Atch 3. Performance Work Statement (Includes Appx A-C).pdf

PERFORMANCE WORK STATEMENT

FOR

MAINTENANCE AND REPAIR

OF

AUTOMATIC DOORS

Cannon Air Force Base, New Mexico

15 May 2020

Performance Work Statement

TABLE OF CONTENTS

SECTION DESCRIPTION

1 DESCRIPTION OF SERVICES

1.1. BASIC SERVICES

1.2. REPORTS

1.3. SCHEDULE

1.4. REPAIRS

1.5. WARRANTY

2 SERVICES SUMMARY

3 GOVERNMENT FURNISHED PROPERTY AND SERVICES

3.1. GOVERNMENT FURNISHED PROPERTY

3.2. GOVERNMENT FURNISHED SERVICES

3.3. CONSERVATION OF UTILITIES

4 GENERAL INFORMATION

4.1. QUALITY CONTROL

4.2. QUALITY ASSURANCE

4.3. SECURITY REQUIREMENTS

4.4. HOURS OF OPERATION

4.5. ENVIRONMENTAL CONTROLS

4.6. CONTINUATION OF ESSENTIAL DOD CONTRACTOR

SERVICES DURING CRISIS

4.7. SAFETY REQUIREMENTS

4.8. CONTRACTOR PERSONNEL

5 APPENDICES

A EQUIPMENT LISTING

B DELIVERABLES

C REPAIR WORKSHEET

D CAFB & MELROSE AIR FORCE RANGE CIVILIAN

CONTRACTOR ENVIRONMENTAL GUIDE*

E HAZARDOUS MATERIALS FORMS*

* Appendices D&E provided separately

1. DESCRIPTION OF SERVICES.

The Contractor shall provide all management, labor, tools, supplies, materials, equipment, vehicles, and other items and services necessary to perform automatic door inspection, preventive maintenance and repairs at Cannon Air Force Base (CAFB), New Mexico. Service shall be in compliance with the original equipment manufacturer (OEM) specifications & in accordance with Federal, State and local laws and regulations.

1.1. BASIC SERVICES.

1.1.1. The Contractor shall perform bi-monthly inspections, preventive maintenance and repairs to all doors listed in Appendix A, in order to sustain fully functional automatic doors. Due to CAFB infrastructure growth, as new facilities are constructed and facilities are demolished, Appendix A will be subject to change. Any changes to the contract will be accomplished with a modification to the contract.

1.1.1.1. The Contractor’s inspection shall include, but is not limited to the following focus areas:

proper wind and weather seals, proper alignment for smooth operation and effective closure, rated speed, responsive and reliable door operation, traffic handling capabilities, signs of wear including the thresholds, rollers, upper and lower bearings, operators, shafts, arms, and guides;

and satisfactory resistance to the effects of a highly variable, exterior wind load.

1.1.1.2. Preventive Maintenance (PM) shall include, but is not limited to the following focus areas: cleaning mechanisms of all debris, lubricating all drive rods, chains, rollers, bearings, and pivots as needed; adjusting door alignments, adjusting mechanical elements, adjusting electronic elements and replacement of small parts.

1.1.1.2.1. During PM, the Contractor shall perform diagnoses of electrical and mechanical problems to determine the extent of any needed repairs or replacements required to restore the unit to a fully operating reliable status. As part of normal PM service, with no additional cost to the Government, the Contractor shall provide at a minimum: all lubricants, rollers, springs, sealant, bumper pads, sweeps, astragals, and limit switches.

1.1.1.3. The Contractor shall submit a cost proposal to the COR, for all needed repairs, parts, and equipment exceeding items listed in paragraph 1.1.1.1 and 1.1.1.2 required to restore units to fully operating reliable status. The Contractor shall use the Repair Worksheet (see Appendix C) to submit the proposal. The proposal is due the same day of reported deficiency, if the repair is intended to be performed while the Contractor is already present at CAFB. The proposal is due within five business days of reported deficiency for repairs that must be scheduled. The proposal shall show part number, quantity, item description, model number (if applicable), manufacturer, item cost, shipping cost and total cost to the Government for each unit needing repair. If requested by the COR, the Contractor shall provide additional price verification information, including vendor price lists and quotes. For any repair cost over $500.00, the Contractor shall obtain quotes for not less than three competitive sources, or provide justification for non-availability of competitive source. Approved repairs will be purchased through the Contractor by the 27th Special Operations Civil Engineer Squadron (27 SOCES) using the Government Purchase Card.

