Attachment_07_-_Rawlins_FO_HVAC_Improvements_Project_Attachment_F_BLM_Forms.pdf
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- RFO HVAC UPGRADE, WY
- Solicitation number
- 140L0626R0001
About this file
This file is Attachment F containing BLM Forms for the Rawlins Field Office HVAC Improvements project in Rawlins, Wyoming. It provides templates and documentation requirements for contractor execution of work on this federal construction project.
The section outlines six mandatory forms that the successful contractor must use: (1) Transmittal Form (CM-16) in Excel format for submitting documents; (2) Transmittal Form Continuation Sheet in Excel for additional transmittal information; (3) BLM Contractor Accident/Property Damage Report (CM-22) in Word format for safety incident documentation; (4) Contractor's Quality Control Daily Report in Word format for work performance tracking; (5) Daily Test Report Information Sheet in Word format for testing and inspection documentation; and (6) Submittal List in Excel format for tracking required submittals. The document also includes a comprehensive Submittal List specifying submittal requirements across multiple specification sections (A10, B10, B20, B30, C10, C20, C30, C40, D20, D30, D40, D50, E10, G10, G20, G30, G40) with requirements categorized as informational or action items, including certification/lab testing, reports/calculations/plans, manufacturer data and instructions, shop drawings, samples, and design/operations and maintenance data. Editable versions of all forms will be provided to the successful contractor, and specific items such as gas piping, furnaces/air handling units, and various HVAC components require shop drawings and manufacturer data submissions.
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Rawlins Field Office HVAC Improvements High Desert District Rawlins, WY
BLM FORMS
ATTACHMENT F
PART 1 GENERAL
1 .1 DESCRIPTION
A. This Section includes forms and document templates to be used by the Contractor for execution of the work.
Editable (Word or Excel) versions of these forms will be made available to the successful Contractor.
B. List of Forms:
1. Transmittal Form (CM-16) [Excel].
2. Transmittal Form Continuation Sheet [Excel].
3. BLM - Contractor Accident/property Damage Report (CM-22) [Word].
4. Contractor's Quality Control Daily Report [Word].
5. Daily Test Report Information Sheet [Word].
6. Submittal List [Excel].
Rawlins, WY
Rawlins, WY
Rawlins, WY
BLM - CONTRACTOR ACCIDENT/PROPERTY
DAMAGE REPORT
Record:
Date:
Name: Trade:
Birth date:
Date of Accident: Time of Accident:
Contractor:
Project: Location:
Description of Accident: (BE SPECIFIC. DESCRIBE WHAT HAPPENED, WHERE.):
What was employee doing when injured?
Specific body parts injured?
Type of injury (i.e. Puncture, sprain, fracture, illness, etc)
First Aid? Yes No Medical Clinic? Yes No Hospitalized? Yes No
Is time loss expected? Yes No How long?
Environmental Factors:
Property Damage Involved? Yes No Describe:
Estimated dollar amount of Damages:
Corrective Action Taken:
Contractor Reporting: Date:
Project Inspector Reporting: Date:
ATTACH COPIES OF ANY ADDITIONAL INFORMATION (& photos)
COMMENTS
May 12, 2004 / Form No. CM-22
Rawlins, WY
CONTRACTOR'S QUALITY CONTROL DAILY REPORT
REPORT NO. _________ SHEET 1 OF _________
PROJECT
CONTRACT NO.
DATE
SITE
CONTRACTOR'S REPRESENTATIVE ON THE JOB
WEATHER (Rain, Snow, Cloudy, Windy, etc.)
RAINFALL
Inches
TEMPERATURE GROUND CONDITIONS (Dry, Damp, Wet, Frozen, etc.)
MAX.
MIN.
1. PRIME CONTRACTOR
NO. EMPLOYEES BY JOB CATEGORIES Hours HEAVY EQUIPMENT ON
JOB
NO.
