MS 067 Steel Building Certifications.pdf

APP

MATERIAL APPROVAL SUBMITTAL

(See Instructions on Reverse)

Form Approved OMB No 9000-0062 Expires May 31, 2005

Public reporting burden for this collection of information is estimated to average 20 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 this burden to the Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project OMB No 9000-0062, Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send your completed form to: SAF/AQCP, 1060 Air Force Pentagon, Washington DC

TO: (Contracting Officer)

Capt. Hillary Ince FROM: (Contractor) FARR Builders LLC S. Gevers, San Antonio, TX 78210

DATE

07 May 2019

CONTRACT NUMBER

FA4661-15-D-0001

SUBMISSION NUMBER

SUBMITTAL

✔ New Resubmittal

PREVIOUS SUBMISSION NUMBER

PROJECT NUMBER

FNWZ 12-0053

TO BE COMPLETED BY CONTRACTOR FOR GOVERNMENT USE ONLY

ITEM

NO.

SPECIFICATION SECTION/

PARA NO./DRAWING NO.

DESCRIPTION OF MATERIAL

(Include Type, Model Number, Catalog Number, Mfg., etc.)

AP-

PROVED

DISAP-

PROVED

SEE

REVERSE INITIAL

1 Per SOW 3D Steel Building Certifications X PR

BY COMPLETING THIS FORM, THE UNDERSIGNED CONTRACTOR CERTIFIES THAT

THE MATERIAL COMPLIES WITH ALL SPECIFICATIONS OF SUBJECT CONTRACT.

DATE (YYYYMMDD)

2019-05-07

TYPE OR PRINT NAME AND GRADE

Wayne Owens, PS

SIGNATURE

FOR GOVERNMENT USE ONLY

TO: (Base Civil Engineering Officer)

502 CE

For Evaluation and Action RNLT OR SOONER

DATE (YYYYMMDD) TYPE OR PRINT NAME AND GRADE SIGNATURE

TO: (AF Contracting Office)

RECOMMEND

X

ROVAL

DISAPPROVAL AS INDICATED ABOVE AND SUBJECT TO ANY APPLICABLE COMMENTS ON THE REVERSE

DATE (YYYYMMDD) TYPE OR PRINT NAME AND GRADE SIGNATURE Digitally signed by

ROLAN.PATRICK.M.1515150249

Date: 2019.08.12 08:40:27 -

20190812 Patrick Rolan, GS-12 TO: (Contractor)

X APPROVED DISAPROVED AS INDICATED ABOVE AND SUBJECT TO ANY APPLICABLE COMMENTS ON THE REVERSE SIDE. REQUEST

RESUBMITTAL ON DISAPPROVED ITEMS WITHIN DAYS OF DATE SHOWN BELOW.

DATE (YYYYMMDD)

2019/08/14

TYPE OR PRINT NAME AND GRADE

Merry K. Sargent-Green, CO

SIGNATURE

AF IMT 3000, 20030901, V1 PREVIOUS EDITION IS OBSOLETE.

COMMENTS

(Number to correspond with applicable Item Number on reverse)

INSTRUCTIONS TO CONTRACTORS

1. The term "material" is defined as articles, supplies, raw materials, equipment, parts, components, and end items that are to be incorporated into the work required by the contract.

2. This form is to be used by contractors for submitting Shop Drawings, Equipment Data, Manufacturer's Literature and Certificates and samples of Materials to the Government for approval in accordance with the provisions of this contract. Unless otherwise specified, it is to be prepared in 4 copies, signed, and provided to the contracting officer with appropriate attachments.

3. Item(s) to be approved will be clearly tabbed or identified. Data pertaining to item(s) to be approved will be clearly identified or tabbed, particularly where documents are voluminous, in order to properly evaluate the materials or articles to be incorporated in the work. Each attachment will be numbered to correspond with the item number shown on the face of this form.

4. Requests submitted shall be numbered consecutively, by contract, in the space entitled "Submission No.". This number, in addition to the Contract No., will be used to identify each Material Approval Submittal. Resubmissions will be indicated in the appropriate block and the insertion of previous submission number and data in addition to a new submission number. A single submission should be used for all work of a section of the specifications, but in NO instance should the submission include work for more than one (1) contract. Submittals requiring priority handling will be submitted by separate submittal using the form and so marked across the face of the form.

5. This Material Approval Submittal is not valid unless it is signed by the contracting officer. This approval is required as called for by the contracting officer under the terms of this contract.

AF IMT 3000, 20030901, V1 (REVERSE)

m sriR

,.stall•..Cea-tlflcatfoaa At).

n&iGl=IDUP, INC.

