B.08.02 PWS Attachment E - Sample SO Submission Form.xlsx
XLSX spreadsheet 31 KB Posted
- Attached to
- RMMR Services for USAF Fuel Facilities Supported by DLA-Energy at Incirlik Air Base, Turkey
- Solicitation number
- W912GB21R0004
- Issued by
-
Department of the Army European Command
About this file
This document contains a sample service order submission form and request for proposal for recurring maintenance and minor repair services. The service order form is a cost reimbursement template for contractors to submit labor, materials, subcontracting, and other direct costs to the U.S. Army Corps of Engineers for corrective maintenance work. It requires contractors to provide health and safety plans and acknowledges applicable profit rates of 0-0.5%. The related solicitation is a request for proposal from the Department of the Army European Command for recurring maintenance and minor repair of U.S. Air Force fuel facilities at Incirlik Air Base, Turkey. Interested offerors must submit proposals by the specified closing date to be considered for this requirements contract.
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Text version
Service Order
| CORRECTIVE MAINTENANCE SERVICE ORDER FORM | ||
| PART I - SERVICE ORDER INFORMATION | ||
| CONTRACTOR: | CONTRACT NO.: | W912GBXXCXXXX |
| CUSTOMER ORGANIZATION: | CONTRACT Year: | |
| DOD SITE CODE: | SERVICE ORDER NAME: | |
| FACILITY NAME/NUMBER: | SO REQUEST NO: | |
| SERVICE ORDER DATE: | CLIN TO BE CHARGED: | |
| SO Descripton (include LOCATION - attach additional sheets as required): |
Action to be Taken:
| FALSE | |||||||
| One of these boxes must be checked: | ROUTINE | EMERGENCY | |||||
| Safety Verification to be completed by Contractor | CENAU Safety Initial | ||||||
| One of these boxes must be checked: | Contractor confirms there is an AHA associated with the work being performed in this SO included in the Accident Prevention Plan (APP) | ||||||
| Contractor acknowledges there is NOT an AHA associated with the work being performed in this SO included in the APP. AHA is attached for review with the SO. | |||||||
| Check if applicable: | Contractor acknowledges there is an activity associtated with the SO that requires an additional plan or program that will be included in an APP addendum. | ||||||
| PART II - COST SUMMARY | |||||||
| LABOR UTILIZED | |||||||
| Labor Classification | Reg Labor Hours | Reg Labor Rate | Reg Labor Amount | OT Hours | Contr O/T Rate | OT Amount | |
| 0.00 | $0.00 | $0.00 | 0.00 | $0.00 | $0.00 | ||
| 0.00 | $0.00 | $0.00 | 0.00 | $0.00 | $0.00 | ||
| 0.00 | $0.00 | $0.00 | 0.00 | $0.00 | $0.00 | ||
| 0.00 | $0.00 | $0.00 | 0.00 | $0.00 | $0.00 | ||
| 0.00 | $0.00 | $0.00 | 10.00 | $0.00 | $0.00 | ||
| $0.00 | $0.00 | $0.00 | $0.00 | ||||
| Labor Notes: | Total Regular Labor | $0.00 | |||||
| Safety Officer will inspect before, during and after work. Quality Control Officer will inspect during testing. | Total OT Labor | $0.00 | |||||
| $0.00 | |||||||
| TOTAL LABOR COST | $0.00 | ||||||
| MATERIALS/SUPPLIES/EQUIPMENT | |||||||
| Description | Qty | Unit | Unit Price | Amount | |||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| MSE Notes: | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| TOTAL MSE COST | $0.00 | ||||||
