Attachment 1 - PWS (Revised 25 Sep 25).pdf

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PKAA - ATS Replacement & Disconnection (Service)
Solicitation number
FA461325Q0026
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This Performance Work Statement (PWS) details the replacement of Automatic Transfer Switches (ATS) and Disconnects in Buildings 34, 363, and 1284 at F.E. Warren Air Force Base in Wyoming. The project requires the contractor to demolish existing ATS and disconnect equipment, install new equipment with specific technical specifications (e.g., 225 Amps rating, 480 Voltage, 3-Phase for Building 363), and conduct testing to ensure operational integrity. The work must comply with Transfer Switches (UL 1008) and National Electric Code (NEC) safety standards, with careful attention to preserving existing infrastructure, such as historic brick walls.

Key requirements include performing work during Monday-Friday hours (0800-1530 hrs), completing 10 minutes of testing for each building, minimizing power outages, and following strict operational security and safety protocols. The contractor must provide documentation including AT Level I Training Certificates, Hazardous Materials Authorization Requests, and OPSEC Training records. Government-furnished property includes the new ATS (Cummins Inc.) and Disconnect (Siemens AG) for Building 34. Additional obligations involve environmental compliance, utility conservation, and adhering to anti-terrorism and safety guidelines specific to working on a military installation.

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PERFORMANCE WORK STATEMENT FOR

Replacing Automatic Transfer Switch in Buildings 34, 363, and 1284, and

Disconnect in Building 34.

F.E. Warren Air Force Base, Wyoming

September 25, 2025

Table of Contents

1. Description of Services

1.1. Basic Services

1.2. Optional Services

1.3. Winter Suspension

2. Services Summary

3. Government Furnished Property and/or Services

3.1. Government Furnished Property

3.2. Government Furnished Services

3.3. Government Property Incidental to the Place of Performance

4. General Information

4.1. Quality Control

4.2. Quality Assurance

4.3. Security Requirements

4.4. Physical Security

4.5. Operational Security (OPSEC)

4.6. Anti-Terrorism

4.7. Location/Hours of Operation

4.8. Conservation of Utilities

4.9. Environmental Controls

4.10. Safety Requirements

4.11. Continuation of Essential DoD Contractor Services During Crisis

4.12. Contractor Personnel

4.13. Records

4.15. Special Qualifications and Training

5. Appendices

APPENDIX A – Photographs & Maps

APPENDIX B – Deliverables

APPENDIX C – Inspection Checklist/Report

1. Description of Services.

The contractor shall provide all management, tools, supplies, equipment, and labor necessary to perform the demolition and installation of the Automatic Transfer Switch (ATS) in Bldg. 363 and Bldg. 1284, and the demolition and installation of the ATS and main disconnect in Bldg. 34 at F.E. Warren Air Force Base, Wyoming, in accordance with all applicable federal, state, local laws and regulations and this performance work statement (PWS).

1.1. Basic Services. The contractor shall remove the existing ATS in Bldg. 363 and 1284, and the existing ATS and Disconnect in Bldg. 34. And install the new ATS and Disconnect for those buildings. The contractor shall program the ATS’s, and test them for each building to make sure that they can transfer between the main power and the backup generator.

1.1.1. Bldg.34 Services. The existing ATS and Disconnect shall be demolished without damaging existing work and disposing of the equipment off-base. The contractor shall install the new equipment.

The Contractor shall be aware of Transfer Switches (UL 1008) and National Electric Code (NEC) safety standards when installing the ATS and Testing procedures shall be conducted to guarantee the operational integrity of the new ATS. Any deficiencies observed during testing must be promptly rectified.

1.1.2. Bldg. 363 Services. The existing ATS shall be demolished without damaging existing work and disposing of the equipment off-base. The contractor shall be responsible for ordering the ATS needed for this task. The specifications required for the new ATS are as follows: 225 Amps rating, 480 Voltage, 3-Phase, and 4-Pole Switch. The dimensions must be 30L x 16W x 40H.

To preserve the historic features of the brick wall, the contractor shall not make new penetrations, instead, attaching the new ATS using the existing holes. If there are no other options but to make new penetrations into the wall, the contractor shall get in touch with the cultural office before continuing with the project.