The "Installer", on behalf of 30 Steel Building Systems, LLC, the "Company" has satisfactorily completed the NCI training seminar and has passed the required exams thereby qualifying as a NCI Authorized Installer for the following NCI products:

V{tra-(J)eft@ j(J)ou6Ce-£oft®, <BattenLoft®/SuperLoft® Lok..§eam®/CraftsmanTM

The installer may represent to thepublic the Authorized Installer status onbehalf of thecompany only. NCIGroup,lnc.("NCI") hereby certifies satisfactory completion of the NCI training seminar for the proper Installation of the NCI products listed onthis certificate. However, the installer and the company are Independent of NCI and are not NCl's agents,employees, contractors, or representatives. NCI DOES NOT WARRANT OR REPRESENTTHATTHEINSTALLER ANDTHE COMPANY WILL UllLIZETHE METHODS AND PROCEDURES DEMONSTRATED by NCI and expressly gives notice to all thirdparties that THE METHODS AND PROCEDURES OFTHE INSTALLER ANDTHE COMPANY ARE NOT SUBJECTTOTHE DIRECTION ANDCONTROL OF NCI.

NCIDOES NOT SUPERVISE OR INSPECT ANY INSTALLATION OF ITS PRODUCTS AS A CONDITION TO CERTIFICATION.

This certificate shall be renewed, without charge, for four successive one-year periods, providing that the Company listed above Is In compliance with Items 1-6 llsted below. However,In the event that NCImakes significant and substantial changes In the procedure for Installation of any of Its product(s), NCI may require re-certification by the Company during the term of this certificate, asextended.In no event shall this certificate remain in force and effect any time on or after the fifth anniversary date from dateof Issuance.

This certificate shall remain In full force and effect during Its term subject to the following conditions:The Installer and thecompany shall:

(1) Cause the Installer to bepresent oneach Job-site to supervise the entire Installation of NCI product; (2) Utilize only those methods and procedures demonstrated by NCI at Its training seminar;(3) Maintain Worker's Compensation Insurance; (4) Maintain Primary Liability coverage In the minimum amount of $250,000 for each loss; (5) Have no claims pending or asserted of negligent or defective workmanship of NCI product;and (6) Have not filed for protection from creditors under any state lnsotvency or debtor relief statutes or under the United States Bankruptcy Code.

·ceco Building Systems

@a c / Building Systems

Metal Roof and Wall

Symnu

A.1.l'

A\CSCO.

B11i!rll11g Soft1ticttf

MIC-

Robertson•.

Robertson Building Syalema

BUILDING SYSTEMS.

METL

SPAN'

3/912017 isfue'oate

"4 )·.

s • ffCIGl=IDUA INC.

The "Installer", on behalf of 30 Steel Building Systems, LLC, the "Company" has satisfactorily completed the NCI training seminar and has passed the required exams thereby

, qualifying as a NCI Authorized Installer for the following NCI products:

V[tra-(J)eft® j(J)ou6Ce-Loft®, <BattenLoft® /SuperLoft® Lok.§eam®/Craftsman™

The installer may represent to thepublic the Authorized Installer status onbehalf of the company only. NCIGroup,lnc.("NCI") hereby certifies satisfactory completion of the NCI training seminar for the proper Installation of the NCI products listed on this certiflcate. However, the Installer and the company areindependent of NCI and are not NCl's agents, employees,contractors,or representatives. NCI DOES NOT WARRANT OR REPRESENT THATTHE INSTALLER ANDTHE COMPANY WILL UTILIZE THE METHODS AND PROCEDURES DEMONSTRATED by NCI and expressly gives notice to all thirdparties thatTHE METHODS AND PROCEDURES OFTHE INSTALLER ANDTHE COMPANY ARE NOT SUBJECT TOTHE DIRECTION ANDCONTROL OF NCI.

NCIDOES NOT SUPERVISE OR INSPECT ANY INSTALLATION OF ITS PRODUCTS AS A CONDITION TOCERTIFICATION.

This certificate shall be renewed, without charge, for four successive one-year periods, providing that the Company listed above Is In compliance withItems 1-6 listed below. However,In the event that NCI makes significant and substantial changes In the procedure for Installation of any of Its product(s), NCI may require re-certificationby the Company during the term of this certificate, as extended. In no event shall this certificate remain In force and effect any time on or after the fifth anniversary date from date of Issuance.

This certificate shall remain In full force and effect during Its term subject to the following condltlons:The Installer and the company shall:

(1) Cause the Installer to bepresent on each job-site to supervise the entire Installation of NCI product; (2) Utilize only those methods and procedures demonstrated by NCI at Itstraining semlnar;(3) Maintain Worker's Compensation Insurance; (4) Maintain Primary Liability coverage In the minimum amount of $250,000 for each loss; (5) Have no claims pending or asserted of negligent or defective workmanship of NCI product;and (6) Have not filed for protection from creditors under any state Insolvency or debtor relief statutes orunder the United States Bankruptcy Code.

ID-WEB"

E •Ut I L H •tN

J e O H eM

PA

J

NY

M

Rober tson •.

Robertson Bulldlng Syaleml r

BUILDING SYillMS, METL

SPAN'