A.03.09 Exhibits-22 Apr 2022.pdf

SECTION J Exhibits

Exhibits

List of Attachments

A. Items to be Delivered at Least One Week Prior to Pre-Work

Conference

B. Mowing and Cleaning Maps

C. Approximate Quantities by Area

D. Safety Plan Outline

E. Partial Listing of Safety Requirements

F. Safety Forms

G. Quality Control Plan

H. Sample Work Schedule

I. Sample Invoice

J. Government Furnished Equipment List

K. Task Order, Form 1449

L. Job Request Form, CELRH 2770

M. Contract Discrepancy Form, DD 2759

N. Contractor Equipment and Inspection Forms

O. Vehicle Operations

P. Inspection Forms

Exhibit A

Items to be Delivered at Least One Week Prior to Pre-Work Conference

Exhibit A

Contractor shall provide the following at least one (1) week prior to the pre-work conference:

A. Schedule of Cleanings. The schedule provided by the Contractor shall be of sufficient detail to allow the Government to inspect all items of work covered under Section C-3 and Section C-4 of the contract as they are being performed.

Schedule should include daily and non-daily items.

B. Quality Control Plan. A suggested outline for the Contractor’s Quality Control

Plan is contained in Exhibit G.

C. Contractor Representatives. List of names of Contractor Representatives and contact information.

D. Contractor Quality Control Inspector. List of Quality Control Inspectors.

E. Contractor Safety Plan. A suggested outline for the Contractor Safety Plan is contained in Exhibit D.

F. Emergency Contacts. A prioritized list, including phone numbers, of those persons (normally Contractor Representatives) to call in case of emergencies.

G. Emergency Work Personnel. A list of names, addresses, and telephone numbers of persons who will be available for emergency work.

H. Operators. A list of qualified equipment operators, their qualifications, experience, and certifications for government furnished equipment.

I. CDL License. A list of individuals with valid CDL operator’s license with endorsements.

J. First Aid and CPR. First Aid and CPR certified individuals on each work crew.

K. SSHO. The contractor shall employ a Site Safety and Health Officer (SSHO) who has completed OSHA 30 hour Construction or General Industry Safety training or its equivalent and has five (5) years experience relative to the work to be performed

Above documents shall be typed and legible

Exhibit B

Mowing and Cleaning Maps

Below Dam Area – Approx. 7.5 Acres

Mowing Limits: Beginning at the gate at the top of the hill mowing the roadway extending 3 feet above the ditch line and 1 foot over the break of the bank. Limits shall be to the wood line or to the water’s edge. In areas where there is a fence, the limit shall be 3 foot beyond the fence line.

Damsite – Approx. 7.5 Acres

Mowing Limits: Beginning at the gate toward the Below Dam area coming back to the office, limit shall be from the wood line to the cliff line, including the road way to the office septic leach area, and the areas behind the office and inside both Maintenance compounds. Mowing area shall extend out Flannagan Dam Road to include all pulloff areas and shall extend 2 foot beyond the break of the bank and also include both parking areas. Limits shall also include the top of the dam on the Left Downstream Abutment and the pulloff areas at the Intake Structure where the limit shall extend 2 foot beyond the break of the bank and include the wide area beside the pulloff behind the guardrail at the Intake Structure.

Damsite – Cont’d

Limits shall include the pulloff overlook area where the limit shall be 2 foot beyond the break of the bank and the Project Sign Area where the limit shall be 20 foot, front and back of the sign and shall extend to the break of the bank and the roadway.

Spillway Area – Approx. 9 Acres

Mowing Limits: Limits shall begin at the traffic island progressing toward the Spillway Launch area, limit shall be 3 feet above the ditch line and 3 feet beyond the fence line. Mowing area does not include the Tennis Court or the Water Plant building, but shall include the ditch line just beyond the Tennis Court. Limits in the Spillway field shall be the water’s edge, the cliff line, the wood line and the Spillway Gates. Also included in these limits is the Project Entrance Sign area, where the limit shall be the roadway to 1 foot beyond the break of the bank and 20 foot in front of the sign to the drain pipe in the curve.

Junction – Approx. 3.5 Acres

Mowing Limits: Limits shall include 5 feet beyond the middle of the ditch line and 5 feet beyond the gate at the back of the parking area, 1 foot over the break of the bank behind the guardrail and to the wood line, taking in the Junction Leach area, and proceeding to the water’s edge and to the entrance of the gas well road.