1.2. REPORTS. The Contractor shall submit to the COR a report listing all buildings inspected, documenting status and any PM, repairs performed, or recommended service, at the end of the bi-monthly visit.

1.3. SCHEDULE. The Contractor shall submit a bi-monthly inspection and PM schedule that includes services at each automatic door location. The Contractor shall submit the schedule within 30 calendar days of award plus each exercised option year. The Contracting Officer (CO) is the approval authority for the schedule. If the Contractor cannot comply with the approved schedule, the Contractor shall notify the CO in order to arrange for an alternate schedule, subject to the CO’s approval. Adjustments to the schedule shall be made at no additional cost to the Government.

1.4. REPAIRS. Doors requiring repairs beyond what is stated in paragraph 1.1.1.1 and

1.1.1.2 may be coordinated to be scheduled for a separate visit. The Contractor shall also determine the feasibility of repairs as compared to providing a proposal for replacement with a new unit. The Contractor must notify the COR immediately of any automatic door found:

a. to be unrepairable

b. to need repair to the operating systems, doors, frames and/or glass

c. to be a safety hazard

1.4.1. For repairs that cannot be accomplished during PM visits, the Contractor may be authorized travel to/from CAFB for the purpose of identifying the problem and preparing a work estimate of needed repairs to include parts and labor. Repairs shall begin immediately upon COR approval of the work request.

1.4.1.1. If the repair is approved by the COR, the Contractor is authorized Per Diem (e.g.

mileage, lodging, and food), for no more than two (2) persons, for travel, as determined by the Joint Travel Regulation (JTR), https://www.defensetravel.dod.mil/site/travelreg.cfm.

1.4.2. The Contractor shall arrive at CAFB within 24 hours of notification. Upon arrival at CAFB, the Contractor shall notify the COR before proceeding to the job site.

1.5. WARRANTY. The Contractor shall be responsible for submitting claims for manufacturer warranty repairs or replacement. The Contractor shall register all newly purchased parts or materials for any applicable warranty, maintain warranty documentation, and inform the CO and COR of manufacturer recall information for potential fire and safety hazards.

2. SERVICES SUMMARY.

The Contractor’s service delivery requirements are summarized into Performance Objectives that relate directly to standards of performance required to meet mission essential needs. For the Performance Objective to be met, service delivery must be in substantial compliance with applicable performance standards. The Performance Threshold describes the minimum overall levels of service delivery required for acceptable quality control. Failure to meet these Performance Thresholds means that Contractor Quality Control is unacceptable. The following is a list of the key Performance Objectives that will be verified as contractually compliant by Government personnel; however, inspection of any contract requirement is authorized.

PERFORMANCE

OBJECTIVE

PWS

Paragraph

PERFORMANCE

THRESHOLD

METHOD OF

ASSESSMENT

PO-1

Inspections

1.1.1.1 No more than 1 discrepancy per bi-monthly visit

Periodic

PO-2 Preventive Maintenance

1.1.1.2 No more than 1 discrepancy per bi-monthly visit

Periodic

PO-3

Reports

1.2 No more than 1 discrepancy per bi-monthly visit

Periodic

PO-4

Schedule

1.3 No more than 1 discrepancy per bi-monthly visit

Periodic

PO-5

Repairs

1.4 inclusive

No more than 1 discrepancy per bi-monthly visit

Periodic

3. GOVERNMENT FURNISHED PROPERTY AND SERVICES.

3.1. GOVERNMENT FURNISHED PROPERTY. NONE.

3.2. GOVERNMENT FURNISHED SERVICES.

3.2.1. UTILITIES. Electricity, water, and sewage service (as necessary) are available for the Contractor’s use, for accomplishment of service in accordance with this contract.

3.3. CONSERVATION OF UTILITIES. The Contractor shall instruct employees in utilities conservation practices. The Contractor shall be responsible for operating under conditions which prevent the waste of utilities which include the following:

3.3.1. Lights shall be used only in areas where and when work is actually being performed.

3.3.2. Mechanical equipment controls for heating, ventilation, and air conditioning systems shall not be adjusted by the Contractor or by Contractor’s employees unless authorized.

