ ' _ ' ' ' _ _ " _ ' _ '�� S _ ' ' ' ' ' ' D002 ' '.' ' ' ' _ ' '
05328338 A4�oIIS A2M:�N7I+ i25-5�)
� TRANSPORTER L1AME`(S) EPA ZD NOAffiEA{S)
NOT APYLICABLE2
N•CES
EPA ID NOt�£R(S) DISPOSAL PHOCEDUFtE
D35P05£R NAME(S) NOT APPLICABLE2 � � ���
MCES
-------------- LS�,� �t�Ll'I�'lj/`a1 ---------
' ' ' ' ' '
' - - ' - - ' ' - ' - ' - - ' ' B z ��}d YOUtt�S D006 DODS
05330465 OSTALYOY SCRAPS
. - EPA 2D NOPIDEft(S)
TRANSPOxTER NP.t�tS) SCR-000-074-591
gp�^•gTy tiySEN SERVICES INC (TG) - �
EPA ID NOMHEB(S) DiSPOSAL PROCIDURE
DISPOS£F NANS'(S1 ZLD-980-502-744 �1tECYC/BII7EF IISE
SAFESY ICL£Eb7 SNC (PECATOS72CA) -
--------------�-------------
05330466 ZII�KER.S � 8-5 FiXAT1�
Cl �� Gr+IS+DA'S D009 D007
� EPA ID NON,SERLS) '
TRP.275PORTER NAME(S) SCR-000-074-591 �
SAFETY RLEEN SERVICES INC (TG)
EBA SD N01d8ER(S) "DISPOSAL PROCEDi7RE
DISPOSER NAME(S) � ZyD_980-502-744 `M1I'T=pl.� �C�'T
Sppgyy pygEN INC (PECATONICA)
/� ' _ ' _ " ' ' '
--------- c '�'�'r, l ��Z�7�z .�--------
' " _ ' " " _ ' ' _ ' _ _ " ' _ C2 J"•°" PODAIDS F003
05330467 PARAEFIN STZLL BOTT��45 '
1RANSPORTER III�ME(S) EPA ID 1S6178SA(S)
- g��y gyEEN SERyICES INC STGj SCR-000-074-591
� £PA ID NQMBER(S) DISEOSAL PROCEDQRE
DZSPOSER NF�NaE(S) ;LD-980-502-744 Z27aN�T$ERMAI'
SA£ETY RLEEN S37C (P£CIaTONZCA)
_ ' ' _ _ _ _ _ ' ' ' ' " _ ' ' ' ' ' ' ' ' _ ' ' _ ' ' _ ' ',��' CODNT _ ' _ _ ' _ ' ' _P002 MNO3 ' ' _ ' '
05330468 DZSCARDID MAJOR APRI+3ANCE B3
�
EPA ZD NI7MSER(S) ,
'lRANSPO1iT&R NAME(S} NOT APPLZCAHL£ '
HAIILED HY TRIiNSPORT£R OF CHOZCE
� : 0 3-�05�'
_• RET[7kN TO: HENNEnIN COIINTY P2,GE NO: 8 ,
* WAST£ i1NIT COMPht^_' SSTE ID: CDCO5079 05316325 � ,
417 NORTH STH STREET CAHPANY SZT£ SIC: 8052 .
' r'T*T^T°a M.7 - 55401-1397 � . GEN�P�TOP SSZE: SQG . . ' .
- � PH- (612)'-348-8100 --- -' �' OF PLAN: 10/29J2002 ' .
