Exhibit 12 Daily Contract Inspection Report.docx

DAILY CONTRACT INSPECTION REPORT

(INSTRUCTIONS ON REVERSE SIDE)

1. CONTRACT NUMBER

2. SPECIFICATION NUMBER

6. ACTUAL DATE STARTED

8a. CONTRACTOR DESCRIBE WORK BEING PERFORMED (INCLUDE LOCATION OF WORK)

8b. NUMBER OF WORKERS ON JOB

8c. NAME OF CONTRACTOR’S REPRESENTATIVE

9b. CONTRACTOR RECORD GOVERNMENT REPRESENTATIVE’S INSTRUCTIONS (IF ANY)

10. CONTRACTOR DESCRIBE DIFFICULTIES ENCOUNTERED (INCLUDE DELAYS, DESCRIBE WORK NOT PERFORMED IN ACCORDANCE WITH SPECIFICATIONS, CORRECTIVE ACTIONS, ETC.)

11. INSPECTOR EVALUATE CONTRACTOR’S INPUT TO ITEMS 8, 9, AND 10

WAS A SITE INSPECTION PERFORMED OF THE WORK IDENTIFIED IN BLOCKS? ____YES ____ NO ____ N/A ________________________

(DATE OF INSPECTION)

12. ESTIMATED COMPLETION

DATE

15. INSPECTOR’S SIGNATURE AND DATE

16. ENGINEERING REVIEW (SIGNATURE AND DATE)

17. CONTRACTING ADMINISTRATOR’S SIGNATURE AND DATE

INSTRUCTIONS FOR FILLING OUT DAILY CONTRACT INSPECTION REPORTS

A. CONTRACTOR’S INSTRUCTIONS.

1. Fill out a report when you are working, one each day, and not less than one each week when you are not working. Give the report to the inspector or deliver it to the Contrating Officers Representative, HFB. If you are not working for a long period, waiting on materials, or waiting on a modification, fill out the report once a week.

2. Fill in Blocks 1 through 10, 14, and 19 daily or not less than once a week when no work is proceeding. Fill in Blocks 12 and 13 each Thursday and more often when appropriate. Government representatives will fill in the balance of the blanks.

3. Block 1 - Write in the Contract Number. The last two number groups are sufficient (i.e., 00-P-0000 for W91QVN-00-P-0000). The Inspector will show you this if you have any questions.

4. Block 2 - Write in the Contact Specifications (Spec) Number.

5. Block 3 - Write in the Contract Short Title from the front page of the Specifications.

6. Block 4 - Write in your company’s name.

7. Block 5 - Write in the date you were given the “Notice to Proceed” by the Contracting Officer.

8. Block 6 - Write in the date you started working on the contract.

9. Block 7 - If the weather affects your contract, record it here. If you are working indoors, leave it blank.

10. Block 8a - Write in what you’ve been doing, what you’ve been working on, location of the work, and facility/building number if it applies.

11. Block 8b - Write in the number of workers on the job consistent with the work described in Block 8a.

12. Block 8c - Write in the name of the contractor’s representative on the job at the time the work described in Block 8a was being performed.

13. Block 9 - Write in any instructions given to you by the Inspector, Contracting Officer’s Representative (COR) , or Project Manager.

14. Block 10 - Write in any problems you may have encountered. Read the instructions in this block.

15. Block 12 - Write in the estimated completion date of contract.

16. Block 13 - Fill in on Thursday’s report (see instruction 2); estimate percent of work completed.

17. Block 14 - The employee who makes the report, signs and dates here.

18. Block 18 - Write in the date(s) or period(s) covered by the report. This is NOT the day you turn it in.

19. Block 19 - This is a sequential report number (Example: If it’s the eleventh report you are turning in, write in “11”).

20. If you have any questions about the Daily Contract Inspection Report, call the HFB 753-6605, 753-7663. He/She is usually at this number Monday through Friday at the following times: 8:00 a.m. - 11:30 a.m. - 12:30 p.m. - 4:30 p.m.

21. If you want to hand-deliver the inspection reports, give them to the Inspector when he visits the job site or deliver them to Building 309.

B. INSPECTOR’S INSTRUCTIONS.

1. Block 11 - Inspector evaluate the input given by the contractor. Read the instructions in this block. If you have performed an inspection of the work identified by the contractor in Block 8, indicate this by checking “YES”; record the date of inspection. If no, check “NO”. If the work involved does not require inspection, check “N/A”. Provide any input, comments, etc., which are or may be relevant to the evaluation of the contractor’s work. Coordinate input with the COR, Contract Administrator, and/or Contractor, if required.

2. Block 15 - Sign and date the report. This date must be consistent with the date of your signature; do not backdate.

3. Forward the report to the COR for review and additional evaluation or instructions.

C. COR INSTRUCTIONS.

1. Engineering review report; add and/or attach comments. Coordinate input with Contracting Office, and/or Inspection, if required.

2. Block 16 - Sign and date report.