3.3.3. Water faucets or valves shall be turned off after the required use has been accomplished.

3.3.4. Government telephones shall only be used for official Government business.

4. GENERAL INFORMATION.

4.1. QUALITY CONTROL. The Contractor is required to control the quality of service delivery and offer to the Government for acceptance only services which conform to contract requirements. The overall control of quality must meet the specified performance thresholds for each requirement in the Services Summary.

4.2. QUALITY ASSURANCE. The Government will periodically evaluate the Contractor’s performance and accomplish this by appointing a representative to monitor performance to ensure services are received. The Government representative will evaluate the Contractor’s performance through periodic on-site inspections.

The Government may inspect each task as completed or increase the number of quality control inspections if deemed appropriate.

4.2.1. The COR is the authorized Government representative who will perform assessments of the Contractor’s performance. The identity of the COR, with a letter defining their duties and authority, will be promptly furnished to the Contractor.

4.2.2. Any matter concerning a change to the scope, prices, terms or condition of this contract shall be referred to the CO and not the COR.

4.2.3. The services to be performed by the Contractor during the period of this contract shall at all times and places be subject to review by the CO or authorized representative(s).

4.2.4. Government personnel, other than CO and COR, may from time to time, with CO coordination, observe Contractor operations. However, these personnel may not interfere with Contractor performance or make any changes to the contract.

4.3. SECURITY REQUIREMENTS. ID Passes and Badges: The Contractor is responsible to obtain such clearances and/or passes as required for his/her employees to enter on CAFB prior to start of work. The Contractor shall be responsible for all passes issued to his/her employees under this contract. Applications shall be coordinated through the CO. At the time of application, 27th Special Operations Security Forces Squadron may conduct a background check on employees. Upon termination of employment, the Contractor shall be responsible for returning identification cards and base passes to Security Forces within 24 hours.

4.4. HOURS OF OPERATION.

4.4.1. Normal Hours of Operation. The Contractor shall perform all routine services during normal work hours. Normal work hours are 7:00 AM to 4:00 PM (MST/MDS), Monday thru Friday except for Federal holidays. The Contractor may work, with prior approval of the CO, extended hours to ensure timely completion of work at no additional cost to the Government.

4.4.1.1. Recognized Holidays. The Contractor is not required to provide service on the following days: New Year’s Day, Martin Luther King Jr. Day, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day and Christmas

Day. If the holiday falls on Saturday, it is observed on Friday. If the holiday falls on a Sunday, it is observed on Monday.

4.5. ENVIRONMENTAL CONTROLS.

4.5.1. The Contractor shall comply, and assure that all sub-Contractors comply, with all applicable federal, state, and local laws, regulations, ordinances, policies and standards related to environmental matters. Where applicable, the Contractor shall use environmentally safe products in the course of completion of their project. The Contractor shall maintain, in company vehicle on site, Safety Data Sheets (SDS) for all approved Hazardous Materials. A copy of all SDSs shall be provided to the CO prior to materials being brought on CAFB. The SDS data are subject to random checks by the Government. The Contractor shall maintain, and provide on demand, an inventory of materials being brought into the Government facility.

4.5.2. Environmental Management System (EMS). All Contractor personnel performing work on CAFB shall complete EMS Awareness training prior to commencement of any activities. Training is available through the learning management system called The Environmental Awareness Course Hub (TEACH) at https://usaf.learningbuilder.com/account/login/?ReturnUrl=%2f. The Contractor shall submit the Awareness Training Certificates of Completion to the COR prior to any on-base performance under this contract. Use of Microsoft Edge, Google Chrome or Mozilla Firefox may be required to print certificates.