' __ _ _�'_—'--__--_—'__'_— _ __'—_ _— ____"
..'___ '__ _ . '
"__--__'" —__"___—__—__'----" - _ _ PLAft D'OE DATE: 22I15I2002 '
___'__'_"'_______"'_.'_____'___'______________"'_"__""'_'_'_""_'_'____'_'__"__"'_"'_'_"'__ _'_'_""'_"'
WASTE ZD WASTE � . Hvt CODE� 2002 EST_GINERATZON IINIT O£ 2�1£ASL'RE EPA CODE(S) -
" "_"""_ _"""' _ _"""__ _ ___"_' _ _ _"' _' _"_ _"_"_' __"_""""' _ _ _""""_"_"' _' _"'""_ _ _""' _""' _"'
DISPOSER NA2�S5)
WASTE HANDLID $Y NON HAZAADOIIS WASTE £ACZZ.ZTY
£PA ZD N[7NffiEIL(S) DISPOSAL PRO.^.EDDA£
NOT A°PLICAHLE RECYC/BENEF IISE
---------------------------------
05332i46 SOIIIli'S FIRATZV£ {1$ PICBSC) Cl ,�<9� GALLONS 8122
TRPNSPORTER NA2�(S} EPA ID NOI78£R(S)
SAFETY P3,EEN SERVICES INC (2G) . SCit-D00-074-591
DISPOS£R NAME(5) _ EPA ID Ni7N,A£R(S) DiSPOSAL PROCEDURE
SA£ETY RLEEN ZNC (PECATONSCA) IISJ-980-502-744 SEWER W/O TREAT
' _ _ _ _ _ � � � �
_ ' _ ' ' _ _ ' ' _ ' _ _ ' ' ' _ � ' ' ' f�WI iL'°� . ' ' ' ' ' ' ' _ ' ' ' _ ' ' ' '
� ' � _ �
(:
05332147 SCRP.P CiRCRZT BOARDS 82 P $SSO:'L'� PODNDS D008 DOIl
TRANSPORTEi2 NP3n'E{S)
HAIIi.ID BY TW�tIISPORTER OF CHOICE
DISPOSER NAME(S)
_ E[NSRO-CHIIS ZNC (ROGERS/N,�T)
EPA iD NDMSER(S)
NOT APPLICASYE
EPA iD NIIMS�t(S)
M•�1D-980-996-805
DZSPOSAL PROCEDIIRE
RECYC/BENEF IISE
_ _ _ ' ' ' _ ' _ ' ' ' ' ' _ _ _ ' ' ' ' _ _ _ ' ' _ ' _ ' ' ' ' _ _ ' ' ' " ' ' _ _ _ ' ' ' ' ' ' ' ' ' ' ' _ '
L!
05334988 D&VEiAPER(Cf,fiAN£it C1 � GALLpNS D001
TRANS?ORT� NAMI'ilS) EPA ZD N[R58ER(S)
SAYETY RLE£N SERVICES INC (TG) SCR-000-074-591
DISPOSER NAL�E(S) - EPA ID NIIMBER(S) DISPOSAL P&OCIDpgE
SAFETY PSE£N INC (PECAT017ICA) ILD-980-502-744 Si7RNID AS ppgL
Q5334989_ RAGS WfTBIC�AROETHYLENB C1 �rC1� �LONS FD02 D040 .
TRF�NSPORTER NFiN.E(S) . EPA ID N[R�ER(S) '
� SAFETY RI,EEN SERVICES SNC (TG) SCR-OUO-074-591 ''
DISPOSER NAMEfS) . £PA ZD NUfffiER1S) DISPOSAL PROCIDIIRE
SAFETY BLEEN INC (PECATONiCA) ILD-980-502-744 INCIN/TH£RMAL
05335103 RAGS W/ZEP SA£ETY SOLVENT C1 �„53�50 GALLONS F002
� TRANSPORTER NP.ME45)
SAFETY RLEEN SII2VICES INC (TG)
DISPOS£R NAN.E(S)
^uA£ETY PS,EEN�INC (PECATOI7ICA)
EPS ID_NOMUER{S)
SCR-000-074591
£PA ID NIINaHER(SJ
Z7,D-980-502-744
DISPOSAL PROCEDS7RE
arcxNl�xMni.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ' - - - - - - - - - - - - - - - - - -
�
05335104 Brauewr WASB SOlVENT C1 fL.Bt� GIeLLONS D001 D039 II210
TRANSPORTER NAY.E(S) EPA ID NOMB£R(S)
SA£ETY RLEEN SERVICES INC (TG) SCR-000-074-591
� s -�^.��,T, TO: HE:3NEYZN COV1`7'fS
, . FLT,ZT.RDOUS WB.STE LR.ZT
�- 417 NORTH SYH 52R£ET
t , LyNEP POiSg� y,p7 55401-1397 � � -� ---
- - ' �PH: (6121 348-810D � _ _..
