659-26-200 SOW.pdf

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C1DB--B21 HVAC Upgrades/Roof Replacement AE Project 659-26-200
Solicitation number
36C24626R0013
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This Statement of Work (SOW) details the architectural and engineering (A/E) services for the B21 HVAC Upgrades and Roof Replacement project at the W.G. Bill Hefner VA Medical Center. The project scope includes installing a new air handling unit (AHU 21-8) for the Pharmacy Compounding Room, evaluating and upgrading the building's steam system, and replacing the roof around AHU 21-8. The A/E services encompass comprehensive design tasks such as site investigations, utility connection assessments, contract drawings and specifications, cost estimating, construction period services, and compliance with VA guidelines and standards.

Key project parameters include a total contract performance period of 788 calendar days, with construction documents completion targeted at 243 days from contract award and a construction budget between $2M-$5M. The project requires strict adherence to VA Technical Information Library (TIL) guidelines, NFPA codes, and energy efficiency standards, including a mandate to reduce energy consumption by 20% below the 2020 baseline. The A/E must provide multiple design submission stages, conduct site visits, prepare detailed documentation, and ensure comprehensive design that minimizes operational disruptions during construction, with specific requirements for phasing, infection control, and technical documentation.

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36C24626R0013 0001.pdf PDF
Standard Form 330 - Architect-Engineer Qualifications.pdf PDF
36C24626R0013_1.pdf PDF

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Statement of Work

Project No. 659-26-200 Project Title: B21 HVAC Upgrades and Roof Replacement

A/E SCOPE OF SERVICES

Updated 12/15/2025

Project Scope

General:

This project will consist of the installation of a new AHU 21-8 to serve Pharmacy Compounding Room, Evaluate B21 steam system for upgrades and repairs to be more efficient, this shall include traps, condensate pumps, PRV stations, and control valves & replace B21 Roof around AHU 21-8. Develop designed drawings from previous working drawings and bid specifications to provide for construction contract. The project will be located solely at Bldg. 21 on the W.G. Bill Hefner VAMC campus.

Services

Provide Professional Architect/Engineer (A/E) and healthcare planning services to include but not limited to:

Site investigation – architectural, structural, electrical, plumbing, and mechanical including HVAC and control replacement, electrical, and site modifications. Prior request for notice to inspect must be coordinated and scheduled for times and dates.

Connections to existing utilities must be fully investigated to ensure that the existing utilities can support the load of the new connection during design.

Contract drawings and specifications for construction.

Cost Estimates that include attention to phasing and ICRA as well as all other items associated with design.

Construction period services - review of submissions, provide recommendations and estimates regarding contractor change proposals, visit site per VA's request and add to drawings as-built conditions from contractor's record drawings; A/E will respond within a twenty-four (24) hour period when requested.

Provide File Transfer system for use throughout duration of project. Site must be in place within 30 days of contract award. Site must remain open until final construction contract is complete. This site is intended for AE, VA, and contractor use. The site must be compatible to transfer large files of types of AutoCAD current, all Microsoft Office current programs (Word, Excel, Project), and pdf files. Site must meet VA OIT rules when transferring the files which will provide encryption during the transfer.

Note: Due to requirements of certain construction submittals (i.e. finishes, profiles, shop drawings, etc.), these must be delivered to COR. Any hand delivered submittals must also have a backup copy of the cover sheet on A/E FT Site. A/E FT site must be secure (password protected), user friendly for uploading and downloading of files, and organized for easy file retrieval by the VA COR, Contracting Officer (CO), and contractors. Site must be organized with folders indicating each level of submission as outlined in this scope of work and corresponding required files. Must also submit hard copies to the VA for Design Review Drawings, Specifications, and Construction Documents.

Comply with VHA Safety & Fire Protection Program to have drawings and specification submittals reviewed by VA at 65% and 95% submissions. Review based on VA standards, codes and regulations.

Provide responses back to the VA fire review comments to verify that the comments have been reflected in the project drawings. Bid documents will be re-reviewed to ensure compliance with VA fire review comments. Items that have not been picked up with require changes to the Bid Documents until all review items have been addressed.

Comply with VA Green Energy Management System (GEMS) program as per specifications.