UNITS
HRS. WORKING
YES NO Comments
WORK PERFORMED BY PRIME CONTRACTOR:
MATERIALS DELIVERED OFFICIAL VISITORS TO SITE
2A. SUBCONTRACTOR, _______________________________________ (If more than one subcontractor use copies of following page.)
JOB
NO.
UNITS
WORK PERFORMED BY SUBCONTRACTOR:
3. SPECIFIC INSPECTIONS: (Inspections performed, results, and corrective actions)
4. TESTING: Check if any testing was performed today. (Complete and attach Test Report Information Sheets.)
Type and Location of Testing: ____________________________________________________________________________________
5. VERBAL INSTRUCTION RECEIVED FROM GOVERNMENT; CONSTRUCTION DEFICIENCIES OR RE-TESTING REQUIRED:
6. REMARKS:
7. CERTIFICATION:
I certify that the above report is complete and correct and that I, or my authorized representative, have inspected all work performed this day by the prime contractor and each subcontractor and determined that all materials, equipment, and workmanship are in strict compliance with the plans and specifications except as may be noted above. ____________________________________________________________ Contractor's Quality Control Representative
Rawlins, WY
SUBCONTRACTOR WORK CONTINUED:
CONTRACT NO. REPORT NO. _______
SHEET ____ OF ____
2B. SUBCONTRACTOR,
NO. EMPLOYEES BY JOB CATEGORIES Hours HEAVY EQUIPMENT ON
JOB
NO.
UNITS
2C. SUBCONTRACTOR,
JOB
NO.
UNITS
2D. SUBCONTRACTOR,
JOB
NO.
UNITS
2E. SUBCONTRACTOR,
JOB
NO.
UNITS
YES NO COMMENTS
Rawlins, WY
DAILY TEST REPORT INFORMATION SHEET
CONTRACT NO._________________________ REPORT NO. _____________ SHEET _____ OF _________
1. Individual Making Inspection or Test:
2. Testing Laboratory; Name: Phone #:
Address:
3. Description of Work and Test Method:
4. Location of Samples and Tests or Inspections:
5. Specification Section:
6. Inspection or Test Data:
7. Test Results and Interpretations of Test Results:
8. Comments or Professional Opinion About Compliance of Inspected Work or Tested Work with contract Document Requirements:
9. Recommendations:
10. Corrective Actions Taken:
CERTIFICATION:
I certify that the above testing report is complete and correct and that all testing performed this day for this contract is in strict compliance with the plans and specifications except as noted above.
Signature of Inspector
Rawlins, WY
SUBMITTAL LIST
Project Title SUBMITTAL REQUIREMENTS (indicate with an "X")
Spec.
Sec.
Par.
No. Description
INFORMATIONAL ACTION
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A10 1.6B Foundation Plan A10 1.6B Reinforcing Steel Shop Drawings
A10 1.6C Perimeter drainage system and soil gas venting system components
A10 1.6C Concrete sealer/hardener A10 1.6C Insulation and insulation appurtenances A10 1.6C Vapor barrier A10 1.6D Concrete mix design including all additives A10 1.6E Soil compaction results A10 1.6E Aggregate gradation A10 1.6E Concrete cylinder test results B10 1.6.2 Pre-engineered wood trusses B10 1.6.2 SIPs layout and connection details B10 1.6.2 Engineered lumber B10 1.6.2 Metal framing connectors X B10 1.6.2 Spray foam insulation X B10 1.6.2 Structural insulated panels X
B10 1.6.3a Qualification Data: For manufacturer/professional engineer X
B10 1.6.3a Structural Steel Framing X
B10 1.6.3b Qualification Data: For manufacturer/professional engineer X
B10 1.6.3b Welding certificates X B10 1.6.3b Manufacturer certificates X
Rawlins, WY
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B10 1.6.3b Mill Certificates: For each type of bolt
B10 1.6.3b
Comprehensive engineering analysis of special joists signed and sealed by the qualified professional engineer responsible for its preparation
X
B10 1.6.3b Field quality-control reports X B10 1.6.3b Open Web Steel Joists B10 1.6.3c Welding certificates X
B10 1.6.3c Product Certificates: For each type of steel deck X
B10 1.6.3c
Product Test Reports: For tests performed by a qualified testing agency, indicating that each of the following complies with requirements
X
B10 1.6.3c Evaluation Reports: For steel deck, from
ICC-ES X
B10 1.6.3c Field quality-control reports X B10 1.6.3c Structural Metal Decking X B20 1.6A Cold Formed Metal Framing B20 1.6B Air/water barrier (housewrap) B20 1.6B Continuous insulation (sheathing insulation) B20 1.6B Wall cavity insulation B20 1.6B Siding and trim B20 1.6B Exterior windows B20 1.6B Exterior paint B20 1.6B Exterior siding B20 1.6B Lock box
Rawlins, WY
Par.
