Attachment 16 PWS - DIA Region IV FSS TE-6 Service Order Forms 20221208.pdf

PWS Technical Exhibit 6 DIA Region IV FSS Service Order Forms

Page 1 of 1 08 December 2022

TE-8.1 General.

The Contractor shall submit the following Service Order Forms with Corrective Maintenance, Alterations, and New Work requests. The Government will provide an Excel or Word version for Contractor use upon contract award. Sample forms are included.

• Service Order Form (All).

• Statement of Competition and Price Reasonableness Determination (All with materials and/or subcontractor above $2,500)

• Sole Source Justification (Sole Source only; not required if multiple subcontractor bids are solicited and only one received)

CONTRACTOR: CONTRACT NO.:

FACILITY NAME : TASK ORDER NO.:

FACILITY LOCATION: CMMS SERVICE ORDER NO:

HNC SERVICE ORDER NO: INITIATOR:

SERVICE ORDER DATE:

One of these boxes must be checked: ROUTINE URGENT EMERGENCY

Reg Labor Hours Reg Labor Rate Overtime Labor Hours OT Labor Rate Total

Description QTY Part # Manufacturer Unit Unit Price Amount each -$ -$ each -$ -$ each -$ -$ each -$ -$ each -$ -$

Trip Description Travelers Days Per Diem (Total) Roundtrip Mileage Mileage Rate Travel Cost $0.00 -$ -$

ME&I 0 0 -$ Roundtrip Airfare -$ ME&I @75% (first and last day) 0 0 -$ Lodging 0 0 -$

Lodging ME&I ME&I @ 75% Standard Rate -$ -$ -$

TOTAL TRAVEL COST -$

Cost Labor Total -$ -$ Materials Cost -$ -$ Tax 0.00% -$ -$ Shipping -$ -$ Travel Cost -$ -$ Prime Total -$ -$ Subcontract Total -$ -$ Prime Contractor SO Fee 0.00% -$ -$ Emergency SO Fee 0.00% -$ -$ Subcontractor Markup 0.00% -$

-$ TOTAL COST -$

I concur this is a valid requirement to meet operational needs covered by this contract.

DESIGNATED GOVERNMENT REPRESENTATIVE:

DATE

SIGNED:

CONTRACTOR

I certify the services described above have been satisfactorily completed

PART II - COST SUMMARY

Contractor confirms there is an USACE accepted AHA associated with the work being performed in this SO included in the APP.

AHA identifier or tracking

SERVICE ORDER FORM

PART I - SERVICE ORDER INFORMATION

SERVICE ORDER SOW:

Contractor acknowledges there is NOT an AHA associated with the work being performed in this SO included in the APP. AHA is attached for review with the SO.

Contractor acknowledges there is an activity associtated with the SO that requires an additional plan or program that will be included in an APP addendum.

CEHNC Safety Compliance

Contractor Signature:_____________________

SCA/CBA or DBA (Select One) SCA/CBA DBA

QUALITY ASSURANCE EVALUATOR

PART IV - CERTIFICATION OF SERVICES

SIGNED:

PART III - AUTHORIZATION

$0.00

Not To Exceed (NTE)Firm-Fixed Price (FFP)FUNDING CLIN:

DATE

$0.00

Contractor acknowledges receipt of KO/SOA approved Service Order

DATE

Notice To Proceed to perform this SO is authorized:

CONTRACTING OFFICER/SERVICE ORDER ADMINISTRATOR

SUBCONTRACTORS

PRIME CONTRACTOR LABOR UTILIZED (add rows if necessary)

TOTAL REGULAR LABOR

TOTAL MATERIALS

Totals

Labor Classification

PRIME CONTRACTOR TRAVEL

Check all applicable boxes:

Inbrief Conducted: Date Work Completed: Outbrief Conducted:

Subcontractor Total

Subcontractor

PRIME CONTRACTOR PARTS/MATERIALS/EQUIPMENT (add rows if necessary)

Bid Amount Valid Until

(signature) (date) (printed name)

** PROPOSAL INFORMATION **

** REQUIRED for all service orders with materials and/or subcontractor quotes exceeding $2,500.00 **

Competitive bids were solicited & results are as follows:

SECTION 1 - STATEMENT OF COMPETITION

Service Order No.:

Location:

Total Price for Approval:

Scope of Work

Comments:

Completed by:

SECTION 2 - PRICE REASONABLENESS DETERMINATION

Justification for subcontractor selection:

Low Bid Best Value (complete scope of work, best technical solution, value added, etc)

Please explain:

How did you determine price reasonableness? * if other than Competition, PRD documentation must be provided

Competition (PRD not needed if two or more valid quotes received) Historical Data (previous similar work, past service orders) Industry Data (catalog/internet research, etc) R.S. Means Other (please explain):

Subcontractor

DISCLOSURE STATEMENT

This proposal includes data that shall not be disclosed outside the Government and shall not be duplicated, used, or disclosed – in whole or in part – for any purpose other than to evaluate this proposal or quotation. If, however, a contract is awarded to this offeror as a result of – or in connection with –the submission of this data, the Government shall have the right to duplicate, use, or disclose the data to the extent provided in the resulting contract. This restriction does not limit the Government’s right to use information contained in this data if it is obtained from another source without restriction.

The data subject to this restriction are contained in all sheets of this proposal.

Sole Source * Sole Sorce Justification Form Provided. **Not required if multiple bids solicited and only one received**

Comments:

STATEMENT OF COMPETITION &

PRICE REASONABLENESS DETERMINATION

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SOLE SOURCE JUSTIFICATION

SITE: TASK ORDER:

DATE: VENDOR:

SERVICES REQUESTED:

ESTIMATED COST:

Utility services available from only one source. IAW FAR 6.302-1(b)(3)

Engineering or R & D capability to be provided by an educational or non-profit institution or federally funded R & D Center. IAW FAR 6.302-3

Only known source of supply. IAW FAR 6.302-1

Compatibility – Unique supplies or services available from only one source or supplier with unique capabilities. IAW FAR 6.302-1(1)(b)(1) Example: direct replacement for a component part; material / equipment / component is required for use in existing equipment; and substitutes cannot be used because of electrical, mechanical, or physical reasons.

Unusual or compelling urgency. IAW FAR 6.302-2 Example: delay of an award would result in serious injury, financial or other, to the government.

Justification provided.

Agency standardization program dictates that only specified makes and models of technical equipment and parts will satisfy the agency’s need for additional units or replacement items, and only one source is available. IAW FAR 6.302- (b) (4)

Limited rights in data, patent rights, copyrights, or secret process. IAW FAR 6.302-1(b)(2)

Repair/maintenance by original manufacturer or authorized agency to preserve conditions of warranty.

FURTHER JUSTIFICATION: **REQUIRED**

Contract Maintenance Manager *Contracting Officer’s Representative

*(REQUIRED SIGNATURE)

REASON FOR LACK OF COMPETITION: