Attch7-DD1354_with_Checklist.pdf

TRANSFER AND ACCEPTANCE OF DoD REAL PROPERTY Form Approved OMB No. 0704-0188

PAGE OF PAGES

1. FROM (Organization Name) 2. DATE PREPARED

(YYYYMMDD)

3. PROJECT/JOB

NUMBER

4. SERIAL NUMBER

7. CONTRACT

NUMBER(S)

5. TO (Organization - Installation Code and Name) 6. RPSUID/SITENAME/

INSTCODE/INSTNAME

8. TRANSACTION DETAILS

a. METHOD (X all that apply)

ACQUISITION BY CONSTRUCTION

TRANSFER BETWEEN SERVICES

CAPITAL IMPROVEMENT

INVENTORY ADJUSTMENT

PARTIAL ASSET

PLACED-IN-SERVICE

TOTAL ASSET

PLACED-IN-SERVICE

9.

ITEM

NO.

11.

CATEGORY

CODE

12.

CATCODE

DESCRIPTION

14.

SUST.

CODE

20.

FUND

SOURCE

15.

PRIMARY

UM

18.

SECONDARY UM

QUANTITY

17.

SECONDARY

UM

16.

PRIMARY UM

QUANTITY

19.

COST

23.

ITEM

REMARKS

24. STATEMENT OF COMPLETION. The facilities listed hereon are in accordance with maps, drawings, and specifications and change orders approved by the authorized representative of the using agency except for the deficiencies listed on the reverse side.

25a. ACCEPTED BY (Typed Name and Signature) b. DATE SIGNED

(YYYYMMDD)

a. TRANSFERRED BY (Typed Name and Signature)

c. TITLE (Area Engr./Base Engr./DPW/Construction Agent)

b. DATE SIGNED

(YYYYMMDD)

c. TITLE (DPW/RPAO) 26. PROPERTY

VOUCHER NUMBER

PREVIOUS EDITION MAY BE USED.̀̀

b. WHEN/EVENT (X one)

7a. PLACED-IN-

SERVICE DATE

(YYYYMMDD)

c. TYPE (X one)

DRAFT INTERIMFINAL

10a.

FACILITY

NO.

AREA OTHER 21.

FUND

ORG

22.

INTER-

EST

CODE

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.

Adobe Designer 9.0

10b.

RPUID

13.

TYPE

CODE

The public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, Alexandria,VA 22350-3100 (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if itdoes not display a currently valid OMB control number.

DD FORM 1354, AUG 2013

27. CONSTRUCTION DEFICIENCIES (Attach blank sheet for continuations) 28. PROJECT REMARKS (Attach blank sheet for continuations)

INSTRUCTIONS

GENERAL. This form has been designed and issued for use in connection with the transfer of military real property between the military departments and to or from other government agencies. It supersedes ENG Forms 290 and 290B (formerly used by the Army and Air Force) and NAVDOCKS Form 2317 (formerly used by the Navy).

Existing instructions issued by the military departments relative to the preparation of DD Form 1354 are applicable to this revised form to the extent that the various items and columns on the superseded forms have been retained. The military departments may promulgate additional instructions, as appropriate.

For detailed instructions on how to fill out this form, please refer to Unified Facilities Criteria (UFC) 1-300-08, dated 16 April 2009 or later.

SPECIFIC DATA ITEMS.

1. From. Name of the transferring agency.

2. Date Prepared. Date of actual preparation. Enter all dates in YYYYMMDD format (Example: March 31, 2010 = 20100331).

3. Project/Job Number. Project number on a DD Form 1391 or Individual Job Order Number.

4. Serial Number. Sequential serial number assigned by the preparing organization (e.g., 2010-0001).

5. To. Name and address of the receiving installation, activity, and Service of the Real Property Accountable Officer (RPAO).

6. RPSUID/SITENAME/INSTCODE/INSTNAME. Site Unique Identifier and name or installation code and name where the constructed facility is located.

7. Contract Number(s). Contract number(s) for this project.

7a. Placed-In-Service Date. RPA Placed In Service Date. This is the date the asset is actually placed-in-service.

8. Transaction Details.

a. Method of Transaction. Mark (X) as many boxes as apply.

b. When/Event. When or event causing preparation of DD Form 1354. X only one box.

c. Type. Draft, interim, or final DD Form 1354. X only one box.

9. Item Number. Use a separate item number for each facility, no item number for additional usages.

10a. Facility Number. Assigned in accordance with the Installation/Base Master Numbering Plan.

