36C78625Q50317 - Final HVAC SOW.docx

Baltimore HVAC SOW

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

A.1 SCOPE

This is a full-service maintenance contract. The Contractor shall furnish all labor, equipment, parts, materials, supplies, and transportation necessary to perform Scheduled Preventive Maintenance Services on Government owned HVAC Systems located at the Baltimore National Cemetery, 5501 Frederick Ave, Catonsville, MD 21228.

A.2 GENERAL REQUIREMENTS

The Contractor shall provide all resources required for the provision of Preventive Maintenance Services program in accordance with the equipment manufacturers scheduled maintenance procedures including labor, parts, materials, lubricants, refrigerants, cleaning fluids, equipment, tools, and travel. Contractor is responsible to determine the nature & extent of any work required to restore equipment to proper condition for operation.

If the contractor determines repairs or maintenance are required or suggested to restore the equipment functionality, the contractor shall provide the facility point of contact (POC) a quote stating at minimum: location of needed repairs, equipment needing repairs, description of proposed repair(s) or maintenance services(s), an itemized cost estimate identifying material (to include manufacturer part numbers)

The Contractor will also provide support onsite or remotely using their own internet service line or cell modem/transmitter for connection to the HVAC equipment to adjust the system if required. All network connections will be secured by the contractor to protect the HVAC system and electronic control assets from any disruption or damage.

A.2.1 Preventive Maintenance Service is defined as "services which are periodic in nature and are required to maintain the equipment in such condition that it may be operated with minimal incidence of malfunction or inoperative conditions".

A.2.3 Quarterly Preventive Maintenance Services: The HVAC System shall be checked four (4) times per year to include the following:

SPRING COOLING MAINTENANCE CHECKLIST (Cooling Start Up)

(a) Replace filters per manufacturers guidelines.

(b) Lubricate all moving parts (grease all bearings, oil all motors to reduce friction, wear, and electric usage

(c) Inspect for leaks (visually inspect for refrigerant, water, gas, exhaust, air, oil leaks)

(d) Inspect blower section (check belts and sheaves for wear and or misalignment. Adjust as necessary and replace belts as necessary)

(e) Inspect and tighten electrical connections, measure voltage and current on motors (inspect for worn, pitted, or doubtful contactors, relays, capacitors)

(f) Clean condensate drains, pan and trap (clean pan and clear lines and use algae tablets in pan as necessary)

(g) Clean condenser coil (clean condenser coil using water and coil cleaner when applicable)

(h) Clean evaporator coil surfaces (no rinse foam spray only)

(i) Check supply and return air temperature differential (check refrigerant pressures only if needed to avoid unnecessary refrigerant loss)

(j) Check economizer, enthalpy controls and damper settings for proper operation.

(k) Check system controls to ensure proper and safe operation (cycle the system for seasonal use to ensure the unit properly starts, operates, and shuts down. Test and inspect all safety controls for proper operation)

(l) Check electrical components and unit efficiency; and

(m) Check heating operations.

A.2.4 SUMMER COOLING MAINTENANCE CHECKLIST

(a) Replace filters per manufacturers guidelines

(b) Lubricate all moving parts (grease all bearings, oil all motors to reduce friction wear and electric usage)

(c) Check thermostat settings to ensure proper function and calibration.

(d) Inspect for leaks (visually inspect refrigerant, water, gas, exhaust, air, oil leaks etc.)

(e) Inspect blower section (check belts and sheaves for wear and / or misalignment. Adjust as necessary.

A.2.5 FALL HVAC CHECKLIST

(a) Replace filters per manufacturers guidelines

(b) Lubricate all moving parts (grease all bearings, oil all motors to reduce friction, wear, and electric usage)

(c) Check thermostats and sensors to ensure proper function and calibration.

(d) Inspect blower section (check belts and sheaves for wear and/or misalignment

(e) Check economizer, enthalpy controls, and damper settings for proper operation to ensure maximum unit efficiency.

(f) Check system controls to ensure proper and safe operation (cycle the system for seasonal use to ensure unit properly starts, operates, and shuts down. Test and inspect all safety controls for proper operation.

(g) Check heat exchanger for holes/cracks to prevent fire and carbon monoxide hazards.

(h) Inspect all: Burners, combustion chambers, flue, gas pressure, (clean burners, pilot assemblies, flame sensors, inspect gas/oil connections)

(i) Sequence electric heat, check AMP draw (electric)

(j) Inspect and tighten electrical connections, measure voltage and current on motors (inspect for worn, pitted, or doubtful contactors, relays, capacitors, etc.)