Lower Twin – Approx. 7 Acres

Mowing Limits: Limits shall be between the wood line and the water’s edge, in areas where there is a ditch line, the limit shall be 3 feet beyond the center of the ditch line, the chain link fence line shall be the limit for the area above the bath house, this shall also include the tent camping area and the day use area just before the campground entrance.

Pound River – Approx. 8 Acres

Mowing Limits: Beginning at the campground entrance, the water’s edge and 3 feet beyond the center of the ditch line on the upper road shall serve as the mowing limit. This shall include the roadway and area around the water tank, which shall be 1 foot over the break of the bank and 3 feet beyond the edge of the roadway up the hill, and shall also include the tent camping area.

Cranesnest - Approx. 9 Acres

Mowing Limits: Limits shall be from water’s edge to wood line, including a 3 foot perimeter around the storage compound, Fishing trail area limit shall be from the water’s edge to 3 feet above the edge of the trail.

Lower Twin Leach Field and Roadway

Mowing Limits: Limits along roadway shall include where regular mowing limits stop to the wood line. Limits for the leach shall begin at the chain link fence area above the bath house and continue to follow the wood line throughout the field. All fallen trees and/or limbs in the leach field area shall be removed and disposed of in an area designated by the COR.

Pound River Access Road and Leach Field

Mowing Limits: Access road limits shall be 12 feet from the road surface edge or 4 feet beyond the center of the ditchline (whichever distance is greater) and 2 foot over the break of the bank, all limbs overhanging the roadway shall be cut to a minimum height of 16 feet. In areas where the upper bank is a rock cliff, cut all vegetation that can be reached.

Limit on the leach field and the hillside shall be from where regular mowing limits stop to the wood line. All fallen trees and/or limbs shall be removed from the leach field area and disposed of in an area designated by the COR.

Hollow Place Compound – Approx. 2 Acres

Mowing Limits: Beginning at the gate at bottom of the hill, limit shall be 4 feet beyond the center of the ditch line and 1 foot over the break of the bank, leading up the hill, limit around the compound shall be 6 feet from the fence line.

Cranesnest Access Road

Mowing Limits: Access road limits shall be 12 feet from the road surface edge or 4 feet beyond the center of the ditchline (whichever distance is greater) and 2 foot over the break of the bank, all limbs overhanging the roadway shall be cut to a minimum height of 16 feet. In areas where the upper bank is a rock cliff, cut all vegetation that can be reached.

Temp Office/Overlook mowing shall extend from edge of Flannagan Dam Road to the waters edge and meeting the Damsite/Office mowing limits, extending 3 foot over the break of the bank around the perimeter.

Temp Office/Overlook Hillside shall extend from the edge of the Temp Office/Overlook limits to 20 feet toward the waters edge.

Intake Pulloff mowing shall be from end of the Intake parking area along Flannagan Dam Road approximately 300 feet and extending toward the water/woodline, over the break of the bank 4 feet.

Intake Pulloff Hillside mowing shall border along the Damsite/Office mowing limits, extending from the edge of the Temp Office/Overlook limits to the Intake Pulloff limits.

Cane Branch shall extend from the edge of the Spillway mowing limits to the hillside and from the edge of the woodline to the gate opening at the tunnel.

Roadway Pulloff Hillside mowing shall be from the edge of the Damsite/Office mowing limits

10 foot toward the water

Below Dam Fishermans Trail shall be from the edge of the Below Dam mowing limits to the

Trophy Stream sign and shall extend from the upper edge of the road and to the waters edge.

Junction Pulloff Fishing Trail limits on the East side of the bridge shall be along the pulloff area of The Lake Road extending 3 feet over the break of the bank and going toward the bridge following the woodline to the waters edge underneath the bridge.

The Fishing Trail limit on the West side of the bridge shall at the pulloff area along The Lake

Road extending down the gated roadway toward the waters edge. Limits shall be 6 feet from the centerline of the roadway.

Pine Mountain Radio Tower Access Road located just across the Kentucky state line along US-

23 shall begin at the edge of US-23 following the access road to the tower site at the top of the mountain and shall be 6 feet from the centerline of the roadway. All overhanging limbs or brush shall be cut to a height of 8 feet. Area around the tower shall be cut to the edge of the woodline.