Comply with VA Design Manuals/Guides, FGI Guidelines, ISO codes, and applicable codes as outlined in the VA Design Guides (most recent versions of all the codes) Infection Control Risk Assessment: The AE shall work with the VA Infection Prevention and Control staff to determine required infection risk assessment levels and shall incorporate VA IPC recommendations into project ICRA drawings.

Project scheduling and phasing. Phasing drawings shall also have provisions for safety and fire protection measures to be taken during construction. These measures are to be fully developed through coordination with VA Safety Department.

Include in design documents to update the Fire Alarm Workstation to reflect the as-built location of all fire alarm devices as well as to reflect the as-built project floor plans. This update shall include all updates to points, lists, tables, and graphics. All fire alarm devices shall be operable from the updated graphic screens as well as from the device list in a manner similar to all existing devices. COR to provide location at design.

Additionally, include in design documents to update the VA campus DDC system to reflect the as-built location of all HVAC and domestic water control devices associated with the project as well as to reflect the as-built project floor plans. This update shall include all updates to points, lists, tables, and graphics and shall include the removal of items demolished under the construction project. All HVAC and domestic water devices shall be operable from the updated graphic screens as well as from the device list in a manner similar to all existing devices.

Project Scope

Specifics:

The project is to isolate the Pharmacy Compounding room on its own HVAC system 21-8 (Equipment procured), Replace roof around the 21-8 AHU, and Evaluate the bldg. 21 steam system for efficiency upgrades. This project will review previous designs of the 21-8 to update and create a new design package for the construction project.

Prior design drawings and revisions will be provided for update and review to awardee. Incorporate previous design of specifications and drawings for one complete project submission. Update any and all applicable codes, layouts, and design.

All design will be done according to VA specifications, Design guides, Infection Control guidelines and all applicable codes. The design will be structured so as to require minimum interruption of space function during construction.

All work shall meet NFPA / Life Safety Code and comply with all applicable building codes. This will include all Architectural, Structural, Electrical and Mechanical engineering associated with this project.

Provide VA Form 10-6298 AE Fee Proposal for the solicitation.

Facility design must meet VA TIL requirements first and foremost, followed by requirements laid out in the most recent edition of the FGI guidelines and NFPA.

Attend design review meetings and make all necessary site visits during design to gather information necessary from the existing sites, building plans, utility plans, etc. to provide a complete assessment of the proposed work. A thorough as-built shall be conducted of the existing site conditions to complete a full detailed set of documents.

Assess the intent and scope of this project and work with the Medical Center staff to develop a final design and cost estimate to best suit the needs and constraints of the government, while incorporating VAMC Salisbury Engineering/Facilities Management Service, Safety and Contracting Officer comments into the final design package.

Field verification of existing space and existing utilities servicing the renovated space.

Evaluation and design modifications to the existing electrical distribution system servicing the renovated space to provide sufficient power to all new lighting and equipment in the scope of work. Electrical engineers shall perform full survey of all impacted spaces/loads to document existing electrical items and their locations in each space to ensure coordination with architectural scope, future mechanical chases, if required, as well as ceiling renovations and replacements so that no electrical item is missed during construction. Note obsolete items and sensors located within design area and coordinate with the VA to see if the items should be removed. Electrical engineer shall also be responsible for coordination of existing electrical items located above the ceiling with the new design ductwork routes, and for identifying those conduits, cable tray, junction boxes, etc. that require relocation both on drawings for the contractor and to the VA for advance coordination of outages. Junction box / pull box / cable tray access shall not be obstructed by new HVAC installation. If this condition is encountered, the electrical engineer shall provide design documentation for relocation of the associated items.

Evaluation and design modifications to the existing Plumbing, Medical Gas, and Fire protection systems servicing the renovated space to provide sufficient water supply and drain lines to all new plumbing fixtures and equipment in the area, as required to accommodate the new scope of work (sanitary drains from roof, modifications to floor drains, make up water or drain coolers as required, etc.). Provide new sprinkler heads in areas within the modifications to existing space layouts to accommodate new layouts where heads are at the end of their service life. Note that sprinkler heads will require modification to maintain accordance with NFPA, especially if new ductwork is over 4 feet wide inside the mechanical room, or if stacked air handling units are provided. Plumbing and fire protection engineer shall also be responsible for coordination of existing plumbing and fire protection items located above the ceiling with the new design ductwork routes, and for identifying those pipes, valves, and other appurtenances that require relocation both on drawings for the contractor and to the VA for advance coordination of outages. Valve and other maintenance access shall not be obstructed by new HVAC installation. If this condition is encountered, the plumbing and fire protection engineer shall provide design documentation for relocation of the associated items.

Evaluation and design modifications to the existing structure servicing the locations of new / relocated equipment associated with the scope of work for this project to allow for safe installation of new permanent and temporary HVAC equipment as required for completion of the scope of work.

Architectural evaluation and design modifications for all spaces associated with the work as required to accommodate changes necessary for the scope of work. Expected: new ceilings where ceilings must be removed to complete the scope of work, new lighting where ceilings must be removed to complete the scope of work, modifications to existing and new chases as required to accommodate the new scope of work, and modifications to existing door closers / door operators if evaluation during design requires a more automated door opener approach. Architectural coordination with all trades is required to create a seamless, high quality project / built environment.

Also required by architect: provisions for detailed phasing drawings and ICRA planning for each phase.

Anticipate separate phases for 21-8 & Steam system. Note that ICRA planning will require topping off existing walls where walls around each phase do not go to deck. Walls, temporary or existing must be floor to deck. The architect shall identify those spaces where topping off of walls is required on the construction drawings, as well as document that the contractor is responsible for 1 hour rated full height walls around each construction phase. ICRA planning will also be required for spaces that are impacted above and below the levels of the Pharmacy renovation, if ceiling work below the associated floors is required such as for new plumbing / sanitary floor drains or access into the ceiling spaces below to accommodate any required structural modifications or new HVAC runs to the roof.

Design for all new interior finishes that are required to accommodate the scope of work (room modifications

– paint, patch, floor base; new ceilings; ceiling access panels; etc.), as well as the small architectural modifications laid out in this scope of work.

Project completion of construction documents, including final design, contract drawings, specifications, and cost estimate is to be 243 calendar days or 8 months from contract award. Construction procurement takes 180 days (assistance with Bid RFIs). Construction period services would be a project duration of 365 days or less (see bullet 5 page 1). Estimated total contract period of performance is 788 calendar days.

Project must remain within the approved project scope, time frame, and construction budget of $2M - $5M or the project will be canceled and require re-submittal and competition process. Planning must include in the project a total of 20% of deductive bid alternate that will need to be identified and incorporated as part of the bidding documents.

Recommend bid alternatives as necessary to meet the budget limitations if the project becomes over budget. Note: the AE shall be fully responsible for providing a complete and functional design to the VA within noted budget limitations. Bid alternates will be required to the amount of 20% of the project budget, but bid alternates are not to be used to bring the overall scope within budget. The base bid shall be in budget and bid deduct alternates shall be supplied to the VA to reduce the budget by 20% from the base bid (max budget) price.

Construction will be addressed in phases to allow operations to continue during construction to the extent possible. Phasing will be incorporated as part of the schematic design options presented during the SD submission, due to the high probable cost of the phasing and its impact upon final system design option selections. Phasing must work within budget and allow the VA to continue operations at minimal interference.

Attend pre-bid job walk and provide all engineering responses to questions asked by potential bidders and issue an addendum, if necessary.

Provide expeditious engineering responses to all design/conflict questions encountered during the construction term.

Provide construction period services to review all shop drawings and submittals prior to sending to the VA for final approval.

Provide construction period site visits to review progress of construction activities and milestones during construction.

Provide final Record Drawings (pdf and AutoCAD) which will be developed based on construction period site visits, RFI’s, submittal responses, and As-Built drawings from the contractor within 30 calendar days after completion of construction.

All designs shall be accomplished in accordance with VA guidelines and specifications, which are available on the Internet at http://www.cfm.va.gov/TIL/ A/E shall pay particular attention to all current NFPA, NEC, ICC, and All Design Manuals and Guides as it pertains to this project.

Referenced Drawings

All designs shall verify and coordinate the referenced drawings provided at award in aspects for this construction project. Drawings are noted below:

Project 659-10-231_Construct Oncology Clinic 21-2 Full Set of construction drawings

Project 659-12-256_Replace Roofs on B21 and B31 Full Set of construction drawings

Project 2019 -Siemens controls As-Built Submittal

Project 659-22-104_Replace AHU Bldgs. 5,6,16,21 Full Set of construction drawings and specs http://www.cfm.va.gov/TIL/

Site Investigation

EXPECTATION: A/E will make site visits as necessary to survey existing conditions.