A.2.6 WINTER HVAC CHECKLIST

(a) Replace filters per manufacturers guidelines

(b) Lubricate all moving parts (grease all bearings, oil all motors, to reduce friction, wear, and electric usage)

(c) Check thermostats and sensors to ensure proper function and calibration.

(d) Inspect for leaks (visually inspect for refrigerant, water, gas, exhaust, air, oil, leaks etc.)

(e) Inspect blower section (check belts and sheaves for wear and/or misalignment. Adjust as necessary, replace belts as necessary.

(f) Check economizer, enthalpy controls and damper settings for proper operation to insure maximum unit efficiency.

A.2.7 MAINTAIN AN ON-SITE LOGBOOK

After completion of service maintenance, technician shall record and report to cemetery representative a list of deficiencies or potential problems which may occur.

A.2.8 OUT-OF-SCOPE REPAIRS

No additional service or repair outside the scope of monitoring and preventative maintenance shall be completed until approval is received in writing from the Contracting Officer. Costs for replacement or repair of HVAC components will be determined at the time of the service call and are a yearly option for this purchase order. Any repairs that are not listed must be found to be fair and reasonable via modification before work can be performed. Repairs for less than $2,000 shall be approved by the GCP and paid by purchase card.

A.2.9 EMERGENCY PREVENTATIVE MAINTENANCE SERVICE CALLS

The contractor shall perform emergency unscheduled preventative maintenance inspection services as prescribed below:

a. The vendor shall provide emergency unscheduled preventative maintenance inspections up to four (4) occurrences per contract year.

b. Preventative Maintenance Inspections must be initiated, by the contractor, within 24 hours of the Government service call unless otherwise specified by the facility POC.

c. Unscheduled corrective maintenance or repair(s) will require Government approval prior to the contractor proceeding with the corrective maintenance or repair(s).

A.3 EQUIPMENT

A.3.1 SYSTEMS TO BE SERVICED

Maintenance shall be provided on the following systems and/or individual components as follows:

BNC Main Campus

BAY HEATERS (X8) – Each heater is in the cemetery maintenance yard, one in each maintenance bay

Make: Nortek Global HVAC (Reznor) Model: UDX-30

FURNACES/AIR HANDLERS – These units are in the cemetery administrative building’s attic area.

Furnace/Air Handler 1 Make: Trane Model: S9X2B060D3PSBAB Serial: 22386SLNKG

Furnace/Air Handler 2 Make Trane Model: S9X2D120D5PSBAB Serial: 22366TRJKG

Furnace/Air Handler 3 Make: Trane

S9X2B040D3PSBAB

Serial: 22386H1YKG

Air Blender Make: Greenheck Model: ECV-10H-VG-P Serial: 22726877

Water Heater Make: Navien Model: NPE-240S2(NG) Serial: 2089E2283161267

OUTDOOR UNITS (Maintenance Area) – These units are located right next to each other, inside the cemetery maintenance yard, adjacent to the cemetery admin. building

Outdoor Unit 1 Make: Trane Model: 4TTR7024A1000CA Serial: 22291XW75F

Outdoor Unit 2 Make: Trane Model: 4TTR7036A1000CA Serial: 22274LSUKF

Outdoor Unit 3 Make: Trane Model: 4TTR7060A1000BB Serial: 22264RPMKF

Director’s Lodge:

Please be aware that the director’s lodge is a private residence.

HEAT PUMPS/AIR HANDLING UNITS (AHU)- Located in director’s lodge attic.

Heat Pump/Air Conditioner (Air Handler) 1 Make: Goodman Model: ARUF31B14AC Serial: 1912098153 Heat Pump/Air Conditioner (Air Handler) 2 Make: Goodman Model: ARUF31B14AC Serial: 1912098155

OUTDOOR UNITS- Both units are in the lodge backyard. Adjacent to the rear of the director’s lodge.

Outdoor Unit 1 Make: Goodman Model: GSZ140301KG Serial: 1909039757 Outdoor Unit 2 Make: Goodman Model: GSZ140301KG Serial: 1909039759

WATER HEATER / BOILER- Located in lodge basement

Water Heater Make: ProLine Model: EN6-50-DORT 130 Serial: 2124124764704

Boiler Make: Weil-McLain Model: EVG 155

A.4 PERIOD OF PERFORMANCE:

The period of performance shall be one (1) base year with four (4) potential (1) one-year option years to be exercised at the discretion of the Contracting Officer. The first quarterly preventative maintenance service shall be completed within 30 days of contract award.

