Exhibit B.doc

DOC document 26 KB Posted Nov 1, 2016

Attached to: Addendum No. 3-PNEUMATIC RUBBER TIRED ROLLER
Solicitation number: CRFQ 0803 DOT1700000019 4
Issued by: Taylor County, West Virginia

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Written by GovTribe AI · Mar 12, 2026

This is an Equipment Preventative Maintenance Questionnaire form required by the West Virginia Department of Transportation (WVDOH) that must be completed in its entirety by the successful bidder or manufacturer's technical representative prior to equipment delivery.

The questionnaire requests comprehensive technical specifications for equipment being procured, including detailed information about the equipment itself (make, model, year, and purchase amount), engine specifications (make, model, fuel type, horsepower, cylinder count, and serial number), cooling system capacity, belt descriptions and part numbers, and axle and tire specifications. The form also requires documentation of critical component specifications including battery, spark plugs or fuel injectors, fuel pumps or injection pumps, alternators, starters, turbochargers, transmissions, hydraulic pumps, and all relevant filters with part numbers. Additionally, the vendor must provide contact information for a designated contact person and specify lubricant manufacturers and types for various systems including engine oil, transmission fluid, power steering fluid, brake fluid, coolant, hydraulic fluid, and differential fluid.

The questionnaire does not contain pricing information, set-asides, incumbent contractor details, contract terms, renewal options, or funding sources. This form serves solely as a technical documentation requirement to ensure WVDOH has complete equipment specifications and maintenance information necessary for ongoing support and preventative maintenance programs.

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Other files

File	Type	Posted
Exhibit A-Cost Sheet.xlsx	XLSX spreadsheet	Nov 1, 2016
Final_CRFQ_0803_DOT1700000019_3_CRFQ_FORM.PDF	PDF	Nov 1, 2016
Addendum No3-CRFQ DOT1700000019.pdf	PDF	Nov 1, 2016
Final_CRFQ_0803_DOT1700000019_4_CRFQ_FORM.PDF	PDF	Nov 1, 2016
Addendum No1-CRFQ DOT1700000019.pdf	PDF	Nov 1, 2016
Solicitation Documents.pdf	PDF	Nov 1, 2016
Final_CRFQ_0803_DOT1700000019_1_CRFQ_FORM.PDF	PDF	Nov 1, 2016
Addendum No2-CRFQ DOT1700000019.pdf	PDF	Nov 1, 2016
Exhibit C-OSHA Act of 1970.pdf	PDF	Nov 1, 2016
Final_CRFQ_0803_DOT1700000019_2_CRFQ_FORM.PDF	PDF	Nov 1, 2016

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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: ________________________

HORSEPOWER: _______________

CYLINDER: ________

ENGINE SERIAL: __________________________

COOLING SYSTEM CAPACITY: ______________________

BELTS:

DESCRIPTION:

PART NUMBERS:

GVW: _______________________AXLE CAPACITY:FRONT: ______________

REAR:______________

TIRES:

FRONT MAKE & SIZE: ______________________________________________

REAR MAKE & SIZE: _______________________________________________

DIMENSIONS OF UNIT:

LENGTH: __________

WIDTH: ______________

LENGTH: ___________

VENDOR CONTACT PERSON: ____________________________________

PHONE: __________________________

PARTS:

BATTERY MAKE: ____________________

MODEL: ___________________

CCA: _______________________