All limbs, brush, or trees that have fallen into the roadway shall be removed.

Exhibit C

Approximate Quantities by Area

Exhibit C

Items Below Dam

Spillway Damsite/ Office

Junction Lower Twin

Pound River

Cranesnest NFP Overlook/

Dam

NFP

Below Dam

Acres to be Maintained 7.5 9 7.5 3.5 10 9 9

Basketball Courts 1 1 1

Benches 3 2 1 3 4 2 6

Boat Ramps 1 1 1 1 1

Bulletin Boards 1 1 1 1 1 1 1 2

Courtesy Dock/Pier 1 1

Drinking Fountains 2 1 0 1 3 2 2 2

Garbage Cans 17 6 1 2 32 19 30 8 1

Grills/Fire Rings 13 6 0 0 39 28 32 4

Horse Shoe Pits 2 1 0 0 1 2 1

Outside Spigots 1 0 0 0 6 5 4

Picnic Shelters 8 2 0 0 0 0 0 3

Picnic Tables 24 6 1 0 39 28 33 4 1

Playgrounds 2 0 0 0 1 1 1

Restrooms 1 0 0 1 1 1 1 1

Road (Miles) 0.4 0.5 1 2.25 6

Exhibit D

Safety Plan Outline, EM385-1-1 Appendix A

Exhibit D

MINIMUM BASIC OUTLINE FOR ACCIDENT PREVENTION PLANS

An Accident Prevention Plan (APP) is a safety and health policy and program document. The following areas are typically addressed in an APP, but an APP shall be job-specific and shall also address any unusual or unique aspects of the project or activity for which it is written.

The APP shall interface with the employer’s overall safety and health program, and a copy shall be available on the work site. Any portions of the overall safety and health program that are referenced in the APP shall be included as appropriate. ANSI/ASSE A10.38 should be referenced for Programmatic Issues.

> For LIMITED-SCOPE SERVICE, SUPPLY AND R&D CONTRACTS, for example, mowing (only), park attendant, rest room cleaning, the Contracting Officer and SOHO may allow an ABBREVIATED APP (customized APP requirements and waive the more stringent elements of this section). > See 01.A.11, and Appendix A, paragraph 11.

1. SIGNATURE SHEET. Title, signature, and phone number of the following:

a. Plan preparer (Qualified Person, Competent Person, such as corporate safety staff person, QC);

b. Plan must be approved, by company/corporate officers authorized to obligate the company;

c. Plan concurrence (e.g., Chief of Operations, Corporate Chief of Safety, Corporate Industrial Hygienist, project manager or superintendent, project safety professional, project QC). Provide concurrence of other applicable corporate and project personnel (Contractor).

2. BACKGROUND INFORMATION. List the following:

a. Contractor;

b. Contract number;

c. Project name;

d. Brief project description, description of work to be performed, and location; phases of work anticipated (these will require an AHA).

3. STATEMENT OF SAFETY AND HEALTH POLICY. Provide a copy of current corporate/company Safety and Health Policy Statement, detailing commitment to providing a safe and healthful workplace for all employees. The Contractor’s written safety program goals, objectives, and accident experience goals for this contract should be provided.

4. RESPONSIBILITIES AND LINES OF AUTHORITIES. Provide the following:

a. A statement of the employer’s ultimate responsibility for the implementation of his SOH program;

b. Identification and accountability of personnel responsible for safety at both corporate and project level. Contracts specifically requiring safety or industrial hygiene personnel shall include a copy of their resumes. Qualifications shall include the OSHA 30-hour course or equivalent course areas as listed here:

(1) OSH Act/General Duty Clause;

(2) 29 CFR 1904, Recordkeeping;

(3) Subpart C: General Safety and Health Provisions, Competent Person;

(4) Subpart D: Occupational Health and Environmental Controls, Citations and Safety Programs;

(5) Subpart E: PPE, types and requirements for use;

(6) Subpart F: understanding fire protection in the workplace;

(7) Subpart K: Electrical;

(8 Subpart M: Fall Protection;

