Attachment 1 Performance Work Statement_v2.pdf

WESTERN AREA POWER ADMINISTRATION

DESERT SOUTHWEST REGION

PERFORMANCE WORK STATEMENT

LANDSCAPING AND GROUNDS MAINTENANCE SERVICES

AT YUMA SERVICE CENTER

Attachment 1

U.S. DEPARTMENT OF ENERGY

WESTERN AREA POWER ADMINISTRATION

PERFORMANCE WORK STATEMENT

LANDSCAPING AND GROUNDS MAINTENANCE SERVICES

AT YUMA SERVICE CENTER

1. GENERAL

1.1. Introduction

The Western Area Power Administration (WAPA), Desert Southwest Region (DSW), requires the services of a qualified contractor to perform all aspects of landscaping services as set forth in this contract. This Performance Work Statement (PWS) describes the landscaping services and contractor furnished materials required by DSW for its Yuma Service Center located in Yuma, AZ. WAPA, DSW and the Government are used interchangeably in this document, and all have the same meaning.

1.2. Background

WAPA is a federal power marketing administration that markets and delivers reliable, cost-based hydroelectric power and related services to wholesale customers in 17 states. DSW is one of four regions of the Western Area Power Administration. Desert Southwest customer service region markets federal hydroelectric power to nearly 70 municipalities, cooperatives, federal and state agencies, and irrigation districts.

Most power sold by the Desert Southwest Region is generated from power plants operated at Hoover, Parker, and Davis dams. Power is also marketed from hydroelectric projects in the Bureau's Upper Colorado Region and the federal portion of power generated at Navajo Generating Station near Page, Arizona.

The Desert Southwest Region also operates and maintains more than 40 substations and 3,100 miles (4,950 kilometers) of transmission lines to keep the system running reliably. Our partnerships with our customers allow us to help them quickly restore service to local residents after storms or other major system disturbances.

1.3. Location

The location of the area needing landscaping services is at the Yuma Service Center in Yuma, AZ. Address is 7488 E. US Highway 95, Yuma, AZ 85365.

1.4. Government Personnel

1.4.1. The Contracting Officer (CO) is the individual executing this contract on behalf of the Government and is responsible for the overall administration of the contract. He/she is the only person authorized to make any changes in the prices, terms or other conditions of the contract.

1.4.2. The Contracting Officer’s Representative (COR) is responsible for giving the Contractor any special technical instructions or guidance necessary to ensure contract execution. The COR has no authority to alter the terms of conditions of the contract.

1.5. Contractor Personnel

1.5.1. The contractor shall furnish adequate supervision at the premises to ensure that work is performed in a satisfactory manner. It is the responsibility of the contractor to maintain close surveillance over personnel employed to perform work on the contract.

1.5.2. The contractor shall have a competent on-site representative authorized to act on behalf of the contractor, available to the CO or COR to receive instructions or information regarding work under the contract. The on-site representative must be able to fluently speak and understand English.

1.5.3. No unauthorized personnel are permitted on the premises.

1.6. Hours of Work

DSW Yuma Service Center, Yuma, Arizona, regular business hours are from 7:30 a.m. to 4:30 p.m. daily, Monday through Friday, except for Federal holidays. Normal work hours for DSW’s Maintenance personnel are from 6:00 a.m. to 4:30 p.m. daily, Monday through Thursday. Differing from this schedule may be authorized on a case-by-case basis with the COR’s and CO’s prior approval.

1.7. Submittals.

1.7.1. Safety Plan. A Safety Plan is required to be submitted to the CO and COR no later than 10 calendar days after contract award. WAPA’s approval of the plan is required prior to the commencement of work.

1.7.2. List of Employees. Contractor shall furnish names of all personnel performing work on this contract no later than 10 calendar days after contract award. List of employees shall be submitted to the CO and COR no later than 10 calendar days after contract award. No unidentified or unauthorized personnel shall be allowed or permitted on the work site.

1.7.3. Work Schedule. Contractor shall submit a proposed work schedule to the CO and COR no later than 10 calendar days after contract award. WAPA’s approval of the work schedule is required prior to the commencement of work.

1.8. Pre- Performance Meeting

The CO will schedule a meeting with the contractor within 1 week following the contract award to discuss the requirements of the contract, to include safety department prior to start of work.

