Attachment 5. APPENDIX C- XLWU22-8124_BEACON BEACH RD.pdf

Appendix C: Other Documents

XLWU 22-8124

REPAIR BEACON BEACH ROAD

Department of the Air Force

325 Fighter Wing (ACC)

Tyndall Air Force Base, Florida

Repair Beacon Beach Road

AF IMT 332:

Base Civil Engineer Work Request

Department of the Air Force

325 Fighter Wing (ACC)

1. FROM (Organization) 3. DATE OF REQUEST 4. WORK REQUEST NO. (For BCE Use)

5. NAME AND PHONE NO. OF REQUESTER 6. REQUIRED COMPLETION DATE

8. DESCRIPTION OF WORK TO BE ACCOMPLISHED (Include Sketch or Plan, when appropriate)

9. BRIEF JUSTIFICATION FOR WORK TO BE ACCOMPLISHED (Not required for maintenance and repair)

10. DONATED RESOURCES: ASSETS YOUR UNIT WILL PROVIDE TO GET PROJECT COMPLETED. IF THERE ARE NO DONATED RESOURCES, MARK NONE.

11. NAME OF REQUESTER, UNIT CC (See Instructions) 12. GRADE

BASE CIVIL ENGINEER WORK REQUEST

SECTION I - TO BE COMPLETED BY REQUESTER

SYMBOL

2. OFFICE

7. BUILDING, FACILITY OR STREET ADDRESS

WHERE WORK IS TO BE ACCOMPLISHED

BASE CIVIL ENGINEER WORK REQUEST

FUNDS LABOR MATERIAL CONTRACT BY REQUESTER NONE

13. SIGNATURE OF REQUESTER

1. From (Organization): This is the requesting organization

2. Office Symbol: This is the requestor’s office symbol

3. Date of Request: This is the date the form is completed up to item 10.

4. Work Request No: For BCE use only

5. Name and Phone No. of Requester: Name and DSN telephone number of request (Note, requesters should be facility managers. Exceptions will be routed through CE Customer Service for approval)

6. Required Completion Date: List the desired completion date. Include any justifications on dates in item 9.

7. Building, Facility or Street Address where work is to be Accomplished: Self explanatory

8. Description of Work to be Accomplished: Please provide a detailed description of requested work. Include any sketches, plans, diagrams, specifications, photographs, and any other data or information that provides a complete description of the location and scope of work requested.

9. Brief Justification for Work to be Accomplished: Please provide justification or reason work needs to be done. The justification should be factual and indicate the urgency of the request. If any documents/directives are referenced (e.g., T.O., A.F.I, AF manual) please attached the referenced page stating the requirement to the this form.

10. Donated Resources: Check any resources the requesting unit will provide to CE in order to complete the work. If there are no donated resources, check none.

11. Name of requester, Unit CC: This should be signed by the requesting facility manager. If the requested work is new work, modification, or minor construction, the organization's commander should sign the request.

12. Grade: List the grade of the person listed in block 11.

13. Signature of requester’s leadership: Electronic or wet signature of the person listed in block 11.

INSTRUCTIONS

SECTION II - TO BE COMPLETED BY APPROVING AUTHORITY

ESTIMATED TOTAL COST

DATESIGNATURE NAME AND GRADE

REMARKS WORK CLASS

1157440345C Sticky Note Accepted set by 1157440345C

1157440345C Sticky Note Accepted set by 1157440345C

1157440345C Sticky Note Accepted set by 1157440345C

1157440345C Sticky Note Accepted set by 1157440345C

1157440345C Sticky Note Accepted set by 1157440345C

AF 813 Form:

Environmental Impact Analysis

Department of the Air Force

325 Fighter Wing (ACC)

AF Form 66:

Schedule of Material Submittals

Department of the Air Force

325 Fighter Wing (ACC)

PROJECT NUMBER SOLICITATION/CONTRACT NO.

FA4819-20-C-XXXX

NO. OF COPIES REQUIRED

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N U M B E R

ITEM OR DESCRIPTION OF ITEM, CONTRACT

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REMARKS

APPROVED DISAPPROVED

1 Design Charrette NA

2 Meeting Minutes (All Meetings) Meeting + 2 Days

3 Contractor Badging Applications Award + 14 Days

4 Project Schedule - AF Form 3064 NTP + 14 Days

5 Work Clearance Request / Digging Permit - AF Form 103

10 Days Prior to Commencing

Work

6 HAZMAT Inventory Form 81 & 82 14 Days Prior to

Commencing Work

7 Progress Report - AF Form 3065 Weekly

8 Material Approval - AF Form 3000 1 1 1 1 5 Days Prior to Order

9 Regulatory Permit Application

Prior to submitting to

Permitting Agency

0 Construction Materials Testing Reports Upon Receipt

1 Welding/Burn Permit - As Required

Prior to Commencing

Work

Draft DD 1354 - Transfer & Acceptance of Military Real Property NTP + 160 Days

3 Pre-Final Inspection Report Pre-Final + 3

Days

Contractor Environmental Reporting Entry - TAFB Form 83

Prior to Final Inspection

5 Equipment Manuals and Parts Lists Prior to Final

Inspection

1 1

SCHEDULE OF MATERIAL SUBMITTALS

PROJECT TITLE

XLWU 21-8111 Repair Roads to Support Rebuild

TO BE COMPLETED BY PROJECT ENGINEER TO BE COMPLETED BY CONTRACT ADMINISTRATOR

AF Form 66

PROJECT NUMBER SOLICITATION/CONTRACT NO.

FA4819-20-C-XXXX

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REMARKS

APPROVED DISAPPROVED

SCHEDULE OF MATERIAL SUBMITTALS

PROJECT TITLE

XLWU 21-8111 REPAIR ROADS TO SUPPORT REBUILD

TO BE COMPLETED BY PROJECT ENGINEER TO BE COMPLETED BY CONTRACT ADMINISTRATOR

Final DD 1354 - Transfer & Acceptance of Military Real Property

At Final Inspection

7 Final Inspection Report

Final Inspection + 5

Days

8 Project Close Out Documents 1

Final Inspection + 7

Days

1 1 1 1 1

AF Form 66

A. Remove existing asphalt pavement, base materials, and excess soils B. Compact subgrade to 95% Modified Proctor value C. Install 8 inches of graded aggregate base (GAB) such as crushed concrete D. Layer SP9.5 or SP12.5 asphalt pavement with standard cross slopes (crown) to shed water E. Install barrier system between the road and walking path at the locations where it abuts the roadway F. Paint new reflective pavement markings G. Address any ancillary work required for a complete and usable roadway