Make site visits as required to determine existing as-built conditions affecting this project. Note: Information including drawings and other documentation provided to the A/E is used as reference only. The AE is expected to perform their own site survey to field verify accuracy of existing drawings and to locate any additional utilities / obstructions in a given area to provide quality new project drawings. All additional references and specifications are available in VHA’s Technical Information Library at address http://www.cfm.va.gov/TIL/. Electronic AutoCAD background drawings will be provided by the VA upon request. A/E shall field verify every aspect that relates to the project. The A/E shall field verify all dimensions and utility connections. AE shall take precautions during field surveys to comply with all ICRA requirements. Coordinate site visits with the COR as determined after award.

Drawings produced by the AE shall account for obstructions in the path of new utilities, relocation of existing utilities as required to accommodate new work, relocation of existing utilities if the architecture team deems it necessary to relocate an existing chase or shaft, and architectural accommodates as required for new / existing utilities (ie – access panels for new and existing utilities shall be covered under specification noted “as needed”. If utility work is required above a hard / drywall ceiling, architectural drawings shall reflect the need to remove and replace the existing ceiling unless the ceiling in question is a walkable plaster ceiling and include requirements for associated ICRA.). All utility tie in points shall be well researched and clearly shown. Utility tie in points showing a general direction and indicated as “tie into existing ________ system in room _______” will not be allowed.

The A/E shall arrange for and oversee the performance of topographic surveys, test borings, test pits, soil tests, subsurface exploration and other such investigations as he/she determines are required for the proper design of the project.

Design Review Schedule

EXPECTATION: Submit review package so they are received on the noted day.

SUBMISSIONS:

Submit review packages so they are received on the noted day (work days after NTP) or earlier:

Initial PDT Meeting ................................................................................................................ 0 days Design Development Documents (15%) ...........................................................................36 days (PDT Meeting) ...........................................................................................................41 days Design Development Documents (35%) ...........................................................................81 days (PDT Meeting) ...........................................................................................................91 days Design Development Documents 65%) ...........................................................................131 days (PDT Meeting) .........................................................................................................151 days Design Development Documents 95%) ...........................................................................191 days (PDT Meeting) .........................................................................................................211 days Design Development Documents 100%) .........................................................................231 days (PDT Meeting) .........................................................................................................236 days Final Construction Bid Documents ................................................................................240 days (PDT Meeting) .........................................................................................................243 days (3 Sets of Drawings and Specifications)

Note: The issue of the Notice to Proceed (NTP) may be combined with the first Project Design Team (PDT) Meeting. A/E will be required to attend and take minutes of each PDT meeting. Minutes will be submitted electronically via e-mail to the COR and Contracting Officer within three calendar days of each meeting.

http://www.cfm.va.gov/TIL/

All new construction shall be designed to achieve an energy consumption level that is at least 30% below the level achieved under ASHRAE Standard 90.1-2010, if life-cycle cost effective. Use Appendix G of ASHRAE Standard 90.1-2010 to document the energy savings.

Should the 30% reduction in energy consumption prove not to be life-cycle cost effective, then the A/E shall evaluate alternative designs at 5% successive decrements in order to identify the most energy-efficient design that is life-cycle cost effective.

The following parameters shall be used for performing the analysis:

• 20 year life-cycle period for system comparisons

• Use Public domain programs such as TRACE, E-CUBE, Carrier E20-II, etc.

• 7% Discount Factor

• Neither include taxes, nor insurance while computing cost.

Major & Minor Renovations and Major Equipment Replacements:

For Major Renovations: Shall include any renovation where an entire area is “gutted” and rebuilt. Any replacement of central HVAC equipment or changes in air distribution shall be considered a “Major Renovation.”

Reduce the energy cost budget by 20% below pre-renovations 2020 baseline. A/E shall estimate 2020 baseline energy consumption before the renovation and compare it to the proposed design after the renovation and document the 20% savings. The primary unit for energy budget reporting is the British Thermal Unit (BTU) per square foot of the area to be renovated. A/E shall develop the energy budget as required in ASHRAE 90.1-2010, Appendix G, using the same parameters outlined above for new construction.

