6 - Utility Locate Request Form-20230301.pdf

128 KB Posted

Attached to
Amendment #0001 IFB-Harney Gym B-664 Renovations
Solicitation number
W91QF4-23-B-0005
Issued by

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This document is a utility locate request form for Fort Leavenworth, Kansas. The form requires contact information for the requestor and details of the proposed work, including the type of work, location, and duration. The form notes that Kansas One Call must be contacted for primary utility checks and that at least seven business days' advance notice is required. It provides contact information for the Directorate of Public Works at Fort Leavenworth to submit completed requests.

The related federal contract opportunity is a solicitation from the Department of the Army Materiel Command Mission and Installation Contracting Command at Fort Eustis for Amendment #0001 to IFB-Harney Gym B-664 Renovations. The solicitation provides no further product or service requirements, pricing terms, response dates, or other salient details.

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UTILITY LOCATE REQUEST FORM

DPW FORT LEAVENWORTH

440 MCPHERSON AVE, LOWER LEVEL, DOOR #3

FORT LEAVENWORTH, KS 66027

(p) 913-684-5555 (f) 913-684-2033 usarmy.leavenworth.imcom-central.mbx.dpw-utilities@army.mil

CUSTOMER IS RESPONSIBLE FOR CALLING KANSAS ONE FOR PRIMARY UTILITY CHECKS

1-800-344-7233 http://www.kansasonecall.com/ KANSAS ONE TICKET #:

**MUST BE SUBMITTED SEVEN BUSINESS DAYS IN ADVANCE

**A REMARK REQUIRES SEVEN BUSINESS DAYS ADVANCE NOTICE

*DATE:

*POC NAME: *PHONE:

*COMPANY NAME:

*OFFICE EMAIL ADDRESS: OFFICE FAX:

*EXPLOSIVES? YES_ _NO _

*TRENCHLESS EXCAVATION? YES_ _NO

*DURATION?

*TYPE OF WORK:

*WORK BEING DONE FOR:

CITY/STATE: FORT LEAVENWORTH, KANSAS

COUNTY: LEAVENWORTH

*ADDRESS:

*NEAREST INTERSECTING STREET:

*DRIVING DIRECTIONS/LOCATION OF WORK/MARKING INSTRUCTIONS:

*REMARK (repeat of markings done in the last 15 days):

* SPECIFIC DATE NEEDED:

YES_ NO

(CANNOT BE EARLIER THAN 7 BUSINESS DAYS FROM THE DATE REQUESTED.)

***ONCE PROJECT IS COMPLETE, PLEASE REMOVE ALL UTILITY FLAGS FROM AREA

FOR DPW USE ONLY DATE RECEIVED:

Fax: Email:

GAS: PHONE/COAX/FIBER:

ELECTRIC: ENVIRONMENTAL:

mailto:usarmy.leavenworth.imcom-central.mbx.dpw-utilities@army.mil http://www.kansasonecall.com/

NEC TICKET #: GEOTHERMAL:

AM WATER: LJEC:

NOTIFIED POC OF COMPLETION

ON: Spoke with:

Left message:

KANSAS ONE TICKET:
DATE:
POC NAME:
PHONE:
COMPANY NAME:
OFFICE EMAIL ADDRESS:
OFFICE FAX:
NO:
TRENCHLESS EXCAVATION YES:
NO_2:
DURATION:
TYPE OF WORK:
WORK BEING DONE FOR:
ADDRESS:
NEAREST INTERSECTING STREET:
DRIVING DIRECTIONSLOCATION OF WORKMARKING INSTRUCTIONS 1:
DRIVING DIRECTIONSLOCATION OF WORKMARKING INSTRUCTIONS 2:
DRIVING DIRECTIONSLOCATION OF WORKMARKING INSTRUCTIONS 3:
DRIVING DIRECTIONSLOCATION OF WORKMARKING INSTRUCTIONS 4:
DRIVING DIRECTIONSLOCATION OF WORKMARKING INSTRUCTIONS 5:
REMARK repeat of markings done in the last 15 days:
SPECIFIC DATE NEEDED:
undefined:
DATE RECEIVED:
GAS:
Fax:
Email:
PHONECOAXFIBER:
ELECTRIC:
ENVIRONMENTAL:
NEC TICKET:
GEOTHERMAL:
AM WATER:
LJEC:
NOTIFIED POC OF COMPLETION:
Spoke with:
Left message:
Check Box1: Off
Check Box2: Off

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