The Contractor shall perform the services required under this requirement within station operating hours which are 7:30am until 4:00pm, Eastern Standard Time (EST), Monday through Friday.

A.5 FEDERAL HOLIDAYS

The contractor is not required to work during Federal Holidays. The following are recognized U.S Holidays

New Year's Day Martin Luther King Jr's Birthday Washington’s Birthday (Presidents Day) Memorial Day Juneteenth Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day

A.5 CONTRACT MANAGEMENT

Post Award Conference: Prior to commencement of work, the VA Contracting Officer, COR and Contractor shall schedule a conference to assure that all parties understand all contractual obligations and the role that each party serves.

A.5.1 REPRESENTATIVES OF THE CONTRACTING OFFICER

(a) The VA Contracting Officer will designate (or more) representatives to serve as the Contracting Officer’s Representative (COR). A copy of the designation shall be furnished to the Contractor at time of award. Such designation will be in writing and will define the scope and limitations of the designee's authority.

(b) The duties and responsibilities of the COR include, but are not limited to, the following:

(i) Provides contract oversight and technical guidance to the Contractor.

(ii) Acts as technical liaison between the National Cemetery and the Contractor and between the cemetery and the Contracting Officer.

(iii) Placing orders for services.

(iv) Determining whether contract deliverables meet functional, technical and performance specifications.

(v) Verification / certification of payments to the Contractor for services rendered.

(vi) Assuring that any changes effecting work involved, price, terms and/or conditions under the contract are not implemented before written authorization is issued by the Contracting Officer.

(vii) The COR may not modify the intent or the terms and conditions of the contract.

(c) Inspection & Monitoring Procedures: A record keeping system of Contractor Work Performance shall be established and implemented by the VA COR for the services involved. The COR will inspect all work performed and submitted by the Contractor for acceptance. The COR will inspect to ensure work performed is acceptable per the terms of the contract and NCA Standards. The Government reserves the right to reject all work that does not meet contract specifications. Work rejected by the COR will be re-performed without cost to the Government.

(d) Service Reporting: Contractor will submit an electronic service ticket for each visit to perform maintenance work. The electronic service ticket must be electronically transmitted to the COR the same day of the actual work being completed. The Contractor must furnish the following information on each service ticket: 1. Name of Qualified Service Technician. 2. Location(s) and Name(s) of units serviced. 3. Name of VA Representative Contacted for Visit. 4. Date, Time, and Duration of Visit. 5. Summary of visit. 6. Resolution of Issue (Y/N). 7. Planned Follow-Up (if applicable). 8. Any applicable recommendation

(e) Contracting Officer: All administrative functions remain with the VA Contracting Officer. Any modifications to the contract, including those involving no-cost changes, increases, and decreases in cost or level of services provided, termination or extension of the contract (in part or in whole) and decisions concerning claims or disputes, must be authorized in writing by the Government Contracting Officer.

A.5.2 CONTRACTOR PERSONNEL

(a) The Contractor shall provide a “Site Manager”, an individual experienced in grounds maintenance and supervision who will be responsible for the following:

(i) Directing, overseeing, and coordinating the work involved.

(ii) Staying abreast of all upcoming cemetery functions including special holiday events and burial activities.

(iii) Ensuring that contract work does not cause any committal service, ceremony, procession, or visitation to be delayed, altered, or otherwise impacted in such a way that the dignity, security, or safety of the event or visit is compromised.

(b) The Contractor shall provide the names, telephone numbers, pager numbers and/or cell phone numbers of the Site Manager and alternate to the Contracting Officer for approval at the Post Award Conference. The Contractor shall provide notice, in writing to the Contracting Officer twenty-four (24) hours in advance of any change of the Site Manager or alternate. The Site Manager and alternate shall be able to speak and understand the English language. The Site Manager or alternate shall be available during performance of the work required.

(c) Other Personnel: The Contractor shall furnish supervisory, administrative, and direct personnel to accomplish all work required in strict accordance with contract specifications. The Contractor may not hire any person(s) whose employment would result in a conflict with legal residents of the United States to accomplish all work and services specified herein. All employees shall by physically able to perform the work involved. Contractor employees are expected to have a minimum required amount of experience in their respective field prior to working on cemetery grounds. Any administrative employees through the contractor are required to have a minimum level of experience in their respective field prior to working with the Contractor.

(d) Cemetery Activities: To cause the least possible interference with cemetery activities, contract personnel will stop (cease) all work in areas where burials are taking place. As a general "rule-of-thumb", work should not take place within 1,000 feet of an ongoing committal service or ceremony. The Site Manager will re-direct work throughout the rest of the Cemetery – so that productive use of labor and equipment is assured, and downtime is avoided. If the Contractor fails to re-direct employees away from an event in a timely fashion, the COR may then do so.

(e) Communication & Coordination of Work with COR: The contractor will notify the COR (or designee) at least one (1) working day prior to having contractor staff working at the cemeteries to facilitate contractor oversight. Work done without proper advance notification may not be recognized by the government as having been completed. Additional communication with the COR (or designee) is strongly encouraged. Burial activities at NCA shall take precedence over contract work activities. Work activity and noise cannot disturb Burial Services. Trucks and workmen are prohibited from passing through the service area during this period.

(f) Notwithstanding the Contractors responsibility for total management during the performance of this contract, the administration of the contract will require maximum coordination between the Government and the Contractor. The Government shall provide, at the time of contract award, a list of Government personnel authorized to act as Contracting Officer's Representatives.

A.5.3 INVOICES & PAYMENT

The contractor shall submit an invoice, electronically, in arrears to the COR for all services rendered for service during the quarter. The contractor shall ensure that invoices are sent promptly and that invoices accurately account for work performed. Invoices shall reference the appropriate contract and purchase order number, identify services rendered as “complete” and/or “partial” preventative maintenance, and extended cost. The COR will review each invoice for accuracy and certify for payment.

A.6 CONTRACTOR RESPONSIBILITIES

(a) Contractor’s employees shall wear all required safety equipment such as goggles or face shield, hearing protection, hard hats, respirators, if required, and uniforms identifying them as an employee of the contractor. The contractor shall be responsible for training and safety precautions prescribed by OSHA standards.

(b) The contractor shall phase all work in such a manner, as not to impact on or interfere with cemetery operations. The contractor shall cease work within 100 yards of any committal service in progress while performing under the contract.

(c) The contractor shall observe all traffic, parking, directional signs and regulations when using the cemetery’s roadways. Contractors shall park only on cemetery roads.

(d) The contractor shall leave all work areas free of debris and in the same condition as before the work commenced. The contractor shall take all necessary precautions to protect vegetation, as appropriate, in the immediate work area(s).

(e) The contractor shall be liable for any damage to headstones and markers caused by contractor personnel arising out of or resulting from performance under the contract.

(f) Contractor employees shall be fully always clothed, to include an upper garment to cover the body from the waist to neck and long pants. Garments that have a message of slogan other than the contractor’s business attire is prohibited.

(g) Contractor personnel do not engage in loud or boisterous behavior, use profane or abusive language or use personal radios. Due to the sensitive mission of the Cemetery, contractor employees must exercise courtesy and respect while within the cemetery. If inquiries are received from visitors, they are to be referred to the COR and/or Baltimore National Cemetery Director.

(h) The cemetery shall provide to the Contractor personnel restroom facilities designated by the COR.

(i) Breaks and lunch periods shall be taken at areas designated by the COR, not in the field.

A.6.1 INSURANCE, LICENSES & PERMITS

(a) The Contractor shall obtain all necessary licenses and permits necessary to perform the work involved and shall take all precautions necessary to protect persons and property from injury or damage during the performance of this contract. Contractor is responsible for any injury or damage during the performance of this contract including injury to himself/herself, his/her employees, or others.

(b) Contractor shall be liable for any damage to personal or public property that occurs during the performance of this contract that is caused by him/her or his/her employee's fault or negligence.

(c) The Contractor shall maintain personal liability and property damage insurance prescribed by the laws of the State of Maryland.

A.6.2 LIABILITY & INDEMNIFICATION

(a) The Contractor shall take all necessary precautions to prevent damage to cemetery structures and Government property. The Contractor shall be charged current replacement costs for any property damaged because of actions by Contractor personnel.

(b) It is agreed and understood that there is no limitation on the Contractor’s liability. In no event shall the Government indemnify and hold harmless the Contractor from all damages, expenses or harm incurred by the Contractor, or from all damages, expenses, or claims, which may arise from third party claims.

