Attachment 0013- Construction Impact Notification Form.doc
DOC document 28 KB Posted
- Attached to
- Detroit Arsenal Construction MATOC
- Solicitation number
- W56HZV20RL812
About this file
This document is a construction impact notification form required by the U.S. Army Garrison - Detroit Arsenal (USAG-DTA) Directorate of Public Works (DPW) at least 14 days in advance of construction activities. The form requires contractors to provide details such as a description of construction activities and locations, schedules including start and end dates as well as any weekend or after-hours work, vehicular and pedestrian impacts and associated traffic control measures, and points of contact. Concurrence from the Engineering and Operations and Maintenance Divisions is also required using the form.
The related federal contract opportunity is a solicitation from the Department of the Army Materiel Command TACOM Life Cycle Management Command for a multiple award task order contract to provide design-build and design-bid-build construction services in support of real property sustainment, restoration, modernization, repair and minor construction at facilities including the Detroit Arsenal and Selfridge Air National Guard Base.
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Text version
US Army Garrison - Detroit Arsenal
Directorate of Public Works
Construction Impact Notification Form
This information is required 14 days in advance for notification of all construction activities and must be submitted in electronic format. Drawings must be attached for work activity. This may be submitted in conjunction with a excavation permit application. The responsible USAG DPW POC for coordination of this document at the Detroit Arsenal, MI, is Moiz Uddin, (586) 282-6004 Project Name:
Contract No.:
Contractor Name:
POC Name & Phone No.
Date Submitted:
Request No.
Revision No.:
1. Describe construction Activity/Type of Work Being Performed:
(E.g., sanitary sewer installation, sidewalk removal, roadway paving, etc)
2. Describe the Exact Location (including limits of construction):
(E.g., Center Ave. from Abrams Ave. to Laboratory Lane, Parking Lot B, etc.)
3. Schedule:
Start Date (indicate time if less than full day):
End Date (indicate time if less than full day):
Any dates omitted? (I.e., weekends):
After hours or weekend work? What dates?
4. Describe all vehicular and pedestrian impacts related to the mentioned construction activity:
(E.g., building entrance, sidewalk, roadway, grass, etc.)
5. Describe appropriate traffic control or other measures being taken to mitigate the impacts:
(E.g., flagmen for one lane traffic, orange construction barrels, "sidewalk closed" signage, etc.)
7. Describe work activities during after-hours or weekend work:
(E.g., full road closures may be approved for weekend work)
8. Describe any special needs, requests, coordination required:
(E.g., need access to room 1615 in building 230 on 01 June 2009 at 0800, etc.)
9. Any additional comments?
10. Engineering Division Concurrence ______________________________________________ Date_______________
11. O&M Division Concurrence ___________________________________________________ Date_______________
12. Special Terms and Conditions:
Form: CIN Last Revision: 30 January 2014
File details come from the government source that posted it. Updated .