No. Description
INFORMATIONAL ACTION
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B20 1.6C Exterior windows B20 1.6D Paint color samples B20 1.6D Wall color samples B20 1.6D Window color samples
B20 1.6E Framing lumber and sheathing, including species, grade, and treatment
B20 1.6E Metal Siding (see spec) B30 1.6A Underlayment B30 1.6A Asphalt shingles B30 1.6A Metal roofing (see spec) B30 1.6A Roofing. for each color, gloss specified X B30 1.6A Paint color samples X
C10 1.6B Countertops, cabinets, wardrobes, and lockers
C10 1.6B Identifying devices/signage C10 1.6C Bathroom accessories C10 1.6C Window blinds C10 1.6C Lockers C10 1.6C Bulletin/Display boards C10 1.6E Interior door finish samples C10 1.6E Paint color samples X C10 1.6E Horizontal blind color samples C10 1.6E Laminate color samples C10 1.6E Locker color samples
Rawlins, WY
Par.
No. Description
INFORMATIONAL ACTION
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C10 1.6E
Signage: Submit three samples illustrating full size sample sign, of type, style and color specified including method of attachment
C20 1.6B Interior Metal Stairs
C20 1.6C
Delegated-Design Submittal: For stairs and railings, including analysis data signed and sealed by the qualified professional engineer responsible for their preparation
C20 1.6D Stair Treads C30 1.6A Interior paint C30 1.6A Wall base
C30 1.6A Flooring (tile, carpet, sheet vinyl, and densified polished concrete)
C30 1.6A Acoustical ceiling tile system C30 1.6B Paint color samples C30 1.6B Wall base samples
C30 1.6B Carpet, VCT, sheet vinyl, and densified polished concrete samples
C30 1.6B
Ceramic Tile: Full-size units of each type and composition of tile and for each color and finish required
C30 1.6B Athletic Flooring: Submit samples of each type-center, border and corner
C30 1.6B Acoustical ceiling grid and tile sample C40 1.9B Door Hardware, with schedule (see spec) C40 1.9C Doors C40 1.9C Hardware C40 1.9C Overhead sectional doors
Rawlins, WY
Par.
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C40 1.9D Paint color samples
D20 1.6B
Plumbing fixtures, including fitting and trim packages associated with each plumbing fixture
D20 1.6B Pipe and fittings D20 1.6B Valves D20 1.6B Backflow preventers D20 1.6B Pressure reducing valves (if used) D20 1.6B Wall hydrants D20 1.6B Domestic water heaters D20 1.6B Floor drains and floor sinks D20 1.6B Cleanouts D20 1.6B Air compressors D20 1.6B Air pressure regulators D20 1.6C Domestic water heaters D20 1.6C Backflow preventers D20 1.6C Pressure reducing valves (if used) D20 1.6C Wall hydrants D20 1.6C Air compressors D20 1.6C Air pressure regulators D30 1.6B Gas piping X D30 1.6B Gas pressure regulators X D30 1.6B Furnaces / Air Handling Units X X
Rawlins, WY
Par.
