Swimming Pool Mx PWS (DRAFT).pdf

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Swimming Pool & Splash Park Seasonal Maintenance
Solicitation number
FA4497-Swimming_Pool_Mx
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This is a Performance Work Statement for annual swimming pool and splash park startup and closure services at Dover Air Force Base, Delaware, effective January 15, 2026. The contractor must provide all management, tools, supplies, equipment, and labor necessary to open and close the 224,400-gallon swimming pool/water slide and splash park facility, with the government supplying CO2 and liquid chlorine while the contractor supplies startup water balancing chemicals and winterization chemicals.

Pool startup occurs during the first week of May (opening for Memorial Day weekend) and includes removing and cleaning the pool cover, draining sediment if needed, installing pump strainer baskets, cleaning and calibrating pH and ORP sensors, ensuring chlorine and CO2 tanks are full, filling the pool to correct level, circulating water through 650 GPM filters, balancing water chemicals, connecting slide pump piping, and checking chemical feed pumps. Pool closure occurs by the third week of September (after Labor Day) and involves removing residual chlorine, draining the pool to 8 inches below the gutter, adding winterization chemicals, cleaning and storing sensors, draining all piping and equipment, and reinstalling the cover. Splash park startup and closure follow similar procedures including manifold piping connection, filter cleaning, UST inspection, and chemical feed system preparation. The contractor must respond to service repair requests within 48 hours and submit service tickets within three business days. Pool operators must hold valid certifications passed within the last three years, and any electrical work must comply with 2023 NEC standards completed by licensed electricians. A pre-opening site meeting two weeks prior involves Base Safety, Public Health (Bioenvironmental), WFSM, FSS Pool Manager, the contractor, and the CES Contracting Officer Representative, with Bioenvironmental conducting independent water quality testing seven days before opening. The contractor must maintain quality control per industry standards, provide all required Safety Data Sheets for chemicals with DAFB Instruction 32-7003 approval, dispose of all hazardous waste per federal/state/local regulations, maintain CMRA labor reporting at http://www.ecmra.mil, and comply with all security, badge, OPSEC, antiterrorism, and base access requirements outlined in sections 3.0-6.0 of the PWS.

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PERFORMANCE WORK STATEMENT

FOR

Annual Swimming

Pool/Splash Park Startup

& Close

Including

Water Balancing

Chemicals Requirement for

Startup & Close

Dover AFB, Delaware

15 January 2026

PERFORMANCE WORK

STATEMENT FOR

Annual Swimming Pool & Splash Park Startup &

Close – Bldg. 841 Startup Chemicals & Water

Balancing Requirement

Overview

Facility 841 on Dover Air Force Base is a mechanical room and bathroom facility that houses the mechanical equipment supporting the Dover Air Force Base 224,400-gallon swimming pool/water slide operation as well as the splash park. This Performance Work Statement is intended to describe what work is required for the annual opening and closing of the swimming pool/water slide and splash park that pertains to the mechanical equipment for chlorination and water circulation as well as chemical balancing of the water. Additionally, the contractor shall repair or replace any mechanical equipment and appurtenances that affect the swimming pool/water slide and splash park water quality and operation as designed. Work shall be performed in a timely manner for seasonal startup and close of pool/splash park operation. Prior to repairing or replacement of mechanical equipment and appurtenance for the swimming pool/splash park the contractor will first contact the 436th CES Contracting Officer Representative for approval. For any repair or replacement of equipment or appurtenances pertaining to 436th FSS splash park, slide, diving board, rock-climbing wall and pool cover please contact the 436th FSS manager for approval. This Performance Work Statement shall serve as a basis for contracting work as listed below but may not be all inclusive.

1. DESCRIPTION OF SERVICES. The service contractor shall provide all management, tools, supplies, equipment and labor necessary to open and close the swimming pool and splash park facility. The government will supply all CO2 and liquid chlorine and the contractor will supply all the startup water balancing chemicals to use for pool/splash park startup operations.

Additionally, the contractor is responsible for providing all winterization chemicals for pool and splash park closure. A site meeting will need to be conducted two weeks prior to the opening day of the pool season to include Base Safety Office Representative, Base Public Health

(Bioenvironmental), WFSM Representative, FSS Pool Manager, Contractor, and the CES

Contracting Officer Representative. Final approval for opening of the pool for the season will be accomplished by the Dover AFB Bioenvironmental section through their own independent water quality testing for proper pH and chlorine residual. Bioenvironmental will need to conduct the water quality testing seven days prior to the season opening of the swimming pool facility and splash park in case water quality chemistry adjustments are necessary.