4.5.3. Hazardous Material (HM) Handling. The Contractor shall comply with all federal, state, and local regulations including Cannon Air Force Base & Melrose Air Force Range Civilian Contractor Environmental Guide, refer to Appendix D, concerning the use, storage, and reporting of Hazardous Materials (HM). In accordance with AFI 32-7086, Hazardous Materials Management, the Contractor shall provide the following information to the CO for all HM to be used:

a. Product identification or label

b. Safety Data Sheet (SDS)

c. Estimate of quantity to be used

d. Maximum quantity to be used

e. Storage location

4.5.3.1. The above information must be submitted to the CO on a CAFB Contractor Hazmat Worksheet and CAFB Contractor HM Usage Worksheet. The Contractor may not bring a HM onto CAFB, nor use a HM, until the Contractor receives all required authorizations. This HM information shall be submitted 30 calendar days prior to the HM being brought onto CAFB. The Contractor shall submit monthly reports thereafter, by the fifth business day after the completed month, to the CO that contains actual usage information. The CO will forward these reports to CAFB HAZMART and 27th Special Operations Civil Engineer Squadron (SOCES) Environmental Section for Hazardous Material inventory tracking purposes. HAZMART, in consultation with 27 SOCES Environmental Section, may determine after review of the initial report that follow-on reports are not necessary. For definition of HM, the Contractor shall refer to FED-STD-313D. HM includes pesticides and cleaning supplies. The Contractor shall not use

EPA-prohibited chemicals and shall be encouraged to not use products which result in the generation of hazardous waste, air or water pollution. Class I Ozone Depleting Substances shall not be used for any requirement of this contract. The Contractor shall maintain a copy of current SDSs readily available to employees for HM in use or being stored. The Contractor shall be OSHA compliant

4.5.3.2. In the event environmental laws/regulations change during the term of this contract, the Contractor is required to comply as such laws/regulations come into effect. The Contractor shall notify the CO at earliest knowledge of the law/regulation change.

4.5.4. Notification of Environmental Spills. If the Contractor spills or releases any substance contained in 40 CFR 302, Designation, Reportable Quantities, and Notification into the environment, the Contractor or its agent shall immediately report the incident to Cannon AFB Fire Dept. at 911 if on CAFB. The liability for the spill or release of such substances rests solely with the Contractor and its agent.

4.5.5. GREEN PROCUREMENT PROGRAM (GPP). In performance of this contract, Contractors shall use Environmental Protection Agency (EPA) designated recycled content products, Information Technology (IT) Energy Star products/appliances, Federal Energy Management Program (FEMP) Designated Energy Efficient Low Stand By Power products/appliances, U.S. Department of Agriculture (USDA) Bio based/Bio preferred products, Environmentally preferable products, Electronic Product Environmental Assessment Tool (EPEAT) registered products, Water Sense or other water efficient products, non- or Low Ozone depleting substances under the Significant New Alternatives Policy (SNAP), non or Low toxic or hazardous constituents (e.g. non-VOC paint) and any other environmentally sustainable product/method, to the greatest extent possible.

4.6. CONTINUATION OF ESSENTIAL DEPARTMENT OF DEFENSE SERVICES

DURING CRISIS DECLARED BY THE NATIONAL COMMAND AUTHORITY OR

OVERSEAS COMBATANT COMMANDER. This service is not essential for performance during a crisis or heightened security according to DODI 3020.37.

4.7. SAFETY REQUIREMENTS.

In performing work under this contract, the Contractor shall:

4.7.1. Conform to the safety requirements contained in the contract for all activities related to the accomplishment of the work, as required by OSHA.

4.7.2. Provide protection to Government property to prevent damage during the period of time the property is under the control or in possession of the Contractor.

4.7.3. Record and report promptly (within one hour) to the CO or COR, all available facts relating to each instance of damage to Government property or injury to either Contractor or Government personnel.

4.7.4. In the event of an accident/mishap, take reasonable and prudent action to establish control of the accident/mishap scene, prevent further damage to persons or property, and preserve evidence until released by the accident/mishap investigative authority through the CO.

4.7.5. If the Government elects to conduct an investigation of the accident/mishap, the Contractor shall cooperate fully and assist Government personnel in the conduct of investigation until the investigation is completed.

4.8. CONTRACTOR PERSONNEL. The Contractor shall have an American Association of Automatic Door Manufacturer (AAADM) certification and at least two (2) years’ experience as a specialized automatic door installation, service and repair business. The Contractor shall have fully qualified person(s) certified by AAADM to perform the work required by this PWS.

The qualified person(s) performing the work shall have at least two (2) years of experience as an automatic door mechanic. The Contractor is required to submit a list of qualified employees and copies of certificates to the CO, no later than 30 calendar days after the award, before service is performed, and each new option year of the contract.

