36C25026Q0075 0002.pdf

5. PROJECT NUMBER (if applicable)

CODE7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODECODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 22

0002 12-23-2025 610-26-2-6091-0008 None

36C250

Department of Veterans Affairs Network Contracting Office (NCO) 10 6100 Oak Tree Blvd., Suite 490

Independence OH 44131

36C250

Department of Veterans Affairs Network Contracting Office (NCO) 10 6100 Oak Tree Blvd., Suite 490

Independence OH 44131

To all Offerors/Bidders

36C25026Q0075

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to: 01-16-2026 1pm EST

See CONTINUATION Page

X 1

The purpose of this amendment is to provide Q&A responses and to extend the due date for responses to Friday January 16, 2026 at 1pm EST.

This amendment also replaces the statement of work (SOW) in its entirety. Please refer to the attached SOW when preparing responses.

All other terms and conditions remain unchanged.

Tiera T. Sims Contracting Officer

CONTINUATION PAGE

1) Can the deadline be extended due to the Holiday Week?

There will be another site visit on January 12, 2026 @ 11:15am Marion Campus 1700 E 38th St, Marion, IN 46953 Building 52 Room 100 POC Mike Turner- 765-674-3321 x73819. Any questions regarding Fort Wayne can be addressed at this time as well.

As such, the response due date for quotes has been extended to Friday January 16, 2026 at 1pm. Submissions should be sent to tiera.sims@va.gov.

2) Would a site visit be possible to both locations prior to bid date?

Word document with photos of the manways is attached. However; photos for the Marion AST (should be accessible since it’s aboveground) and the manways for the Marion Building 76 tanks are not available as they are sealed. Inspection criteria is outlined in the statement of work, reference table 1, section B.

VA Northern Indiana Health Care Systems (VANIHCS) Fuel Storage Tank System / Inspection & Maintenance

Scope of Work (SOW)

GENERAL:

The contractor shall provide all materials, labor, and equipment required to inspect tanks, sample, and test fuel from all referenced underground and aboveground fuel storage tanks per minimum of PE.03.01.01 EP 3. The JC standards on fuel testing states the following: At least annually, the hospital tests the fuel quality to ASTM standards (NFPA 110-2010: 8.3.8). The Contractor shall ensure that compliance, leak detection, new installations, upgrades and tank closures, all faucets of fuel storage are completed in accordance with Indiana’s Storage Tank Rules in accordance with NFPA 110, Joint Commission standards and any other applicable departments and laws. The Contractor shall be responsible for maintenance, test, repair proposals to maintain dependable operation of the equipment.

The Contractor shall inspect and service in accordance with the manufacturer’s recommendations, prevailing industry standards and local, state, national, and international codes where applicable.

CONFORMANCE STANDARDS:

All services provided under this contract shall be performed in conformance with applicable Local, State, and Federal codes, rules, and regulations (e.g., the Environmental Protection Agency (EPA), Occupational Safety and Health Administration (OSHA), and Equipment Manufacturer Standards and Industry Codes / Standards, etc.). EPA has created a webpage that has specific hyperlinks to Industry Codes and Standards for UST systems. This web-address is located below: contractor shall comply with these industry codes and standards throughout this contract.

https://www.epa.gov/ust/underground-storage-tanks-laws-and-regulations#code

LOCATION OF SERVICES:

VA Northern Indiana Health Care System, Marion Medical Center, 1700 E. 38th Street, Marion, IN, 46953

VA Northern Indiana Health Care System, Fort Wayne Medical Center, 2121 Lake Avenue, Fort Wayne, IN, 46805

SERVICE HOURS:

All Work shall be done during normal business hours. Monday through Friday from 0700 – 1630.

Contractor shall be required to check in and out with the Contract COR – Kylee Baker for Marion Campus and William Stevens for Fort Wayne Campus. A log of visits to VAMC campuses shall be logged with dates, times, and what services were provided.

The Period of Performance (POP) shall extend 12 months from the date of award date for a base period, with four (4), twelve (12) month option periods.

