Attachment 2_ HotelMotel Evaluation Checklist 2024.docx
DOCX document 33 KB Posted
- Attached to
- V231--Lodging Service
- Solicitation number
- 36C25525Q0116
About this file
This file is a Hotel/Motel Evaluation Checklist template and an ACH Vendor Payment Enrollment Form (SF3881) related to lodging services for the VA St. Louis Health Care System at two locations: 915 N. Grand Blvd. and 1 Jefferson Barracks Dr in St. Louis, MO.
The evaluation checklist contains 50 criteria points covering room requirements, cleanliness, furnishings, bathroom facilities, and amenities. Key requirements include security features (door locks, viewports), basic furnishings (chair, writing surface, storage), functioning utilities (HVAC, electrical, plumbing), and cleanliness standards. The checklist requires a minimum score of 40 out of 50 points (80%) to pass. The SF3881 form is included for vendor payment setup through the VA Financial Services Center in Austin, TX, requiring banking and contact information for ACH payments.
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| 36C25525Q0116 0001.docx | DOCX document | |
| Self-Performance Worksheet.pdf | ||
| 36C25525Q0116 Hoptel Solicitation.docx | DOCX document | |
| Attachment 1_MCM 122-06_2019 April 19.docx | DOCX document |
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Text version
Enclosure 2: Hotel/Motel Evaluation Checklist
NAME OF FACILITY: VA St. Louis Health Care System
ADDRESS:
915 N. Grand Blvd. St. Louis, MO 63106 or 1 Jefferson Barracks Dr St. Louis, MO 63125
ROOM REQUIRMENTS (40 out of 50 = 80%)
| YES |
| NO |
| NA |
| 1 |
| Primary lock on all doors/dead-bolt/all windows |
| 2 |
| Door has a viewport/window |
| 3 |
| Smoke detector |
| 4 |
| Active light switch at main entry to unit |
| 5 |
| Sufficient lamps to properly illuminate the room for reading or writing |
| 6 |
| At least one chair (in good condition) |
| 7 |
| Writing surface (in good condition) |
| 8 |
| A night stand or equivalent ( in good condition) |
| 9 |
| Clothes hanging facilities; drawers or clothes storage area |
| 10 |
| Television (if provided/functioning) |
| 11 |
| Telephone (functioning/direct dial or 24 hour switchboard) |
| 12 |
| Waste basket |
| 13 |
| Electrical Outlets (functioning) |
| 14 |
| Alarm/clock radio |
| 15 |
| Adequate space for one piece of luggage |
| 16 |
| Shades, draperies or blinds on all windows |
| 17 |
| Window covering effectively shut out light from outside |
| 18 |
| Heating system (functioning/reasonably quiet) |
| 19 |
| Air Conditioning system (functioning/reasonably quite) |
OVERALL ROOM CLEANLINESS
| 20 |
| Free of insects/rodents |
| 21 |
| No dust/dirt/liter/stains/cobwebs |
| 22 |
| Odorless/Clean windows |
ROOM CARPETING
| 23 |
| Not dirty/stained/worn-out/torn |
ROOM WALLS/CEILING
| 24 |
| Clean/no peeling paint |
| 25 |
| Free of defects such as cracks, holes or stains |
MATTRESS/BOX SPRINGS
| 26 |
| Non-sagging/ sized to fit bed frame |
| 27 |
| Odorless, not stained |
| 28 |
| Non protruding/unbroken |
OTHER BEDDING REQUIREMENT
| 29 |
| Clean pillow(s)/pillow cases |
| 30 |
| Two clean sheets, mattress pad |
| 31 |
| Clean pillow case(s) |
| 32 |
| Suitable, clean blanket, bedsheet |
BATH AREA
| 33 |
| Private bath (with no carpeting in commode area |
| 34 |
| Adequate ventilation (fan/window) |
| 35 |
| Adequate lighting |
TOILET
| 36 |
| Functioning/clean |
SHOWER/TUB
| 37 |
| No grout problems/cracks |
| 38 |
| Adequate water pressure/hot water |
| 39 |
| Non-skid pad/strips |
| 40 |
| Shower curtain/tub enclosure clean and free from tears and mildew |
VANITY/SINK
| 41 |
| Functioning/clean |
| 42 |
| Adequate water pressure/hot water |
| 43 |
| Adequate light fixture above vanity/mirror/electrical outlet convenient |
to mirror
BATH TOWELS
| 44 |
| One quality bath/hand/wash towel/bath mat |
| 45 |
| Towel rack |
OTHER BATH REQUIREMENTS
| 46 |
| Spare toilet tissue/facial tissue |
| 47 |
| One wrapped drinking glass per person |
| 48 |
| Bathroom waste basket |
| 49 |
| One individually wrapped bar of soap per person |
OVERALL BATH AREA CLEANINESS/WALLS/CEILING
| 50 |
| No hair/stains/odor/no peeling paint/free of defects such |
as cracks, holes or stains
TOTAL SCORE: _____________
EVALUATORS:
NAME
TITLE
SIGNATURE/DATE
Attachment (3) – SF3881 ACH VENDOR/MISCELLANEOUS PAYMENT OMB No. 1510-0056
ENROLLMENT FORM
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment-related information processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means to vendor's financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System.
AGENCY INFORMATION
FEDERAL PROGRAM AGENCY:
VA Financial Services Center
AGENCY IDENTIFIER:
AGENCY LOCATION CODE (ALC):
ACH FORMAT:
|_| CCD+ |_| CTX
ADDRESS:
P.O. Box 149971
Austin, TX 78714
CONTRACT PERSON NAME:
Attn: Vendorizing Unit
TELE PHONE NUMBER:
(512) 460-5049
ADDITIONAL INFORMATION:
Fax # (512) 460-5221
COMPANY INFORMATION
NAME:
SSN NO. OR TAXPAYER ID NO.
ADDRESS:
CONTACT PERSON NAME:
TELE PHONE NUMBER:
FINANCIAL INSTITUTION INFORMATION
NAME:
ADDRESS:
ACH COORDINATOR NAME:
TELE PHONE NUMBER:
NINE-DIGIT ROUTING TRANSIT NUMBER:
DEPOSITOR ACCOUNT TITLE:
DEPOSITOR ACCOUNT NUMBER:
TYPE OF ACCOUNT:
|_|CHECKING |_| SAVINGS
| S |
| SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL: |
(Could be the same as ACH Coordinator)
TELE PHONE NUMBER:
| SF 3881 (Rev. 12/90) | ||
| NSN 7540-01-274-9925 | Prescribed by Department of Treasury |
IGNATURE AND TITLE OF AUTHORIZED OFFICIAL:
(Could be the same as ACH Coordinator)
TELE PHONE NUMBER:
NSN 7540-01-274-9925 Prescribed by Department of Treasury SF 3881 (Rev. 12/90)
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