R4-ConcreteVaultToiletOrderForm.Engr-CATB-3_3_21_Bear_Creek_TS.pdf

No Screen Full Screen

Roof Slope (ex: 6:12)Roof Pitch Slope: Gable Style

Partial Screen

Monitor Style Roof

Toilet Type : : Single Vault

Entry Approach (for single units):

Access Screen (for single units):

Front Entry Left Hand Entry Right Hand Entry

Min. Snow load (psf) (Standard is 250 psf) Min. Wind load (mph) (Standard is 120 MPH) Seismic load category Standard is Category D)

Region 4 Concrete Vault Toilet Order Form

Roof Exterior Simulated Finish (not all options are available on all models:

Wood Shake Metal Ribbed Exposed Aggregate Other:

Wall Exterior Simulated Finish (not all options are available on all models:

Exposed Aggregate Board/Batt

Struck Trowel Skip Trowel

Split Block Everlog

Rock Lap Siding

Bottom

Barnwood

Easybrick

Dual Texture: Top

Wood Shake Metal Ribbed Exposed Aggregate Other:

Roof Exterior Color (other colors may be available):

Natural (Exposed Aggregate) Green

Light Medium Dark Other:

Wall Exterior Color (other colors may be available):

Green Brown Gray

Other:

Brown Gray

Natural (Exposed Aggregate)

Light Medium Dark

Two Tone: Top Bottom

Interior Color (other colors may be available):

White White Grays Beige Other:

Interior Floor Color (other colors may be available):

White Grays Beige Other:

Wall Vent Location (should be on side of prevailing wind):

Door Right Left Rear

Check items to be included with requirement:

Requisition #:

Project Title:

Project Location:

Quantity of this model/style to be ordered from this form.

Design Criteria:

Double Vault Double Vault w/ Chase

Form Updated 5/25/19

Bear Creek Transfer Camp Vault Toilet

Bear Creek Transfer Camp is located 34 miles north of Fairfield, Idaho.

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Region 4 Concrete Vault Toilet Order Form (Continued) Other Options Available:

Delivery and Installation:

Delivered to Site, Placed in Hole, Including Excavation & Backfilled Delivered to Site and Placed in an Excavated Hole (Government Excavated & Backfilled)

Warranty:

Shall conform for GSA Schedule/Commercial Practice Concrete Structure - Minimum of 3 Years All other - Minimum of 1 Year.

Statement of Work:

To be attached with Directions to Site, Include Mapping and Description of Placement.

Additional Comments, Instructions or Options:

Standard Delivery Time is 90 days or Less upon award of contract.

Evaluation Criteria: Best Value (Price, Past Performance, Delivery Time)

Vault Poly Liner Coat Hooks Extended Vent Stack (for shady locations) 3 Roll Stainless Steel Paper Holder (pad-lockable) Solar Light Kit Solar Fan Kit Waste Basket Chain Door Strap Raptor Vent Screen Cap Hand Sanitizer Deadbolt Mortised Type operated by Key from Outside ONLY, US26D (Dull Chrome Finish) See additional notes below

Women Unisex Exterior Signage Color: Brown Other: Blue

Form Updated 5/25/19

Signage for Men djeppsen Cross-Out djeppsen Cross-Out

OFFEROR’S COMPANY INFORMATION:

Total Amount including FOB $_____________________

Name of Company (please print): _________________________________________

GSA Schedule: ________________________________________________________

DUNs Number: ________________________________________________________

Printed Name of Company Agent: ________________________________________

Signature of Company Agent: __________________________________________

Date: ________________________________________________________________

Phone Number: _______________________ ________________________________

E-Mail Address: _____________________________________________________

Form Updated 5/25/19

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