AF103.pdf
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- Solicitation number
- W9128F21R0007
About this file
This document contains a federal contract solicitation and a base civil engineering work clearance request form.
The federal contract solicitation is for a $99 million Rapid Disaster Infrastructure Multiple Award Task Order Contract set aside for HUBZone small businesses. The Northwestern Division of the U.S. Army Corps of Engineers Omaha District will issue task orders for time-sensitive construction, rehabilitation, and flood risk reduction support in response to disasters. Offerors must register under NAICS code 236220 and submit proposals by January 15, 2021. Task orders may be firm fixed price or cost reimbursement. The contract has an indefinite ordering period and no limit on the number of task orders.
The base civil engineering work clearance request form is used to coordinate work that may disrupt base operations like traffic, utilities, security systems, or routine activities. It identifies hazardous work conditions to prevent accidents. Clearance is requested before starting work identified in an attached sketch by work order and contract number. Review and approval is required from base civil engineering as well as other base offices and utility companies impacted. Precautionary measures must be described.
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Text version
I. ZONE
J. OTHER (Specify)
BASE CIVIL ENGINEERING WORK CLEARANCE REQUEST
(See Instructions on Reverse)
AF FORM 103, 19940801 (EF-V3) PREVIOUS EDITIONS ARE OBSOLETE.
DATE PREPARED
1. Clearance is requested to proceed with work at on Work Order No. , Contract No. , involving excavation or utility disturbance per attached sketch. This area has has not been staked or clearly marked.
2. TYPE OF FACILITY/WORK INVOLVED
A. PAVEMENTS
B. DRAINAGE SYSTEMS
C. RAILROAD TRACKS
D. FIRE DETECTION & PROTECTION SYSTEMS
E. UTILITY
F. COMM
G. AIRCRAFT OR VEHICULAR TRAFFIC FLOW
H. SECURITY
I. OTHEROVERHEAD UNDERGROUND
OVERHEAD UNDERGROUND
3. DATE CLEARANCE REQUIRED 4. DATE OF CLEARANCE
5. SIGNATURE OF REQUESTING OFFICIAL 7. ORGANIZATION6. TELEPHONE NO.
15. OTHER (Specify)
16. REQUESTED CLEARANCE APPROVED DISAPPROVED
TELEPHONE
GAS
ELECTRIC
14. COMMERCIAL UTILITY COMPANY
17a. DATE SIGNED
8.
B A S E
C I V I L
E N G I N E E R I N G
A. ELECTRICAL DISTRIBUTION
B. STEAM DISTRIBUTION
C. WATER DISTRIBUTION
D. POL DISTRIBUTION
E. SEWER DISTRIBUTION
F. ENVIRONMENTAL
G. PAVEMENTS/ GROUNDS
H. FIRE PROTECTION
REMARKS (Use Reverse for additional comments) REVIEWER'S NAME AND INITIALSORGANIZATION
9. SECURITY POLICE
10. SAFETY
11. COMMUNICATIONS
12. BASE OPERATIONS
13. CABLE TV
17. TYPED NAME AND SIGNATURE OF APPROVING OFFICER (Chief of Operations Flight or Chief of Engineering Flight)
The BCE work clearance request is used for any work (contract or in-house) that may disrupt aircraft or vehicular traffic flow, base utility services, protection provided by fire and intrusion alarm system, or routine activities of the installation. This form is used to coordinate the required work with key base activities and keep customer inconvenience to a minimum. It is also used to identify potentially hazardous work conditions in an attempt to prevent accidents. The work clearance request is processed just prior to the start of work. If delays are encountered and the conditions at the job site change (or may have changed) this work clearance request must be reprocessed.
INSTRUCTIONS
18. REMARKS. (This section must describe specific precautionary measure to be taken before and during work accomplishment. Specific comments concerning the approved method of excavation, hand or powered equipment, should be included.)
AF FORM 103, 19940801 (EF-V3) (REVERSE)
File details come from the government source that posted it. Updated .