Exhibit 5 - Blank Daily Inspection.pdf

DAILY CONTRACT INSPECTION REPORT

1. CONTRACT NUMBER

2. SPECIFICATION NUMBER

Task Order #

5. NOTICE TO PROCEED DATE

6. ACTUAL DATE STARTED

Company #Emp Trade Total Hours

Equipment Data O / R Hours Used Hours Standby HRS THIS DATE

PREVIOUS HRS

TOTAL HOURS

8b. NUMBER OF WORKERS ON JOB

11.GOVERNMENT REPRESENTATIVE COMMENTS (comments to items 8,9, and 10) Was site inspection performed of any work? Date of inspection.________________ No NA

13. CONTRACT COMPLETION DATE

19. DATE OF REPORT (S)

REV. 11-22-05

AM

Work Performed

14. PERCENT COMPLETE

8c. NAME OF CONTRACTOR'S REPRESENTATIVE

15. QUALITY CONTROL SIGNATURE AND DATE

(i.e. materials received, off site activities, three phase meetings-inspections) 9. CONTRACTOR INSTRUCTIONS GIVEN/RECEIVED

12. SAFETY OBSERVATIONS

Contractor Verification: The above report is complete and correct. All material, equipment used, and work performed

16. QUALITY ASSURANCE SIGNATURE AND DATE

during this reporting period are in compliance with the contract documents except as noted above.

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

17. PROJECT MANAGER REVIEW

18. CONTRACTING ADMINISTRATOR'S SIGNATURE AND DATE 20. REPORT SERIAL NUMBER

4. NAME OF CONTRACTOR (COMPANY NAME)

7. WEATHER AND TEMPERATURE

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

PM

3. ABBREVIATED CONTRACT NAME

Block 1 Government contract number (Stays the same for all remaining reports).

Block 2 Government Task Order number (Stays the same for all remaining reports).

Block 3 Contract name (shorten with abbreviations if needed and Stays the same for all remaining reports).

Block 4 General Contractor Name (Stays the same for all remaining reports).

Block 5 Notice to proceed date (Stays the same for all remaining reports).

Block 6 should stay blank until the first day of site work then that date (Stays the same for all remaining reports).

Block 7 add approximate temp to description and you are good, nothing needed on no work days unless the weather is the cause for the no work.

Blocks 8a – 8c covers Number of workers and company they work for, plus equipment on site and hours, (note check your contract and umbrella contract for required information).

Block 11 is for government comments.

Block 12 I think you understand.

Block 13 is the Legal completion date for the contract, and can change if there is an extension to the contract by the contracting officer.

Block 14 percent complete based on entire contract; please note contracts can have multiple jobs (Contract Line Item Number, CLIN percentage is based on entire task order).

Block 15 is your QC signature (who checks them and sends them to the Government QAR, please check them completely to avoid revised reports).

Blocks 16-18 is for government use.

Block 19 is the date of the report being filed.

Block 20 is the serial number of the reports for the project.

peter.subitch Typewritten Text When completed print to a PDF prior to sending the daily to your QAR and only send the now non-fillable version.

peter.subitch Typewritten Text

PWDAYL