(c) The Department of Veterans Affairs shall indemnify and hold harmless the Contractor from and against any and all claims, demands, damages, liabilities or causes of action resulting from the negligent acts or omissions of the Department, its agents, and employees, acting within the scope of their Federal employment, arising from the performance of this contract.

A.6.3 MISCELLANEOUS

(a) The Contractor shall be responsible for maintaining satisfactory standards of personnel conduct and work performance.

(b) Minimum qualifications for technicians are knowledge of all listed equipment and any manufacturer, State required licensures, training and certifications.

(c) The Contractor shall also be responsible for training and safety precautions for contractor employees performing work under these specifications. OSHA standards shall be observed by the Contractor in all work performed. Appropriate safety equipment shall be furnished by the Contractor-to-contractor personnel and shall be used as prescribed by OSHA standards, including hard hats, safety shoes, safety glasses, and hearing protection devices.

A.7: DISCREPANCY REPORTING PROCEDURES:

a) a Contract Discrepancy Report (CDR) (See Attachment A) shall be issued when work is found to be below the Minimally Acceptable Level listed in the Quality Assurance Surveillance Plan or if found to be unsafe, or in violation of Contract Requirements.

b) The CDR will require the Contractor to explain in writing why performance was unacceptable, how performance will be returned to an acceptable level, and how recurrence of the problem will be prevented in the future. The Contractor will not be paid for services not rendered in accordance with the standards set forth in this contract.

c) If the Government created any of the discrepancies, these will not be counted against the Contractor's performance. When the Government has caused the Contractor to perform in an unsatisfactory manner, the COR will forward a written notice to the responsible organizational element requesting corrective action be taken.

d) Normally, the COR will verbally advise or give a written inspection report to the Contractor of discrepancies the first time they occur and ask the Contractor to correct the problem. A notation will be made on the COR checklist of the date and the time the deficiency was discovered and the date and time the Contractor was notified. Failure to correct discrepancies in the required time frame or repeated occurrences of discrepancies will result in issuance of a CDR.

e) When the Contractor is not meeting the limits of satisfactory performance, a CDR will be issued to the Contractor. The seriousness of the failures should govern whether to issue CDR at the end of the period, or as soon as the limits of satisfactory performance are exceeded.

f) A CDR will be prepared by the COR and forwarded to the CO and Contractor.

(End of Work Statement)

ATTACHMENT A

image1.emf

CONTRACT DISCREPANCY REPORT

1. CONTRACT OR AGREEMENT NUMBER:

2. REPORT NUMBER FOR THIS DISCREPANCY:

3. TO:

4. FROM:

5. DATES

a. DISCREPANCY IDENTIFIED:

b. CDR DELIVERED/RECEIVED:

c. INITIATE CORRECTIVE ACTION:

6. DISCREPANCY OR PROBLEM: (Describe in detail. Include reference to PWS section; use attached continuation sheet(s) if necessary.)

7. SIGNATURE OF COR:

DATE:

8. SIGNATURE OF CONTRACTING OFFICER:

DATE:

9a. TO:

9b. TITLE:

10. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable Quality Control Plan procedures or new procedures. Use attached continuation sheet(s) if necessary.)

11. SIGNATURE OF CONTRACTOR REPRESENTATIVE: DATE:

12. GOVERNMENT ACTIONS. (Acceptance, partial acceptance, rebuttal. Use attached continuation sheet(s) if necessary.)

13. GOVERNMENT EVALUATION. (Acceptance, partial acceptance, rebuttal. Use attached continuation sheet(s) if necessary.)

14. CDR CLOSE OUT. (Following successful resolution of contract discrepancy(ies).)

ACKNOWLEDGEMENT: TO THE BEST OF MY KNOWLEDGE AND BELIEF - INITIALS DATE

a. CONTRACTOR: (I accept that appropriate corrective actions and close out remedies where employed.)

b. COR: (I accept that appropriate corrective actions and close out remedies where employed.)

c. CO: (I accept that the parties worked cooperatively to correct the discrepancy(ies).)

CONTRACT DISCREPANCY REPORT (block 6 continuation sheet)

6. DISCREPANCY OR PROBLEM: (Describe in detail. Include reference to PWS section.)

CONTRACT DISCREPANCY REPORT (block 10 continuation sheet)

10. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable Quality Control Plan procedures or new procedures.)