(9) Rigging, welding and cutting, scaffolding, excavations, concrete and masonry, demolition;

health hazards in construction, materials handling, storage and disposal, hand and power tools, motor vehicles, mechanized equipment, marine operations, steel erection, stairways and ladders, confined spaces or any others that are applicable to the work being performed.

c. The names of Competent and/or Qualified Person(s) and proof of competency/qualification to meet specific OSHA Competent/Qualified Person(s) requirements must be attached. The District SOHO will review the qualifications for acceptance;

d. Requirements that no work shall be performed unless a designated competent person is present on the job site;

e. Requirements for pre-task safety and health analysis;

f. Lines of authority;

g. Policies and procedures regarding noncompliance with safety requirements (to include disciplinary actions for violation of safety requirements) should be identified;

h. Provide written company procedures for holding managers and supervisors accountable for safety.

5. SUBCONTRACTORS AND SUPPLIERS. If applicable, provide procedures for coordinating SOH activities with other employers on the job site:

a. Identification of subcontractors and suppliers (if known);

b. Safety responsibilities of subcontractors and suppliers.

6. TRAINING.

a. Requirements for new hire SOH orientation training at the time of initial hire of each new employee.

b. Requirements for mandatory training and certifications that are applicable to this project (e.g., explosive actuated tools, confined space entry, crane operator, diver, vehicle operator, HAZWOPER training and certification, PPE) and any requirements for periodic retraining/recertification.

c. Procedures for periodic safety and health training for supervisors and employees.

d. Requirements for emergency response training. > See paragraph 9.b. below for a list of requirements that may require emergency response training.

7. SAFETY AND HEALTH INSPECTIONS.

a. Specific assignment of responsibilities for a minimum daily job site safety and health inspection during periods of work activity: Who will conduct (e.g., SSHO, PM, safety professional, QC, supervisors, employees – depends on level of technical proficiency needed to perform said inspections), proof of inspector’s training/qualifications, when inspections will be conducted, procedures for documentation, deficiency tracking system, and follow-up procedures;

b. Any external inspections/certifications that may be required (e.g., USCG).

8. ACCIDENT REPORTING. The Contractor shall identify person(s) responsible to provide the following:

a. Exposure data (man-hours worked);

b. Accident investigations, reports, and logs: Report all accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative (CO/COR). The contractor shall thoroughly investigate the accident and submit the findings of the investigation along with appropriate corrective actions to the CO/COR in the prescribed format as soon as possible but no later than five (5) working days following the accident. Implement corrective actions as soon as reasonably possible;

c. The following require immediate accident notification:

(1) A fatal injury;

(2) A permanent total disability;

(3) A permanent partial disability;

(4) The hospitalization of three or more people resulting from a single occurrence;

(5) Property damage of $200,000 or more.

9. PLANS (PROGRAMS, PROCEDURES) REQUIRED BY THE SAFETY MANUAL. Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans may include but not be limited to:

a. Layout plans (04.A.01);

b. Emergency response plans:

(1) Procedures and tests (01.E.01);

(2) Spill plans (01.E.01, 06.A.02);

(3) Firefighting plan (01.E.01, Section 19);

(4) Posting of emergency telephone numbers (01.E.05);

(5) Man overboard/abandon ship (Section19.A.04);

(6) Medical Support. Outline on-site medical support and off-site medical arrangements including rescue and medical duties for those employees who are to perform them, and the name(s) of on-site Contractor personnel trained in first aid and CPR. A minimum of two employees shall be certified in CPR and first-aid per shift/site (Section 03.A.02; 03.D);

c. Plan for prevention of alcohol and drug abuse (01.C.02);

d. Site sanitation plan (Section 02);

e. Access and haul road plan (4.B);

f. Respiratory protection plan (05.G);

g. Health hazard control program (06.A);

h. Hazard communication program (06.B.01);

i. Process Safety Management Plan (06.B.04);

j. Lead abatement plan (06.B.05 & specifications);

k. Asbestos abatement plan (06.B.05 & specifications);

l. Radiation Safety Program (06.E.03.a);

m. Abrasive blasting (06.H.01);

n. Heat/Cold Stress Monitoring Plan (06.I.02)

o. Crystalline Silica Monitoring Plan (Assessment) (06.M) ;

p. Night operations lighting plan (07.A.08);

q. Fire Prevention Plan (09.A);

