Attachment 4 BARC Construction Authorization Form.pdf

Application for Beltsville Agricultural Research Center (BARC) Construction Authorization Submit Application to:

BARC, Head, Engineering and Construction Branch (ECB) 10300 Baltimore Ave., Bldg. 426A, BARC-East Beltsville, MD 20705 301-504-8434 Please Allow 5 Business Days for Processing of Application

PART I - Contractor Requirements (To be completed by ECB Project Manager)

Project Number: Project Manager: Teofilo V Reyes

The Contractor shall submit the following permits and plans with this Authorization for approval prior to starting work:

A. Open Flame Permit . . . . . . . . . X D. Revocable Permit/ G. Asbestos Abatement Plan B. Confined Space Entry Plan . . . X Easement Deed . . . . H. Other . . .

C. Erosion and Sediment Control E. Safety Plan . . . . . . . . . X I. COVID-19 Plan

Plan/Permit . . . . . . . . . . . . . . F. Lead Abatement Plan .

PART II - Contractor Information Start Date: ___________ (To be completed by the Contractor) Date of Application:

Completion Date: ___________ (Refer to instructions on back of application.)

Name of Contractor (Company): Daytime Telephone Number:

Name of Supervisor/Foreman:

After Hour Emergency Contact: Telephone Number:

Company’s Mailing Address:

Description of Work to be Performed:

Purchase Order/Contract Number:

Location(s) of Work:

Number of Vehicle Permits Required: Number of Personnel Identification Badges Required: Proxy Card

RN-LNKey Label:

What Heavy Equipment is to be used?

I have received and read a copy of the BARC Special Conditions and agree to comply with all requirements. Yes No

Applicant’s Signature: Date

Print Name: Title:

PART III - Authorization Approval

Application Received By: Date:

Authorization has been: Authorization Number:

Approved Approved with the following conditions:

Disapproved (reason):

ECB’s Authorization Signature: Date:

Print Name: Title:

Approved Construction Authorization Must Be:

In Construction Supervisor’s Possession on the Job Site Posted at the Job Site

INSTRUCTIONS

(Construction Authorization Form)

PART I - Contractor Requirements

The boxes checked indicate the permits and/or plans that shall be provided by the applicant when submitting the Construction Authorization Application.

Box A - Open Flame Permit: Comply with BARC Special Conditions, Section 2-24, Cutting, Welding, Brazing, and Hot Work Operations. Application is attached with the contract package, if applicable.

Box B - Confined Space Entry Plan: Submit six (6) copies of your company’s Confined Space Entry Plan for this project.

Box C - Erosion and Sediment Control Plan/Permit: For any project that exceeds Maryland Department of the Environment (MDE) requirements, your company must submit a copy of their approved MDE/Washington Suburban Sanitary Commission (WSSC) drawings and permit before starting work.

Box D - Revocable Permit/Easement Deed: All utility companies and State and Federal Agencies outside of Agricultural Research Service (ARS) shall submit a copy of an approved BARC easement permit before starting any work. Easement permits can be obtained from the Facilities Management and Operations Division, Real Property Office (301-504-5187), Building 003, Room 311. Allow the Real Property Office five (5) business days for processing of request form.

Box E - Safety Plan: Provide six (6) copies of your company’s safety plan. The safety plan will be kept on file at BARC for one (1) year, at which time a new copy must be submitted.

Box F - Lead Abatement Plan: Submit six (6) copies as specified in the attached contract specifications.

Box G - Asbestos Abatement Plan: Submit six (6) copies as specified in the attached contract specifications.

PART II - Contractor Information

This part must be filled out completely by the contractor before submitting application.

Complete and return the E&P Parking Permit and Visitor’s Pass Request which is attached to the contract package. List all vehicles and employees (including sub-contractors) requiring passes (in order to complete this project.) Non-Citizen workers must complete the attached NON- CITIZEN WORKER DATA SHEET prior to being issued Visitor Passes.

Contractor vehicle permits and Visitor Passes will be issued at the same time the Construction Authorization is granted. Once the contract package is completed, it will be the Contractor’s responsibility to ensure that all passes (personnel and vehicle) are accounted for and returned to the Engineering and Planning Office, Building 426A, BARC-East, before final payment is approved.

NOTE: Contractor Identification Badges shall be worn or be in their possession at all times. If this requirement is not met, the Contractor shall be subject to removal from

BARC.