10b. RPUID. Identified in Real Property Inventory.

11. Category Code. The category code describes the facility usage.

12. Catcode Description. The category code name which describes the facility usage.

13. Type. Type of construction: P for Permanent; S for Semi- permanent; T for Temporary.

14. Sustainability Code. Reports whether or not an asset meets the sustainability guidelines set forth in Section 2(g) of Executive Order 13514. Valid values are: 1 (asset meets the guidelines); 2 (asset does not meet the guidelines); 3 (asset not evaluated); 4 (asset not subject to guidelines).

15. Area: UM 1. Area unit of measure; use the unit of measure associated with the category code selected in 11.

16. Total Quantity UM 1. The total area for the measure identified in Item 15. Use negative numbers for demolition.

17. Other: UM 2. Unit of Measure 2 is the capacity or other measurement unit (e.g., LF, MB, EA, etc.).

18. Total Quantity UM 2. The total capacity/other for the measure identified in Item 17.

19. Cost. Cost for each facility; for capital improvements to existing facilities, show amount of increase only. If there is no increase for the capital improvement, enter N/A.

20. Fund Source. Enter the Fund Source Code for this item.

21. Funding Organization. Enter the code for the organization responsible for acquiring this facility.

22. Interest Code. Enter the code that reflects government interest or ownership in the facility.

23. Item Remarks. Remarks pertaining only to the item number identified in Item 9; show cost sharing.

24. Statement of Completion. Typed name, signature, title, and date of signature by the responsible transferring individual or agent.

25. Accepted By. Typed name, signature, title, and date of signature by the RPAO or accepting official.

26. Property Voucher Number. Next sequential number assigned by the RPAO in voucher register.

27. Construction Deficiencies. List construction deficiencies in project during contractor turnover inspection.

28. Project Remarks. Project level remarks and continuation of blocks.

DD FORM 1354 (BACK), AUG 2013

DD Form 1354 Checklist

DD Form 1354 Checklist

Description/Title: Repair MWD Kennel Sewer Drainage Project #: MPYJ150009

BOD Date:

Total Project Cost $ - 0 calixa: Do not input data in this cell. It will pre-fill once cost data is entered below.

1. General Building Data.

Category Codes Nomenclature Total Cost Total SF

$ - 0

$ - 0

$ - 0

Exterior Dimensions: Square Footage

Main Bldg:

Wings:

Offsets:

No. of Stories:

Dimensions of Covered Walkways/Corridors:

Type of Construction:

Foundation:

Floors:

Exterior Walls:

Roof:

Utilities:

Water (Type and size of pipe):

Gas (Type and size of pipe):

Electric (Phase, voltage, wire):

Other Utility (Type, capacity, etc.):

2. Installed Systems & Plants.

Fire Protection.

Category Nomenclature Unit Quantity Cost

880-211 Closed Head Auto Sprinklers SFIHD $ - 0

880-212 Open Head Deluge System SFIHD $ - 0

880-216 Pre-action Sprinkler System SF/HD $ - 0

880-217 AFFF PA Sprinkler System SF/HD $ - 0

880-218 Hi-expansion Foam, System EA $ - 0

880-221 Auto Fire Protection System SF/EA $ - 0

880-222 Manual Fire Alarm System EA $ - 0

880-231 CO2 Fire System EA $ - 0

880-232 Foam Fire System EA $ - 0

880-233 Other Fire System EA $ - 0

880-234 Halon 1301 Fire System EA $ - 0

880-235 Dry Chemical System EA $ - 0

880-236 Foam System EA $ - 0

Total Fire Protection Cost $ - 0 calixa: Do not input data in this cell. It totals Fire Protection RPIE cost automatically.

Security.

Category Nomenclature Unit Quantity Cost

872-841 Security Alarm System EA $ - 0

Installed Plants.

Category Nomenclature Unit Quantity Cost

890-124 A/C From Central Plant SF $ - 0

890-126 A/C Window Units SF/TN $ - 0

890-125 A/C Plant < 5 Tons SF/TN $ - 0

890-121 A/C Plant 5 to 25 Tons TN $ - 0

826-122 A/C Plant 25 - 100 Tons TN $ - 0

826-123 A/C Plant Over 100 Tons TN $ - 0

821-115 Heating Plant MB $ - 0

811-147 Emergency Power Generator KW $ - 0

124-XXX Fuel Tank for Htg/Generator GA $ - 0

Total Installed Plants Cost $ - 0 calixa: Do not input data in this cell. It totals Installed Plants RPIE cost automatically.

calixa: Do not input data in this cell. It will pre-fill once cost data is entered below.