The Contractor shall be aware of Transfer Switches (UL 1008) and National Electric Code (NEC) safety standards when installing the ATS, and Testing procedures shall be conducted to guarantee the

1.1.3. Bldg. 1284 Services. The existing ATS shall be demolished without damaging existing work and disposing of the equipment off-base. The contractor shall be responsible for ordering the ATS needed for this task. The specifications required for the new ATS are as follows: 125 Amps rating, 480 Voltage, 60 Hertz Frequency, and 3-Pole Switch.

The Contractor shall be aware of Transfer Switches (UL 1008) and National Electric Code (NEC) safety standards when installing the ATS, and Testing procedures shall be conducted to guarantee the

1.2. Optional Services. The contractor must inspect the existing cables for the ATS in Bldg.34 and determine whether the electric cable gauge mismatch aligns with the electric code.

1.3. Winter Suspension. In the case of the winter season that has direct impact to performing the work outlined in this SOW, the Contractor will notify the Government they can no longer perform work. 90 CES will validate that the weather no longer allows work to be performed within the specifications. If the reason for stopping work is due to weather impacted material supplies, a letter will need to be provided to support the winter suspension. The project will be placed into suspension and the remaining number of PoP days will be documented. When the weather starts to become workable weather, 90 CONS will start conversations with the contractor regarding when they can come back to work. When the suspension is lifted, a new completion date will be established based on the remaining PoP days.

2. Services Summary.

The contractor service delivery requirements are summarized as performance objectives that relate directly to the standards of performance required to meet essential mission needs. For the Performance Objective to be met, service delivery must be in substantial compliance with applicable performance standards. The Performance Threshold describes the minimum overall levels of service required for acceptable quality control. Failure to meet these Performance Thresholds means that contractor Quality Control is unacceptable.

The following is a list of the key performance objectives that will be verified as contractually compliant by Government personnel; however, inspection of any contract requirement is authorized.

Performance Objective

(BLDG.34)

PWS

Para. Performance Threshold Method of Surveillance

SS-1: Perform ATS and Disconnect demolition services

1.1,1.1.1

Demolition process shall not damage existing works

100% Inspection

SS-2: Dispose of all demolished materials and equipment off-base

1.1,1.1.1 The disposal of the materials shall not be on government territory.

SS-3: Perform ATS and Disconnect installation services

1.1,1.1.1 If possible, the new ATS must be bypassed to minimize the blackouts.

SS-4: Perform Testing and Commissioning Services

1.1,1.1.1 10 minutes of testing

(BLDG.363)

PWS

Para. Performance Threshold Method of Surveillance

SS-1: Perform ATS demolition services

1.1,1.1.2

Demolition process shall not damage existing works

100% Inspection

SS-2: Dispose of all demolished materials and equipment off-base

1.1,1.1.2 The disposal of the materials shall

SS-3: Perform ATS installation services

1.1,1.1.2 If possible, the new ATS must be

1.1,1.1.2 10 minutes of testing

(BLDG.1284)

PWS

Para. Performance Threshold Method of Surveillance

SS-1: Perform ATS 1.1,1.1.3 Demolition process shall not 100% Inspection demolition services damage existing works SS-2: Dispose of all demolished materials and equipment off-base

1.1,1.1.3 The disposal of the materials shall

SS-3: Perform ATS installation services

1.1,1.1.3 If possible, the new ATS must be

1.1,1.1.3 10 minutes of testing

3. Government Furnished Property and/or Services

3.1. Government Furnished Property.

3.1.1. The new ATS (Cummins Inc.) and the Disconnect (Siemens AG) shall be provided and ready to install for Bldg. 34 only.

3.2. Government Furnished Services.

3.2.1. None

3.3. Government Property Incidental to the Place of Performance.

3.3.1. The power outages must be limited to 4 hours or less per outage. It is recommended, if possible, to bypass the ATS to keep the building powered while this task is being worked on.

Notifications from the Contractor regarding the time and date of the outages.

4. General Information.

4.1. Quality Control.

The contractor is required to control the quality-of-service delivery and offer to the Government for acceptance only services which conform to contract requirements. The overall control of quality must meet the specified performance thresholds for each requirement in the Services Summary. The contractor shall submit a copy of a manual for each ATS the contractor orders to the base.