Any routine work at the Government site shall not take place on Federal holidays or weekends unless directed by the COR and Contacting Officer (CO). The CO shall direct emergency services, as requested by the COR. If needed, the CO may direct the Contractor to work after normal work hours including holidays and weekends.

Contractor shall be required to provide at least 48-hour notice prior to arrival for scheduled maintenance. Any work required after hours of 7:30 AM to 4:00 PM Monday thru Friday, weekends, and/or Holidays shall be approved by the COR prior to scheduling.

The Federal Holidays as follows:

New Year’s Day January 1st

Martin Luther King’s Birthday Third Monday in January

President’s Day Third Monday in February

Memorial Day Last Monday in May

Independence Day July 4th

Labor Day First Monday in September

Columbus Day Second Monday in October

Veterans Day November 11th

Thanksgiving Day 4th Thursday in November

Christmas Day December 25th

1. Also included would be any other day specifically declared by the President of the United States to be a National Holiday.

2. When a holiday falls on a Sunday, the following Monday shall be observed as a legal holiday by U.S. Government agencies. When a holiday falls on a Saturday, the preceding Friday shall be observed as a legal holiday.

SERVICES REQUIRED:

Reference Table 1 – Services required for the VANIHCS Scope of Work (SOW)

This table outlines sixteen (16) specific services required by VA Northern Indiana Health Care Systems.

Keys used under the Associated Tank are associated with Reference Table 2 column as follows:

FW – Fort Wayne Medical Center 1 – Diesel East 2 – Diesel West 3 – Gasoline 4 – B16 Gen

M – Marion Medical Center 1 – B76-1 (East Tank) 2 – B76-1 (West Tank) 3 – B175

4 – B76 10K AST

TANK INVENTORY (EQUIPMENT INCLUDED IN SERVICE CONTRACT):

Reference Table 2 – Underground Storage Tank Compliance Matrix for an overview of all Marion & Fort Wayne USTs.

CONTRACTOR REQUIREMENTS:

1) Contractor shall perform work in a professional manner and follow applicable UST and AST compliance requirements (e.g., 329 IAC 9 – Underground Storage Tanks)

2) Contractor shall be licensed/certified by the State of Indiana and provide a copy of Certification from State Fire Marshal that contractor can perform service (i.e. in accordance with 675 IAC 12)

3) Contractor shall check in with VAMC (COR- Marion: Kylee Baker Fort Wayne: William Stevens) at time of arrival and checkout as defined in service hours. A log shall be kept by COR with dates, times, and services provided for record of work completed.

4) Contractor to complete the VA Vendor Credentialing process and have all employees working on VA property badged with VA contractor badges through Police Services before beginning any work at the VA. All contractors shall always wear VA Contractor Badges while onsite.

5) Contractor shall be required to follow all Infection Control Risk Assessment (ICRA) requirements set forth by the infection control staff. Contact the COR if any service work would need to obtain an Infection Control Construction Permit.

6) Contractor to remove all trash and debris at the completion of job. The work area is to be always kept clean.

7) The Contractor shall furnish all parts as necessary to complete all tests.

SITE VISIT:

Offerors or quoters are urged to inspect the site where services are to be performed and to satisfy themselves regarding all general and local conditions that may affect the cost of contract performance, to the extent that the information is reasonably obtainable. In no event shall failure to inspect the site constitute grounds for a claim after contract award. The contractor is encouraged to conduct a thorough investigation of the site prior to beginning work and report any preexisting conditions to the COR prior to beginning work.

NOTE:

All work is expected to encounter normal conditions. If anything, unusual (e.g., hazardous material spill, other hazards not normally faced during service operations, etc.) is encountered the VA shall be notified and pricing shall adjust accordingly.

In the event that UST(s) systems or the systems that monitor these UST(s) are replaced (due to malfunction or the determination is made that these UST(s) have reached the end of their life expectancy), a contract addendum shall be made to accurately reflect the maintenance and service of the facilities UST(s).