r. Wild Land Fire Management Plan (09.K);

s. Hazardous energy control plan (12.A.01);

t. Critical lift Plan (16.H);

u. Contingency plan for severe weather (19.A.03);

v. Float Plan (19.F.04);

w. Site-Specific Fall Protection & Prevention Plan (21.C);

x. Demolition plan (to include engineering survey) (23.A.01);

y. Excavation/trenching plan (25.A.01);

z. Emergency rescue (tunneling) (26.A.);

aa. Underground construction fire prevention and protection plan (26.D.01);

bb. Compressed air plan (26.I.01);

cc. Formwork and shoring erection and removal plans (27.C);

dd. PreCast Concrete Plan (27.D);

ee. Lift slab plans (27.E);

ff. Steel erection plan (27.F.01);

gg. Site Safety and Health Plan for HTRW work (28.B);

hh. Blasting Safety Plan (29.A.01);

ii. Diving plan (30.A.13);

jj. Confined space Program (34.A).

10. RISK MANAGEMENT PROCESSES. Detailed project-specific hazards and controls shall be provided by an Activity Hazard Analysis (0I.A.13) for each major phase/activity of work.

11. ABBREVIATED APP for LIMITED-SCOPE SERVICE, SUPPLY AND R&D CONTRACTS. If service, supply and R&D contracts with limited scopes are awarded, the contractor may submit an abbreviated Accident Prevention Plan. This APP shall address the following areas at a minimum. If other areas of the EM 385-1-1 are pertinent to the contract, the contractor must assure these areas are addressed as well.

a. Title, signature, and phone number of the plan preparer.

b. Background Information to include: Contractor; Contract number; Project name; Brief project description, description of work to be performed, and location (map); The project description shall provide a means to evaluate the work being done (see AHA requirements in 01.A.13) and associated hazards involved. Contractor’s APP shall address the identified hazards involved and the control measures to be taken.

c. Statement of Safety and Health Policy detailing their commitment to providing a safe and healthful workplace for all employees.

d. Responsibilities and Lines of Authorities – to include a statement of the employer’s ultimate responsibility for the implementation of his SOH program; Identification and accountability of personnel responsible for safety at all levels to include designated site safety and health officer (SSHO) and associated qualifications. The District SOHO will review the qualifications for acceptance.

e. Training - new hire SOH orientation training at the time of initial hire of each new employee and any periodic retraining/recertification requirements.

f. Procedures for job site inspections - assignment of responsibilities and frequency.

g. Procedures for reporting man-hours worked and reporting and investigating any accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative (CO/COR). An accident that results in a fatal injury, permanent partial or permanent total disability shall be immediately reported to the Contracting Officer.

h. Emergency Planning. Employees working alone shall be provided an effective means of emergency communication. This may be cellular phone, two-way radio or other acceptable means. The selected means of communication must be readily available and must be in working condition.

i. Drinking Water provisions, toilet and washing facilities.

j. First Aid and CPR training (at least two employees on each shift shall be qualified/certified to administer first aid and CPR) and provision of first aid kit (types/size).

k. Personal Protective Equipment.

(1) WORK CLOTHING - Minimum Requirements. Employees shall wear clothing suitable for the weather however minimum requirements for work shall be short-sleeve shirt, long pants (excessively long or baggy pants are prohibited) and leather work shoes. If analysis determines that safety-toed (or other protective) footwear is necessary (i.e., mowing, weed eating, chain saw use, etc), they shall be worn.

(2) Eye and Face Protection. Eye and face protection shall be worn as determined by an analysis of the operations being performed HOWEVER, all involved in chain saw use, chipping, stump grinding, pruning operations, grass mowing, weed eating and blowing operations shall be provided safety eyewear (Z87.1) as a minimum.

(3) Hearing Protection. Hearing protection must be worn by all those exposed to high noise activities (to include grass mowing and trimming, chainsaw operations, tree chipping, stump grinding and pruning).

(4) Head Protection. Hard hats shall comply with ANSI Z89.1 and shall be worn by all workers when a head hazard exists. At a minimum, hard hats shall be worn when performing activities identified in (2) above.

(5) High Visibility Apparel shall comply with ANSI/ISEA 107, Class 2 requirements at a minimum and shall be worn by all workers exposed to vehicular or equipment traffic.