1.9. Quality Control and Quality Assurance

1.9.1. The Contractor is responsible for quality control and shall utilize its own internal quality control processes in the performance of this contract. The contractor shall develop and maintain a Quality Control Plan (QCP) to ensure all services are performed in accordance with the Government’s performance standards outlined in the Performance Requirements Summary (PRS) section of this

PWS.

1.9.2. Performance Standards. See Exhibit 1. The PRS is a listing of significant performance objectives with associated performance standards that will be monitored and inspected by Government personnel. Each performance objective represents a critical function as identified by the Government at the time of contract award. The performance standard represents the minimum acceptable level of Contractor performance. The performance objectives and standards represent only the critical components of this Contract, and do not excuse the Contractor from performance of other responsibilities identified in the PWS. All services described in this PWS are subject to inspection/surveillance by the Government.

1.9.3. Government Surveillance of Contractor Performance. In order to supplement the Contractor’s QCP, WAPA personnel will verify contractor compliance with essential performance requirements. The Government may use various methods to perform surveillance of Contractor performance, including customer input, random sampling, periodic inspection, contractor reporting, etc.

1.9.4. Contract Discrepancy Report (CDR). A CDR (PWS Exhibit 2) will be initiated by the CO or COR if, at any time during the performance, the results of WAPA’s surveillance show the number of observations of unacceptable performance during the period exceeds the threshold specified in the

PRS, and the CO/COR determines that the unacceptable performance was not caused by the Government. Instructions for completing the CDR are as follows:

1.9.4.1. The COR completes Blocks l through 6 and sends the form to the CO. Block 6 must include the PRS number corresponding to the discrepancy, the threshold of that PRS item, the number of discrepancies documented, and the PWS paragraph reference describing the Government’s expectations for that PRS item.

1.9.4.2. The CO evaluates the CDR, and if appropriate, signs it and sends it to the Contractor with a cover letter requesting a response within a specified number of days.

1.9.4.3. The Contractor must complete Blocks 7 through 10 and return the CDR to the CO within the specified time period on the cover letter.

1.9.4.4. Upon receipt of the Contractor’s response, the CO, in consultation with the COR, will evaluate the Contractor’s response and take appropriate action. The CO will document the evaluation in Block 11 and action taken in Block 12.

1.9.4.5. In most cases, the preferred action is re-performance by the Contractor at no additional cost to the Government. If deduction from payment is the appropriate action, the COR and CO will calculate the payment deduction based on the performance period in which the discrepancy occurred. The deduction is taken from the Contractor’s payment as close as possible to the month in which the discrepancy occurred, but not necessarily the same month. The Government should not withhold payment of an invoice while calculating the deduction.

1.9.4.6. The COR will complete Blocks 13a and 13b. The CO signs the CDR in Block 13c. These signatures indicate concurrence with the actions taken.

1.9.4.7. In the event the CO determines that issuance of a CDR is not appropriate; the CO shall document the contract file indicating why such action is not appropriate.

1.10. Compliance with Regulations

In performing the work required by this Contract, the Contractor shall comply with all applicable Federal, State and local laws and regulations.

1.11. Licenses and Permits

The Contractor shall obtain and maintain, at its sole expense, all necessary licenses and permits required to meet the requirements of the contract.

1.12. Materials, Equipment and Storage

1.12.1. The Contractor shall furnish all materials and supplies required for the performance of work under this contract.

1.12.2. The contractor shall determine and furnish all equipment required for the performance of the work under this contract. All equipment shall comply with applicable OSHA guidelines and shall be in good operating condition. The Contractor shall operate the equipment in accordance with the original manufacturer’s recommendation and applicable laws and regulations

1.12.3. The contractor shall provide off-site storage space for its materials and equipment. Materials and equipment shall not be stored on WAPA property.

1.13. Interference with Business

The Government may undertake or award other contracts for additional work, and the Contractor shall fully cooperate with such other contractors and Government employees and carefully schedule its own work to such additional work as may be directed by the COR. The Contractor shall not commit or permit any act that will interfere with the performance of work by any other contractor or by Government employees.

The services under this contract shall be performed in such a way that there will be no interruption to or interference with the normal operation of Government business on the premises. Persons employed by the contractor shall, while on the premises, comply with all applicable regulations.

1.14. Government Furnished Property, Equipment, Materials and Utilities

1.14.1. The Government will not furnish any property, equipment or materials for use under this contract.

1.14.2. The Government will provide electrical power at sites with existing power outlets for the operation of equipment as necessary to perform services. Contractor shall furnish and provide power for those sites without electrical power.

