CRFQ DOT2000000170_Exhibit B Equipment Questionnaire.pdf

49 KB Posted

Attached to
SLOW WEIGHT IN MOTION SCALE (7020E040)
Solicitation number
CRFQ 0803 DOT2000000170 1
Issued by
Taylor County, West Virginia

About this file

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This is an Equipment Preventative Maintenance Questionnaire form for the West Virginia Department of Transportation (WVDOH), required as part of CRFQ DOT2000000170. The form must be completed in its entirety by the successful bidder or manufacturer's technical representative prior to equipment delivery to the WVDOH. The questionnaire requires comprehensive documentation of equipment specifications including description, make, model, and year, as well as detailed engine information such as make, model, fuel type, horsepower, and cylinder count. Additionally, the form requests specifications for critical components including belts, tires, transmission, alternator, starter, turbocharger, and hydraulic systems, along with vehicle dimensions (length, width, height) and weight ratings (GVW, GVWR, and axle capacity). The vendor must provide contact person information and phone numbers for reference purposes.

The questionnaire also mandates documentation of all fluid specifications and filter types required for equipment maintenance, including engine oil weight, transmission fluid type, power steering fluid type, hydraulic oil weight, coolant type, and brake fluid type. Vendors must identify manufacturers and part numbers for batteries, spark plugs or fuel injectors, fuel pumps, alternators, starters, and turbochargers. The form includes additional sections for other components and specifications as applicable to the specific equipment being procured. No pricing information, contract terms, set-asides, incumbency details, or award dates are specified in this questionnaire document.

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EXHIBIT B

EQUIPMENT PREVENTATIVE MAINTENANCE QUESTIONNAIRE

THIS FORM MUST BE COMPLETED IN ITS ENTIRETY BY SUCCESSFUL BIDDER OR MANUFACTURER’S TECHNICAL

REPRESENTATIVE PRIOR TO DELIVERY TO THE WVDOH.

DESCRIPTION: _______________________________________ MAKE: ___________________________________

MODEL: ________________________ YEAR: __________ PURCHASE AMOUNT: ______________________

ENGINE: MAKE: ______________________ MODEL: __________________ FUEL TYPE: _______GALLONS:_______

HORSEPOWER: _______________ CYLINDER: ________ ENGINE SERIAL: __________________________

BELTS: DESCRIPTION: PART NUMBERS:

GVW: ____________GVWR_____________AXLE CAPACITY: FRONT: ______________REAR:______________

TIRES: FRONT MAKE & SIZE: ______________________________________________

REAR MAKE & SIZE: _______________________________________________

DIMENSIONS OF UNIT: LENGTH: __________ WIDTH: ______________ HEIGHT: ___________

VENDOR CONTACT PERSON: ____________________________________ PHONE: __________________________

PARTS:

BATTERY MAKE: ____________________ MODEL: ___________________ CCA: _______________________

SPARK PLUGS OR FUEL INJECTORS MAKE: ______________ PART # __________________________________________

FUEL PUMP OR INJECTION PUMP MAKE: ________________ MODEL: _________________________________________

ALTERNATOR MAKE: __________________________________ PART #:__________________________________________

STARTER MAKE: ______________________________________ PART #: _________________________________________

TURBO CHARGER MAKE: ______________________________ PART #: _________________________________________

TRANS. MAKE: ____________________ MODEL: _________________________ AUTO/MANUAL: ____________________

HYDRAULIC PUMP MAKE: _____________________________ MODEL: _________________________________________

FILTERS MAKE PART NO. LUBRICANT MANUFACTURER TYPE

OIL __________________________________ ENGINE OIL WEIGHT ___________________________________

AIR INNER __________________________________ TRANSMISSION FLUID TYPE______________________________

AIR OUTER__________________________________ POWER STEERING FLUID TYPE____________________________

FUEL PRIMARY ______________________________ HYDRAULIC OIL WEIGHT_________________________________

FUEL SECONDARY ___________________________ DIFFERENTIALS OIL WEIGHT_____________________________

COOLANT __________________________________ BRAKE FLUID TYPE______________________________________

HYDRAULIC _______________________________ COOLANT TYPE__________________________________________

OTHER __________________________________ OTHER __________________________________________________

OTHER______________________________________ OTHER __________________________________________________

OTHER______________________________________ OTHER___________________________________________________

OTHER______________________________________ OTHER___________________________________________________

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