Attachment H - Laydown Areas Request Form.docx
DOCX document 35 KB Posted
- Solicitation number
- 36C26222B0009_1
About this file
This document is a contractor laydown areas request form for the VA Long Beach Healthcare System construction project 600-17-108 SPS Sterilizers and Equipment Site Prep. The form requires contractors to provide details such as the project number, title and dates for the requested laydown period, a description of items to be stored, and the amount of space needed. Contractors must agree to comply with the VA's laydown area policy. Approvals are then required from the PM/COR, Occupational Safety and Environmental Management Service, PM/COR's Section Chief, and Planning & Program Management Section, with the option to approve or deny the request. If approved, the size of the approved area is recorded. A closeout section requires inspection of the vacated area and approval signatures from the PM/COR and P/PM Section to confirm the area has been satisfactorily cleared and cleaned.
The related federal contract opportunity is a solicitation from the Department of Veterans Affairs Veterans Health Administration VISN 22 for construction project 600-17-108 SPS Sterilizers and Equipment Site Prep at the VA Long Beach Healthcare System. The solicitation seeks construction services including general construction, alterations, mechanical and electrical work to accomplish the site preparation for sterilizers and equipment in a functioning hospital environment.
View the file
Other files
Show all 32
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
VA Long Beach Healthcare System ES Form 600-138G-3 CLAR Tibor Rubin VA Medical Center Revised – N/A
CONTRACTOR LAYDOWN AREAS REQUEST FORM
Section I. Request – Completed by Contractor
1. Project No.
2. Project title
3. Date of Request:
4. Contractor
5. Phone #
6. PM/COR
7. Phone #
8. Duration of Construction Period. (This is the time space will be needed)
| Start Date: |
| Start Time: |
| End Date: |
| End Time: |
9. What items will be stored in the laydown area? (i.e. materials, trailers and/or heavy machinery.)
10. Amount of Space Requested
11. Contractor’s compliance:
Contractor confirms he/she has read and understood ESSOP 400.3 “Contractor Laydown Area Policy”, applicable references, and agrees to comply with all conditions set; by signing below.
Printed Name: Signature: Date:
Section II. Approvals – Completed by COR, OSEMS FLS/GEMS, PM/COR’s Section Chief and P/PM Section
12. Approval signatures
a. PM/COR: ________________________________________ Signature:_________________ Date: ____________ (Printed Name)
b. OSEMS FLS/GEMS________________________________ Signature:_________________ Date: ____________ (Printed Name)
c. PM/COR’s Section Chief ___________________________ Signature:_________________ Date: ____________ (Printed Name)
d. Planning & Program Management (P/PM) Section
Request: Approved / Denied Space Approved:
Size:
Approved by: _________________________________________ Signature:_________________ Date: ____________
Note:
1. The Project’s PM/COR shall ensure that the P/PM Section is made aware of any changes to the construction schedule if it affects length of time laydown space will be needed.
2. Refer to ESSOP 400.3 Contractors Laydown Area Policy.
Section III. Closeout – Completed by the COR & P/PM Section after Contractor vacates laydown area.
| 13. Inspection Performed on |
| Date: |
| Time: |
14. Is the Contractor present during the final inspection? Yes / No
15. The following items were inspected by the VA and were found to be:
| a. All equipment, materials have been vacated from the layout area. |
| Acceptable / Unacceptable |
| b. Area has been cleared of all debris. |
| Acceptable / Unacceptable |
| c. Fence has been removed or coordinated to remain with the COR & P/PM Section. If the fence is to remain it must be in good condition. |
| Acceptable / Unacceptable |
| d. All contractor’s signs have been removed from area. |
| Acceptable / Unacceptable |
| e. Area has been environmentally cleared (OSEMS FLS/GEMS). |
| Acceptable / Unacceptable |
16. If any items were found to be unacceptable, record date and time the contractor needs to resolve all unacceptable items for re-inspection. This is the same date & time the area will be re-inspected by the VA. N/A this section if all items were found Acceptable during initial inspection.
Date: Time: All items were found Acceptable during re-inspection
Section IV. Closeout Approvals - Completed by the COR & P/PM Section
17. Signatures below signifies that final inspection of the vacated laydown area has been performed and has been found acceptable by the VA.
a. PM/COR: ________________________________________ Signature:_________________ Date: ____________ (Printed Name)
b. P/PM Section: ____________________________________ Signature:_________________ Date: ____________
Note: COR/PM shall save a copy of the completed form in the Project’s Closeout Folder.
Page 4 of 5.
File details come from the government source that posted it. Updated .