For Minor Renovations: Shall be defined as a small portion of a building, where only architectural treatments or simple equipment replacement is planned. The renovation will have little to no impact on the central HVAC System, or energy use within the renovated area.

Any part of the renovation which impacts energy consumption shall be designed with the mandate to reduce energy consumption. For example, if exterior walls are part of the project, then their R-Value shall be increased. If lighting fixtures are to be replaced, then they shall be replaced with the most energy efficient fixture that is cost effective (20 year life).

Renewable Energy Resources:

For any work, renewable (geothermal, heat recovery, wind, PV solar, solar hot water, etc.) shall be evaluated for life-cycle cost effectiveness.

Design Requirements / Submissions

EXPECTATIONS: Submit complete review package in accordance with the following requirements and guidelines outlined in https://www.cfm.va.gov/til/aeDesSubReq.asp PG 18-15 Volume C Document

Please pay specific attention to the schematic, design and construction submission requirements.

Deliver all design packages electronically and hardcopies to the Project Manager on the established dates to allow the VA Project Development Teams to meet as scheduled. A transmittal letter and check lists is required to be emailed to the Contracting Officer and the project manager on the same day as delivery.

Include all information as follows and as outlined in the attachments for each submission. Information required for each submittal is outlined in Program Guide PG-18-15 Volume C. The manual is at the following address:

https://www.cfm.va.gov/til/aeDesSubReq.asp

Design Development 15%: See Attachment - B, 15% Submission Requirements

• Requirements for the 15% Schematics Development Documents Submission.

• Address all comments from the Initial PDT Meeting and site visits.

• Provide spreadsheet of VA review comments and their completion status.

Design Development 35%: See Attachment - B, 35% Submission Requirements

• Requirements for the 35% Design Development Documents Submission.

• Address all comments from the Schematic 15% Submission review.

• Provide spreadsheet of VA review comments and their completion status..

Design Development 65%: See Attachment - B, 65% Submission Requirements

• Requirements for the 35% Design Development Documents Submission.

• Address all comments from the Schematic 35% Submission review.

• Provide spreadsheet response to VA Fire review comments and their completion status.

Construction Documents 95%: See Attachment - B, 95% Submission Requirements

• Requirements for the 95% Design Development Documents Submission.

• Address all comments from the 65% review.

• Provide spreadsheet of VA review comments and their completion status.

• Provide spreadsheet response to VA Fire review comments and their completion status.

• Provide Design finishes, required submittals.

• Consolidate all necessary submittals by specification section on an Excel spreadsheet. Checklist to be utilized to track/monitor submittal process.

Construction Documents 100%: See Attachment - B, 100% Submission Requirements

• Requirements for the 100% Design Development Documents Submission.

• Address all comments from the 95% review.

• Provide spreadsheet of VA review comments and their completion status.

• Provide spreadsheet response to VA Fire review comments and their completion status.

• Finalize cost estimate.

Final Construction Documents Submission (CD): See Attachment B

• Provide spreadsheet response to VA Fire review comments and their completion status.

• Submit a complete document of all contract requirements for approval signatures.

• Continue to update and submit until approved.

As-Built Drawings: See Attachment C

• Submit a complete document of all as-built drawings for VA review and approval. Continue to update and submit until approved.

• Update the record drawings for both campuses, associated floors to include all renovations for this project. Final submitted record drawings should be incorporated into most current floor plan submitted by VA at close of documents.

Construction Period Services

Expectations: Respond to submittals requests in ten (10) calendar days.

Provide services:

* Assist the VA to determine whether the contractor or subcontractor meets qualification requirements, support by written recommendations of any problems or litigation encountered in past based on first-hand knowledge.

* The AE shall call into weekly construction meetings with the VA.

* Review all submissions and provide recommendations to the VA within ten (10) calendar days or (5) calendar days upon request.

* Review and provide replies to contractors generated RFIs when required by the project manager within

(5) Calendar days.

* Review and provide recommendations to contractors generated RFPs and cost estimates within ten (10) calendar days.

* Make thirty (30) site visits at a minimum on the requests of the VA and prepare written reports to include agreed upon changes in design as determined necessary during the construction. Visits made based on errors and omissions in design will be at no cost to the VA.

* Participate in partial/final acceptance inspections as scheduled and generate punch list items for completion. The punch list shall reference the contract documents for specific deficiencies (i.e.

specification section, drawing detail, etc.)