PAYMENT FOR SERVICES:

Invoices shall be paid in arrears monthly upon completion of the services. Each invoice shall include VA purchase order number, and invoice number and the month of the service being invoiced.

SECURITY REQUIREMENTS:

The Contractor’s employees shall wear visible identification and company uniforms approved by the COR at all times while on the premises of VANIHCS. It is the responsibility of the Contractor to park in the appropriate designated parking areas. Information on parking is available from the VA Police Section or from the COR. The VAMC shall not invalidate or make reimbursement for parking violations of the Contractor under any conditions. Smoking is prohibited inside any buildings at the VAMC. Possession of weapons is prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of VA regulations may result in citation answerable in the United States (Federal) District Court, not a local district, state, or municipal court.

Reference Table 1 – Services Required for VANIHCS Emergency Supply System (s) –

A. FUEL SAMPLE AND TESTING - Annual

1. The contractor shall test fuels to the definitions and standards tests for fuel quality to ASTM (American Society for Testing and Materials) standard (Joint Commission) according to NFPA 110 at a minimum of every 12 months.

2. All samples shall be pulled using ASTM recommended methods. The facility shall provide access to contractor to all units for sampling.

3. A detailed written report shall be submitted for each fuel tank noting results of the fuel testing and recommended solutions. Service reports shall be signed by both service provider and COR at completion of work. An electronic version of same shall be sent to the COR.

4. The Contracting Officer or his/her designee shall notify the contractor of any noncompliance with the foregoing provisions of any federal, state, local, or VA Safety Requirements and the action to be taken. The Contractor shall, after receipt of such notice, immediately correct the conditions to which attention has been directed. Such notice, when served on the Contractor or his/her representative at the site of the work, shall be deemed sufficient for the purpose aforesaid. If the Contractor fails or refuses to comply promptly, the Contracting Officer may issue an order stopping all and any part of the work and hold the Contractor in default.

5. Services such as inspection, Original Equipment Manufacturer (OEM) required maintenance, or other maintenance and repair vital to the continued functioning of the systems may be added only after written modification from the contracting officer, unless they are inclusive to the requested services. No other person, including the COR or any other VA personnel are authorized to request additional work be performed by the Contractor. Any additional services performed that are not authorized by the Contracting Officer shall be considered inclusive.

6. The contractor shall provide all services in accordance and compliant with the latest standards, rules, regulations, and laws, including but not limited to Joint Commission (JC) standard PE.03.01.01 EP 3, National Fire Protection Association (NFPA) 110-2010:8.3.8, and ASTM.

7. The Contractor shall supply all Safety Data sheets for any chemicals used on site.

8. Contractor shall be responsible for any hazardous waste disposal, environmental fees, and hauling permits.

9. The Contractor shall notify the Contracting Officer of the existence or development of any defects in, or repairs to, the equipment covered under this contract which the Contractor considers they are not responsible for under the terms of the contract (such as operator misuse).

10. The following fuel testing shall be performed annually.

NFPA 110 §8.3.7 - A fuel quality test shall be performed at least annually using applicable ASTM standards or the manufacturer’s recommendations.

Appendix A – Explanatory Material A.8.3.7 - Diesel Fuel maintenance and regular testing should begin on the day of installation and first fill to establish a benchmark guideline for future comparison. Diesel fuel should be monitored for water on the tank bottom and tested for degradation and contamination.

All testing should be performed using ASTM-approved test methods such as, but not limited to, the following and meet engine manufacturer requirements….

The following characteristics are subject to degradation and may change with time and the environment. D975 requires the following tests to be conducted annually post-delivery.

Compliance Determination: Facilities shall provide annual testing records demonstrating adequate monitoring of water on the tank bottoms, degradation, and contamination as listed below.

DEGRADATION

DESCRIPTION ASTM 975

Flashpoint D93 Water and Sediment D1796 Distillation D86 Viscosity/ Kinematic Viscosity D445 Sulfur D5453/D2622 Cetane Index or Cetane Number (The Density/API Gravity test will be necessary to support the Cetane Index calculation)

D976/D4737 or D613/D6890

Cloud Point D2500

CONTAMINATION

DESCRIPTION ASTM 975/ ISO

Microbial (ATP Bioluminescence Recommended) D7463 In addition to the above-mentioned characteristics, the facility shall determine if the engine manufacturer identifies any additional annual fuel oil testing requirements, ensure that the fuel oil is tested in accordance with both the ASTM and engine manufacturer’s requirements, and maintain documentation documenting all testing.

Density / API Gravity – ASTM D1298 / D287

Thermal Stability – ASTM D6468

All others recommended additional testing and considerations removed from SOW.

Fuel Analysis Sample Location:

Marion: B76 West; B76 East; B175 UST; B76 10k AST

Fort Wayne: Diesel West; Diesel East; B16 UST

Reporting Requirements:

The contractor shall submit a complete report with laboratory analysis results to the facility within 30 calendar days from the day of sampling.

Each complete report shall include the following items at a minimum:

Cover letter: A short description on sampling procedure(s), company name, date of sampling, sampler name, and laboratory name.

Laboratory analysis report: The report shows the results and applicable threshold for each parameter shown above.

Copy of chain of custody.

Copies of sampler and laboratory credentials.

Miscellaneous: The contractor does not need access to VA sensitive information or VA IT system to perform the job described above.

The contractor shall provide procedures and checklists with worksheet originals indicating work performed and actual values obtained.

B. UNDERGROUND STORAGE TANK TESTING SCHEDULE

Times Defined:

Annually – Every Year – Once a Year Annual is defined as every twelve (12) months, prior 30 days from the month of the last test. For example, within 30 days prior to the month/date of the last test (but not 30 days after). This is a “per device” requirement; meaning each device shall individually meet this time frame.

Triennially – Once Every 3 Years – Every 36 months Triennial is defined as every thirty-six (36) months, prior 30 days from the month of the last test. For example, within 30 days prior to the month/date of the last test (but not 30 days after). This is a “per device” requirement; meaning each device shall individually meet this time frame.

Service/ Activity

ID

Applicable Tank(s)

Service/Activity Description Frequency

1 FW – Diesel W; Diesel E;

Gasoline;

B16

M – Bldg.

Leak and Release Detection – Automatic Tank Gauge Certification & Calibration

Contractor shall determine if Leak Detection Equipment (i.e., Veeder Root TLS 450) is certified for the types of tanks, piping, and stored contents on which the release detection system is used and meets minimum performance standards, with the probability of detection and probability of false alarm. Most manufacturers have their Leak Detection devices tested and certified by a third party to verify that their equipment meets specific performance requirements set by regulatory agencies.

a) Contractor shall test the automatic tank gauging system alarm, battery backup, operation, and any associated line leak detector.

b) Contractor shall verify system configuration in accordance with

Base Year (within 90 days from contract award) and during any UST system change or upgrade.

Federal Citations Related to this Service/Activity:

➢ 40 CFR 280.40(a)(3)

Leak Detection Equipment at VANIHCS consists of the following:

Veeder Root TLS-4c (Marion 3)

InCon Franklin Fueling Systems TS- 550 evo with Probes (Fort Wayne 1,2,3,4 & Marion 1,2) manufacturer’s instructions.

Contractor shall evaluate the facilities Leak Detection Equipment and provide documentation in a written report (i.e., in PDF Format) which will be e-mailed to COR within ten business days from date of service.

2 FW – Diesel W; Diesel E;

Gasoline;

B16

M – Bldg.

Leak and Release Detection – Probes and Sensors

Contractor shall service all ATG system components according to the manufacturer’s service instructions, as outlined below:

a) Contractor shall evaluate Automatic Tank Gauge Probe and Sensor maintenance:

- Check the sensor is resting firmly on bottom of monitored pan/sump.

- Replace probe and mag sensor cables according to manufacturer instructions.

- Verify epoxy kits have been installed on field wiring.

b) Contractor shall evaluate Containment Sump and Piping Sump Sensor (including dispenser pan):

- Inspect sensors to verify floats move freely (float type only).