CONTRACT DISCREPANCY REPORT (block 12 continuation sheet)

12. GOVERNMENT ACTIONS. (Acceptance, partial acceptance, rebuttal.)

CONTRACT DISCREPANCY REPORT (block 13 continuation sheet)

13. GOVERNMENT EVALUATION. (Acceptance, partial acceptance, rebuttal.)

INSTRUCTIONS FOR COMPLETION:

1. State the base contract or agreement number for which task/delivery orders are being issued against.

This includes agency awards which contain either A, C, or D in the numbering convention (e.g. VA118- 16-C-0001) as well as VA FSS or NAC BPAs. This also includes MAS, GWACs, and other agency MACs authorized as either assisted acquisition or direct acquisition by another agency.

2. Generate a unique report number to track each CDR, using the current order number which contains F or J; or definitive contract number which contains C, followed by the initials ‘CDR’ and then a sequential number, as the official numbering convention (e.g. [VA118-16-F-0202]CDR-0001).

3. Print name of the Prime Contractor Company.

4. Print name of the division/department/party affected by the discrepancy.

5. Pertinent dates, (a) when was the discrepancy first identified, (b) when was the CDR delivered to the Contractor POC for their review/comment, and (c) after delivery of the CDR when does the Program Office require corrective actions to commence. (Note: The CDR is considered to be received by the Contractor at time of delivery).

6. Provide a concise yet vivid explanation of what the discrepancy is. Cross reference the discrepancy to the corresponding PWS, PRS and/or QASP sections in discrepancy.

7. COR signs, certifying delivery of the CDR.

8. CO signs, certifying notification of CDRs delivery.

9. Responsible Contractor POC name and title (e.g. Program Manager, CEO, etc.).

10. The Contractor POC narrative explanation as to what, in their view, caused the discrepancy along with the proposed corrective measures.

11. The Contractor POC signs, certifying responsibility for correcting the CDR.

12. In the event there is shared responsibility for causing the discrepancy, the Government must also state actions it will take concurrent with Contractor actions, otherwise this is not applicable. (Note:

Government actions will be initiated commensurate with the date established at block 5(c).)

13. After corrective actions have been taken, evaluate whether actions had an impact in being able to resolve the discrepancy. In the event corrective actions are long term in scope, evaluate whether proposed actions provide adequate assurance of being able to resolve the discrepancy. For any matter that is not able to be resolved, the Program Office shall initiate steps for issuance of a cure notice.

14. Upon successful resolution of the discrepancy, or after determining that either a cure notice or stop-work order is required, the CDR shall be acknowledged as a closed action.

1 CONTRACT OR AGREEMENT NUMBER:

2 REPORT NUMBER FOR THIS DISCREPANCY:

3 TO:

4 FROM:

a DISCREPANCY IDENTIFIED:

b CDR DELIVEREDRECEIVED:

c INITIATE CORRECTIVE ACTION:

6 DISCREPANCY OR PROBLEM Describe in detail Include reference to PWS section use attached continuation sheets if necessary:

7 SIGNATURE OF COR:

DATE:

8 SIGNATURE OF CONTRACTING OFFICER:

DATE_2:

9a TO:

9b TITLE:

10 CONTRACTOR RESPONSE AS TO CAUSE CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE Cite applicable Quality Control Plan procedures or new procedures Use attached continuation sheets if necessary:

11 SIGNATURE OF CONTRACTOR REPRESENTATIVE:

DATE_3:

12 GOVERNMENT ACTIONS Acceptance partial acceptance rebuttal Use attached continuation sheets if necessary:

13 GOVERNMENT EVALUATION Acceptance partial acceptance rebuttal Use attached continuation sheets if necessary:

a CONTRACTOR:

INITIALSI accept that appropriate corrective actions and close out remedies where employed:

DATEI accept that appropriate corrective actions and close out remedies where employed:

b COR:

INITIALSI accept that appropriate corrective actions and close out remedies where employed_2:

DATEI accept that appropriate corrective actions and close out remedies where employed_2:

c CO:

INITIALSI accept that the parties worked cooperatively to correct the discrepancyies:

DATEI accept that the parties worked cooperatively to correct the discrepancyies:

6 DISCREPANCY OR PROBLEM Describe in detail Include reference to PWS section:

10 CONTRACTOR RESPONSE AS TO CAUSE CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE Cite applicable Quality Control Plan procedures or new procedures:

12 GOVERNMENT ACTIONS Acceptance partial acceptance rebuttal:

13 GOVERNMENT EVALUATION Acceptance partial acceptance rebuttal: