13-ATTACHMENT A-3 DAILY SVC RPT.pdf

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Attached to
FEMA Compliant Fabricate and Refurbish Water and Wastewater Control Panels
Solicitation number
OPN2131152B1
Issued by
Broward County, Florida

About this file

This is a Daily Service Report form used by Broward County for documenting water and wastewater operations and maintenance services. The form serves as the primary documentation tool for vendor work performed under the FEMA Compliant Fabrication and Refurbishment Water and Wastewater Control Panels contract. The report captures essential project information including vendor identification, purchase order and work order numbers, service dates, and detailed descriptions of work performed. Vendors are required to document parts used with supporting backup documentation, labor classifications (Master, Journey, Apprentice, or Laborer), hourly rates, and any subcontractors engaged for the work. The form designates specific sections for documenting model and serial numbers of equipment serviced, quantities of line items, and total costs associated with parts and labor.

Authorization and acceptance procedures are clearly delineated on the form, requiring contractor signatures to certify work completion and authorized county personnel signatures to confirm satisfactory completion and payment authorization. The form utilizes a tri-copy distribution system with separate copies designated for the Building and Grounds (BC) department and the vendor, ensuring accountability and record-keeping across all parties. Status updates are required if work is incomplete, with fields for job completion verification, agency identification, and time-out documentation. This standardized reporting mechanism ensures compliance with FEMA requirements and maintains transparent documentation of all fabrication, refurbishment, and maintenance services related to water and wastewater control panels across Broward County agencies.

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Text version

VENDOR: PURCHASE ORDER #:

LOCATION: WORK ORDER #

ADDRESS: DATE OF SERVICE: ______________________

PM: SERVICE:

DESCRIPTION OF JOB:

MODEL # SERIAL #

QTY / LINE # PARTS USED / LINE DESCRIPTION (MANDATORY VENDOR BACKUP NEEDED) PRICE $ TOTAL

SUB-CONTRACTORS USED (MANDATORY VENDOR BACKUP NEEDED)

NAME & CLASSIFICATION (Master, Journey, Apprentice, Laborer) TIME IN RATE $ TOTAL

WORK PERFORMED:

CONTRACTOR SIGNATURE_________________________________ BC SIGNATURE_____________________________________

INFORMATION BELOW TO BE COMPLETED BY AUTHORIZED COUNTY PERSONNEL

JOB COMPLETE? YES NO

IF YES, SIGN "FINAL ACCEPTANCE" *AUTHORIZED COUNTY PERSONNEL SIGNATURE________________________________________

*I HAVE THE AUTHORITY TO ORDER WORK OUTLINED ABOVE WHICH HAS BEEN SATISFACTORLY COMPLETED AND AGREE TO PAY ALL PARTS

AND HOURS AS INDICATED ON THIS SERVICE REPORT.

WHITE-BC, YELLOW-Vendor

IF NO, STATUS:

TIME OUT

AGENCY: _____________

DAILY SERVICE REPORT

ATTACHMENT A-3

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Service Report for WWOD

File details come from the government source that posted it. Updated .