4.8.1. Contract Manager. The Contractor shall provide a Contract Manager and alternate Contract Manager (responsible in the absence of the Contract Manager) who shall be responsible for the performance of the services. The names of the Contract Manager and alternate(s) shall be provided to the CO in writing prior to the beginning of the first performance period. The Contract Manager and alternate(s) must be able to read, write, speak, and understand English.

4.8.2. The Contract Manager and alternate shall have full authority to act for the Contractor on all contract matters relating to daily operations of this contract.

4.8.3. The Contract Manager or alternate shall be available during normal duty hours within four

(4) hours of notification to meet on CAFB with Government personnel (designated by the CO) to discuss problems. After normal duty hours the Contract Manager or alternate shall be available within six (6) hours of notification.

4.8.4. Contractor Employees: the Contractor shall not employ persons for work on this contract if such employee is identified to the Contractor by the CO as a potential threat to the health, safety, security, general well-being or operational mission of the installation and its population.

4.8.5. Contractor personnel shall present a neat appearance and be easily recognized as Contractor employees. This may be accomplished by wearing distinctive clothing bearing the name of the company or by wearing appropriate badges, which contain the company name and employee name in English.

4.8.6. The Contractor shall not employ any person who is an employee of the U.S. Government if employing that person would create a conflict of interest. Additionally, the Contractor shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval according to DOD 5500-7-R Joint Ethics Regulation. The Contractor shall not employ any person who is an employee of the Department of the Air Force if such employment would be contrary to the policies in AFI 64- 106, Air Force Industrial Labor Relations Activities.

4.8.7. The Contractor is cautioned that off-duty active military personnel hired under this contract may be subject to permanent change of station, change in duty hours or deployment.

Military Reservists and National Guard members may be subject to recall to active duty. The abrupt absence of these personnel could adversely affect the Contractor’s ability to perform;

however, their absence at any time shall not constitute an excuse for nonperformance under this contract.

4.8.8. Unless notified by the COR, the Contractor shall report to the 27 SOCES Service Contracts Office, at Building 355, 506 North Air Commando Way, Cannon AFB, NM 88103 after performing the services in this contract to submit Report described in para 1.2.

5. APPENDICES

A. Equipment Listing B. Deliverables C. Repair Worksheet D. Cannon Air Force Base & Melrose Air Force Range Civilian Contractor Environmental Guide E. Hazardous Materials Forms

APPENDIX A: EQUIPMENT LISTING

LOCATION MANUFACTURER TYPE

of

UNITS

Building 70, 101 Albright Ave.

(Base Theater)

Besam Single, automatic push button

Building 74, 105 Albright Ave.

(Bowling Center)

Besam Single, automatic push button

Building 75, 107 Albright Ave.

(Library)

Stanley Sliding 2000 Series Interior/Exterior Electronic Motion Detector

Building 77, 102 Levitow Ave.

(Base Exchange)

Stanley Siding 2000 Series Interior/Exterior Electronic Motion Detector

Building 77, Garden Center, 102 Levitow Ave. (Base Exchange)

Nabco GT 1175 Model H

Interior/Exterior Electronic Motion Detector, Emergency Breakaway Panel

Building 160, 206 Alison Ave. Stanley Sliding 2000 Series Interior/Exterior Electronic Motion Detector

Building 206, 502 N. Chindit Ave. BMW Industries SDW Single Automatic Motion Detector

Building 355, 506 N. Air Commando Way (CE)

Nabco GT710 Single, automatic push button

Building 356, 109 Engineers Way

(CE)

Nabco GT710 Single, automatic push button

Building 444, 400 N. Air Commando Way (Fitness Center)

Stanley Dura-Glide 2000 Series Emergency Breakaway Panel 4

Building 600, 110 Alison Ave.(Personnel)

Nabco GT710 Interior/Exterior Electronic Motion Detector

Building 624, 121 Cochran Ave. Stanley Sliding 2000 Series Interior/Exterior Electronic Motion Detector

Building 1111, 108 Eagle Claw Blvd. (Shoppette)

Stanley Interior/Exterior Electronic Motion Detector

Building 1111, 108 Eagle Claw Blvd. (Shoppette)

Stanley Sliding 2000 Series Emergency Breakaway Panel Automatic Lock, Motion Detector

Building 1435, 335 DL Ingram Blvd. (Child Development Center)

Nabco GT710 Double, automatic push button

Building 1812, 305 Eagle Claw Blvd.