*The contractor shall perform the following tasks as outlined but does not relieve the contractor from the responsibility to perform additional tasks as necessary to accomplish this requirement as described above.

1a. Start up (POOL): 1st week of May (Open to Customers Memorial Day Weekend)

1. Remove the cover and anchors from the decking- Clean per manufacturer’s instruction and store in a manner that prevents damage by moisture or insects or rodents. (Store Cover in Shed Located in

Pool Yard)

2. Drain the pool only if needed to remove heavy sediment, pressure wash/scrub the liner as needed.

(Recommend Contractor Provide Aquatic Robotic Pool Cleaning equipment for Startup)

3. Remove/inspect/reinstall the main drain covers.

4. Install/clean pump strainer baskets for main pool and splash pad per manufacturer’s instruction.

5. Clean chemical controller pH and ORP sensors with dish soap, install probes and calibrate equipment. (Probes stored at 436 CES WFSM Shop# 302-677-4786)

6. Ensure liquid chlorine storage tanks are full - 150 gallons per tank. (Provided by 436th CES, WFSM

Shop Coordination)

7. Ensure the CO2 storage tank is full (Provided by 436th CES, 436th WFSM Shop Coordination).

8. Fill the pool to the correct level, circulate water through the filters (650 GPM) via the installed pump and balance the water chemicals. (Water balancing chemicals provided by Contractor)

9. Fill all associated piping and equipment (sand filter, controller, pumps) for main pool with water.

10. Connect the suction/discharge piping and check valve assembly to the slide pump with new bolts and gaskets if needed. (Slide Pump Replacement or Rebuild Responsibility of 436th FSS).

11. Grease the slide pump and motor.

12. Prime the slide pump and establish a flow rate of 650-700 GPM.

13. Check existing chemical feed pumps for proper operation and calibration.

1b. Close (POOL): By 3rd week of September (Closes to Customers after Labor Day Weekend)

1. Remove residual Chlorine from the storage tanks and place in the pool. Purge chemical treatment systems with clean water to remove residual chemicals from pipe/equipment.

2. Drain the pool to a level 8-inches below the gutter to avoid freeze damage to the gutter.

3. Remove the strainers from the gutter and main pool pump.

4. Remove pump strainer baskets from main pool.

5. Add winterization chemicals to pool (Provided by Contractor)

6. Remove, and clean chemical controller pH and ORP sensors (main pool and splash pad) with dish soap. Store in temperature-controlled area (Stored at 436th CE, WFSM Shop (302) 677-4786)

7. Drain water from all associated piping and equipment (sand filter, controller, pumps)

8. Reinstall the cover and anchors

9. Remove the suction/discharge piping and check valve assembly to the slide pump and store in shed located in pool yard. Attach blind flange on pump suction/discharge piping during off season.

1c. Start Up (SPLASH PARK) – 1st Week of May (Opens to Customers Memorial Day

Weekend)

1. Connect manifold piping

2. Install fixture cover plates

3. Install and test Underground Storage Tank (UST) fill line and backflow prevention device

4. Remove manhole cover to clean/Inspect 1000 gallon (UST), reinstall manhole cover.

5. Clean/install filters & strainers per manufacturers instruction

6. Clean chemical controller pH and ORP sensors with dish soap, install probes. (Probes stored at

436 FSS Bldg.476, Telephone (302-677-3978 during offseason)

7. Fill the chemical feed tank with new chlorine (Provided by 436th CES, WFSM Shop Coordination.

To be reimbursed by 436th FSS)

8. Check and adjust chemical feed pumps and water pump for proper operation

9. Perform a flow test to check for leaks and proper operation of sensors/timers

1d. Close (SPLASH PARK) - By 3rd week of September (Closes to Customers after Labor Day

Weekend)

1. Remove the water features and spray nozzles from all connections including the floor- store in a manner to prevent damage. Disconnect manifold piping and purge with compressed air to remove water and prevent from freezing for each water feature- Plug or cover each line to prevent debris/water from entering.