03-/o5a�'
pAGE N0= 9
COLiPANY SZTE ID_ 000050:9 05316325
Cpr7ppNY SIT� SZC_ 89b2 .
GFS7F,gATOR SiZE: SQG � .
nza� o� rr.r,x� io/zslzooz
— --PI,2N-DII�DR1�:--�-Z/1512909 '- '_ -- _'-__
� " _ ' ___ ` _ ' __ ' _ ' _"'_" ' _"'_'____'__'_'_""'_'_""_ '__'_"___'__"'_'__ EPA COD£ (5)_""'_'_'
_'_'_"'__ nmrpN - i7NiT OP GIIRE
"---"'--' HW CODE 2002 E^uT-"�"`e
'_____"'_'_ ___'____'_""
p�g ZD iTASTE NAME ' ""____"_'_'_'_'_'___'_
W _"_'_"_
_'__"
"__"_""_'_'__'_________"- '
' gp8 � 270l�9&RiS� DISPOSA3+ PROCIDIIiL°
DISPOSER NA�^(S) - ZLD-980-502-�44 S`�J�'
� g�F'ETy iCLE�t7 Z3:C CP£CATONIG) - " ' _ " " ' _ " _ ' ' " ' ' "
� � � _ _ _ _ - _ _ _ _ - _ __ _.-__.._ _�_ .Br-- _-_ __-_- JT_�3 ____"__ .__.
� _ �.�n�
^J . � �
05345138 .FII£L/wATER MZ%TL'!�E
y�(2A17SPORTEit AF+ME(51
q'p B£ DElEgMINID
DIS°OSER 3SPd'�(s)
. 1'p BE D�ERMSNID
£PA iD NCaffiE8�5)
NOT A�p�CT*��
- EPA ID i10Pffi��'it(5)
- NOT APPLICABLE
'_'_' _' _"""' _ _ _""_' _""""_ _"""
DISPOSAL PROCEDDRE
pNSIZE ACCOM
I2E7'IISiN TO: HENNEPZN COIINTY
HSZARDOIIS WASTE IINIT
?17 NORTTi STH STREET
1:INA'EF.POZZS, tII7 55401-139'7
.. . . . P$: (612) 348-8100 . ""'
03-�058
Pe1GE NO: 1D •
C9�ANY SITE ZD: 009050�9 05316325 .
CON.PEI'Y SITE SIC: 8062
G£RERAIVB SZ2E: SQG "_
: DATE OP PLAN: . � 10/29/2002 "
—ar:au�nrrr�.nm�i-r�icrrn�' —'__ - "_
Q
03—/a�
2e��}� �Iazard��.�s �'a S�E �_'r�iISC �.�3�IIC3�i(3IlIC
-- --= --- — --- _
--
----.:__ =Retur�r��ith-ManageirientPlan-Su�niriary - - -
Environmeutal Programs Snrvey
'I'his }�ear, aur iicense applicarion giritisiuvey is desi�ed io pro�t you to r.�a:� about how }:�- =2'y u�� obsolete,
dama�ed, broken or inoperable elecironics equipment such as compurers, monitars, servers, fax madvnes, wPiers,
printers, etc.
Piease answer the folloRjn¢ one_cn�nc-_ -_. ---'
- -- ---- ___ _ - - _ - -
__ --- --- - — •
1) Do you curreudY have anY electronics equipmenx at youx business that you no lon�er plan to use and ` Y � �
must dispase of?