- Turn sensor upside down to verify the monitor liquid alarm is activated (float type only).

- Inspect sensor cable for any cracking or damage.

- Verify sensor is firmly secured in an upright position on the bottom of the pan (solid state only)

- Verify epoxy kits have been installed on field wiring.

- Replace sump or piping sensor cables if cracked or damaged.

- Inspect floats and probe shaft for any residue build up. Clean with mineral spirits as necessary.

c) Tank annular sensor functionality (i.e., annular sensor, brine) -Contractor to test sensors per manufacturer instructions or list the recommended practice

Annually

Federal Citations and other Information Related to this Service/Activity:

➢ 40 CFR 280.40(a)(3)(ii)

➢ Veeder Root Service / Maintenance Manuals

Leak Detection Equipment at VANIHCS consists of the following:

Veeder Root TLS-4c (Marion 3)

InCon Franklin Fueling Systems TS- 550 evo with Probes (Fort Wayne 1,2,3,4 & Marion 1,2) used.

-Verify the annular space does not contain product or water and monitoring equipment is functional.

-Verify monitoring equipment is compatible with the product stored and communicating with the controller.

c) Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

3 FW – Diesel W; Diesel E;

Gasoline;

B16

M – Bldg.

Leak and Release Detection – Interstitial Monitoring – Containment Sumps

Contractor shall evaluate Interstitial Monitoring (Including Sump Sensors).

a) Inspection shall include the following:

- Electrical junction boxes, wires, and conduit are intact and sealed with no obvious wire breaks are visible -Visually check the containment sump for damage, leaks to the containment area, and releases to the environment -Sump sensor is present

- Sensor is positioned correctly in the proper location

- There is no liquid or product present

- The lid has a tight seal and is securely fastened

- Check to ensure the walls of the sump are intact and are not slumping or warping -Check to ensure no cracks are present around the areas where components, such as wiring conduit and piping enter the sumps -Check to ensure no new stains are present since the last inspection

- Check to ensure test boots are in good conditions, not cracked or torn, and positioned correctly in the sump.

-Ensure Pipe boots are not capped to allow for pipe's interstitial space to drain liquids into sump

b) Contractor shall remove liquid and debris from containment sumps, if discovered.

c) Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-

Triennially

Federal Citations and other Information Related to this Service/Activity:

40 CFR

280.35(a)(1)(ii)

➢ 40 CFR 280.43(g)(1)

➢ 40 CFR 280.43(g)(2)

➢ 40 CFR 280.40(a)(2) mailed to COR within ten business days from date of service.

4 FW – Diesel East;

Gasoline

Line Tightness Testing – Pressurized Piping

Contractor shall conduct tightness testing of piping (pressurized piping).

a) Contractor shall conduct line tightness testing (in accordance with an EPA approved method: e.g., precision, volumetric or nonvolumetric). This tightness testing shall be conducted by a professional trained in performing line tightness testing or by using a permanently installed electronic system.

b) Contractor shall provide verification and detect a 0.1 gal/hr. leak rate at 1 and 1 ½ times the operating pressure.

c) Contractor shall test containment sumps used for piping interstitial monitoring.

d) Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

Annually

Federal Citations and other Information Related to this Service/Activity

40 CFR 280.41(b)

40 CFR

280.41(b)(1)(i)

5 FW – Diesel East;

Gasoline

Release Detection – Line Leak Detector

Contractor shall conduct piping inspection (Automatic Line Leak Detector).

a) Contractor shall conduct a service test on the Automatic Line Leak Detector for proper function.

Confirm proper connection points. Verify unit is product appropriate.

b) Verify epoxy kits have been installed on field wiring

c) During or immediately after running a test (i.e., simulating a leak), visually inspect the flexible fuel lines for leakage and check flexible fuel control lines for any chafing or excessive corrosion.

d) Contractor shall indicate results in a written

Annually

Federal Citations and other Information Related to this Service/Activity:

➢ 40 CFR 280.44(a)

➢ 40 CFR 280.40(a)(2) report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

6 FW – Diesel East;

Gasoline

Leak and Release Detection

Contractor shall perform a tank tightness test (in accordance with an EPA approved method:

e.g., precision, volumetric or nonvolumetric) on applicable tank(s).

a) Contractor shall perform a tank tightness test on applicable tanks.