2. Purge with water, then blow compressed air through the chemical feed and controller lines to remove water and prevent from freezing. Plug or cover each line to prevent debris/water from entering

3. Remove UST fill line backflow device- store in a manner that prevents freeze damage.

4. Disconnect all pumps and remove strainer basket and drain water to prevent freezing, store in a manner that prevents damage.

5. Remove and clean filter cartridges and store in dry area until season reopening.

6. Remove and clean chemical controller pH and ORP sensors with dish soap. Store in temperature-controlled area (Probes stored at 436 FSS Bldg. 476, Telephone (302-677-3978 during offseason)

7. Drain water from the 1000-gallon UST & clean/inspect the tank. Install manhole cover

8. Remove residual Chlorine from 50-gallon storage tank and place in the pool

9. Add winterization chemicals to splash park system as needed (provided by Contractor)

1.1 SERVICE REPAIRS. The contractor may be requested to respond in order to fix a known issue with a specific system or component IAW industry standard. The contractor shall be capable of providing replacement parts, maintenance and programming services for swimming pool/splash Park mechanical equipment and chemical controllers. Response time of

48 hours from initial notification.

1.2 CLEANUP. Upon completion of w o r k , the contractor shall dispose of debris gene ra t ed as w e l l a s g eneral cleanup of t h e area including removal o f o l d p a r t s and any other materials accumulated during w o r k . D isposal of a l l debris to include old filter media i f i t is d e t e r m i n e d n e c e s s a r y t o b e r e p l a c e d i s the responsibility of the contractor and is to be removed from Dover AFB and disposed of in accordance with all Federal, State and Local regulations.

1.3 CERTIFICATIONS.

1.3.1 Pool Operator Requirements

a. Have passed a pool operator exam within the last three years.

b. Have a valid pool operator certificate.

c. Demonstrate knowledge and be able to take the necessary actions to address aquatic health and safety issues.

d. Any and all electrical equipment to be installed will be completed by a licensed electrician.

1.4 STANDARDS. All electrical work will comply with the 2020 NFPA 70 National Electric

Code (2023 NEC). Raceways will be PVC Conduit or Liquid tight Flexible Metallic or Non-

Metallic conduit. All enclosures will be NEMA Type 4X. All circuits required to support the work described in this paragraph will be installed to meet a wet location rated environment

IAW the 2023 NEC.

1.5 SERVICE DELIVERY SUMMARY.

Performance Objective PWS Para Performance Threshold

Perform Spring opening of Pool/Splash Park.

1A & 1C

Mechanical systems and controls are operational upon completion of work. Balance pool water chemistry to industry standards 100% of the time.

Perform Fall closing of Pool/Splash Park. 1B & 1D Mechanical systems are disassembled and drained and chemical controllers and pumps are shut off and winterized and probes are stored properly upon completion of work. Winter chemicals are added to pool water chemistry to industry standards 100% of the time.

Perform Service Repairs to Pool/Splash Park Systems or Components as Requested.

1.1 Repairs completed as requested

and system 100% operational.

Contractor responds within 48 hours from time of notification.

Service tickets are submitted within 3 business days of work completion.

2.0 GENERAL INFORMATION.

2.1 Records Management. The contractor understands that when creating, handling, and maintaining records for the Air Force, either electronic or paper, you must meet the requirements established in AFRIMS Records Disposition Schedule (RDS), AFI 33-322, Records Management Program. In order to meet the requirements established IAW the above-mentioned regulations contact the Base Records Management Office (436 CS/SCXK, Bldg.

310) at (302) 677-5157 for guidance and training.

2.2 Contractor shall perform all work in strict accordance with the highest safety standards and applicable OSHA guidelines in order to eliminate the possibility of personal injury and damage to equipment and building structures. Work shall be in accordance with

NFPA 70, UFC 3-230-02 and applicable Air Force AFI’s for inspecting, testing and maintaining Swimming Pools.

2.3 Upon seasonal opening, the contractor is responsible for ensuring all i n s t a l l e d m a t e r i a l a n d equipment p e r f o r m satisfactorily.

2.4 The contractor shall turnover all manufacturer documentation, drawings and warranties related to any parts or components replaced. Documentation shall be in compliance with item

2.1 Records Management.

2.5 MATERIALS: The contractor shall provide all materials necessary to provide a professionally completed job. This includes all personal protective equipment and cleaning products. The contractor shall submit Safety Data Sheets (SDS) of all chemicals planned for use on Dover AFB and fill out the attached documents for approval. The contractor must receive approval on DAFB Instruction 32-7003 for these items prior to usage on Dover AFB.

2.6 WASTE and HAZARDOUS WASTE REMOVAL: The contractor shall dispose of all trash, empty solvent containers, etc. that was used in the performance of their task. No hazardous waste or waste materials shall be placed in any trash receptacle on Dover AFB. The Contractor must comply with all federal, state, and local regulations regarding the transport and disposal of any and all hazardous wastes generated as a result of the work under this agreement.

2.7. QUALITY CONTROL. Contractors shall maintain quality control to ensure maintenance and repair services are performed in accordance with industry standards to include the manufacturer’s instructions. The contractor shall develop and implement procedures to identify defective services and provide recommendations to keep them from reoccurring.

2.8 SEASONAL OPEN/CLOSE INSPECTION AND ACCEPTANCE. The contractor shall conduct a final inspection with the 436 Civil Engineer WFSM Forman and 436th

Bioenvironmental Office representative and the Contracting Officer Representative with a date to be determined by the WFSM Foreman and the Bioenvironmental representative for both the opening and closing of the swimming pool facility operations. Final approval and acceptance of the seasonal opening of the swimming pool and splash park work will only be approved once all discrepancies are resolved and the Bioenvironmental office deems the pool and splash park water safe for use.

2.9 AIR FORCE TOBACCO POLICY. The Contractor shall ensure that all Contractor employees do not use tobacco products within any base facility, around fuel tanks and generators, within any clearly marked ''No Smoking" areas to include facility 841.

2.10 Base Hours of Operation. The contractor shall perform maintenance services during normal duty hours which are 7:30am to 4:30pm, Monday through Friday, excluding federal holidays, unless otherwise required in the contract or approved by the CO. There may be situations that require the contractor to work at times other than normal working hours. When the contractor’s work schedule conflicts with an Air Force mission requirement, advise the CO and reschedule the work to minimize disruption.

Recognized Holidays. The contractor is not required to provide service on federal holidays, except in emergency situations. Federal holidays are as follows:

New Year’s Day - 1 January

Martin Luther King Day - 3rd Monday in January

Washington’s Birthday - 3rd Monday in February

Memorial Day - last Monday in May

Emancipation Day – 19 June

Independence Day - 4 July

Labor Day - 1st Monday in September

Columbus Day - 2nd Monday in October

Veteran’s Day - 11 November

Thanksgiving Day - 4th Thursday in November

Christmas Day - 25 December

3.0. SECURITY.

3.1 All personnel employed by the contractor in the performance of this contract, or any representative of the contractor entering the governmental installation shall abide by all security instructions and directives of Dover AFB. Employees are responsible for safeguarding all government property provided for contractor use.

3.2 At the close of each work period, government facilities, equipment and materials shall be secured, lights, heat and water turned off and all doors and windows secured.

3.3 The contractor and, as applicable, subcontractor shall not employ persons for work on this contract if such employee is identified as a potential threat to the health, safety, security, general well-being or operational mission of the installation and its population, nor shall the contractor or subcontractor employ persons under this contract who have an outstanding criminal warrant as identified during the Criminal Background Investigation (CBI).

3.4 Contractors shall ensure their employees and those of their subcontracts have the proper credentials allowing them to work in the United States. Employees and subcontractors later found to be undocumented or illegal aliens will be remanded to the proper authorities.

3.5 The contractor shall submit any request for compensation on delays to the Contracting

Office for approval. The contractor shall notify the Contracting Office or authorized representative as soon as the contractor realizes/determines any potential delays in accordance with the terms and conditions of this requirement.

3.6 All contractors and subcontractors when working in a Controlled, Restricted or other sensitive areas must be escorted at all times. The D o v e r A FB C i v i l E n g i n e e r

S q u a d r o n W FS M s ec t i o n is responsible for providing es co r t s . The Contractor shall follow existing procedures and instructions for obtaining entrance to restricted or controlled areas.

3.7 Operations Security (OPSEC):

3.7.1. Avoid revealing or discussing information/media related to work conducted on/for the installation to any person without a valid need to know and adhere to a 100% shred policy when discarding written/printed materials.

3.7.2. Contractors or subcontractors possessing a Common Access Card (CAC) will complete

DAF-Operations Security Awareness Training (CBT) course through the MyLearning site. This training site is available through the AF Portal at https://lms-jets.cce.af.mil/moodle/. This site automatically records members’ completion of training and enables the user to print a certificate if needed by the Unit or Base Training Manager.

3.7.3 For contracts that require additional OPSEC measures, elevated security requirements will be conducted utilizing DD Form 254, Department of Defense Contract Security

Classification Specification and appropriately annotated IAW DODM5220.22V2_AFMAN 16-

1406v2, NATIONAL INDUSTRIAL SECURITY PROGRAM: INDUSTRIAL SECURITY

PROCEDURES FOR GOVERNMENT ACTIVITIES. Additionally, if the OPSEC block is checked on the DD Form 254, the 436th Contracting Squadron unit OPSEC coordinators shall:

Task the contractor to develop an OPSEC program plan to address how the contractor plans to protect critical and sensitive contracted information, and upon organization acceptance, implement an OPSEC program plan crafted for nature of work and operational concerns.

3.8 ANTITERRORISM.

References:

• Department of Defense Instruction O-2000.16, Volume 1 DoD Antiterrorism (AT)

Standards, Standard 18

• Defense Federal Acquisition Regulation Supplement (DFARS) (Reference (r)) reflects current DoD AT security requirements for defense contractors.

• Joint Publication 3-07.2 Antiterrorism

Terrorism is defined as: The calculated use of unlawful violence or threat of unlawful violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological.

Antiterrorism: As a prelude and during performance of any contract, it is critical that the

Contractor be supportive of all Department of Defense (DoD) requirements to protect personnel and their families, installations, facilities, information, and other resources from terrorist acts.

Antiterrorism Awareness Level I Training

Contractors or subcontractors possessing a Common Access Card (CAC) will complete AT

Awareness Level I training IAW DAFI 31-145, Antiterrorism, Standard 25, by completing the―Force Protection computer-based training (CBT) course through the MyLearning site. This training site is available through the AF Portal at https://lms-jets.cce.af.mil/moodle/. This site automatically records members’ completion of training and enables the user to print a certificate if needed by the Unit or Base Training Manager.

Contractors or subcontractors without a CAC or who do not have access to a government Non-classified Internet Protocol Router Network (NIPRNET) computer performing construction/services on the installation will complete AT Awareness Level I training IAW DAFI

31-145, Antiterrorism, Standard 25, by completing the Level I Antiterrorism Awareness computer https://lms-jets.cce.af.mil/moodle/ based training (CBT) course through the Joint Knowledge Online (JKO) Learning Management

System (LMS) at https://jkodirect.jten.mil/Atlas2/page/login/Login.jsf

Force Protection Condition (FPCON) Impact on Work Levels: If the DAFB FPCON level is elevated to Charlie, the installation shall evaluate the need for contract services to be discontinued. At FPCON Delta, services are discontinued. Services shall resume when the

FPCON level has been lowered.

Administrative Note: In the event of an emergency, dial 9 1 1 from any land line on the installation. The call will be routed to the Emergency Control Center (302-677-6666). If you use a cell phone and dial 9 1 1, you will be routed to the county 9 1 1 dispatch (Kent

County). Simply inform the dispatcher that you are on DAFB, they will route your call to the DAFB Emergency Control Center.

4.0. CONTRACTOR BADGE POLICIES.

4.1 All requests for contractor badges will be submitted through the Base Contracting

Squadron Office and/or the requesting agencies base point of contact. The Contracting

Squadron Office or base point of contact will then fill out an Operational Risk Management

Assessment Form (ORM) for the requesting agency and submit it to the Pass and Registrations section for approval IAW OPlan 31-101. As a minimum the ORM will be submitted 10 days prior to the requested date of employment.

4.2 All contactor employees who’ll be granted unescorted access to the installation are required to consent to a Criminal Background Investigation (CBI) prior to being granted entry to the installation. Continued employment is contingent upon successful completion and favorable reporting of criminal background checks.

4.3 Contractor badges will be issued for a maximum period of one year. Prior to reissuing new badges, all old badges must be returned to Pass and Registration for destruction. Also, before a new badge is issued an ORM must be resubmitted to the Pass and Registration section for approval again. In the event a badge is lost or stolen, the badge holder must accomplish the

Loss/Theft of Identification Worksheet and provide it to his/her supervisor. The supervisor of the contractor will investigate the loss and report in writing the circumstances in which the badge was lost to the Base Contracting Office and 436th Security Forces Squadron and submit a new request for badge renewal per paragraph 1.8.4.1. Before a new badge can be reissued.