2) What bazardoas components im_°_ht be found in scrap electronia equipment?
" a) lead
b) mercury
c) .cadmium
� PCBs
e all of the above
�� �� of Yhe �ollowfng pam oP our en�ironment sni�ht be hazmed by impzoper clisposal of electronics equipm�nl?
a) air
b) drin�ng water
c) Iakes & meams
� so�3
' � ) all of the above
L%
4) Wuere can businesses geY information on oQtions available for managing elecironics equipmenY?
a) Hemmepin Counry DES
b) w�+vw co heuneoin.mn.us�environmentai
/�� call'612-3�8-3690
( d) 1 all of the above
LJ
answezs to questions: 2e,3e 4d
Application/Certification
I cert� undrr penalry of law t/wt !/tm�e persona7/y e<mnfned the irz romwiion lisfed on tke accomP�l�N"S C0i�Pr�lerPrimout induding.
cornparsy s�e nmire, 7oca8on address, mailL:g address, comparsy contact penon, Compnny Sue ID Number, EPA �D nun+U� and waste
management injormation I have rnade a11 neceuary corlections or changes irz thai information, either on iheprintmet or on a separate sheet
of'paper attad�ed to the printoat I beliere, based on my inqc�iry of those persons immediareSy rerponsfble for checld�xg or obtaining the,
information, thai the infonnation that I am submiiting on the printout and all auaclied docun+enls is hue, accurate and complete I understm�d'
tGat there me sion�cant Penalhes for subr>vtiing false infonnation, inctuding the possibiliry offzne and imprisomn�L I hereby appZy for h
Hennepin Co+mry Ha�ardous Y�°s�e Generator License, s�bjed�to'a/l conditions and provisions ofM'vueesoia Ruler CTiapter 7045 and��
Henne,pinCou�vt�%OrdUianceSeven . e . _ T - ..
��Z�
Compaay Site Name .
�ni�'�l//� ��J � s �G�� t�
Signature ( .
` � � S�n � r z
�ame (Pzinted)
- Company Site ID
r�l��tr��. �
Date (�
C�Gh��Ca� ��tFnC✓ �'Tt;CE?F
Title
- -- _.NA=ZARDOUSv�71!ASTEj-LI.GENSE:MAN/
_ _ -_ .��.,_„_,,:_ . _ .
. �-� _ � " _� _H_NN�F7iV�COL'1N'f\'_pEP:4PTh
". ' 'd17Nori(�.57"'Sircci�Suiic200.Mi��jw7rs�NL�J55:07-U'97
Piease print or fype ail information._ Complete one column (items A{hru
Company Site Name �a��v -,� �g ��kt��f'S �1�C�tC•c�
Column 3
A) Wa'ste?��ame
8) Source or Process of Generztion � J
�G.i11�
C) Year WasYe was F•�rsi Produced
D) Physicat Sxaze (circle)
E) 4-digit Hazardous Waste Code(sj
� Amount per Yeaz
G) Type of Stomge Container{s)
[� S2oraae Location {circ]e)
n On-Site Manaaement Method(circ{e)
1j Treatment or Shipment Frequeacy
K) Transporter Name
`,) Transporter ID Number
-J _ - �_ _ ,
v� Designated Facility Name ��� �1, �� ,_ (j, ��
y � t_i�
� Designated Facility ID Number � � s � � � � � � � � � �� � � �s �� � e'�� �� � �' �
�_'� � -
burn as fuel recycle 'inciner 6urn as fue! recycle incinera e
�) Designated Facility Mana�emenY �4ethod chemical fttatian neutralize and 'cal fuation neuhalLe land disposa[
oiher
Z�Z
SOlf �IL�i[!!1 a4$ sludge
D3-1 oc
PtAN - FORM'2
!7P,LSERVICES �. �
"•FAXjGt �
� requlated waste__Siq th�co�npletei
Column 2
Zt�o2
solid liquid gar sludge
�obl �i ��
1\D Goa�ohs . �O �,jans.
