0200000 F Forms.pdf

Deliverables Form Preparation Instructions

Deliverable Title: (Title of Report)

Form Attachment No.:

Government Approval Required: _ X Yes No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

The report shall be prepared using Microsoft Office Word software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s comments and resubmit the request via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

Deliverable Title: Request to Work Outside Government’s Regular Working Hours

Form Attachment No.: N/A

Government Approval Required: ___ Yes X No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

The report shall be prepared using Microsoft Office Word software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Sign-In Sheets and Minutes

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Final Revision of Minutes

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Permits and Licenses

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Certificate of Insurance

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Work Schedule Form Attachment No.: N/A

Government Approval Required: X Yes No

Media: Hard Copy X Electronic Direct System Input

Instructions:

The schedule shall be prepared using Microsoft Office Word or Excel software.

Submit schedule for approval at least 30 days prior to commencement of services on a semiannual basis.

Submit via email to KO/FMFS PAR for Government review and comment.

Deliverable Title: Quality Management Plan

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: QC Inspection Plan

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Contractor Quality Inspection and Surveillance Report

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Quality Inspection and Surveillance File

Form Attachment No.: N/A

Government Approval Required: X Yes No

Media: Hard Copy X Electronic Direct System Input

Instructions:

To ensure that the work performed conforms to the contract requirements, the Contractor shall document and maintain a file of all scheduled and performed inspections and surveillances, inspection and surveillance results and dates and details of corrective and preventative actions. The quality inspection and surveillance file shall be property of the Government and made available during the Government’s regular working hours.

The Quality Inspection and Surveillance file shall be prepared using Microsoft Office Word software.

At the end of each year, the Contractor shall turn over the electronic files to the Government, and they shall become the property of the Government. The file shall be turned over to the KO within five calendar days of completion/termination of the contract.

Deliverable Title: List of Key Personnel and Qualifications

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Organizational Chart

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Proof of Legal Residency

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Contractor Labor Hours (eCRMA) Report

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Employee List

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Passes and Badges

Form Attachment No.: N/A

Government Approval Required: X Yes __ No

Media: X Hard Copy X Electronic Direct System Input

Instructions:

Coordinate with the COR or the Performance Assessment Representative (PAR) to complete the steps below:

1. Assemble the names of all your personnel that need base access.

2. If possible, assure their personnel history will not prohibit base access.

3. Gather their required information and submit it to the PAR and/or Visitor’s Control Center

(VCC) (located at the front gate)

4. Submit applications (completed form SECNAV 5512s) to the Security Department’s Visitor

Control Center and /or PAR.

Ask your COR if an additional Restricted Area Access Request Form is required

You may call the VCC if you have additional questions regarding Bass Access – (732) 866-2214

Deliverable Title: Accident Prevention Plan

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s comments and resubmit the request via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

The APP shall follow the format and include all elements in Appendix A of the US Army Corps of Engineers, Safety and Health Requirements Manual EM 385-1-1. The APP shall incorporate Activity Hazard Analyses (AHAs) and Occupational Risk and Compliance Plans and Programs that are relevant to the site specific hazards and controls for each activity and type of work that may be encountered in the performance of this contract.

Submit in a tabbed binder following the format/sequence as outlined in Appendix A of EM 385-1- 1, and submit a copy via email and a hard copy to the KO/FMFS PAR for Government review and comment.

1. If the KO/FMFS PAR accepts the Accident Prevention Plan, the Government shall notify the

Contractor of Government acceptance.

2. If the KO/FMFS PAR responds to the Accident Prevention Plan with review comments, then incorporate the Government’s comments and resubmit the Accident Prevention Plan via email and hard copy to the KO/FMFS PAR. Continue this cycle until the Government notifies the Contractor of Government acceptance.