3. Related Facilities.

Category Nomenclature Unit Quantity Cost

116-XXX Pads (Type: SY $ - 0

411-XXX Large Storage Tanks BL $ - 0

Contents:

*Transformers KVA $ - 0

*Power Poles LF/EA $ - 0

*Transformers KVA $ - 0

*Power Poles LF/EA $ - 0

831-169 Sewage Septic Tank KG $ - 0

841-161 Water Supply Mains LF $ - 0

Category Nomenclature Unit Quantity Cost

890-144 Compressed Air Distr (x-line) LF $ - 0

890-158 Load/Unload Platform (x-line) SF $ - 0

890-187 Utility Vault (x-line) SF $ - 0

890-272 EMCS Field Equipment (x-line) EA $ - 0

890-273 EMCS Data Links (x-line) LF $ - 0

135-583 Telephone Duct LF $ - 0

135-586 Telephone Pole LF/EA $ - 0

Total Related Facilities Cost $ - 0 calixa: Do not input data in this cell. It totals Related Facilities cost automatically.

(Note: " * " denotes Facility Number)

Demolition Cost Related to Project 1 JB $ - 0

Construction Deficiencies (attach blank sheet for continuations)

Project Remarks (attach blank sheet for continuations)

4. Additions to Existing Facilities. Use checklists 1 - 3 above. Include any plants, systems, real property installed equipment, or related facilities added, removed, or replaced.

5. Alterations or Renovations to Existing Facilities. Use checklists 1 - 3 above. Include plants, systems, real property installed equipment, or related facilities added, removed, or replaced. If demolition of existing facilities was a part of the project, include the specifics and costs related to the demolition.

6. Remarks. Where needed, add any explanatory remarks or descriptions, which more fully describe items.

7. When is a DD Form 1354 Required?

* Initial construction of a new facility

* Addition to an existing facility

* Demolition of an existing facility (and all its associated related real property)

* Removal of, or upgrade to, an installed system

* In general, if the project was funded in part or in whole with minor construction (EEIC 529) or MCP funds, a DD Form 1354 is required in order to transfer the completed construction to real property records.

DD Form 1354, Transfer and Acceptance of DoD Real Property, August 2013

WHS/ESD/IMD

9.0.0.2.20120627.2.874785 TRANSFER AND ACCEPTANCE OF DoD REAL PROPERTY Form Approved OMB No. 0704-0188

PAGE

OF

PAGES

1. FROM (Organization Name)

2. DATE PREPARED

(YYYYMMDD)

3. PROJECT/JOB

NUMBER

4. SERIAL NUMBER

7. CONTRACT

NUMBER(S)

5. TO (Organization - Installation Code and Name)

6. RPSUID/SITENAME/

INSTCODE/INSTNAME

8. TRANSACTION DETAILS

a. METHOD (X all that apply)

ACQUISITION BY CONSTRUCTION

TRANSFER BETWEEN SERVICES

CAPITAL IMPROVEMENT

INVENTORY ADJUSTMENT

PARTIAL ASSET

PLACED-IN-SERVICE

TOTAL ASSET

PLACED-IN-SERVICE

9.

ITEM

NO.

11.

CATEGORY

CODE

12.

CATCODE

DESCRIPTION

14.

SUST.

CODE

20.

FUND

SOURCE

15.

PRIMARY

UM

18.

SECONDARY UM

QUANTITY

17.

SECONDARY

UM

16.

PRIMARY UM

QUANTITY

19.

COST

23.

ITEM

REMARKS

24. STATEMENT OF COMPLETION. The facilities listed hereon are in accordance with maps, drawings, and specifications and change orders approved by the authorized representative of the using agency except for the deficiencies listed on the reverse side.

25a. ACCEPTED BY (Typed Name and Signature)

b. DATE SIGNED

(YYYYMMDD)

a. TRANSFERRED BY (Typed Name and Signature)

c. TITLE (Area Engr./Base Engr./DPW/Construction Agent)

b. DATE SIGNED

(YYYYMMDD)

c. TITLE (DPW/RPAO)

26. PROPERTY

VOUCHER NUMBER

PREVIOUS EDITION MAY BE USED.̀̀

b. WHEN/EVENT (X one) 7a. PLACED-IN-

SERVICE DATE

(YYYYMMDD)

c. TYPE (X one)

DRAFT

INTERIM

FINAL

10a.

