B & B Attachment A-II.docx
DOCX document 319 KB Posted
- Solicitation number
- RFP-591-210000000583-3
- Issued by
- Berrien County, Michigan
About this file
This is an attachment file containing required forms for RFP 210000000583 issued by the Michigan Department of Transportation (MDOT) for Bicentennial and Blossomland Lift Bridge Operational and Custodial Services. The document includes five essential forms: Bridge Operator's Report, Unnecessary Bridge Openings Report, Contractor/Operator's Inspection Form, Equipment Check List, and Accident Incident Report. These forms are designed to document daily bridge operations, track unnecessary bridge openings, conduct operational inspections, verify safety equipment, and report accidents.
The forms detail specific equipment requirements including 2 first-aid kits, 2 life jackets, 2 life rings, 150 feet of rope, 6 fire extinguishers (4 ABC and 2 BC types), emergency warning flags, 2 flashlights, 6 traffic cones, and 2 reflective vests. The inspection forms cover evaluation criteria for bridge operators' knowledge, operational ability, safety conditions, appearance, and housekeeping. The documents focus on maintaining operational safety and compliance with Coast Guard regulations, though no specific pricing or funding information is included in these forms.
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Other files
| File | Type | Posted |
|---|---|---|
| B & B Attachment A-V.docx | DOCX document | |
| B & B Proposal Inst.CT.VQ.docx | DOCX document | |
| B & B Attachment A-IV.docx | DOCX document | |
| B & B Attachment A-VI.docx | DOCX document | |
| B & B standard_contract_terms.docx | DOCX document | |
| B & B Attachment A-III.docx | DOCX document | |
| B & B Schedule B Pricing.docx | DOCX document | |
| B & B Attachment A-I.docx | DOCX document | |
| B & B Schedule A-SOW.docx | DOCX document |
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Text version
RFP 210000000583 - Bicentennial and Blossomland Lift Bridge Operational and Custodial Services
ATTACHMENT A-II
FORMS
1. BRIDGE OPERATOR’S REPORT (Form 0406)
2. UNNECESSARY BRIDGE OPENINGS
3. CONTRACTOR/OPERATOR’S INSPECTION
4. EQUIPMENT CHECK LIST
5. ACCIDENT INCIDENT
UNNECESSARY BRIDGE OPENINGS
BRIDGE NAME: BRIDGE No.
BRIDGE LOCATION:
· NUMBER OF VESSEL (IF NUMBERED):
· NAME OF VESSEL:
· HOME PORT (IF SHOWN):
· NAME & ADDRESS OF OWNER:
| MONTH: | DAY: YEAR: | TIME: AM: | PM: |
| DIRECTION OF PASSAGE: UP STREAM: | DOWN STREAM: |
CAUSE OF UNNECESSARY BRIDGE OPENING
APPURTENANCES UNESSENTIAL TO NAVIGATION:
ANTENNA: OUTRIGGER: DECORATIVE MAST:
FLAGPOLE: FALSE STACK: CANVAS TOP:
OTHER:
CLEARANCE GAUGE: FEET
ESTIMATED CLEARANCE OF VESSEL’S HIGHEST FIXED POINT: FEET
REMARKS:
BRIDGE OPERATOR:
(VIOLATION CANNOT PROCEED WITHOUT THIS INFORMATION)
CONTRACTOR/OPERATOR’S INSPECTION
BRIDGE NAME:
INSPECTOR: TIME: DATE:
| EVALUATION |
| GOOD |
| FAIR |
| POOR |
A. Bridge Operators Overall Knowledge Of Functions
1. Knowledge of routine operations procedures
2. Knowledge of emergency operating procedures
3. Knowledge of administrative requirements
4. Knowledge of Coast Guard Regulations
B. Bridge Operators Overall Operational Ability
1. Ability to operate bridge
2. Bridge logs (Completeness)
C. Bridge Navigation And Safety Conditions
1. Navigation lights (daily checks)
2. Fender systems
3. Other safety devices
D. Bridge Operators Appearance
E. Housekeeping Overall
1. Operators bridge house floors
2. Bridge house windows
3. Control console and switchgear
4. Walkways and platforms
5. Commode
F. Overall Bridge Condition
EQUIPMENT CHECK LIST
BRIDGE NAME:
| 1. | FIRST-AID KIT – (2 required) | |
| a. | In a readily accessible place? | |
| b. | Has it been used? | |
| c. | Has it been replenished? |
| 2. | LIFE JACKETS – (2 required) and LIFE RINGS – (2 required) | |
| a. | Is the required number accounted for? | |
| b. | Ripped, torn, or cracked? | |
| c. | General Condition: New Good Fair Poor |
| 3. | ROPE, 150 linear feet 1/4 inch (plus vertical distance of the draw span to water) | |
| a. | Is it in a readily accessible condition? | |
| b. | General Condition: New Good Fair Poor |
| 4. | FIRE EXTINGUISHERS (6 required) | |
| a. | Are there 4 ABC, 10 lbs.? | |
| b. | Are there 2 BC, 10 lbs.? | |
| c. | Date filled? | |
| d. | Has the pin been broken? |
| 5. | BIG RED FLAG FOR EMERGENCY SHIP WARNING | |
| a. | Is the required number accounted for? | |
| b. | Are they properly stored? |
| 6. | FLASHLIGHTS – (2 required) | |
| a. | Is the required number accounted for? | |
| b. | Are they in working condition? | |
| c. | Are the batteries good? |
| 7. | ARE THE FOLLOWING AVAILABLE? | |
| a. | Cones – (6 required) | |
| b. | Vests (Reflectorized) – (2 required) |
| 8. | ARE THE FOLLOWING WORKING SATISFACTORILY? | |
| a. | Commode | |
| b. | Fan/air conditioner | |
| c. | Door locks | |
| d. | Telephone |
e. Intercom (if available)
9. COMMENTS:
PROJECT MANAGER DATE
ACCIDENT INCIDENT
LOCATION:
TIME OF ACCIDENT: ____________ DATE: ____________ HOUR: ______ AM: PM:
WEATHER CONDITIONS: ______________________________ (CLEAR, RAIN, FOG, ETC.)
| OPERATOR’S NAME, ADDRESS & PHONE NUMBER |
| VEHICLE / BOAT IDENTIFICATION NUMBER |
| DRIVERS LICENSE NUMBER |
| INSURANCE COMPANY |
MDOT PROPERTY DAMAGED:
DESCRIPTION OF ACCIDENT:
POLICE AGENCY REPORT NUMBER:
SKETCH IF NECESSARY
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