4.4 Base Contracting Office or base point of contact will immediately notify Security Forces, Pass and Registration when a contractor’s employment has been terminated. The Agency

Chief or Site Supervisors are responsible for notifying and returning the contractor’s badge to

Pass and Registration when this occurs. At no time will a contractor contact Security Forces directly regarding badge denial; they need to contact the Dover AFB Contracting Office.

5.0. INSTALLATION ACCESS.

5.1 The contractor shall obtain personal contractor identification badge for all employees requiring entry onto Dover AFB from Pass and Registration, for the duration of the contract.

Employees are only permitted to enter the installation during the date and time periods indicated on their contractor access badge.

http://jko.jten.mil/courses/atl1/launch.html

5.2 Vehicle registration, proof of insurance and a valid driver’s license must be presented for all vehicles while operating on the installation. All vehicles entering the installation or sensitive areas are subject to search. Any refusal or non-consent by an employee will result in termination of their base access and immediate confiscation of this access badge.

5.3 During Force Protection Condition (FPCON) Normal, Alpha and Bravo, personnel without base issued badges must be sponsored onto the installation.

5.4 During FPCON Bravo, Charlie and Delta, personnel without base issued identification shall be physically escorted onto the installation.

5.5 During Higher FPCONs (Charlie and Delta) the base will curtail non-essential operations/functions; access by Non-Essential Contractors will be suspended at the direction of the Installation Commander.

6.0 MANPOWER.

6.1 The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the Seasonal

Swimming Pool/Splash Park Opening & Closing service contract via a secure data collection site. The contractor is required to completely fill in all required data fields at http://www.ecmra.mil.

Reporting inputs will be for the labor executed during the period of performance for each

Government fiscal year, which runs from 1 October through 30 September of each calendar year. Contractor may direct questions to the CMRA help desk.”

*Reporting Period: Contractors are required to input data by 31 October of each year.

Uses and Safeguarding of Information: Information from the secure web site is considered to be proprietary in nature when the contract number and contractor identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the contractor’s name and contract number associated with the data.

User Manuals: Data for Air Force service requirements must be input at the Air Force CMRA link.

However, user manuals for government personnel and contractors are available at the Army

CMRA link at http://www.ecmra.mil.

http://www.ecmra.mil/

Contractor Name:

[Company performing the work] Contract Number and Title:

Project Number (FJXT):

Estimated Start Date: Estimated Completion Date:

Shop Code (DV):

[To be completed by base personnel]

PROCESS CODE:

[To be completed by Bioenvironmental Engineering]

National Stock Number (NSN), or Part Number:

Manufacture:

Material Name: Size:

[Be Specific] [ounces, gallons or pounds, etc.] Amount used: Container type:

[Per week, month, year] [box, bottle, can, tube, drum etc.] Unit of Issue: Units per container:

[each, dozen, kit, etc.] [2 ea., one dz., 3 part kit, etc.] Will the process be performed inside or outside?

Will the process be performed on equipment, structure or aircraft?

Physical location of process performance:

Location Of stored Material:

Is a Hazardous Waste Generated? YES NO If yes, how is waste disposed:

[remarks] Is a site diagram available? YES NO [remarks] Does the site have a listing of base procedures for reporting a spill? YES NO [remarks]

This request requires both the contractors and COR signature for processing.

Contractor and Title:

Phone: Date:

Government Representative:

Phone: Date:

CONTRACTOR’S MONTHLY REPORT FOR HAZMATS

Contractor: Shop Code:

Contract# Location:

The following information is required for tracking of Hazardous Materials on Dover AFB. For contracts exceeding six months, this form is required to be filled out on a monthly basis and returned to the Contracting Officer Representative (COR). Contracts less than six months, this form is required at the beginning and at the completion of the work.

The COR will provide a copy to the Hazmart Pharmacy. This information is required to comply with State, Federal and Air Force laws and regulation.

Material Name Manufacture NSN/Part # Start

Balance Amount Used

Use additional sheets if required.

Contractor printed and name and date:

Signature:

Government Rep. printed name and date:

Signature:

File details come from the government source that posted it. Updated .