4.2. Quality Assurance

The Government will evaluate the contractor’s performance by appointing a representative(s) to monitor performance to ensure services are received. The Government representative will evaluate the contractor’s performance through on-site inspections and receipt of customer complaints. The Government will inspect each task as completed. The Government will investigate complaints received from customers. The Government representative shall make final determination of the validity of customer complaint(s) in cases of disagreement with customer(s). Remedies for non-conforming services will be resolved IAW the applicable Inspection/Acceptance clause attached within the contract.

4.2.1. The Contracting Officer’s Representative (COR) is the authorized Government representative(s) who will perform assessments of the contractor’s performance. After contract award, the identity of the COR(s), with a letter defining their duties and authority will be promptly furnished to the successful bidder/offeror.

4.2.2. The COR(s) will inform the contract manager when discrepancies occur and will request corrective action. The COR(s) will make a notation of the discrepancy on their surveillance checklist with the date and time the discrepancy was noted and will request the contract manager (or authorized representative) to acknowledge the discrepancy.

4.2.3. Any matter concerning a change to the scope, prices, terms, or conditions of this contract shall be referred to the Contracting Officer and NOT to the COR(s).

4.2.4. The services to be performed by the contractor during the period of this contract shall (at all times and places) be subject to review by the Contracting Officer or authorized representative(s).

4.3. Security Requirements.

The contractor shall be responsible for all passes issued to their employees under this contract. Applications shall be coordinated by the Contracting Officer or designated representative. At the time of application, Security Forces will conduct a background check on employees. Upon termination of employment or contract completion, the contractor shall be responsible for returning identification cards/base passes to Security Forces within 24 hours.

4.4. Physical Security.

The contractor shall be responsible for safeguarding all Government property provided for contractor use. At the close of each work period, Government facilities, property, and materials shall be secured.

4.4.1. Key Control.

The contractor shall establish and implement methods of ensuring that all keys/key cards issued to the contractor by the government are not lost or misplaced and are not used by unauthorized persons. The contractor shall not duplicate any keys issued by the government.

NOTE: all references to keys also include key cards. No keys issued to the contractor by the government shall be duplicated. The contractor shall develop procedures covering key control. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas.

4.4.1.1. The contractor shall immediately report the occurrences of a lost or duplicate key to the contracting officer.

4.4.1.2. In the event keys, other than master keys, are lost or duplicated, the contractor shall, upon written direction of the contracting officer, rekey or replace the affected lock or locks; however, the government, at its option, may replace the affected lock or locks or perform rekeying. When the replacement of locks or rekeying is performed by the government, the total cost of rekeying or the replacement of the lock or locks shall be deducted from the monthly payment due the contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the government and the total cost deducted from the monthly payment due the contractor.

4.4.1.3. The contractor shall prohibit the use of keys issued by the government by any persons other than the contractor’s employees. The contractor shall prohibit the opening of locked areas by contractor employees to permit entrance of persons other than contractor’s employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

4.5. Operational Security (OPSEC).

The contractor shall adhere to the following minimum requirements in support of this requirement:

4.5.1. All contractors, subcontractors, their employees, associates, and consultants who have access to critical information and indicators must comply with the Air Force-sponsored Operations Security (OPSEC) program.

4.5.2. OPSEC is an information-related capability that preserves friendly essential secrecy by using a process to identify, control, and protect critical information and indicators. If critical information and indicators are disclosed, it could allow adversaries or potential adversaries to identify and exploit friendly vulnerabilities leading to increased risk to mission failure or the loss of life. The desired effect of OPSEC is to influence the adversary’s behavior and actions by reducing the adversary’s ability to collect and exploit critical information and indicators about friendly activities.

4.5.3. Responsibilities:

4.5.3.1. Contractors must ensure employees receive OPSEC education that includes an overview of the OPSEC process, the definition of OPSEC, its purpose, what is critical information, the individual’s role in protecting critical information, and the general adversary threat to the AF’s critical information. Additionally, OPSEC education must include updated threat information, changes to critical information and indicators, new procedures and/or OPSEC measures implemented, altered, or deleted by the organization.

4.5.3.2. DoD Contractors with OPSEC requirements or that have access to critical information and indicators shall complete initial and annually recurring refresher training. Accomplishment of initial OPSEC training must not exceed 90 days from initial assignment to a contract with OPSEC requirements. Access to mission-critical information will not be allowed until OPSEC education has been completed and documented.

