36C78619Q0426-003.pdf

EXHIBITS

Exhibit 1 Cemetery Map

Exhibit 2 Work Summary & Progress Report (template)

Exhibit 3 Contract Discrepancy Report (CDR) (form)

Exhibit 4 Initial Headstone/Marker Raise and Realign Survey (form)

Exhibit 5 Daily Headstone/Marker Raise & Realign Verification Survey (form)

Exhibit 6 List of References (template)

Exhibit 7 Work Assignment

Exhibit 8 Employee Statement of Compliance

EXHIBIT 1

CEMETERY MAP

EXHIBIT 2A

WORK SUMMARY & PROGRESS REPORT Period Covered:

From:

To:

Cemetery Location: Contractor Information:

Fort Logan National Cemetery

Project Title:

Headstone/Marker Raise and Re-alignment

Contract No:

Inspection / Acceptance: The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test some or all of the services that have been tendered for acceptance. The Government may require re-performance of nonconforming services at no increase in contract price.

The Government shall exercise its post-acceptance rights:

1. Within a reasonable time after the defect was discovered or should have been discovered; and

2. Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

WORK COMPLETED & SUBMITTED FOR ACCEPTANCE

(This form is not to be used as an Invoice)

Section keystones have been properly chosen with the approval of the COR in order to achieve a smooth, flowing transition between the rows and columns. Keystones have been set in accordance with the requirements using a licensed surveyor.

No. of Keystones

& Section #’s:

Date

Completed:

Flat marker sockets or trenches are dug to meet the height and alignment requirements. Sockets are clean and free of loose dirt and debris. The crushed stone base material has been added to the correct level and fully compacted.

Quantity & Section #’s:

Date Completed:

Flat markers in burial sections are uniform in height, horizontally and vertically plumb, with inscriptions visible, and installed to ensure a pleasing top line while compensating for irregular terrain (sloping and uneven ground). Transverse and lateral alignment is within the maximum allowable tolerance of 1/8" and vertical alignment is within one degree of fully vertical when measured on front and sides using a digital level. COR has randomly sampled the flat markers to verify height and alignment.

Quantity & Section #’s:

Date Completed:

Completed raised and realigned flat markers in all soil and terrain conditions are firmly set in place so that the flat markers are rigid with no give or play. COR has randomly checked to assure flat markers are firmly set in place.

Section Numbers:

Date Completed:

Flat markers otherwise present a neat overall appearance in a line vertically, laterally & transversely and provide a uniformly flowing transition throughout the Section and with adjoining Sections.

Section Numbers:

Date Completed:

6 Flat Markers have been cleaned in accordance with the contract requirements.

Quantity & Section #’s:

Date Completed:

Report below any circumstances which may have adversely affected work progress such as weather, strikes, delays by the Government, etc.

Signature of Contractor: Date Signed Signature of Cemetery

Director / COR Date Signed

Note: Contractor shall sign confirming that services indicated have been completed. Government shall also sign in acknowledgment of receipt of the Progress Report.

Duplicate Form as Necessary

EXHIBIT 2B

WORK SUMMARY & PROGRESS REPORT Period Covered:

From:

To:

Cemetery Location: Contractor Information:

Fort Logan National Cemetery

Project Title:

Turf Renovation, Topsoil Removal/Installation

Contract No:

Inspection / Acceptance: The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test some or all of the services that have been tendered for acceptance. The Government may require re-performance of nonconforming services at no increase in contract price.

The Government shall exercise its post-acceptance rights:

1. Within a reasonable time after the defect was discovered or should have been discovered; and

2. Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

WORK COMPLETED & SUBMITTED FOR ACCEPTANCE

(This form is not to be used as an Invoice)

Contractor shall inventory, remove, and store all irrigation heads and cap head risers within the limits of work with a copy of the inventoried equipment and materials provided to the COR. Exposed components, risers, valve boxes, quick couplers, etc. have been protected.

Quantity & Section #’s:

Date Completed:

The entire vegetated area has been treated with an application of a non-selective herbicide by a licensed pesticide applicator. A minimum of 10 to 14 days has elapsed for the herbicide to fully translocate throughout all plant parts. The COR confirms that all vegetation in the treated area is completely dead.

Quantity & Section #’s:

Date Completed:

3 The entire treated area has been power raked or verti-cut and all residual plant debris including thatch has been removed.

Quantity & Section #’s:

Date Completed:

Turfgrass fertilizer has been applied and roto-tilled to a minimum depth of 6 inches to uniformly mix fertilizer with the topsoil and to loosen top surface for re-grading and leveling.

Quantity & Section #’s:

Date Completed:

Topsoil has been graded, leveled, and compacted to achieve a finished appearance that is smooth, uniformly level, and free of all surface ripples, depressions, high spots, low areas, and ridges. The finish grade is a maximum of 1 inch below the adjoining grade of any surfaced area and is nominally 25 inches below the top of all upright headstones abd 1 inch below flat markers unless otherwise approved by the COR.

Quantity &

Date Completed:

All irrigation components and sprinkler heads have been re-installed to finish grade and adjusted to provide full coverage with the best distribution uniformity.