FACILITY

NO.

AREA

OTHER

21.

FUND

ORG

22.

INTER-

EST

CODE

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.

Adobe Designer 9.0 10b.

RPUID

13.

TYPE

CODE

The public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, Alexandria,VA 22350-3100 (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if itdoes not display a currently valid OMB control number.

DD FORM 1354, AUG 2013

27. CONSTRUCTION DEFICIENCIES (Attach blank sheet for continuations)

28. PROJECT REMARKS (Attach blank sheet for continuations)

INSTRUCTIONS

GENERAL. This form has been designed and issued for use in connection with the transfer of military real property between the military departments and to or from other government agencies. It supersedes ENG Forms 290 and 290B (formerly used by the Army and Air Force) and NAVDOCKS Form 2317 (formerly used by the Navy).

Existing instructions issued by the military departments relative to the preparation of DD Form 1354 are applicable to this revised form to the extent that the various items and columns on the superseded forms have been retained. The military departments may promulgate additional instructions, as appropriate.

For detailed instructions on how to fill out this form, please refer to Unified Facilities Criteria (UFC) 1-300-08, dated 16 April 2009 or later.

SPECIFIC DATA ITEMS.

1. From. Name of the transferring agency.

2. Date Prepared. Date of actual preparation. Enter all dates in YYYYMMDD format (Example: March 31, 2010 = 20100331).

3. Project/Job Number. Project number on a DD Form 1391 or Individual Job Order Number.

4. Serial Number. Sequential serial number assigned by the preparing organization (e.g., 2010-0001).

5. To. Name and address of the receiving installation, activity, and Service of the Real Property Accountable Officer (RPAO).

6. RPSUID/SITENAME/INSTCODE/INSTNAME. Site Unique Identifier and name or installation code and name where the constructed facility is located.

7. Contract Number(s). Contract number(s) for this project.

7a. Placed-In-Service Date. RPA Placed In Service Date. This is the date the asset is actually placed-in-service.

8. Transaction Details.

a. Method of Transaction. Mark (X) as many boxes as apply.

b. When/Event. When or event causing preparation of DD Form 1354. X only one box.

c. Type. Draft, interim, or final DD Form 1354. X only one box.

9. Item Number. Use a separate item number for each facility, no item number for additional usages.

10a. Facility Number. Assigned in accordance with the Installation/Base Master Numbering Plan.

10b. RPUID. Identified in Real Property Inventory.

11. Category Code. The category code describes the facility usage.

12. Catcode Description. The category code name which describes the facility usage.

13. Type. Type of construction: P for Permanent; S for Semi- permanent; T for Temporary.

14. Sustainability Code. Reports whether or not an asset meets the sustainability guidelines set forth in Section 2(g) of Executive Order 13514. Valid values are: 1 (asset meets the guidelines); 2 (asset does not meet the guidelines); 3 (asset not evaluated); 4 (asset not subject to guidelines).

15. Area: UM 1. Area unit of measure; use the unit of measure associated with the category code selected in 11.

16. Total Quantity UM 1. The total area for the measure identified in Item 15. Use negative numbers for demolition.

17. Other: UM 2. Unit of Measure 2 is the capacity or other measurement unit (e.g., LF, MB, EA, etc.).

18. Total Quantity UM 2. The total capacity/other for the measure identified in Item 17.

19. Cost. Cost for each facility; for capital improvements to existing facilities, show amount of increase only. If there is no increase for the capital improvement, enter N/A.

20. Fund Source. Enter the Fund Source Code for this item.

21. Funding Organization. Enter the code for the organization responsible for acquiring this facility.

22. Interest Code. Enter the code that reflects government interest or ownership in the facility.

23. Item Remarks. Remarks pertaining only to the item number identified in Item 9; show cost sharing.

24. Statement of Completion. Typed name, signature, title, and date of signature by the responsible transferring individual or agent.

25. Accepted By. Typed name, signature, title, and date of signature by the RPAO or accepting official.

26. Property Voucher Number. Next sequential number assigned by the RPAO in voucher register.

27. Construction Deficiencies. List construction deficiencies in project during contractor turnover inspection.

28. Project Remarks. Project level remarks and continuation of blocks.

DD FORM 1354 (BACK), AUG 2013