1.14.3. The Government will provide water at sites where it is available from an existing outdoor source.

Contractor shall furnish and provide water for those sites without existing water.

1.14.4. Sanitation facilities are available at some sites.

1.15. Security of Facilities

Security of Government facilities is a shared responsibility of all employees, both Federal and contractor.

1.15.1. Contractor personnel shall be alert to surroundings and notify the CO, COR, DSW Safety/Security Office, or on-duty contractor security staff after hours of suspicious activity, including unescorted persons who do not have a visitor’s badge, or known or suspected unauthorized removal of Government property from the facility.

1.15.2. Contractor personnel shall notify the CO, COR and DSW Safety/Security Office, or on-duty contractor security staff after hours, if they have any security issues or concerns.

1.15.3. Contractor personnel shall protect identification badges and card keys and notify the DSW Security Manager within 24 hours if card keys or badges are lost. Badges and card keys shall be returned to the DSW Security Manager when employment is terminated. (Reference clauses WES-H-1045 and

WES-H-1055.)

1.15.4. Contractor personnel shall not prop open doors, and when entering or leaving the complex shall ensure that doors and gates are secure. Contract staff shall notify the DSW Security Manager if they are unable to secure a door or gate.

1.15.5. Contractor personnel shall not allow any person to enter WAPA property without proper clearance from the DSW Security Office.

1.15.6. The Government may require immediate removal of the employee from the contract and the job site for conduct issues deemed by the Government to be serious (for example, violent behavior or comments, theft, misuse of Government equipment, unsafe work practices, fraudulent activity, etc.).

1.16. Safety

1.16.1. Minimal. Working with or around hazards such as: (1) Non-toxic chemicals; (2) Well-maintained hand tools; (3) Operating standard motor vehicles; (4) No crane or rigging required; or (5) Settings that are not exposed to energized electrical equipment. Examples of Minimal Hazards include using pickup trucks to landscape office building lawns and painting rooms of standard height with latex paint.

1.16.2. The Contractor shall comply with the latest effective standards promulgated by the Department of

Labor, Occupational Safety and Health Administration, Safety and Health Standards, 29 CFR 1910 and 29 CFR 1925, and shall comply with all applicable safety and health regulations and requirements, including DOE and WAPA requirements.

1.16.3. The Contractor shall take all reasonable precautions in the performance of the work under this contract to protect the safety and health of employees and members of the public and shall comply with all applicable safety and health regulations and requirements, including DOE and WAPA requirements.

1.16.4. The Contractor shall maintain an accurate record of and shall immediately report to the COR and the CO, all cases of death, occupational disease, or traumatic injury to employees or the public, and any property damage as a result of performance under this contract.

1.16.5. The Contractor shall ensure that its employees are provided with personal protective equipment

(PPE) as necessary in accordance with established regulations and procedures. This equipment includes, but is not limited to, occupational foot protection and eye and face protection as required by OSHA Standards, 29 CFR 1910 and as required by Western safety standards and directives.

1.16.6. The Contractor shall ensure that its employees have been appropriately instructed and trained in the proper use of any equipment, vehicles, and/or personal protective equipment needed for the performance of their duties. The Contractor shall ensure that its employees comply with all applicable Federal, State, and/or local safety rules and regulations in the performance of their duties.

1.16.7. The Contractor shall report all near misses to the CO, COR within 24 hours of the occurrence.

These near-miss reports, identifying the nature of the hazard and the corrective actions which have been implemented to prevent a reoccurrence in the future, may be generic, with no mention of individual employees involved in the incident. Near-miss reports are used as an information tool and are distributed regionally.

1.17. Environmental Requirements

1.17.1. Contactor shall follow the guidelines listed by the Yuma County Environmental Programs Division.

Refer to http://www.yumacountyaz.gov/government/development-services/divisions/environmental-programs/air-quality. Oil shall not be used as a dust suppressant. Dust suppressants shall be approved by the COR prior to use.

1.17.2. Contractor shall not store fuel, maintain vehicles, or maintain equipment within 200 feet of wetlands, washes, and/or waterways, including domestic water sources or storm water drainage.

1.17.3. Contractors shall cleanup oil, herbicide, fuel, and/or any other hazardous material spills in accordance with Arizona Department of Environmental Quality and the U.S. Environmental Protection Agency Standards.

1.17.4. Contractors shall not apply herbicides within 200 feet of washes, stormwater drainages, wetlands, tributaries, rivers, lakes, or ponds.

1.17.5. Contractors shall obtain and maintain all applicable and permits and/or licenses, including county or state permits and licenses.

1.17.6. Contractors shall implement the stipulations of all permits and licenses.

1.17.7. Contractors shall not use acrolein, magnesium phosphide, sodium nitrate, aluminum phosphide, or potassium nitrate herbicides/pesticides.

1.17.8. Contractors shall possess a valid, qualified, applicators license for Arizona.

1.17.9. Contractors shall only use herbicides approved by the Arizona Department of Environmental Quality and the U.S. Environmental Protection Agency.

http://www.yumacountyaz.gov/government/development-services/divisions/environmental-programs/air-quality http://www.yumacountyaz.gov/government/development-services/divisions/environmental-programs/air-quality

1.17.10. Contractors shall cover excavations greater than 1 foot deep at the end of each working day or escape ramps (1:1 slope) provided to prevent the entrapment of wildlife. Trenches and holes will be inspected for entrapped wildlife before being filled. Any entrapped animals will be allowed to escape voluntarily before construction activities resume, or they may be removed by qualified personnel with the appropriate handling permit(s), as required.

1.17.11. If project activities will occur between February 15 and July 31, Contractors shall inspect the work area for birds, active bird nests, wildlife, and burrows before the start of the workday.

1.17.12. If birds or eggs occur in nests between February 15 and July 31, Contractors shall avoid working within a 50-foot radius of the discovery, notify COR, and only resume work within that area after the COR provides written notice.

1.17.13. If wildlife occurs with the work area, the Contractor shall avoid working within a 50-foot radius of the discovery and wait for the wildlife to vacate the area. If wildlife does not vacate the area, the Contractor shall notify COR, and only resume work within that area after the COR provides written notice.

1.17.14. In the unlikely event wildlife are incidentally taken, the contractor will stop work (at their expense), immediately contact the COR, and proceed with work only after receiving written authorization by the COR.

1.17.15. If archaeological or paleontological materials are discovered, including human remains (bone), the Contractor shall avoid the discovery within a 50-foot radius, notify the COR, and resume work after receiving written notification from the COR.

1.18. PWS Exhibits

The exhibits listed below are attached to and incorporated into this PWS.

Exhibit 1: Performance Requirements Summary (PRS). The purpose of the PRS is to communicate the Government’s quality expectations and the process to evaluate the Contractor’s performance.

Exhibit 2: Contract Discrepancy Report (CDR)

2. Scope of Work

The Contractor shall provide all personnel, supervision, tools, materials and services necessary to ensure that grounds maintenance is performed at the Yuma Service Center, located at 7488 S. US Highway 95, Yuma, AZ 85365. The grounds will be maintained in a manner that will maintain healthy trees, shrubs, and plants and so that the facility presents a clean, neat, and professional appearance. The work includes all management, preventive maintenance, and Quality Control actions in addition to the specific tasks addressed in this section and listed in this scope of work. The Contractor must perform all work in a professional manner using appropriate equipment, methods, and quality materials. The Contractor is responsible for the cost and the replacement of all plant materials (trees, shrubs, etc.) which become damaged or die as a result of lack of maintenance, improper trimming or care provided by the Contractor. Replacements shall be "like-for-like" unless otherwise approved by the COR. The replacement shall occur within 15 days of notice of damage, unless an extension is approved by the COR.

The on-site supervisor shall be present during all operations. If changes to work schedules to ensure on-site supervision, they must be approved by the COR prior to being implemented. The on-site supervisor shall supervise all specialized plant care activities to include, but are not limited to, selecting and applying fertilizers, insect control, disease control, horticulture applications, and assessing irrigation conditions, problems and solutions.

2.1. Tree Maintenance Requirements

2.1.1. Tree trimming and Pruning. All trimming and pruning shall be accomplished in accordance with industry standards (ANSI Z133 and A300). Shrubs and small trees shall be trimmed and pruned to enhance the beauty and health of the plant. During pruning, deadwood 1/2 inch and greater shall be removed.

2.1.2. In addition to pruning, shaping, or trimming, the skirt of any tree adjacent to a road, driveway, or walkway shall be pruned as needed to ensure it is clear of the road, driveway, walkway, building, and/ or security camera view. Trees shall be pruned as necessary to ensure they do not touch or hang over buildings or encroach into the fences.