ru parl bottle origina! contairer drum pail bottle original container
undera ound tank above grouxd tank vnderground tank abweground tank
other other
indoors outdoors indoors outdoors
storedjorshi me iecycled neutralized to�ed,forshipmen recycled neutralizea
ion erchange wastewater treatmem ion ezc ange was[ewater Zreatment
other otfier
l times per �_ year(s) _L times per �_ year(sJ
disposa! chemt
other
_-� _- ° _
:c;;:rs�_�-°`- - _`4'=: � ''= - -� - - - -- ,- _ - _ _ - -..�-<_�- -_
' . ' _ _— " _ _ '_ _ ' _ �";rE^�:-�' . '
- -_� - �_--...:. • .... . - �... - __. . . _. ._ .:.. ,. . . -
' � : 03-�058
p� ptint or type a(i information. Comple:� one column (items A thru 0) ior each reguiat2d v.-aste. Sien the comp!=ted ;orm.
� ' � Column 3 Colunin 4
q) ���asic Namc
----�-- -...----------
Q) Source or Prxess of Gencsation
C) Year Wasie w2s Firs[ Produced -
D) Pfiysical Sta.e (circlej
� 4-digit Aazardous Wasce Code(5)
� Aanount pc- Year
G) Type of Starage Container(s)
[-i) Sion�e Location (circle)
solid fiquid g¢t slud�e � solid liyuid gas s.ud�e
i pai! bott[e original tonfciner drum pail bonle ori�ina! container
underground tank above grourr.l rank underground tank above ground tank
oths other
indoors outdoors
indnon outdoors
� On-Site Manaeemeni Muhod jcirclej � ion exchange was�ewatvr treatment J ion erchange wastewa�¢r treotment
other + other
� Treatrnent or Shipmen4 Frequency
[imes per year(s)
times p2r year(s)
C) Transporter Name
,j Trazuporter ID 1lumbu
� Designated Faciliiy Name
� Designated Facility ID Numbu
burn as fuel recycle incinerele burn ar fuel recycle incineraie
)) Designated Faciliry Management Method chemicalfttaiion neutralize land d'upasal chemical firation neutralize Iand di.sposal
� ather _ _ ' other
certriy under pena7tyotlaw that t have personally examined antl am famlllar wJth the informaSon su6miKed in this and alf aHached documenfs, and
�af based on my inquiry of fhoseindividua/s immediate7yresponsible fo� obtaining the informaSon, 1 b�eve that fhe submiHed informaSon is frue,
ccurzte, and complete. ! am aware thaf ihere are significanf penaffies for submitting faVse info�rnaGon, incfuding fhe possibilify of fine and
nprisonmenL �/ �
�!�//� "o� `�, ��l�f�� /���.�/6 2/
Signafure /' 1 Date
f�`Q �7 Cc°S r7�1 •,�G7 i G'�i J�'✓ tf � �i Cd{' i'�.f�� lA��P �//'/�C7 /
. Name (Please p�nt or type) . ' TNe ,
' "' •}iAZARQOUS:-INASTEi�LICENSE:h9ANAGE�ENT
. ... - 4'"1 '.
� ..._� �_ � " _-
. . : °.(IZNoCfiS"�^' . t.tin'nc5jwlii, p',ti 35AOi-li9] . (613) i4S-F lA0
'lease print or ty�e �i! in�ormation._Complefe oae column (ifems- thru O for each
:ompany Site�Name `v ��C��f� �1PAifci, l_�.'_l'l'CQ(
Column 1
1) Waste t�ame
3) Source or Process of Generar.on
;) Year Wasie was Fi-si Produced
�) Physical Srate {circle) -
) 4-digit Hazardous i Code(s)
j Amount per Year
) Type of Ston�e Container(s)
) Storage Locazion {circle)
On-Site Management Metho3 (circle)
Treahnent or Shipment Frequency
1 Transporter Name
Transporter ID Number
) Designated FaciIity Name
Desiznated Pacility ID Number
Desionated Facility Ma�a�ement Ivterliod
Cotumn 2
� L� F� 1 ZZ �TUf
1 �
���1� <� l�ai � o �
�^ ��
Z�c2 Zao2
solr liquid gas sludge solyd liqaid gas sludge
�ob1 I�co�
t\� Caa�\pnS 3t7 C�,.1,��nS .