Quantity & Section #’s:

Date Completed:

All turfgrass sod has been installed using certified sod as specified. Sod pieces are not stretched or overlapped and that all joints are butted tightly to prevent voids that would cause air drying of the roots and to prevent weed growth.

Quantity & Section #’s:

Date Completed:

Apply turf fertilizer after sod is fully rooted; established and has been mowed at least 2 times. Provide and apply a 3:1:2 ratio (preferably analysis of 21:7:14) or similar; the fertilizer shall have a 50% of nitrogen in a slow release form. Fertilizing shall be approved by the COR prior to application.

Quantity &

Date Completed

All turfgrass is completely established and ready for final acceptance.

All turfgrass is uniform in color, leaf texture, and shoot density.

Turfgrass is reasonably free of weeds, diseases and other visible imperfections. The turfgrass has been mowed at least three times. Areas void of turfgrass greater than one square foot and larger have been replanted and re-established.

Quantity & Section #’s:

Date Completed:

Report below any circumstances which may have adversely affected work progress such as weather, strikes, delays by the Government, etc.

Signature of Contractor: Date Signed Signature of Cemetery

Director / COR Date Signed

Note: Contractor shall sign confirming that services indicated have been completed. Government shall also sign in acknowledgment of receipt of the Progress Report.

Duplicate Form as Necessary

EXHIBIT 3

CONTRACT DISCREPANCY REPORT

Contract Number:

Report No. for this Discrepancy:

To: (Contractor/Manager’s Name)

From: (Name of COR)

5. Dates

5a. Prepared:

5b. Returned by Contractor:

5c. Action Complete:

Discrepancy or Problem: (Describe in detail. Include reference to PWS Directive; attach additional sheet if necessary.)

Signature of Contracting Officer or COR:

8a. To: (Contracting Officer and/or COR)

8b. From: (Contractor)

9. Contractor Response as to Cause, Corrective Action and Actions to Prevent Recurrence: (attach additional sheet if necessary.)

10a. Signature of Contractor Representative:

10b. Date:

11. Government Evaluation: (Acceptance, partial acceptance, reflection; attach additional sheet if necessary.)

12. Government Actions: (Reduced payment, cure notice, show cause, other)

13. Close Out Name Title Signature Date

Contractor Notified

b. COR

c. CO

EXHIBIT 4

INITIAL HEADSTONE/MARKER RAISE & REALIGN SURVEY

Station Number: __________ Date: __________

Cemetery: _______________ Cemetery Director: __________________

Contracting Officers Representative: __________________

Instructions: The Contracting Officer’s Representative (COR) /Cemetery Director/Cemetery Foreman/ Work Leader/designee MUST conduct an initial survey of ALL headstones/markers included in the scope of work (SOW) before any work is performed. The COR/Cemetery Director/Cemetery Foreman/Cemetery Work Leader/designee will use the Burial Register Report and the Gravesite Layout Map(s) for the initial survey.

Discrepancy/Issue Identified: Y/N _________ Date: ___________________

All discrepancies/issues resolved Y/N ________ Date: ___________________

I certify that the Initial Headstone/Marker verification survey was completed by the COR/Cemetery Director/Foreman or Work Leader/designee. The Burial Register Report and the Gravesite Layout Map for the Cemetery and sections listed in the SOW were used to complete the survey.

COR/Director/Foreman/Work Leader/designee Signature: _______________________

Date: ________

Prior to the completion of the workday, a Daily Headstone/Marker R&R Verification Survey MUST be completed by the COR/Cemetery Director/Cemetery Foreman/Work Leader/designee utilizing the same Burial Register Report and Gravesite Layout Map as used in the initial survey for ALL completed work.

EXHIBIT 5

DAILY HEADSTONE/MARKER RAISE & REALIGN VERIFICATION SURVEY

Station Number:______ Date:__________

Cemetery: _______________ Cemetery Director: ________________

COR: _________________

Instructions: Prior to the completion of the workday, the Cemetery Director/COR/Foreman/Work Leader/designee MUST perform a re-verification survey for ALL completed work of headstones/markers included in the scope of work. The Cemetery Director/COR/Foreman/Work Leader/designee will use the original Burial Register Report and Gravesite Layout Map used for the Initial Verification Survey.

List Sections and Headstones/Markers R&R: _______________________________

List discrepancy/issue: _________________________________________________

All discrepancies/issues resolved: Y/N ______

Cemetery Director/COR/Foreman/ Work Leader/designee informed District Director and Contracting Officer of all unresolved discrepancies/issues: Y/N _______

By signing below, I certify the Headstones/Markers re-verification survey was completed.

Daily Headstone/Marker Verification:

Date: __________ Time Completed: ______________

COR/Director/Foreman/Work Leader/designee Signature: _____________________

EXHIBIT 6

LIST OF REFERENCES

EXPERIENCE – LIST OF REFERENCES: List below references for which you performed like or similar services. (Performed services at like dollar values, degree of work, amount of area serviced, type of grounds maintenance service).