- The tightness test method shall be able to detect a leak at least as small as 0.1 gallon per hour from any portion of the tank with certain probabilities of detection and of false alarm.

b) Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

Triennially

Federal Citations Related to this Service/Activity:

➢ 40 CFR 280.43(c)

7 FW – Diesel W; Diesel E;

Gasoline;

B16

M – Bldg.

Spill Prevention Equipment – Spill Bucket

Contractor shall conduct a visual inspection of spill bucket.

a) Contractor shall inspect the spill bucket for signs of wear, cracks, or holes.

b) Contract shall ensure spill buckets are clean, in good condition, and empty of liquid and debris. Contract shall remove any debris or liquid, if found during the inspection

c) Contract shall check to ensure that the lid is not touching the fill cap.

d) Based on this inspection, the contractor may suggest a test to determine if the spill bucket is tight or needs repair or replacement.

e) Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

Annually

Federal Citations Related to this Service/Activity:

40 CFR 280.35(a)(1)

8 FW – Diesel Spill Prevention Equipment – Liquid tightness Triennially

W; Diesel E;

Gasoline;

B16

M – Bldg.

test

a) Contractor shall conduct a hydro testing on all spill bucket(s) and sumps every three years for liquid tightness. The test shall be conducted according to a code of practice or manufacturer’s instructions.

b) Sumps shall be filled to 4” above the highest penetration and verify water level drop < 1/8”

C) Spill buckets shall be filled to within 1 ½” of the top and verify water level drop < 1/8”

d) An integrity test shall be performed on the spill bucket and any sumps associated with a piping system that uses interstitial monitoring as a method of leak detection such as a turbine sump, UDC sump or transitional sump.

Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

Federal Citations Related to this Service/Activity:

40 CFR

280.35(a)(1)(ii)

9 FW – Diesel W; Diesel E;

Gasoline;

B16

M – Bldg.

Overfill Prevention Equipment – Functionality Test

a) The contractor shall ensure that overfill prevention equipment is set to activate at the correct level specified and shall activate when regulated substances reach that level.

There are three types of overfill protection devices:

1. Automatic shutoff devices (also known as drop tube shutoff devices or “flapper” valves).

2. Overfill alarms; and

3. Ball-float valves (also known as float-vent valves). Ball-float valves can no longer be used on new tank installations. Repair or replacement of existing ball-float valves is prohibited.

A faulty ball-float valve will be replaced by an approved method of overfill prevention.

b) Contractor shall determine the following:

Triennially

Federal Citations Related to this Service/Activity:

40 CFR 280.35(a)(2)

-Device activates at 90%, restricts flow or triggers an audible and visual alarm (e.g., ATG or ball float.).

-Device that restricts flow 30 minutes before overflow provided at no more than 95% capacity and activates an alarm 5 minutes before overflow (e.g., ATG and ball float.)

-Device activates at 95%, positive shut-off of flow to UST (e.g., drop tube flapper valves.); or -Device provides positive shut-off before UST fittings are exposed to product.

c) Remove automatic shutoff and ball float devices to confirm functionality. Remove probes to confirm functionality of exterior alarm/float communication at calculated height.

Verify conflicting equipment does not affect overfill device operability. Conflict examples:

ball float device may not function with suction pumps or coaxial fills; automatic shutoffs may not function with ball float stem inside tank unless the automatic shut-off device is set lower than the ball float stem. If known, include the overfill device make and model and list the recommended practice or code followed.

d) Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

10 FW –

Gasoline

Dispensers and Emergency Shut-Offs

Contractor inspection of stand-alone dispenser and hose and nozzle components.

a) Contractor shall calibrate product dispensers according to local standards or to an accuracy of six cubic inches for every five gallons of product withdrawn.