�ru pail baule original container drum pail bottle origin¢! container
underground tank above ground tank vndvground tank above ground tank .
othec other
indoors outdoors indaors outdoors
ron ercharige wastewater treatment
ther
I timesPer --(__ Ye¢t'�S�
�y Y�1�e�1
��� ����- ��
�- - = <
s fue! recycle ?n`cine
J'uation neutralize and
- — _ - _ - _ ':�:
.+A "�"'"' __ _ _ _
3-�os�
Pi_AN
ron excnange wastewater ireahnent
odrer
�L times per �_ year(s)
�c.K - u�u - u�y - . 7�
'� l.t �2ap
���� ���:`� ����y�
ZL-!2`� ' �b�-��1�'
burrr as firel recycle incinera e
chemieal fttatior, neutra/i:e land disposal
other
. . . .- ��.�� . -.
. � � 03-�058
Please print or type s11 irformation. Complete bne column (i,ems A thru O) for each regulated waste. Sign the conipleted form.
. " Co{umn 3 Cotumn 4
q) Wastc Nar.�c
B) Source or Proccss of Generatioa
C) Year Watte was Frst Produced
D) Physical Su:e (cirdej
E) 4-digit Hazardous ��aste Code(s)
' � Amouc�t per Year
G) Type of Stora�e Container(s)
f� Storage Loca:ion (circle)
I) On-Site Malaeemer.t Me:hod (cirde)
n Treatment or Shipment Frequency
iQ Trnnspozt°.: t�Tame'
Lj Transporter?D humbu �
Iv� DesiguaIed FaciliYy 3da¢ne
i� Designa;ed Facility ID 1�'umber
O} Dcs�nated Faciiity Management Method
soliG liquid gas rludge
drum pail bo!!le original conlainer
undergrovnd tank . above ground tank
othr�
indoors autdoors
storedjorshipment reeycled neuvatized
ian eschange w¢rtewalerlreatmerst
other _.
�imesper yem(sj
neutralize iandclisposal
solid Iiyuid gas slud�e
?rum pai! bottle o�iginal container
undero ound tank above ground tank
other
indoors ouidoors
tored far sh+pment re.ry neutralized
ion er.change w¢slewater uectmeni
times per
year{sj
0
other
recycle inciaerate
neutralize larrd d'uposa!
J cerfify under penalSy of/aw fhatf have personally eza.mived andam famiJiarwifh the infoYmalion submitted in this and all aKached documents, and
L.at based on my inquiry ofihose individuals immedrate(yrPSponsible for obtaining �ffie infonnaSon, f believe that the submiKed informaSon is true,
accurate, and comptele. f am aware thaf there are signi{canf pena/Ses for submilfing fa7se informaSon, including fhe possi6i/ity o7 fine and
ir.�priscnmenf. � � . .
�i? // e �_�, l�ir� �Ll�, S/6 2J
Signature Date
�A,� �PS � Sl; �„�� �� - �.t� �/-��,��� �'/� ,
ruamn fPlease orint or fvoe) Title � ��
' :`%� _ q�':. SPA S� :.;=.. 03 8
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� 9 PARi�NG AREA
, - 1 .145 _ACRES .
� : 16 PACES
�. _.
� � G �
28. C12�S Radioactive
� 7 . . PAGES . waste
` GARA�E
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� ` 71A Fiammable soivents
. 1 i LB 71B Chemicais, batferies
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