4.5.3.3. OPSEC education is a continuous requirement. The host unit OPSEC coordinator must track OPSEC training statistics to include the personnel working on the contract, when each individual received the required initial OPSEC training, and when refresher training is due and/or completed.

4.5.4. Contractor personnel shall not discuss government operations in public or over unprotected or unencrypted communications. Controlled unclassified information (CUI) may only be transmitted as directed in this PWS.

4.5.5. The Contractor shall not post to company websites, publications, newsletters, or other media any images, data, or information that reveal sensitive government operations, personnel, equipment, and/or classified or controlled unclassified information. When in doubt, company press releases related to this contract should be coordinated through the COR or CO, as applicable.

4.5.6. Prior to seeking approval through the F. E. Warren AFB Public Affairs, any information to be released outside of official U.S. Government channels, via any media (to include electronic communications), must be approved through an OPSEC review. All personnel must promptly report OPSEC-related incidents, issues, and concerns to the host-unit OPSEC coordinator.

4.5.7. Contractor shall restrict access to those individuals with a valid need-to-know who are actually providing services under the contract. Further dissemination to other contractors, subcontractors, or other government agencies and private individuals or organizations is prohibited unless authorized in writing.

4.5.8. Because observation of events, operations, physical changes, etc., may reveal National Security information, specific restrictions are needed to preclude unintentional release of this information to unauthorized parties. Unauthorized disclosure and transfer of National Security Information is punishable under 18 USC § 793. Therefore, contractor personnel shall not disclose to unauthorized third parties, post to unofficial sites (including Social Networking sites) any images, data/information, or observed events that reveal sensitive government operations, personnel, equipment, including, but not limited to:

4.5.8.1. Tactics, techniques, and procedures, production, or work schedules, any visible or concealed modifications, upgrades, additions to vessels, aircraft, or weapons or equipment; increases, change, or decreases in work/deployment frequency or government personnel, vehicle, vessel, or aircraft movements;

specialized equipment orders, deliveries, shipments, etc. Unauthorized disclosures and attempts to solicit this type of information by unauthorized third parties or others not affiliated with this contract shall be reported to the COR or CO, as applicable.

4.5.8.2. Government issued badges, identification shall be removed and/or concealed from plain sight when off base and shall not be left in vehicles or unprotected areas. Badges and passes may not be duplicated, copied, or loaned to others. Lost or stolen identification badges, vehicle passes, etc., will be immediately reported to the COR, CO, and/or Installation Security Office.

4.6. Anti-Terrorism

4.6.1. Notification: If the Contractor (contract employees/subcontractors) identify any suspicious activity, they shall contact the Base Defense Operations Center (BDOC) at 307-773-3501 (On-installation)/Missile Security Control (MSC) at 307-773-2701 (Off-installation) and notify the CO and COR (if appointed) that they contacted the BDOC and/or MSC.

4.6.2. Training. Contractor employees that require routine physical access to a Federally-controlled facility or military installation shall complete Level I antiterrorism awareness training within 30 days of requiring access and annually thereafter and send a copy of their employees’ training certificate(s) to the CO and COR (if assigned). Training is located at Joint Knowledge Online (JKO) website:

https://jkodirect.jten.mil/Atlas2/page/login/Login.jsf

4.7. Location/Hours of Operation.

4.7.1. Location. Place of performance is at FE Warren AFB WY. Telework shall not be permitted for this task order/contract.

4.7.2. Normal Hours of Operation. The contractor shall perform the services required under this contract during the hours listed within Table 1, Location and Hours of Work. The contractor may work (with prior approval of the CO) extended hours to ensure timely completion of work at no additional cost to the Government.

4.7.3. Recognized Holidays. The contractor is not required to provide service on the following days, unless otherwise noted:

New Year's Day (January 1).

Birthday of Martin Luther King, Jr. (Third Monday in January).

Washington's Birthday (Third Monday in February).

Memorial Day (Last Monday in May).

Juneteenth National Independence Day (June 19).

Independence Day (July 4).

Labor Day (First Monday in September).

Columbus Day (Second Monday in October).

Veterans Day (November 11).

Thanksgiving Day (Fourth Thursday in November).

Christmas Day (December 25).