* Prepare as-built drawings on original set with A/E’s stamp, based on record drawings that the contractor kept during construction and with correspondence performed during construction. Transpose contractor’s as-builts to AutoCAD 2025 file type and provide a set of updated as-builts and specifications on CD and on A/E FTP site within 30 days to the COR. These should be posted on A/E FTP site for VA retrieval.

Attachment A – Sample Checklist

Site Development: Schematics* DD** CD***

Narrative Analysis of site Circulation study Phasing analysis Parking analysis Development concept showing proposed buildings and structures

Landscape drawings with plant groupings

Topographic, utility, and landscape survey

Demolition plan Layout plan showing location of:

• Building and structures

• Roads

• Fire Access

• Parking

• Accessible spaces

• Van spaces

• Mechanical and electrical equipment on grade

• Future expansion

• Off-site roads

• Off-site utilities

• Service area(s)

• Entrances and exits

• Walks

• Inlets

• Contractor's staging area

Attachment B

Schematic Submission:

Drawings (electronic) Specifications Narrative Estimate Full (30x42) Half (15x21) 0 0 1 edited TOC Prelim N/A

Design Development Submission:

Drawings Specifications Narrative Estimate

1 2 1 set (unedited) Final Prelim

Construction Documents Submission:

1 2 1 set (edited) Final Final

Final Bid Documents Submission:

1 2 2 set (bound unbound) Final Final

Each submission shall include a digital copy of all documents electronically in base file and PDF version transmitted through government approved document share.

Attachment C

As-Builts Requirements

1 set complete set in Auto CAD 2025, uploaded to A/E’s FTP site. Set to include all final mark ups from contractor site set and architect. All CAD drawings are to be bound files with the engineering / architect stamps removed.

2 copies of complete set (1 full size, 1 half size) prepared in Auto CAD 2025.

Standards/Codes/Requirements/Regulations

Meet all applicable and current federal and state codes/requirements, i.e.:

OSHA Occupational Safety and Health Administration EPA Environmental Protection Agency NFPA 101 Life Safety Code TJC The Joint Commission AHERA Asbestos Hazard Emergency Response Act NESHAPS National Emission Standards for Hazardous Air Pollutants NFPA Applicable codes published by the National Fire Protection Association ASTM ASTM International (formerly the American Society for Testing and Materials UFAS Uniform Federal Accessibility Standards

Design using the following VA publications http://www.cfm.va.gov/TIL

PG-18-1 Master Construction Specifications PG-18-3 Design and Construction Procedures PG-18-4 Standard Details and CAD Standards PG-18-5 Equipment Guide List H-18-8 Seismic Design Handbook PG-18-9 Space Planning Criteria PG-18-10 Design Manuals (by discipline) PG-18-12 Design Guides (graphical, by function) PG-18-13 Barrier Free Design Guides PG-18-14 Room Finishes, Door, and Hardware Schedules PG-18-15 Minimum Requirements for A/E Submissions PG-18-17 Environmental Compliance Manual H-7545 VA Cultural Resource Management VA Handbook 0730/1 Security and Law Enforcement References for Mental Health Environmental Care Current Version

VHA DIRECTIVE 7715

All applicable requires per the TIL in reference to VA Guidelines.

Design using the following VA publications are available on the internet address http://www.cfm.va.gov/TIL

(End of Scope) http://www.cfm.va.gov/TIL http://www.cfm.va.gov/CFM/TIL/spec.asp http://www.cfm.va.gov/CFM/TIL/cPro.asp http://www.cfm.va.gov/CFM/TIL/sDetail.asp http://www.cfm.va.gov/CFM/TIL/equip.asp http://www.cfm.va.gov/CFM/TIL/seismic.asp http://www.cfm.va.gov/CFM/TIL/planning.asp http://www.cfm.va.gov/cfm/til/dManual.asp http://www.cfm.va.gov/cfm/til/dGuide.asp http://www.cfm.va.gov/CFM/TIL/accessibility.asp http://www.cfm.va.gov/cfm/til/room/RoomFinishes.pdf http://www.cfm.va.gov/CFM/contract/aeDesSubReq.asp http://www.cfm.va.gov/cfm/til/spclRqmts.asp#EC http://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=312&FType=2 http://www.cfm.va.gov/TIL

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