Besam 939 Model A037117

Power-Glide AMD Floor Mat Type

Building 1820, 211 W.

Levitow St.

Nabco GT710 Single, automatic push button

Building 1900, 311 Eagle Claw Blvd (Lodging Office)

Stanley Dura-Glide 2000 Series Emergency Breakaway Panel Automatic Lock, Motion Detector

Building 2209, 601 Chindit Blvd. (Main Gate Visitor's Center)

Nabco GT710 Interior/Exterior Push Button

Building 848, 300 Air Commando Way

Ingersoll Rand Model 8200 Series and Nabco GT710

Double, automatic push button

Building 4616, 132 Dagger Rd. Horton Series Double, automatic push button

Building 4625, 100 Dagger Rd. Stanley Phi Series Double , automatic operated individually

Building 7019, 101 James F.

Boatwright Blvd. (Child Development Center)

Nabco GT710 Double, automatic push button

Total 55

APPENDIX B: DELIVERABLES

DELIVERABLE

PARA

REFERENCE

DUE DATE

DELIVER

TO

Reports 1.2 End of each bi-monthly visit COR

Inspection and Preventive Maintenance Schedule

1.3 NLT 30 calendar days after

award or each exercised Option Year

CO

EMS Awareness Training Certificate

4.5.2 Prior to performing any

contract activity

COR

Hazardous Material Authorization

4.5.3.1

30 calendar days prior to anticipated on-base use, thereafter, actual usage monthly by the 5th business day

CO

Certification and list of Employees

4.8 NLT 30 calendar days after

award or each exercised Option Year

CO

Name of Contract Manager

4.8.1 Prior to performing any

contract activity

CO

APPENDIX C: Repair Worksheet

1. Repair Worksheet Definition. The worksheet shall be used for repair work discovered during the course of contract performance that is within the general scope of the contract, not covered by PM (PWS para 1.1.1.1 & 1.1.1.2) and necessary in order to satisfactorily complete the contract. The Contractor shall identify needed repairs and recommend corrective action during contract performance. Using the worksheet permits the Government and the Contractor to negotiate parts and labor which are within the general scope of the contract and are necessary to make repairs or prevent malfunctions but are not specifically identified and priced.

1.2.1. Repair Worksheet Procedures.

1.2.2. In accordance with PWS para 1.1.1.3, the Contractor shall submit to the COR a proposal describing the work being required. The worksheet, with all applicable fields completed, shall be submitted at the same day of reported deficiency if repair is intended to be performed while the Contractor is already present at CAFB. Proposal is due within five business days of reported deficiency for repairs that must be scheduled.

1.2.3. The Contractor and COR will negotiate a firm-fixed-price settlement for the work. The Contractor shall not begin work until COR has approved proposal. The Contractor shall commence work and complete work by the mutually agreed upon dates stipulated in the form/memo.

1.2.4. Failure of the Contractor to provide the information required on the proposal, within the specified timeframe, may be grounds for the Government to openly compete the work.

Additionally, if the Government and the Contractor cannot agree upon a firm-fixed price, the Government has the right to openly compete the work.

APPENDIX C REPAIR WORKSHEET

Government Control Number __________ Contractor Control Number __________

1. Description of work to be performed:

2. Costs:

a) Labor: The total labor price shall include all labor costs.

Labor Number Price Total Classification of Hours Per Hour Labor price

Total of Labor Costs: $ _____________

b) Materials, Supplies, Equipment: Contractor shall identify all materials, supplies, and equipment required regardless of cost. For any repair cost in excess of $500.00 the Contractor shall provide at least three competing vendor quotes.

Vendor Name & Contact Info Item Cost

Total of Materials, Supplies, Equipment Costs $ ____________

c) Per Diem, in accordance with PWS paragraph 1.4.1.1:

Name Mileage Lodging Meals Incidentals Sub Total Person 1: ____________________________________________________________________________ Person 2: ____________________________________________________________________________

Total of Per Diem: $ ____________

d) Total of all work request costs: $ ____________

3. Warranty period: Parts ___________ Labor ____________

4. Schedule of Work: Start ___________ Complete ____________ Days and Hours ____________

5. Other Conditions: