Attachment 1 - Enclosures to Statement of Work (SOW).pdf

Enclosure (1)

APPENDIX P – CONTRACTOR CRANE (OR ALTERNATE MACHINE USED TO LIFT

SUSPENDED LOAD) AND RIGGING GEAR REQUIREMENTS

CERTIFICATE OF COMPLIANCE

This certificate shall be signed by an official of the company that provides cranes (or multi-purpose machines, MHE, or construction equipment used to lift loads suspended by rigging gear) or rigging gear for any application under this contract. Post a completed certificate on each crane or alternate machine (or in the contractor’s on-site office for rigging operations) brought onto Navy property.

CONTRACTING OFFICER’S POINT OF CONTACT

(Government Representative)

PHONE

PRIME CONTRACTOR/PHONE CONTRACT NUMBER

CRANE OR ALTERNATE MACHINE SUPPLIER/PHONE

(if different from prime contractor)

CRANE OR

ALTERNATE MACHINE

NUMBER (i.e., ID number)

CRANE OR ALTERNATE MACHINE MANUFACTURER/TYPE/CAPACITY

CRANE OR ALTERNATE MACHINE OPERATOR'S NAME(S)

I certify that

1. The above noted crane or alternate machine and all rigging gear conform to applicable OSHA regulations (host nation regulations for naval activities in foreign countries) and applicable ASME B30 or other standards. The following OSHA regulations and ASME or other standards apply:

2. The operators noted above have been trained and are qualified for the operation of the above noted crane(s) or alternate machine(s).

3. All safety devices and operator aids are enabled and functioning properly and the operators noted above have been trained not to bypass safety devices and operator aids during lifting operations.

4. The operators, riggers and company officials are aware of the actions required in the event of an accident as specified in the contract.

5. Signal persons used in construction work are qualified in accordance with 29 CFR 1926.1428.

6. Riggers are qualified in accordance with NAVFAC P-307, paragraph 11.1.k.

7. All personnel working on the job site have been trained to not stand under a load or in the fall zone of a suspended load unless specifically allowed by USACE EM 385-1-1.

COMPANY OFFICIAL SIGNATURE DATE

COMPANY OFFICIAL NAME/TITLE

POST ON CRANE (OR ALTERNATE MACHINE)

(IN CAB OR VEHICLE)

(or in the contractor’s on-site office for rigging operations)

FIGURE P-1

1 Enclosure (2)

CONTRACTOR CRANE/WHE ENTRY PACKAGE CHECKLIST

1 Company / Equipment Information

Company Name

Equipment Manufacturer / Equipment Model / Equipment Number

2 Date of Annual Inspection Expiration Contract Number

3 Date of Quadrennial Inspection Expiration

4 Name & phone number of Contracting Official (or designated local representative)

Contracting Official

Phone Number

5 Does the package include a routine or critical lift plan? Yes No

6 Has the contract been verified to contain all the requirements of NAVFAC P-307 Paragraphs 11.1 a-n as applicable? Yes No

7 Location of lift site

Duration equipment will be continuously on the job site (Hours, days, weeks…)

Does plan include certification from contractor that the equipment complies with ASME standard [B30.5 (mobile cranes), B30.8 (floating cranes), B30.22 (articulating boom cranes),or B30.3 (construction tower cranes)] as applicable?

Yes No

10 Does plan include a certificate of compliance per COMNAVREGMIDLANTINST 11262.1A (Enclosure 1)? Yes No

Which OSHA regulation does the certificate of compliance indicate? (for cranes used in cargo transfer, 29 CFR 1917 applies; for cranes used in construction, demolition, or maintenance, 29 CFR 1926 applies; for cranes used in shipbuilding, ship repair, or ship breaking 29 CFR 1915 applies)

Does plan include valid medical certificate and proof of operator qualification from a source that qualifies crane/equipment operators? (union, government agency, or an organization that tests and qualifies crane/equipment operators) Verify each back-up operator (if provided) on the certificate of compliance.

Yes No N/A

13 Does the plan designate a qualified Rigger-In-Charge? Yes No

14 What is the weight of the heaviest load to be lifted? lbs.

15 What is the weight of the rigging gear? lbs.

16 What are the crane components (and their weights) that add to the weight of the load? (hook, jib, etc)

Main Block lbs.

Aux. Block lbs.

Jib (Stowed) lbs.

Jib (Erected) lbs.

Other lbs.

17 What is the maximum total crane lift (sum of 14, 15, & 16 above)? Total lbs.

18 What is the capacity of the equipment as configured? lbs.

19 What percentage of the equipment capacity does this lift represent? %

20 What is the main boom length? If a jib will be utilized, indicate the length and offset.

Main Jib Offset

21 What are the minimum and maximum load radii? Min. Max.

22 Does the plan include the manufacturer’s load chart for entire range of lift(s)? Yes No

23 Does the plan include ground loading outrigger reaction data to determine cribbing requirements, or a Waterfront Operational Permit? Yes No N/A

2 Enclosure (2)

CONTRACTOR CRANE/WHE ENTRY PACKAGE CHECKLIST (CONT)

24 For crawler cranes, does the plan indicate area restrictions for operation? Yes No N/A

25 For floating cranes, does plan include maximum allowable list? Yes No N/A

For mobile crane mounted on a barge, is crane equipped with load indicating device? Wind indicating device? Marine type list and trim indicator? (readable in one-half degree increments)

Yes No N/A

27 For mobile crane mounted on a barge, does plan include revised load chart? Yes No N/A

28 Are mobile cranes on barges positively secured (OSHA 1926.550 (F0(1)(IV)) Yes No N/A

Has a critical lift plan been required for mobile cranes mounted on a barge for lifts over 50% of the capacity of barge mounted crane’s hoist at any radius of lift (NAVFAC P-307, 11.1 (G)).

Yes No N/A

30 What are the environmental conditions under which crane/WHE operations are to be stopped?

31 Will the crane perform critical lifts per COMNAVREGMIDLANTINST 11262.1A? (if no, skip items 31-

52) Yes No

What circumstances require this lift to be classified as a critical lift? (Blind lift, 75% of load chart non-routine rigging, etc.)

33 What are the exact dimensions of the load? (L x W x H)

34 Does the plan indicate the crane position? (overhead view) Yes No

35 What is the maximum lift height of the lift?

36 What is the minimum boom angle?

37 What is the maximum boom angle?

38 What is the name of the operator?

39 Indicate name(s) of back-up operator (if required)

40 Does this plan show lift points? Yes No

41 Does the plan describe the rigging procedure? Yes No

42 Does the plan indicate rigging hardware requirements? Yes No

43 For personnel lifts, does the plan demonstrate compliance with 29 CFR 1926.1431? Yes No N/A

44 Does EM 385-1-1 govern this lift? Yes No N/A

45 What are the coordination and communication requirements for the lift? (e.g. radio and hand signals)

46 For tandem or tailing crane lifts, does the plan indicate the make and model of the crane, the line, boom and swing speeds, and the requirement for an equalizer beam? Yes No N/A

47 For floating cranes, refer to questions 20-22?

48 What is the name of the lift supervisor?

49 Does the plan indicate the qualifications of the lift supervisor? Ye No

50 What are the names of the riggers?

51 Does the plan indicate the qualifications of the riggers? Yes No

52 Did the involved personnel (Operator, riggers, lift supervisor, etc.) sign the lift plan? Yes No Signatures below verifies crane package complies with CNRMA INST 11262.1A and NAVFAC P-307

Name Organization Signature Date Phone Contracting Official:

Reviewed By:

Reviewed By:

APPLICATION FOR PRSONNEL TO WORK UNDER DEPARTMENT OF DEFENSE CONTRACT ON JOINT BASE CHARLESTON (JBC)

JBC Contract Security FORM 74, 20100511 Page 1, Enclosure (3) This form is subject to the Privacy Act of 1974, 5 U.S.C. 552A

Complete Name As it appears on identification

(Last, First Middle)

Complete Address (Street, Apt Number, City, State, Zip)

SSAN DOB

(MM/DD/YY)

Driver’s License or ID Card Number and State of issue

NCIC SFMIS Date Pass Issued

Issuer Initials

Section 1:

1. Company or Vendor Name: ____________________________ 2. Prime/Sub Contractor or Vendor 3. Job Site Phone #: ________________ Personal Phone# ________________

4. Company Phone #: _________________________________________________ 5. Days & Times Access is required: __________________________________

6. Company Address: ___________________________________________________________________________________________________

7. Prime contractor’s Name (if applicable) _________________________________ 8. Contract for/service provided: ____________________________________________

9. Location of Work: _________________________________________________ 10. Prime Contract#: _________________________________________________________ (Area 1 (Hunley Park, Area 2 (Main Base Housing), Area 3 (Main Base, Area 4 (Flightline IMC)

11. Start Date: __________ 12. End Date: ___________ 13. Base Sponsoring Unit: __________________ 14. Base Sponsor Info: ________________________________________

Section 2:

(If you are a Foreign Born Naturalized U.S. citizen please provide INS Form I-9 and Certificate of Naturalization)

15. Are you a U.S. citizen? � Yes � No 16. If no, please provide INS Form I-9 or subsequent information

17. Are you a Job Site Verifying Official for this Project? � Yes � No 18. Will you require access to the Flightline controlled Area? � Yes � No

19. Have you ever been convicted of a felony? � Yes � No 20. Do you possess a Military I.D.? � Yes � No

21. Please list any visible identifying marks (i.e. birthmarks, tattoos, scars, etc.) ___________________________________________________________________________________

The above information is true and correct to the best of my knowledge. The Contractor/Vendor or Designated Supervisor will sign/date below. The Contractor/Vendor Sponsor (Base Contracting Representative or Unit Representative) must also sign. Must include phone number to verify employment and sponsorship.

Section 3

22. Applicant’s signature/Date: _____________________________________________ 23. Employment Supervisor/Superintendant:

Must be original pen & ink signature, no copies or faxes accepted Signature/Date: __________________________________________ Upon signing, I certify that I have read and understand item #19 on reverse side of form Printed Name: ___________________________________________ (attach legible copy of drivers license or state ID card with clear photo) Phone No: _____________________ � I have verified last five years of employment

24. Base sponsor (see reverse): 25. SFS/S5X Official:

Signature/Date: ______________________________ Signature/Date:__________________________________________ Printed Name: _______________________________ Printed Name: __________________________________________ Phone No: __________________ Note: The purpose of this form is to control access to the base. It is important that Security Forces knows where everyone working so pass/badge can be issued correctly.

NOTE: AFTER BASE SPONSOR SIGNS, ORIGINAL MUST BE HAND CARRIED TO THE SECURITY FORCES PASS & REGISTRATION SECTION BLDG 1953 (VCC) at JBCA and BLDG. 302 (VCC) For JBCW. THE ORIGINAL IS KEPT AT THE 628th SECURITY FORCES CONTRACT SECURITY SECTION (628 SFS/S5X). INSTRUCTIONS FOR COMPLETING THIS FORM ARE ON THE

REVERSE SIDE.

(on base #)

(MM/DD/YY) (MM/DD/YYY) (Rank/Name/Phone)

JBC Contract Security FORM 74, 20100511 Page 2, Enclosure (3) This form is subject to the Privacy Act of 1974, 5 U.S.C. 552A

Instructions/Guidelines for the SFS Form 74:

Section 1: (Fill in all information)

1. “COMPANY/VENDOR NAME” If the company is a (sub) also include the primary company’s name. (i.e. If the Sub is Coke, then the Primary is DECA)

9. “LOCATION OF WORK: Area 1 (Hunley Park), Area 2 (JBCA Main Base Housing), Area 3 (JBCW Main Base), Area 4 (Flightline Controlled Area, IMC). Area 5 (JBCW Eastside Ordnance) Area 6 (JBCW Northside ordnance) Area 7 ( JBCW Wharf Alpha) Area 8 (JBCW Pier Bravo) Area 9 (JBCW Pier Charlie) Area 10 (JBCW TC dock AREA 11 (JBCW NORTHYARD MRAP) Areas 1, 2, 3, 5, 6, 7, 8, 9, 10, 11 are Green Badge. Area 4 is Red Badge.

14 . “BASE SPONSOR CONTACT INFO” This is the person that signs the form at the bottom as the base sponsor (#14 & #24 are the same).

Section 2: (Fill in all information) All the information is important and must be correct.

17. “JOB SITE VERIFYING OFFICIAL” is person to be contacted to verify anyone attempting to gain access for support of contract/job site (i.e. material or equipment deliveries). Supervisor Badge.

18. “INDUSTRIAL MAINTENANCE COMPLEX/ FLIGHTLINE CONTROLLED AREA” is the area that requires you to enter through the access gates and doorways along the flightline. The controlled area consists of the flightline, buildings, and activities that support, maintain and secure the aircraft. Access is controlled through buildings along the perimeter and the vehicle and pedestrian gates. If working within this area mark “YES” for issuance of a badge that allows you access to this area.

19. When answering the FELONY question, be honest! If the NCIC investigation produces a positive finding and you answered “NO”, your integrity will be questioned which will/can lead to denial of installation access.

• Any individual convicted of a felony to include but not limited to: murder, assault with intent to commit murder, rape, extortion, robbery, armed robbery, or any drug offense may be denied access to the installation.

• In addition, any individual currently on parole, probation or on the Sex Offender Registry will be denied access to the installation.

Section 3: (Fill in all information)

23. “EMPLOYMENT SUPERVISOR:”Your job site/contractor supervisor/superintendent for whom you work for

24. “BASE SPONSOR” A DoD or military approving agency, to include Units, that can verify a need for installation access for the purpose of a job/contract (i.e. Contracting Office, DECA,CE, Army Corps of Engineers, etc).

HOW LONG DOES IT TAKE

You do not get the form back once it has been turned into the SFS VCC. The form normally takes 72-hours to process; longer if discrepancies are found. We appreciate your patience as we work to secure Charleston AFB.

CONTRACTOR PASS PROCEDURES

(a) Once the contracting company hires the individual, the individual will be required to fill out all information on the front of this form, so he or she can obtain a pass. It is the responsibility of the company requesting the contractor pass to verify the validity of the employee’s driver license and legal status prior to the request being submitted. Any individual operating a vehicle on the installation must insure that it meets the minimum insurance requirements for the installation and the state of South Carolina. The issuance of a pass is a privilege, which can be withdrawn, and the individual can be barred from base for noncompliance with Charleston AFB policies and or USAF directives. This pass must be in the possession of the contractor at all times while on the installation. Contractor pass must be visible on the employee at all times and the vehicle pass must be visible inside the POV at all times.

(b) When reporting to the registration office to obtain an identification badge, each employee will present a valid driver’s license or other picture identification and an original Social Security Card. In order to obtain a vehicle pass, the employee should also provide current vehicle registration and valid vehicle insurance certificate along with the valid driver’s license.

(c) The pass does not allow family members or friends to be sponsored on the installation at any time. In cases when family or friends must drive the contractor to the base, the drop off point is at the base entry gates. Employees are responsible for their own transportation to the job site.

(d) If the contractor terminates an employee, the contractor will confiscate the employee pass and the vehicle pass to be returned to Security Forces in Bldg. 1953 (VCC).

(e) Placing Job ads in the newspapers such as “Respond to the base for information, interviews, or employment,” is strictly prohibited. Companies are required to conduct their interviews and employee hiring off base.

(f) Upon completion or termination of the contract or expiration of the identification passes, the prime contractor shall ensure that all base identification passes issued to employees and subcontractor employees are returned to the issuing office, Security Forces in Bldg. 1953, Visitors Control Center (VCC)

(g) Failure to comply with these requirements may result in withholding of final payment.

JBC Contract Security FORM 74, 20100511

Page 2, Enclosure (3)

This form is subject to the Privacy Act of 1974, 5 U.S.C. 552A

NAVAL NUCLEAR POWER

TRAINING UNIT (NPTU)

VISIT REQUEST

CHECK ONE

REPLY REQUIRED

REPLY ONLY IF NEGATIVE

DATE OF REQUEST

FROM: (COMPLETE ADDRESS AND PHONE NUMBER)

TO: NAVAL NUCLEAR POWER TRAINING UNIT

ATTN: COMMAND SECURITY MANAGER

1260 SNOW POINT ROAD

GOOSE CREEK, SC 29445

FAX: 843-863-5994 PHONE: 843-794-4386

NPTU POC INFORMATION

(Name, Title, Dept., Phone #)

PURPOSE OF VISIT

DEGREE OF ACCESS REQUIRED

ESCORTED

UNESCORTED

ARRIVAL DATE

DEPARTURE DATE

DO THEY HAVE BASE ACCESS

YES

NO (If no, you must submit a Base Access request worksheet) SPECIFIC VISIT/WORK AREA LOCATION SPECIFIC ROUTE TO BE TAKEN TO WORK/VISIT AREA (Use back of form if needed)

NAME, RANK, TITLE

AND/OR POSITION

SOCIAL

SECURITY

NUMBER

DATE

OF BIRTH

PLACE OF

BIRTH

NATIONALITY

(CHECK ONE)

*If duel citizen, annotate which countries*

LEVEL/DATE OF

CLEARANCE/

INVESTIGATION

US CITIZEN ONLY

*DUEL CITIZEN

IMMIGRANT ALIEN

US CITIZEN ONLY

US CITIZEN ONLY

(COMPLETED ON DAY OF VISIT)

AUTHORIZED DERIVATIVE CLASSIFIER (ADC) WORK

SITE SANITIZED CERTIFICATION

MUST BE COMPLETED FOR ESCORTED UNLEARED VISOTORS(S) TO

MODIFIED LEVEL ONE AREAS(S)

ADC PRINTED NAME, RANK AND SITE PHONE #

ADC SIGNATURE AND DATE

PRINTED NAME, RANK, TITLE OF NPTU STAFF MEMBER

SPONSORING VISIT (MUST BE NPTU STAFF MEMBER (MIL or NNL)

SPONSOR SIGNATURE AND DATE

**SECURITY MANAGERS USE ONLY BELOW THIS BOX**

ACCESS REQUEST

APPROVED

DISAPPROVED

BLUE

GREEN

ORANGE

PINK “V”

WHITE “E”

RED “E”

(NR APPROVED)

JBC Contract Security FORM 74, 20100511

Page 2, Enclosure (3)

This form is subject to the Privacy Act of 1974, 5 U.S.C. 552A

ACCESS EXPIRES AT 2400 ON

NAME, RANK, TITLE OF

OFFICIAL AUTHORIZING

SIGNATURE / DATE APPROVED

NPTU FORM 5521 (Feb 17)

HOW LONG DOES IT TAKE