If the holiday falls on Saturday, it is observed on Friday. If the holiday falls on a Sunday, it is observed on Monday.

Table 1. Location and Hours of Work

Building No. Name of Facility Days Time

34 Security Forces Monday - Friday 0800-1530 hrs

363 CE Resources Monday – Friday 0800-1530 hrs

1284 Supply, BSS, TMO, Finance & Wing Mobility

Monday – Friday 0800-1530 hrs

4.8. Conservation of Utilities.

The contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions which prevent the waste of utilities which include the following:

4.8.1. Lights shall be used only in areas where and when work is being performed.

4.8.2. Mechanical equipment controls for heating, ventilation, and air conditioning systems shall not be adjusted by the contractor or by contractor employees unless authorized.

4.9. Environmental Controls.

4.9.1. Compliance with Laws and Regulations. The contractor shall be knowledgeable of and comply with all applicable Interstate, federal, state, and local laws, regulations, and requirements regarding environmental protection, to include Section 01 57 19.05 32, Environmental Protection. In the event environmental laws/regulations change during the term of this contract, the contractor is required to comply as such laws come into effect. If there is an increase or decrease in cost because of the change, the contractor shall inform the CO pursuant to notice requirements and negotiate a modification to the contract.

4.9.2. Notification of Environmental Spills. If the contractor spills or releases any substance contained in 40 CFR 302 into the environment, the contractor or its agent shall immediately report the incident to the F.E. Warren AFB Fire Dept at 911 (landline) or 307-773-2931 (cell phone). The liability for the spill or release of such substance(s) rests solely with the contractor and its agent.

4.9.3. Hazardous Material (HM). If hazardous materials will be used in the execution of this contract, the contractor shall comply with all federal, state and local regulations concerning the use, storage, and reporting of HM in accordance with AFMAN 32-7002, Environmental Compliance and Pollution Prevention. The contractor shall be required to obtain authorization per the Installation Hazardous Materials Management Program before ordering or purchasing any hazardous product and may not bring a HM onto F.E. Warren AFB property, nor use a HM, until the contractor receives all required authorizations. This authorization process may take up to three weeks. The contractor shall provide the information listed in Attachment 1 of Section 01 57 19.05 32 to request authorization for all hazardous materials proposed for use on FE Warren AFB or the missile field.

4.9.4. Green Procurement Program (GPP). In performance of this contract, contractors shall use Environmental Protection Agency (EPA) designated recycled content products, Information Technology (IT) Energy Star products/appliances, Federal Energy Management Program (FEMP) Designated Energy Efficient Low Stand By Power products/appliances, U.S. Department of Agriculture (USDA) Bio based/Bio preferred products, Environmentally preferable products, Electronic Product Environmental Assessment Tool (EPEAT) registered products, Water Sense or other water efficient products, non- or Low Ozone depleting substances under the Significant New Alternatives Policy (SNAP), non or Low toxic or hazardous constituents (e.g. non- VOC paint) and any other environmentally sustainable product/method, to the greatest extent possible.

4.10. Safety Requirements.

4.10.1. In performing work under this contract, the contractor shall:

4.10.1.1. Conform to the safety requirements contained in the contract for all activities related to the accomplishment of the work.

4.10.1.2. Record and report promptly (within one hour), to the contracting officer or designated COR, all available facts relating to each instance of damage to Government property or injury to either contractor or Government personnel.

4.10.1.3. In the event of an accident/mishap, take reasonable and prudent action to establish control of the accident/mishap scene, prevent further damage to persons or property, and preserve evidence until released by the accident/mishap investigative authority through the CO.

4.10.2. Safety and Health Plan.

4.10.2.1. The contractor shall submit a safety and Health Plan and corresponding site safety checklist to the CO within 10 business days after contract award or any contract modification that affects personnel safety and health. This requirement includes preparing, implementing, and maintaining a confined space program (if applicable). The contractor’s plan shall include appropriate measures to ensure the contractor reacts promptly to investigate, correct, and track alleged safety and health violations and/or uncontrolled hazards in the contractor work areas.

4.10.2.2. The contractor shall be responsible for performing an arc flash survey via NFPA 70E. This survey shall be done prior to any demolitions and installations for the services mentioned in this statement of work to avoid any hazards that might harm the contractors. A copy of this survey shall be given to FE Warren AFB for their records. Arc flash stickers will need to be used after the services are done.