Contract Title & Number: ____________________________________________________ Installation_______________________/Address: ___________________________ Dollar Amount: $ _______________ Point of Contact: ____________________________________ POC Title: ___________________ Phone: ____________ E-mail: ________________________________ Contract Title & Number: ____________________________________________________ Installation_______________________/Address: ___________________________ Dollar Amount: $ _______________ Point of Contact: ____________________________________ POC Title: ___________________ Phone: ____________ E-mail: ________________________________ Contract Title & Number: ____________________________________________________ Installation_______________________/Address: ___________________________ Dollar Amount: $ _______________ Point of Contact: ____________________________________ POC Title: ___________________ Phone: ____________ E-mail: ________________________________ Contract Title & Number: ____________________________________________________ Installation_______________________/Address: ___________________________ Dollar Amount: $ _______________ Point of Contact: ____________________________________ POC Title: ___________________ Phone: ____________ E-mail: ___________________________________________

List any company employees who had experience on above jobs planned to be involved on this contract and list the extent of their involvement.

Describe how and to what extent that your previous experience benefits the requirements of this contract. Be specific and address all the major work requirements of the contract.

EXHIBIT 7

WORK ASSIGNMENT

FORT LOGAN NATIONAL CEMETERY

CONTRACT NUMBER:______________

Date of Assignment:____________________

Contractor: ______________________________________________________

PERIOD OF PERFORMANCE: From:________________To:____________________

CONTRACT LINE ITEM NUMBER (CLIN)(s):

CLIN: ____________

Description/Section: ____________________________________________

Quantity: __________________

Estimated Quantity: __________________

Estimated Quantity: __________________

Contracting Officer’s Representative Date

Contractors Authorizing Official Date

After Work Assignment is signed, forward a copy to the Contracting Officer for recording purposes. The Work Assignment is considered in-scope technical direction against the contract shown above. The Work Assignment does not alter the terms of the contract. The COR has verified the anticipated value of the assigned efforts is available on the applicable work assignment.

EXHIBIT 8

EMPLOYEE STATEMENT OF COMPLIANCE

EMPLOYEE NAME: ______________________________

POSITION/TITLE: ______________________________

DATE: ______________________________

Please check the appropriate blank.

____ New Employee, New Contractor

____ Annual Confirmation for current Employees or Contractor(s) (Due on November 1 of each Contract year)

FOR ALL EMPLOYEES

I have been briefed and understand the following guidance:

INITIALS

_________ The National Cemetery Administration honors veterans with a final resting place and lasting memorial that commemorate their service to our Nation. National Cemeteries are National Shrines. Therefore, the standards for management, maintenance, appearance and operational procedures have been established by the National Cemetery Administration to reflect this Nations’ concern and respect for those interred there. For this reason, my strict adherence to the Performance Work Statement, Performance Work Requirements Summary and Guidance Specifications shall be required and shall be essential.

_________ I will remain aware of the remains buried in the grounds where work is being performed. The utmost care must be given to these remains and the headstones and flat grave markers that mark those gravesites and memorialize the service of individuals.

_________ I will not walk, stand, lean, sit or jump on headstones, markers, or monuments. Nor will I drive over them.

_________ I will not place or lean tools, equipment, or other items on headstones, markers, or monuments at any time.

_________ I have been briefed on the approved methods and tools to remove headstones and markers from their sockets in accordance with the Contract Specifications. I will use the tools and methods approved by the Contracting Officer Representative (COR) to lift headstones and markers out of the ground in order to avoid damage; pick axes are not an acceptable tool.

_________ I will not place headstones or markers on dirt piles or mud once they are removed from their sockets; in order to show appropriate respect towards the families visiting the gravesites and the remains that are buried, I will ensure headstones and markers are carefully stored on each associated gravesite and protected from damage or soiling, in accordance with Contract Specifications.

_________ I understand that the Contractor shall be responsible for replacing damaged headstones and markers and for restoring turf damaged during performance of this work.

_________ Should any on-site activity, incident, emergency, or disaster result in exposure and/or damage to any remains, container for remains (i.e., casket or urn), or outer burial container, I will IMMEDIATELY notify the Cemetery Director, the COR and/or the Contracting Officer; I will take immediate steps to protect and render safe any exposed remains; and stop any further work until the Cemetery Director provides the Contractor Supervisor guidance regarding disposition of the remains and permission to proceed.

SIGNATURE BLOCK

Signature

Printed Name

Date

IF THIS STATEMENT IS THE EMPLOYEE’S ANNUAL COMPLIANCE

STATEMENT, THIS COMPLIANCE STATEMENT MUST BE RETURNED TO THE

COR BY NOVEMBER 1.

AS TO STATEMENTS OR COMMITMENTS OF FUTURE ACTIONS, THIS COMPLIANCE

STATEMENT COVERS THE PERIOD FROM OCTOBER 1 OF THE CALENDAR YEAR

DURING WHICH THIS COMPIANCE STATEMENT IS DUE THROUGH SEPTEMBER 30

OF THE NEXT CALENDAR YEAR.