Exhibit B.pdf
PDF 49 KB Posted
- Attached to
- ADDENDUM 2 CONVEYOR LOADER (7019EC10)
- Solicitation number
- CRFQ 0803 DOT1900000122 3
- Issued by
- Summers County, West Virginia
About this file
This is an Equipment Preventative Maintenance Questionnaire form required by the West Virginia Department of Transportation (WVDOH) for successful bidders or manufacturers' technical representatives to complete prior to equipment delivery.
The form requires comprehensive documentation of equipment specifications and maintenance requirements across multiple categories. Bidders must provide detailed information on the primary equipment including make, model, year, and purchase amount, followed by engine specifications such as make, model, fuel type, horsepower, cylinder count, and serial number. The form also requests cooling system capacity, belt descriptions with part numbers, and vehicle specifications including GVW, axle capacity, tire information, and unit dimensions. A vendor contact person and phone number must be designated.
The questionnaire requires extensive parts documentation, specifically identifying manufacturers and part numbers for batteries, spark plugs or fuel injectors, fuel pumps or injection pumps, alternators, starters, turbochargers, and transmissions. Additionally, the form mandates detailed filter information organized by type, including engine oil, transmission, air inner and outer, power steering, fuel primary and secondary, hydraulic, and differential filters. Lubricant specifications for coolant, brake fluid, and hydraulic fluid must also be documented. This comprehensive information collection ensures that the WVDOH maintains detailed maintenance records and procurement data for all equipment received through the contract, facilitating future preventative maintenance scheduling and parts procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum 2.pdf | ||
| Final_CRFQ_0803_DOT1900000122_1_CRFQ_FORM.PDF | ||
| Complete Solicitation Documents.pdf | ||
| Final_CRFQ_0803_DOT1900000122_2_CRFQ_FORM.PDF | ||
| Exhibit A Pricing Page.xlsx | XLSX spreadsheet | |
| Final_CRFQ_0803_DOT1900000122_3_CRFQ_FORM.PDF | ||
| PLEASE READ-INSTRUCTIONS TO BIDDERS.pdf | ||
| Addendum 1.pdf |
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Text version
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: _______________________
TOP OR SIDE POST: __________________ DIMENSIONS: LENGTH ________ WIDTH ________ HEIGHT __________
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 __________________________________________
AIR INNER __________________________________ TRANSMISSION__________________________________________
AIR OUTER__________________________________ POWER STEERING _______________________________________
FUEL PRIMARY ______________________________ HYDRAULIC __________________________________________
FUEL SECONDARY ___________________________ DIFFERENTIALS _________________________________________
COOLANT __________________________________ BRAKE FLUID __________________________________________
HYDRAULIC _______________________________ COOLANT __________________________________________
OTHER __________________________________ OTHER __________________________________________
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