(6) Protective Leg chaps shall be worn by all chainsaw operators.

(7) Gloves of the proper type shall be worn by persons involved in activities that expose the hands to cuts, abrasions, punctures, burns and chemical irritants.

(8) If work is being performed around water and drowning is a hazard, PFDs must be provided and worn as appropriate.

l. Machine Guards and safety devices. Lawn maintenance equipment must have appropriate guards and safety devices in place and operational.

m. Hazardous Substances. When any hazardous substances are procured, used, stored or disposed, a hazard communication program must be in effect and MSDSs shall be available at the worksite. Employees shall have received training in hazardous substances being used. When the eyes or body of any person may be exposed to corrosives, irritants or toxic chemicals, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within 10 seconds of the worksite.

n. Traffic control shall be accomplished in accordance with DOT’s MUTCD.

o. Control of Hazardous Energy (Lockout/Tagout). Before an employee performs any servicing or maintenance on any equipment where the unexpected energizing or startup of the equipment could occur, procedures must be in place to ensure adequate control of this energy.

p. Driving, working on (i.e., working with equipment/mowers) while on slopes, working from/in boats/skiffs, etc shall also be considered and dealt with accordingly

Exhibit E

Partial Listing of Safety Requirements

Exhibit E

PARTIAL LISTING OF SAFETY AND SECURITY REQUIREMENTS

1. The following is a clarification of the Corps of Engineers' policy concerning the use of personal protective equipment for contract employees as defined in the EM 385-1-1, Safety and Health Requirements Manual. This is not meant to be a complete review of required safety equipment, but is simply provided to answer some of the more common questions concerning our safety policy.

The items of equipment listed below should be issued to each employee or made readily available for employee's use, when the work environment requires it:

a. Safety shoes - All employees except park aids performing traffic surveys and clerical personnel are to wear hard-toe safety shoes at all times. For those not required to wear steel toed safety shoes, leather work shoes shall be worn.

b. Hard hats - Hard hats are to be worn when operating or working around equipment that lifts overhead (e.g. backhoe-end loader) or working at ground level around mowing equipment. Hard hats will not be required when operating a riding mower, unless other mowing equipment is present. Hard hats will be required during construction type activities and wildfire suppression.

c. Safety glasses or goggles - Safety glasses with side shields or goggles are to be worn when operating equipment or working around equipment that may cause harm from flying debris (e.g. weed eaters), and when using power or hand tools.

d. Welders - Full face welder's helmets are to be worn during electric arc welding operations, and appropriate shields or warning shall be given or posted to protect other persons from the flash. During oxyacetylene welding or cutting, appropriate goggles or full face shield shall be worn.

e. Gloves - The proper type gloves are to be worn when there is a danger of burns, cuts, scrapes, scratches, wood splinters, or other injury to employee's hands.

f. Ear protection - Ear plugs or muffs shall be worn when operating any device that has been determined to produce 85 decibels or greater on a time-weighted average. It is the Contractor’s responsibility to determine the noise level of your equipment. Each piece of equipment that exceeds 85dB(A) rating should be labeled to indicate the need for hearing protection.

g. Protective leg chaps - Protective leg chaps are to be worn when operating equipment such as a chain saw.

h. P.F.D's (Personal Flotation Device/Life Jacket) - P.F.D's are to be worn at all times when working around the water or on board watercraft.

i. Safety cans - Containers for flammable liquids shall be labeled and meet the requirements specified in Section 9.B.

j. Seat belts - Seat belts are to be worn at all times when operating, or being transported by motor vehicles and when operating mobile equipment with rollover protection.

k. Safety vests - High-visibility apparel meeting, at minimum, ANSI/ISEA 07-2004 Performance Class 2 requirements, shall be worn when employees are working along roadways.

l. Lock-Out/Tag-Out - Lock-Out/Tag-Out procedures will be used in accordance with EM385-1-1, Section 12 and in coordination with project personnel.

m. Respiratory Protection - For work involving hazardous atmospheres, Contractors will provide a written Respiratory Protection Plan, which includes training and medical clearance. Section 05.G

2. The Contractor shall conduct monthly safety meetings and weekly "tool box" safety meetings in accordance with EM 385-1-1, Safety and Health Requirements Manual. The Contractor may contact the COR about upcoming work planned, to determine appropriate subjects for the monthly safety meetings.

The Government makes no guarantee that the list of upcoming work planned, will actually be ordered nor will work ordered be restricted to said list. The Contractor shall inform the COR of the date, time, and place of the monthly safety meeting, a minimum of 7 days prior to the meeting.

3. Great emphasis will be given to the development and proper use of Activity Hazard Analysis (AHA).

When ordered, AHAs will be developed in detail, utilized during job performance, and available to employees at the job site.

4. Transporting employees and equipment to worksites:

a. Vehicles used to transport staff and equipment must be well maintained and never overloaded.

Each vehicle occupant must have a seat belt available to him or her and must wear the belt.

b. Personnel and tools must be kept apart during travel. Tools and tool boxes must be secured in a manner which will prevent their causing injury in case of a sudden stop or collision.

c. Tool box lids must be securely latched or locked.

5. Contractor vehicles involved in liter pick-up along project and public roads must be equipped with an orange rooftop revolving light, a rear mounted warning sign and reflective warning tape on the bumper.

Employees performing liter pickup along public and project roads must wear High-visibility apparel meeting, at minimum, ANSI/ISEA 07-2004 Performance Class 2 requirements.

SECURITY REQUIREMENTS

1. The Contractor shall cooperate with the Government in providing for the security of Government property. Some examples of the security measures expected include:

a. Closing and locking all gates and doors which were opened to allow Contractor personnel access for work.

b. Ensure that only Government personnel or authorized Contractor personnel enter secured areas.

The COR or his representative shall be informed immediately if any unauthorized persons enter a secured area.

c. Secure or maintain constant surveillance on all pilfer able items to prevent theft. Provide control to ensure that Government furnished equipment, property, or materials are utilized only for contract-purposes.

Exhibit F

Safety Forms

Activity Hazard Analysis, CELRH-2796 OSHA’s Form 300 Log of Work Related Injuries and Illnesses

Accident Investigation Report, ENG-3394

ACTIVITY HAZARD ANALYSIS CHECKLIST

1. Are all blocks in the top 1/3 of the form completed including:

Project:

Date:

Job:

Estimated Starting Date:

Prepared by:

Recommended Protective Clothing and Equipment:

Reviewed by:

Page of ______

Positions Assigned to do Job:

2. Does the "Job" block include the job request number and sufficiently descriptive information to understand the tasks to be performed?

3. Is all the protective equipment necessary for all phases of the work listed in PART I?

4. Are all job steps listed and numbered consecutively in Part I including if applicable but not limited to:

a. Inspection of equipment and safety gear.

b. Loading and unloading of personnel and equipment.

c. Transportation to and from the job site.

d. Setting up equipment and safety markers.

e. Performance of tasks.

f. Securing job site while it is unattended.

g. Clean-up and storage of safety gear and equipment.

5. Are all hazards associated with each job step in Part I listed in Part II opposite the appropriate job step?

Hazards may include but are not limited to:

a. Potential injuries during loading and unloading of equipment.

b. Potential injuries from improperly loaded and/or secured equipment and vehicles during transportation to and from job site.

c. Potential injuries from failure to follow defensive driving procedures or wear seat belts and shoulder harnesses to and from job site.

d. Potential electrical shock and/or fire hazards.

Exhibit G

Quality Control Plan

CONTRACTOR QUALITY CONTROL PLAN (OUTLINE)

1. INSPECTION OF SERVICES. Define the method of inspection for each service in the contract including, but not limited to: the individual(s) who shall inspect the service (Quality Control Inspectors); when or with what frequency inspections shall be performed (e.g. at the completion of each task, etc.); and a copy of the Contractor's inspection forms or other documents identifying the specific tasks involved in the service which shall be inspected.

2. DEFICIENCIES AND CORRECTIVE ACTION. Explain the procedures for identifying deficiencies in the quality of services provided and methods of correction, before the level of performance is unacceptable.

3. RECORDS. Define the method for maintaining records of inspections and records of corrective actions taken, the individual(s) responsible for the records, and the location where the records shall be kept.

4. QUALITY CONTROL INSPECTORS. A consolidated list of authorized Quality Control Inspectors.

5. CONTRACTOR REPRESENTATIVES. A list of names and phone numbers of authorized

Contractor Representatives.

6. SECURITY. Define and explain the procedures and safeguards which shall be used to protect all equipment, materials, supplies, tools, and other resources provided by the Government to the Contractor including; but not limited to, Contractor audit procedures and inventory systems, if appropriate. Examples of procedures and safeguards include:

a. All pilferable materials shall be kept under constant surveillance and shall be collected at the end of each work day and secured under lock.

b. Keys shall be removed from all vehicles and equipment when not in use.

c. All gates and doors which were opened to allow Contractor personnel access for work shall be closed and locked. Only authorized Contractor personnel or Government personnel shall be permitted to enter secured areas. The COR or his representative shall be informed immediately if any unauthorized person enters a secured area.

Exhibit H

Sample Work Schedule

Exhibit H

Sample Work Schedule

John W Flannagan Dam & Reservoir

Contractor Name

Cleaning and Policing Schedule

Monday and Fridays

Time Area

07:00 A.M Lower Twin Recreation Area

08:30 A.M. Below Dam Recreation Area

09:00 A.M. Spillway Recreation Area

Exhibit I

Sample Invoice Format

Exhibit I

SAMPLE INVOICE

FROM: Contractor's Name INVOICE NO:

Address

Phone Number

INVOICE FOR MONTH OF: DATE OF INVOICE:

CONTRACT NUMBER:

TO: Resource Manager

John W Flannagan Dam & Reservoir

192 Whitewater Road

Haysi, VA 24256

DATE WORK ORDER NUMBER AMOUNT

7-1-13 Work Order Number 0001

Item No 0005, Mowing Below Dam $3,000.00

Item No 0014, Mowing Spillway $500.00

7-7-13 Work Order Number 0002

Item No 0032, Laborer $700.00

Item No 0039, Truck Operator $300.00

TOTAL INVOICE $4,500.00

Exhibit J

Government Furnished Equipment List

Exhibit J

Government Furnished Equipment List

A. Farm Tractor w/Attachments

- Make:Kubota

- Model: L3830

- Year: 2005

- Serial Number: 36027

- Hours: 750+

- Acquisition Value: $24,990.00

B. Pontoon Boat

-Make: Fire and Marine

-Model: Work Master

-Year: 2012

-Serial Number: VCP-25110K112

-Hours: 250+

-Acquisition Value: $54,717.42

Exhibit K

Task Order Form, Form 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

1. REQUISITION NUMBER PAGE 1 OF

2. CONTRACT NO. 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY

13b. RATING

14. METHOD OF SOLICITATION

CODE

15. DELIVER TO 16. ADMINISTERED BY CODE

18a. PAYMENT WILL BE MADE BY CODE17a. CONTRACTOR/

OFFEROR

CODE

FACILITY

CODE

CODE

TELEPHONE NO.

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

BELOW IS CHECKED

RFQ IFB RFP

SEE ADDENDUM

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

29. AWARD OF CONTRACT: REF. OFFER

DATED . . YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR

30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

31b. NAME OF CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

10. THIS ACQUISITION IS UNRESTRICTED OR

NAICS:

SIZE STANDARD:

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

SET ASIDE: % FOR:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

ARE ARE NOT ATTACHED

ARE ARE NOT ATTACHED

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

8 (A)

EDWOSB

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SMALL BUSINESS

STANDARD FORM 1449 (REV. 2/2012) BACK

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

40. PAID BY

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

PARTIAL FINAL

37. CHECK NUMBER

38. S/R ACCOUNT NO. 39. S/R VOUCHER NUMBER

36. PAYMENT

COMPLETE PARTIAL FINAL

Exhibit L

Job Request Form, CELRH 2770

Exhibit M

Contract Discrepancy Report, CELRH 1104

Exhibit M

Exhibit N

Contractor Equipment and Supply Inspection

Exhibit O

Vehicle Operation Record, CELRH-2813

Pre-Operation Checklist, CELRH-2796

Property Control Receipt, ENG Form 4900-R, ENG Form 4866

Exhibit P

Inspection Forms

Monthly Water Meter Readings

Month_______________________ Year _____________________

Area ______________________

Date

Meter

Reading Time Comments

Exhibit Q

Geometric Shapes for Drift & Debris Material

Exhibit Q