Deliverable Title: Activity Hazard Analysis

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Compliance Plans, Programs, and Procedures

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: NAVFAC Contractor Incident Reporting System (CIRS)

Form Attachment No. J-0200000-05

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Monthly On-Site Labor Report

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: OSHA Citations and Violations Corrective Action Report

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Safety Certifications

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Hazardous Waste Disposal Reports

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Spill Report

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Emergency Planning and Community Right-To-Know Act (EPCRA) Report

Form Attachment No.: N/A

Government Approval Required: X Yes ___ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

2. Include the following:

a. EPCRA Plans and Procedures:

1) Hazardous Materials Planned for Use: Include an inventory of hazardous materials planned for use, including estimated quantities, and a copy of the corresponding material safety data sheets (MSDS) for hazardous materials expected to be used for this contract during each calendar year. The inventory shall include all information required to complete the Contractor Hazardous Material Inventory Log shown in the Form Attachment. This report shall be submitted to the KO and Environmental Compliance Office via the KO.

2) Plan for protecting personnel and property during the transport, storage, and use of the materials.

3) Emergency procedures for spill response and disposal, including a site map with approximate quantities on site at any given time. The site map, showing where the hazardous substances are stored, shall be attached to the inventory.

4) Approved labeling system to identify contents of all containers on-site.

b. Hazardous Materials Actually Used: Include an inventory of the actual hazardous materials used, including include quantities, to the KO and Environmental Compliance Office via the KO. The inventory shall include all information required to complete the Contractor Hazardous Material Inventory Log shown in the Form Attachment.

3. Submit additional information to the Government as requested to support EPCRA reporting requirements.

Deliverable Title: Contractor Hazardous Material Inventory

Form Attachment No.: J-0200000-14

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Detailed Scope of Work and Detailed Estimate

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s

Deliverable Title: Non-Recurring Work Proposals

Form Attachment No.: N/A

Government Approval Required: Yes __X_ No

Media: ___ Hard Copy X Electronic ___ Direct System Input

Instructions:

1. The report shall be prepared using Microsoft Office software.

Submit a copy via email to recipients on the distribution list for Government review and comment.

1. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.

2. If the KO responds to the request with review comments, then incorporate the Government’s comments and resubmit the request via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

Submit Detailed Work Proposal

Submit Non-recurring work proposal to the KO within 2 working days which includes:

Complete list of all tasks necessary to perform the required scope of work

Number of direct labor hours to perform each task

Projected quantity and cost of materials and equipment to perform the scope of work

Detailed Estimate The estimate shall be prepared using Microsoft Office Excelâ software.

The estimate shall include:

Separately priced labor for each laborer including management

Separately priced material

Separately priced equipment

Itemized additional other cost for consideration

The total cost.

In addition:

Clearly show the deductions for the applicable recurring work limit of liability.

The resultant proposed price shall be for the portion of the work exceeding the recurring work limit of liability

Deliverable Title: Service Program Plan Form Attachment No.: N/A

Government Approval Required: X Yes No

Media: Hard Copy X Electronic Direct System Input

Instructions:

The report shall be prepared using Microsoft Office Wordâ and shall be submitted within 30 calendar days after contract award, and annually thereafter.

Submit a copy of the report via email to KO/FMFS PAR for Government review and comment.

Deliverable Title: Service Work Schedule Form Attachment No.: N/A

Government Approval Required: X Yes No

Media: Hard Copy X Electronic Direct System Input

Instructions:

The schedule shall be prepared using Microsoft Office Wordâ or Excel software.

Submit schedule for approval at least 30 days prior to commencement of services on a semiannual basis.

Submit via email to KO/FMFS PAR for Government review and comment.

Deliverable Title: Service Report Form Attachment No.: N/A

Government Approval Required: X Yes No

Media: Hard Copy X Electronic Direct System Input

Instructions:

The report shall be prepared using Microsoft Office Wordâ or Excel or other approved software and submitted to the KO/FMFS PAR for Government review and comment.

The Service Report shall be submitted to the KO/FMFS PAR electronically via email within 5 days after the completion of services.

The Contractor shall develop a report that contains the following information (report format is subject to review and approval by the Government prior to the start of work, and shall be subject to modification by the direction of the Government):

a. Detailed description of work actually completed, problems encountered and recommended follow-up actions required.

b. Brief description of material and parts used.

c. Date and time work began.

d. Date and time work was completed.

e. Total hours of labor (by craft) expended, including travel time.

f. Name of person accepting the work.

g. Last name and first initial of the Contractor employee(s) performing the work.

Submit a copy of the report via email to KO/FSCM PAR for Government review and comment.