2.1.3. Small Trees, Shrubs, and Cacti. Removal of small trees less than 12 inches diameter small shrubs at breast height, and cacti shall be considered to be part of general grounds maintenance. Suckers on trees shall be removed as part of general maintenance. Bracing and tree supports shall be removed as soon as the plants become self-supporting. Tree stakes, tree ties, and guy wire shall be of materials to match those existing on the site and will be replaced or repaired by the Contractor to prevent damage to young trees.

2.1.4. Damaged Tree and Shrub Replacement. Damage to trees from trimming shall be repaired by the

Contractor. If a plant should die or require replacement due to damage, the Contractor shall be responsible for replacing the damaged plant with a plant of the same size and type at the Contractor’s expense.

2.2. Hedge, Shrubbery and Ground Cover Maintenance

2.2.1. Hedges and Shrubs. Hedges and shrubs shall be trimmed and shaped throughout the year to maintain a neat, professional, pleasing shape, and a healthy growth pattern. Hedges shall be trimmed as necessary and be maintained at less than 5 feet in height. Shrubs shall be trimmed and maintained to ensure they are clear of adjacent doors, below adjacent windows, and they do not touch buildings or fences.

2.2.2. Potted Plants. Provide fertilizer and maintain irrigation system in order to water potted plants.

Manually, not chemically, remove or eradicate weeds and debris from potted plants. Repair or replace damaged or dying plants as needed to maintain a healthy and pleasant appearance.

2.2.3. Ground Cover. Ground cover shall be pruned and shaped throughout the year to maintain a neat, attractive, and pleasing shape to promote a healthy growth pattern. Ground cover shall not touch the inside edge of curbing.

2.2.4. The Government anticipates and accepts a loss of two percent of the plants and trees each year as part of normal plant and tree life cycles. The Government shall provide replacements for these plants and trees. The Contractor will be responsible for all replanting and planting of new shrubs, trees, hedges, and plants. With the approval from the COR, the Government shall pay for the extraordinary bracing or cabling required preserving large trees.

2.3. Desert Landscape

2.3.1. Decorative Rock. The Contractor shall maintain a minimum rock depth of 2 inches. If additional decorative rock is required to meet the 2-inch minimum depth, the Contractor will notify the COR by providing all details to accurately procure the rock (type of rock and quantity). Once the Government has purchased and coordinated the delivery, the Contractor will place and spread the landscaping rock. The condition and depth of the rock shall be maintained throughout the facility where landscaping rock exists. Maintain decorative rock to keep a clean and neat appearance.

2.3.2. Edging- shall be maintained in order to protect from erosion.

2.4. Weed Control and Undesirable Vegetation

2.4.1. All grounds shall be weeded regularly to maintain a consistently neat appearance. All cracks in sidewalks, curbs, street gutters, parking lots, and other paved areas shall be kept weeded.

2.4.2. Desert landscape shall be maintained by eliminating all undesirable vegetation in the desert landscape. All undesirable vegetation shall be eradicated dependent on the size of the weed.

2.4.3. Eradication methods: If the weed is mature and developed, manually remove it. When waiting for herbicides to take effect, weeds shall be removed mechanically. Additionally, when this method is used, the debris must be picked up and disposed of immediately. Lastly, the preferred method, is to remove unwanted vegetation with herbicides along with a pre-emergent which prevents future growth. Tree leaves, seed pods, needles, etc., shall be raked up and removed and the area will be swept or raked to present a well-groomed appearance. The breezeway and atrium areas will be maintained each business day. Sidewalks, curbs, roof downspouts and gutters shall be kept clean of rocks, vegetation, debris, etc.

2.5. Chemical Treatment

2.5.1. Trees and all vegetation should be fertilized per standard industry guidelines. All application materials shall have a Safety Data Sheet stored at the Yuma Service Center Office.

2.5.2. The Contractor shall provide a current business license and current pesticide and herbicides qualification certifications for all Contract personnel who are applying pesticides or herbicides. Prior to any work being performed, pesticide labels and Safety Data Sheets shall be provided to the COR for review and approval. If herbicides or pesticides are used, report it to the COR and contain the following data:

• Date performed

• Individual applying chemical

• Type of vegetation

• Area treated

• Type and amount of concentrate used

2.5.3. The Contractor shall comply with laws and instructions pertaining to weed control within the state of Arizona. In addition, the Contractor will comply with all applicable parts of the Code of Federal Regulations 29 CFR 1910, 29 CFR 1926, and 49 CFR 171 while on site to ensure safe working conditions for personnel.

2.6. Removal of Debris & Policing of Grounds

2.6.1. The Contractor shall perform general litter patrol on all grounds (within property boundaries), drainage ditches, roads, streets, and parking lots on each business day. Responsibilities shall include, but not be limited to, the removal and disposal of all-natural debris, (clippings, trimmings, cuttings, tree limbs, dry brush, leaves, rodent habitats, dead animals, etc.), and man-made debris.

Dispose of all debris in appropriate waste disposal containers found on site. The Contractor shall police the area within and along Highway 95 outside of DSW’s property lines. Disposal of all waste shall be in compliance with all existing local, state, and federal regulations. All areas under this contract shall be free of all trash, debris, paper, plastic, empty cans, and bottles, discarded gum residue, cigar and cigarette butts, and other discarded material at the end of each workday.

2.6.2. Walkways and Hardscapes – Sidewalks, paved areas, and hardscapes shall be swept and cleared of debris so as to maintain a neat appearance at all times.

2.7. Irrigation and Watering System

2.7.1. The Contractor shall be responsible for the complete management and operation of all water control devices and irrigation systems to ensure the system is in good working order and in operational condition on a daily basis. The Contractor shall check, clean, adjust, repair and maintain the irrigation system.

2.7.2. All major repairs, updates to the irrigation system or layout, trenching and uncommon replacement items, such as timers and regulators, will be the responsibility of the Government. Only common normal wear and tear items and those items damaged by the Contractor will be the responsibility of the Contractor.

2.7.3. Damaged plugged or leaky emitters shall be promptly replaced. Drip end caps should be opened and flushed quarterly. As plants grow emitters will be moved out to promote long-term healthy growth. All dripline irrigation lines shall be run underground. All emitters that are not being utilized shall be plugged.

2.7.4. The drip irrigation system shall be operated and maintained to provide adequate water to trees and shrubs as appropriate for the species and season. On a continuing basis, the Contractor shall adjust and revise settings of automatic controllers to establish frequency and length of watering periods.

2.7.5. The Contractor shall program the controllers in a manner that is most efficient and conserves the maximum amount of water while maintaining healthy plant growth.

2.8. Emergency Services, Storm Drainage and Repair of Damaged Areas

2.8.1. All debris caused by acts of nature shall be removed as soon it is safe to do so. Emergency services shall be limited to clearing walkways and driveways unless otherwise directed by the COR.

Seasonal storm clean up should normally be completed within 48 hours. Reasonable extension of time may be granted with the approval of the COR.

2.8.2. Areas damaged by vehicles, erosion, drought, insects, or disease shall be repaired to meet the standards outlined in this PWS.

EXHIBIT 1

PERFORMANCE REQUIREMENTS SUMMARY

Performance Objective PWS Section Performance Standard

Tree Maintenance 2.1 100% with two discrepancies per Quarter

Hedge, Shrubbery and Ground Cover Maintenance 2.2 100% with two discrepancies per Quarter

Desert Landscape 2.3 100% with two discrepancies per Quarter

Weed Control and Undesirable Vegetation 2.4 100% with two discrepancies per Quarter

Chemical Treatment 2.5 100% with two discrepancies per Quarter

Removal of Debris and Policing of Grounds

Irrigation & Watering Systems

Emergency Services

2.6

2.7

2.8

100% with two discrepancies per Quarter

EXHIBIT 2

Contract Discrepancy Report

Contract No. 1. Report No. for this Discrepancy:

Contractor’s Name:

2. From: (Name of Contracting Officer representative)

Dates

3. Prepared:

4. Returned by Contractor:

5. Action Complete:

6. Discrepancy or Problem: (Describe in detail; include reference to PWS directive; attach continuation sheet, if necessary):

Signature of CO:

7. To: (Contracting Officer)

8. From: (Contractor)

9. Contractor Response as to Cause, Corrective Action and Actions to Prevent Recurrence (Attach Continuation Sheet if Necessary)

10. Signature of Contractor Representative:

Date:

11. Government Evaluation:

12. Government Actions:

13. Close Out Name Title Signature Date

(13a) Contractor Notified

(13b) COR

(13c) CO