b) Contractor shall open each dispenser and inspect all visible dispenser lines, fittings and couplings, and inspect the UDC sump beneath the dispenser for any signs of leakage.

c) Contractor shall observe for obvious leaks, cracks, deformations and ensure breakaway is

Annually

Federal Citations and other Information Related to this Service/Activity

40 CFR 280.43(a)(5) 40 CFR 280.20(f) (2) installed (i.e., in the hose and nozzle components).

d) Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

11 FW –

Gasoline

Dispensers and Emergency Shut-Offs

Contractor inspection of dispenser pan sensor (solid-state only), dispenser sump.

a) Contractor shall evaluate the following elements of the dispenser pan sensor:

- Inspect sensor cable for any cracking or Damage

- Verify sensor is firmly secured in the upright position on the bottom of the pan

- Verify epoxy kits have been installed on field wiring

- Replace sensor cable if cracked or damaged

b) Contractor shall evaluate the following elements of the dispenser sump:

- Inspect shear valve. Assess unit is in place and properly anchored. Observe for obvious leaks.

- Inspect sump. Assess sump is clean and empty. Note any signs of leaks.

- Ensure interstitial sensors if installed are positioned at the lowest portion.

- Observe for obvious open electrical junction boxes or broken wiring

c) Contractor shall inspect emergency shut off to ensure it is accessible and has not obvious damage.

d) Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

Annually

Federal Citations and other Information Related to this Service/Activity

40 CFR 280.40(a)(2) 40 CFR 280.20(f) (2)

12 Site Wide UST Overview Document

Contractor shall evaluate the accuracy of the UST Compliance Matrix (i.e., Attachment 2 of this SOW).

a) Contractor shall evaluate the UST

Annually

Compliance Matrix and make the necessary adjustments so that the document reflects all UST information accurately (e.g., Tank and Pipe Information, Release Detection Method Utilized, Spill Protection and Overfill Control), or provide a contractor-produced inventory of UST system components and regulatory testing, inspection, recordkeeping applicability.

b) Contractor shall indicate results in a written report (i.e., in PDF Format) which shall be e-mailed to COR within ten business days from date of service.

13 N/A Contractor Hourly Rate to Correct Deficiencies

- Hourly rate for contract employees correcting deficiencies identified during inspections and testing services outlined in SOW.

See Schedule of Supplies Template (amount is based upon 80 hours of contract work per year)

14 N/A Contractor Estimated Cost of Supplies and Materials

Estimated amount (cost) of supplies and materials for correcting (e.g., replacing UST components, etc.) deficiencies identified during inspections and testing services outlined in

SOW.

See Schedule of Supplies Template

*(Amount is based upon contractors estimate to correct deficiencies identified during inspections.

and testing services per year).

*This amount should not include total UST replacement – this SOW is for the service and maintenance of existing UST(s) and ATG equipment.

15 N/A Administrative Assistance

Contractor shall assist COR in completing the notification of each owned UST to IDEM (if required) including:

(1) a notification for each regulated UST owned;

(2) complete information required on the form for each UST owned; and

Base Year and anytime there is an update to a tank substantial enough to warrant notification.

Federal Citations and other Information Related to this Service/Activity

➢ 329 IAC 9-2-2(c)

(3) if applicable, a separate notification form for each separate place of operation at which the USTs are located.

All testing shall be performed by a trained and/or certified technician.

Upon completion of each, inspection and/or testing the Contractor shall provide VA Northern Indiana Health Care System with documentation listing all work performed, defects found and corrected, and any corrective action suggested.

All testing shall be documented and provided to COR before leaving the testing site.

The Contractor shall submit an estimate for a resolving any issues. No work shall be performed unless a written authorization is provided to the Contractor from a Contracting Officer in the form of a bi-lateral modification.

Reference Table 2 – Underground Storage Tank Compliance Matrix – Marion & Fort Wayne

Underground Storage Tank Compliance Matrix (living).xlsx

See attached document: Reference Table 2 - Underground Storage Tank Compliance Matrix.

See attached document: Manway Pictures.