10-Final Draft Exhibit F - CM Authorization Form.pdf

Page 1 of 3 Exhibit F - Final Draft RFP 2025

EXHIBIT F

CM AUTHORIZATION FORM

COMPANY LEVEL B CORRECTIVE MAINTENANCE REQUEST

Location (i.e. WRF/Building/Conv Site) Facility (i.e. building, equipment, vehicle or asset type and number)

Age of Facility Expected useful life of the Facility Description of the Issue Investigated by

Priority of project and reason for priority (e.g. reduced capacity, no redundancy, safety issue)

Expected scope of repairs

Summary of PM and CM history (i.e. previous issues identified and recurring issues)

Other existing issues to be addressed as part of the project (e.g. add hard facing to a screw conveyor, increase capacity of pump)

P.E. stamp needed: Yes ☐ No ☐ Unknown ☐

Expected total cost of repairs

Proposed process for completing repairs (i.e. Company staff, Contracted, Combination, Spare parts used, managed by Company, managed by District), initial cost breakdown and initial schedule.

Overtime requested by Company: Yes ☐ No ☐

Page 2 of 3 Exhibit F - Final Draft RFP 2025

MMSD AUTHORIZATION

Scope

Approved as proposed: ☐

Approved with conditions noted below: ☐ Conditions/Comments: Click or tap here to enter text.

Not Approved ☐

Proposed Implementation

Approved as proposed: ☐

Approved with conditions noted below: ☐ Conditions/Comments: Click or tap here to enter text.

Not Approved ☐

Does responsibility for payment need to be reviewed?

Yes ☐ No ☐ Reason for review

Reviewed by _________________________________ Date _____________

Approved by ________________________________ Date _____________

IF APPROVED BY THE DISTRICT AND ASSIGNED TO COMPANY

STAFF TO EXECUTE

Detailed Scope of work

For any work performed in-house, what is the expected start date

For any work advertised by the Company, what is the expected advertisement date

Page 3 of 3 Exhibit F - Final Draft RFP 2025

Expected duration of repairs, including work performed in-house, contracted work, and parts/equipment lead time

Detailed cost estimate

Final Implementation

Approved as proposed: ☐

Approved with conditions noted below: ☐

Conditions/Comments: Click or tap here to enter text.

Not Approved ☐

Maintenance Officer Signature: ________________________________________

Date: