S06 Amendment 2_Q48 600-138G-3 LAR_24FEB21.docx
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- Attached to
- Z2DA--EHRM Long Beach, 600-20-120, Construction Federal contract opportunity
- Solicitation number
- 36C26221B0004
About this file
This document is a Contractor Laydown Areas Request Form used by the Department of Veterans Affairs (VA) Tibor Rubin VA Medical Center. The form is to be completed by contractors requesting laydown space for materials, trailers, heavy machinery, or other items needed during a construction period. The form details the process for contractors to receive approval for laydown areas including signatures required from the Project Manager/Contracting Officer, Occupational Safety and Environmental Management Services, and Planning & Program Management Section. It also outlines the inspection and closeout process to ensure the laydown area is cleared of all debris, equipment and contractor signs once work is complete.
The federal contract opportunity notice is for upcoming construction services for Project 600-20-120 Electronic Health Record Modernization Infrastructure Upgrades at the VA Long Beach Healthcare System. Work will be performed at the functioning hospital and include general construction, alterations, mechanical and electrical work to upgrade utility systems. The 100% SDVOSB set-aside contract will be awarded between $10-20 million. The solicitation will be issued on April 12, 2021 via beta.SAM.gov and include a mandatory site visit. The NAICS code is 236220 for Commercial and Institutional Building Construction.
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Text version
VA Long Beach Healthcare System ES Form 600-138G-3 CLAR Tibor Rubin VA Medical Center Revised – N/A
CONTRACTOR LAYDOWN AREAS REQUEST FORM
Section I. Request – Completed by Contractor
1. Project No.
2. Project title
3. Date of Request:
4. Contractor
5. Phone #
6. PM/COR
7. Phone #
8. Duration of Construction Period. (This is the time space will be needed)
| Start Date: |
| Start Time: |
| End Date: |
| End Time: |
9. What items will be stored in the laydown area? (i.e. materials, trailers and/or heavy machinery.)
10. Amount of Space Requested
11. Contractor’s compliance:
Contractor confirms he/she has read and understood ESSOP 400.3 “Contractor Laydown Area Policy”, applicable references, and agrees to comply with all conditions set; by signing below.
Printed Name: Signature: Date:
Section II. Approvals – Completed by COR, OSEMS FLS/GEMS, PM/COR’s Section Chief and P/PM Section
12. Approval signatures
a. PM/COR: ________________________________________ Signature:_________________ Date: ____________ (Printed Name)
b. OSEMS FLS/GEMS________________________________ Signature:_________________ Date: ____________ (Printed Name)
c. PM/COR’s Section Chief ___________________________ Signature:_________________ Date: ____________ (Printed Name)
d. Planning & Program Management (P/PM) Section
Request: Approved / Denied Space Approved:
Size:
Approved by: _________________________________________ Signature:_________________ Date: ____________
Note:
1. The Project’s PM/COR shall ensure that the P/PM Section is made aware of any changes to the construction schedule if it affects length of time laydown space will be needed.
2. Refer to ESSOP 400.3 Contractors Laydown Area Policy.
Section III. Closeout – Completed by the COR & P/PM Section after Contractor vacates laydown area.
| 13. Inspection Performed on |
| Date: |
| Time: |
14. Is the Contractor present during the final inspection? Yes / No
15. The following items were inspected by the VA and were found to be:
| a. All equipment, materials have been vacated from the layout area. |
| Acceptable / Unacceptable |
| b. Area has been cleared of all debris. |
| Acceptable / Unacceptable |
| c. Fence has been removed or coordinated to remain with the COR & P/PM Section. If the fence is to remain it must be in good condition. |
| Acceptable / Unacceptable |
| d. All contractor’s signs have been removed from area. |
| Acceptable / Unacceptable |
| e. Area has been environmentally cleared (OSEMS FLS/GEMS). |
| Acceptable / Unacceptable |
16. If any items were found to be unacceptable, record date and time the contractor needs to resolve all unacceptable items for re-inspection. This is the same date & time the area will be re-inspected by the VA. N/A this section if all items were found Acceptable during initial inspection.
Date: Time: All items were found Acceptable during re-inspection
Section IV. Closeout Approvals - Completed by the COR & P/PM Section
17. Signatures below signifies that final inspection of the vacated laydown area has been performed and has been found acceptable by the VA.
a. PM/COR: ________________________________________ Signature:_________________ Date: ____________ (Printed Name)
b. P/PM Section: ____________________________________ Signature:_________________ Date: ____________
Note: COR/PM shall save a copy of the completed form in the Project’s Closeout Folder.
Page 4 of 5.
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