Appendix B - WP Work Order Form.pdf
PDF 206 KB Posted
- Attached to
- West Point Renovations Construction & Repairs
- Solicitation number
- PANHES-26-P-0000-029922
About this file
This is a Work Order Form used by the U.S. Army Engineering & Support Center for authorizing and tracking contracted work. The form serves as the primary document for documenting labor, materials, subcontracts, and associated costs for work performed under an existing contract.
Part I captures administrative information including contractor name, facility details, work order request number, date, and contract/task order numbers. Part II provides detailed cost tracking with separate sections for prime contractor labor (broken down by classification such as Site Supervisor and SSHO/QC with regular and overtime rates), prime contractor parts/materials/supplies/equipment (with manufacturer part numbers, quantities, and unit pricing), and subcontracts including labor, travel, and materials with associated markups. The form requires identification of whether payment bonds are required for orders exceeding $35,000. Part III contains authorization signatures from the Designated Government Representative and Contracting Officer. Part IV includes certification of satisfactory service completion by the contractor and quality assurance evaluation. Part V provides final acceptance and receipt acknowledgment by the Contracting Officer. The form also mandates CEHNC Safety Compliance documentation, including either a USACE-accepted Activity Hazard Assessment (AHA) or an attached AHA for review, verification of a competent person with an appointment memo on file, and notation of any additional required safety plans or programs. A separate pricing template (9203-16 Rev A) is referenced for detailed cost breakdowns including labor, rental equipment, MSE handling fees, profit, subcontractor costs, travel, and materials with associated taxes.
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Text version
CONTRACTOR:
FACILITY NAME:
FACILITY LOCATION:
WO REQUEST NO:
WORK ORDER DATE:
Check if applicable:
Labor Classification Reg Labor Hours
Regular Labor Rate OT Labor Hours OT Labor Rate Firm-Fixed Price Labor (Y or N) Total Regular Labor Total OT
Labor Site Supervisor
SSHO/QC
TOTAL FFP LABOR
Description Manf Part # Qty Unit Price Amount
TOTAL MATERIALS
Cost Total Subcontract Labor From Sheet 2 Subcontract Travel From Sheet 2 Subcontract Materials From Sheet 2
0.00% 0.00%
Total Subcontractor Price $0.00
TOTAL COST $0.00
Firm-Fixed Price (FFP) (This Work Order)
DESIGNATED GOVERNMENT REPRESENTATIVE: DATE:
CONTRACTING OFFICER
CLIN/SUB-CLIN:
Distribution:
CONTRACT NO.:
TASK ORDER NO.:
INITIATOR:
PAYMENT BOND REQUIRED? (OVER $35K)
PRIME CONTRACTOR LABOR
PART II - COST SUMMARY
Competent Person One of these boxes must be checked:
Subcontract Total
I concur this work is a validated requirement.
PART III - AUTHORIZATION
Subcontractor Markup
Unit
PRIME CONTRACTOR PARTS/MATERIALS/SUPPLIES/EQUIPMENT
SUBCONTRACTS
Shipping Material Handling
WORK ORDER FORM
PART I - WORK ORDER INFORMATION
Contractor Signature:
Contractor confirms the competant person has an appointment memo approved on file and will be documented on the AHA prior to start of work.
There is an appointment memo and proof of qualifications attached to this WO for review and approval.
CEHNC Safety Compliance
Safety AHA One of these boxes must be checked:
Contractor confirms there is a USACE accepted AHA associated with the work being performed in this WO included in the APP. AHA identification number:
Contractor acknowledges there is an activity associated with the WO that requires an additional plan or program. Plan is attached for review with the WO.
Work Order Work Plan:
Contractor acknowledges there is NOT an AHA associated with the work being performed in this WO included in the APP. AHA is attached for review with the WO.
1 copy: US Army Engineering & Support Center, Attn: ____________________
PART V - Final Acceptance
SIGNATURE: DATE:
PART IV - CERTIFICATION OF SERVICES
I certify that the services under the above Work Order have been satisfactorily completed.
Inbrief Conducted: Outbrief Conducted:
DATE/TIME WORK COMPLETED
FOR FINAL BILLING OVERTIME
LABOR TO BE CHARGED ( ) Yes ( ) No
DATE:SIGNATURE: QUALITY ASSURANCE EVALUATOR
Distribution:
CONTRACTOR
Work Order Authorized
Prime Contractor WO Fee
Totals Labor Total
Materials Cost
CONTRACTING OFFICER
1 copy: COR
RECEIPT AND ACCEPTANCE IS HEREBY ACKNOWLEDGED
SIGNATURE:
SIGNATURE:
DATE:
DATE:
Bond Fees Prime Total
Labor -$ Rental Equipment -$ MSE handling fee -$ Profit -$
Total -$
Subcontractor -$ Subcontractor Handling Fee -$ Total -$
SubContractor Total -$
Travel -$ G&A on Travel -$ Travel Total -$
Materials -$ MSE handling fee -$ profit -$ Tax -$ Materials Total -$
Total -$
See Attached 9203-16 Rev A
| Summary |
| Sub Break Down |
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