| SUBCONTRACTOR COSTS | |||||||
| Description | Amount | ||||||
| $0.00 | |||||||
| $0.00 | |||||||
| SUB Notes: | $0.00 | ||||||
| $0.00 | |||||||
| TOTAL SUB COST | $0.00 | ||||||
| OTHER DIRECT COSTS | |||||||
| Description | Amount | ||||||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| ODC Notes: | $0.00 | ||||||
| $0.00 | |||||||
| TOTAL ODC COST | $0.00 | ||||||
| TRAVEL | |||||||
| Description | Amount | ||||||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| Travel Notes: | $0.00 | ||||||
| TOTAL TRAVEL COST | $0.00 | ||||||
| TOTAL SO COSTS TO BE INVOICED | $0.00 | ||||||
| PART III - AUTHORIZATION | |||||||
| CONRACTOR: Receipt & Acceptance Acknowledged. | |||||||
| E-SIGNED & DATED: | |||||||
| CUSTOMER: SO is accepted and requests NTP from USACE. | |||||||
| E-SIGNED & DATED: | |||||||
| CENAU COR: May approve SOs up to $10,000 or as otherwise authorized by the Contracting Officer. | |||||||
| E-SIGNED & DATED: | |||||||
| CONTRACTING OFFICER: Service Orders over $10,000 or as otherwise specified by Contracting Officer. | |||||||
| E-SIGNED & DATED: | |||||||
| This is a cost reimbursable service order and the initial prices submitted reflect the Contractor's best estimate to complete the work necessary to satisfy the requriement. This SO is considered technically acceptable and within scope. | |||||||
| PART IV - CERTIFICATION OF SERVICES | |||||||
| I certify that the services under the above Service Order have been satisfactorily completed. |
| QUAILITY ASSURANCE EVALUATOR: |
| E-SIGNED & DATED: |
| DATE/TIME WORK COMPLETED |
Add Row Add Row Add Row Add Row Add Row
Admin Page
| Rates: | Non-Emergency | Emergency |
| Profit on Labor: | 0.0% | 0.0% |
| Profit on MSE: | 0.0% | 0.0% |
| Profit on Outside Vendor: | 0.0% | 0.0% |
| Indrect Rate (applied to Direct Labor): | 0.00% | <-- year 1 |
| Escalation Rate (applied to Direct Labor): | 0.00% | <-- year 1 |
| Country: | ||
| Tax Rate: | 0.00% | |
| MSE Handling Charge Rate: | 0.00% | |
| SUB Handling Charge Rate: | 0.00% | |
| G&A Rate: | 0.00% | |
| Labor Classification | BASE RG | BASE OT |
| Program Manager | € - 0 | € - 0 |
| Project Manager | € - 0 | € - 0 |
| Team Leader | € - 0 | € - 0 |
| Site Supervisor/Superintendent | € - 0 | € - 0 |
| Petroleum Maintenance Technician (Senior) | € - 0 | € - 0 |
| Petroleum Maintenance Technician (Mid-Level) | € - 0 | € - 0 |
| Petroleum Maintenance Technician (Junior) | € - 0 | € - 0 |
| Engineer (Senior) | € - 0 | € - 0 |
| Engineer (Mid-Level) | € - 0 | € - 0 |
| Engineer (Junior) | € - 0 | € - 0 |
| Environmental Scientist (Senior) | € - 0 | € - 0 |
| Environmental Scientist (Mid-Level) | € - 0 | € - 0 |
| Environmental Scientist (Junior) | € - 0 | € - 0 |
| CADD Operator | € - 0 | € - 0 |
| Admin Specialist | € - 0 | € - 0 |
| Certified Surveyor | € - 0 | € - 0 |
| Haz Waste Specialist | € - 0 | € - 0 |
| Industrial Hygienist | € - 0 | € - 0 |
| Site Safety and Health Officer (SSHO) | € - 0 | € - 0 |
| Contracts Administrator | € - 0 | € - 0 |
| Project Controls | € - 0 | € - 0 |
| Cost Tracker | € - 0 | € - 0 |
| Quality Control Manager/Specialist | € - 0 | € - 0 |
| Database Developer | € - 0 | € - 0 |
| Database Administrator | € - 0 | € - 0 |
| € - 0 | € - 0 |
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