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D30 1.6B Cased evaporator coils X D30 1.6B Condensing units X D30 1.6B Exhaust fans X D30 1.6B Air inlets and outlets X D30 1.6B Thermostats X D30 1.6B Radiant tube heaters D30 1.6B Evaporative coolers D30 1.6B ERVs D30 1.6B Diesel exhaust filtration systems D30 1.6B HVLS fans D30 1.6B VRF Equipment D30 1.6C Certified TAB report X D30 1.6C Certified Cx report X D30 1.6D Gas pressure regulators X D30 1.6D Furnaces X D30 1.6D Condensing units X D30 1.6D Exhaust fans X D30 1.6D Thermostats X D30 1.6D Radiant tube heaters D30 1.6D Evaporative coolers D30 1.6D ERVs D30 1.6D Diesel exhaust filtration systems
Rawlins, WY
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D30 1.6D HVLS fans D30 1.6D VRF Equipment D40 1.6B Pipe and fittings D40 1.6B Valves D40 1.6B Backflow preventers D40 1.6B Riser assemblies D40 1.6B Sprinklers D40 1.6B Fire department connections D40 1.6B Fire extinguishers and cabinets
D40 1.6C
Sprinkler system shop drawings showing pipe routing and coordination of all building components
D40 1.6D Backflow preventers D40 1.6D Riser assemblies D50 1.6B Wire and cable X D50 1.6B Wiring devices X D50 1.6B Outlet and junction boxes X D50 1.6B Conduit and raceway X D50 1.6B Panelboards X D50 1.6B Lighting fixtures D50 1.6B Fire alarm system D50 1.6B Transient voltage surge suppressor D50 1.6B Lightning protection system
Rawlins, WY
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D50 1.6B Security system D50 1.6C Ground resistance test D50 1.6D Fire alarm system D50 1.6D Security system
E10
1.3, 1.4, 1.5
Product Data: For each type of product (see specs for full list of products and required submittals)
G10 1.6A Erosion Control Plan G10 1.6A Blasting Plan G10 1.6A Silt fence G10 1.6A Erosion control blanket
G10 1.6A Gradation and Atterberg limits for imported borrow material
G10 1.6A Soil compaction results G20 1.6B Wheel stops G20 1.6B Retaining wall block G20 1.6B Fencing, gates, and sliding gate operator G20 1.6B Flagpole G20 1.6B Bike rack
G20 1.6B Signage: Show fabrication and installation details for signs
G20 1.6C Mix designs for asphalt concrete and Portland cement concrete
G20 1.6D Gradation and Atterberg limits for base and subbase materials
G20 1.6D Compaction results
Rawlins, WY
Par.
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INFORMATIONAL ACTION
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G30 1.6B Pipe and pipe fittings for water, sewer, storm drainage, and fuel gas
G30 1.6B Valves and valve boxes
G30 1.6B
Lift station sump, sewage pump, and controls if a lift station is required for the project
G30 1.6B Storm drainage drop inlets and grates
G30 1.6C Results of water flow and pressure (static and residual) tests
G30 1.6C Piping pressure test and bacteriological test results
G30 1.6C Soil compaction results
G30 1.6D Sewage pump and controls if a lift station is required for the project
G40 1.6B Wire and cable G40 1.6B Conduit G40 1.6B Pull boxes and handholes G40 1.6B Site lighting fixtures
G40 1.6B Photovoltaic system components [If applicable]
G40 1.6C Soil compaction results G40 1.6D Photovoltaic system [If applicable].
END OF SUBMITTAL LIST
| 1 Part 1 general |
| 1 .1 DESCRIPTION |
| A. This Section includes forms and document templates to be used by the Contractor for execution of the work. Editable (Word or Excel) versions of these forms will be made available to the successful Contractor. |
| B. List of Forms: |
| 1. Transmittal Form (CM-16) [Excel]. |
| 2. Transmittal Form Continuation Sheet [Excel]. |
| 3. BLM - Contractor Accident/property Damage Report (CM-22) [Word]. |
| 4. Contractor's Quality Control Daily Report [Word]. |
| 5. Daily Test Report Information Sheet [Word]. |
| 6. Submittal List [Excel]. |
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