04. DCNR DSA Attachment A Form.pdf

10/18/2022

ATTACHMENT A

Signed Acknowledgement of DCNR DSA Specifications

1. The Contractor must choose the appropriate acknowledgement letter:

a. DSA Contractor Acknowledgement of DSA Specifications (A.1)

This form is used when the Contractor will be creating and supplying the DSA.

b. DSA Quarry Letter of Intent (A.2)

This form is used when the DSA will be created and supplied by a quarry not owned by the Contractor.

2. The appropriate form must be printed, completed in its entirety, signed, and dated.

a. Both A.1 and A.2 must be signed only by approved representatives of the Contractor and Quarry respectively.

b. The authorized representative must include their title with their signature.

c. Representatives must be knowledgeable of DSA and be prepared to answer all questions on the product.

3. The Contractor must then include the appropriate fully executed form with their bid response (either A.1 or A.2.).

DO NOT attach both acknowledgements.

4. Failure to comply with this requirement could result in a non-responsive determination and subsequent disqualification for the Contractor.

BUREAU OF ADMINISTRATIVE SERVICES

A.1

CONTRACTOR ACKNOWLEDGEMENT OF DSA PRODUCT

Solicitation # 6100057462 FD10 - Sproul Cattaraugus Road Approximate Tonnage – 5,075 (Tonnage is estimated and can increase or decrease based on the needs of the Department.)

By signing this acknowledgement I, _______________________________________ (Print Name), an authorized representative of ____________________________________________ (Name of Contractor), confirms that ___________________________________________ (Name of Contractor) has the ability to competently create and supply certified Driving Surface Aggregate (DSA) for the Solicitation listed above that meets the following specifications.

Passive Sieve

Low Percentage

High Percentage

1 ½ inch 100% -- ¾ inch 65% 97%

#4 30% 65% #16 15% 30%

#200* 10% 15%

The fines passing the #200 sieve must be rock material. No clay or silt soil may be added. Limestone material passing the #200 sieve may be used to make up a deficit in the distribution of sandstone aggregate rock, and vice versa. All added material passing the #200 sieve must be derived from rock material that conforms to program specifications. Lime kiln dust and cement kiln dust may be added to DSA to account for up to 50% of the fines passing the #200 sieve. The amount of particles passing the #200 sieve will be determined using the washing procedures specified in PTM No. 100.

*If the Plasticity Index for the Material is 2 or below, then the #200 sieve is permitted to be 10-17%.

pH: 6 – 12.45 as measured by EPA 9045C

LA Abrasion: < 40% loss based on Los Angeles Abrasion test, AASHTO T-96 [ASTM C 131]

Plasticity Index: ≤ 4 based on ASTM D4318 – Standard Test Method for Liquid Limit, Plastic Limit, and Plasticity Index of Soils.

Optimum Moisture: Material will be delivered and placed at optimum moisture content, or up to 2% below that value, as determined for that particular source. The optimum percentage moisture will be determined using Proctor Test ASTM D698, procedure C, Standard.

Signature of Authorized Representative & Title Date

Division of Procurement & Supply Rachel Carson State Office Building | P.O. Box 8769 | Harrisburg, PA 17105-8769 | 717.787.3278 | F 717.787.8624 | www.dcnr.pa.gov

BUREAU OF ADMINISTRATIVE SERVICES

A.2

QUARRY ACKNOWLEDGEMENT OF DSA PRODUCT - LETTER OF INTENT

Solicitation # 6100057462 FD10 - Sproul Cattaraugus Road Approximate Tonnage – 5,075 (Tonnage is estimated and can increase or decrease based on the needs of the Department.)

By signing this Letter of Intent I, _______________________________________ (Print Name), an authorized representative of ____________________________________________ (Name of Quarry), confirms that ___________________________________________ (Name of Quarry) has the ability to competently create and supply to ____________________________________ (Name of Contractor) certified Driving Surface Aggregate (DSA) for the Solicitation listed above that meets the following specifications.

The fines passing the #200 sieve must be rock material. No clay or silt soil may be added. Limestone material passing the #200 sieve may be used to make up a deficit in the distribution of sandstone aggregate rock, and vice versa. All added material passing the #200 sieve must be derived from rock material that conforms to program specifications. Lime kiln dust and cement kiln dust may be added to DSA to account for up to 50% of the fines passing the #200 sieve. The amount of particles passing the #200 sieve will be determined using the washing procedures specified in PTM No. 100.

*If the Plasticity Index for the Material is 2 or below, then the #200 sieve is permitted to be 10-17%.

pH: 6 – 12.45 as measured by EPA 9045C

LA Abrasion: < 40% loss based on Los Angeles Abrasion test, AASHTO T-96 [ASTM C 131]

Plasticity Index: ≤ 4 based on ASTM D4318 – Standard Test Method for Liquid Limit, Plastic Limit, and Plasticity Index of Soils.

Optimum Moisture: Material will be delivered and placed at optimum moisture content, or up to 2% below that value, as determined for that particular source. The optimum percentage moisture will be determined using Proctor Test ASTM D698, procedure C, Standard.

Signature of Authorized Representative & Title Date

Division of Procurement & Supply Rachel Carson State Office Building | P.O. Box 8769 | Harrisburg, PA 17105-8769 | 717.787.3278 | F 717.787.8624 | www.dcnr.pa.gov

Passive Sieve

Low Percentage

High Percentage

1 ½ inch 100% -- ¾ inch 65% 97%

#4 30% 65% #16 15% 30%

#200* 10% 15%