4.11. Continuation of Essential DoD Contractor Services During Crisis.

IAW DFARS 237.7602(a), it is determined that the ATS and Disconnect Replacement and Service, has NOT been identified as an essential service.

4.12. Contractor Personnel.

4.12.1. Contract Manager: the contractor shall provide a contract manager who shall be responsible for the performance of the services. The name of the contract manager shall be provided to the CO in writing prior to the beginning of the first performance period. The contract manager must be able to read, write, speak, and understand English.

4.12.1.1 The contract manager shall have full authority to act for the contractor on all contract matters relating to daily operations of this contract.

4.12.2. Contractor Employees: the contractor shall not employ persons for work on this contract if such employee is identified to the contractor by the CO as a potential threat to the health, safety, security, general well-being or operational mission of the installation and its population.

4.12.2.1. Contractor personnel shall present a neat appearance and be easily recognized as contractor employees. This may be accomplished by wearing distinctive clothing bearing the name of the company or by wearing appropriate badges, which contain the company name and employee name in English.

4.13. Records. The contractor shall be responsible for creating, maintaining, and disposing of only those government required records that are specifically cited in this PWS or required by the provisions of a mandatory directive listed in (LIST APPLICABLE APPENDICES) Applicable Publications and Forms. If requested by the Government, the contractor shall provide the original record, or a reproducible copy of any such record within five working days of receipt of the request.

4.15. Special Qualifications and Training.

4.15.1. The contractor must have a minimum of one (1) year experience performing hood and duct cleaning on commercial kitchen exhaust systems on a recurring schedule (i.e. monthly, quarterly).

5. Appendices

APPENDIX A –

Photographs & Maps

Bldg. 34 ATS Visual Reference

Bldg. 34 Work Location Map

Bldg. 363 ATS dimensions

Bldg. 1284 ATS

APPENDIX B – Deliverables All deliverables must meet professional standards and the requirements set forth in the applicable contractual documents. The Contractor shall be responsible for delivering all specified end items. The end items listed in the table below are outputs, which fall within the scope of this effort and are illustrative of the type of work the Government expects to require.

Title Submission Date Distribution Copies AT Level I Training Certificate(s) (PWS para. 4.6.2.)

Within 30 days of requiring access and annually thereafter

COR 1 each

Hazardous Materials Authorization Request and Safety Data Sheets (SDS) (PWS para 4.9.3.)

Three weeks prior to planned use on FE Warren AFB or missile field.

CO 1 each

OPSEC Training (PWS para 4.5.3.2.)

Within 90 days of assignment and annually thereafter

COR 1 each

APPENDIX C – Inspection Checklist/Report

Hood and Duct Cleaning Service

Facility Inspected/Cleaned:

Date and Time:

Cleaning Contractor:

Hoods, grease removal devices, fans, ducts, and other appurtenances, to include fire suppression system piping, nozzles, fusible links and cables are cleaned and free of grease, cleaning agents, and residual water.

The roof and exterior ductwork penetrating the roof is free of grease, cleaning agents, and residual water.

The grease filters are clean and undamaged. (NOTE: filters are the responsibility of the facility owner and not part of this cleaning contract. Dirty filters will be noted in the corrective actions section of this report.)

Identify any damage, in the corrective actions section of this report, to the following:

Electric wires and conduit Hood lighting Motors Hood and Ductwork Fire suppression system components

When cleaning is completed, all drip pans, trays, traps, access panels (doors) and cover plates shall be restored to their designated locations and secured as designed.

Dampers and diffusers are positioned for proper airflow.

When cleaning is completed, all electrical switches and system components shall be returned to an operable state.

_ All hood components are functioning properly, to include fans and lights.

Work area is cleaned and restored to pre-cleaning conditions.

After cleaning is completed, the contractor will place or display on the hood a label indicating the date cleaned, the name of the servicing company, and areas not cleaned.

_ Problems, deficiencies, damaged/inoperable equipment annotated in the Corrective Actions Section of this report.

RECOMMENDED CORRECTIVE ACTIONS: (use separate sheet of paper if necessary)

Certifying Official’s Signature:

Name:

Fire Inspector Signature:

Name:

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