Attach 2 - AF Form 103.xfd

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Attached to
3d Generation Multiple Award Construction Contract Federal contract opportunity
Solicitation number
FA4690-10-R-K102
Issued by
Department of the Air Force Air Combat Command

About this file

From the source

Solicitation Attach 2 - AF Form 103

Text of this file

15/11/2002

D0C68CA8-F2C7-42CE-A44E-B5FD8820160A
1.7.6
AF FORM 103, 19940801
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AF00103, 19940801
OPR

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T-7CQY-AK9Z-5K86-Z9YU-AKXC

AF
103
U
NONE
1994/08/01
Base Civil Engineering Work Clearance Request
3
3220
TBD
EF
EA
AFI32-1001
HQ USAF/ILEOP
E
AFPUBS
F
F
AD

PAGE1.Email_BUTTON

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Ay F FORM 103, 19940801 I M T V 1.

BASE CIVIL ENGINEERING WORK CLEARANCE REQUEST.

The BCE work clearance request is used for any work (contract or in-house) that may disrupt aircraft or vehicular traffic flow, base utility services, protection provided by fire and intrusion alarm system, or routine activities of the installation. This form is used to coordinate the required work with key base activities and keep customer inconvenience to a minimum. It is also used to identify potentially hazardous work conditions in an attempt to prevent accidents. The work clearance request is processed just prior to the start of work. If delays are encountered and the conditions at the job site change (or may have changed) this work clearance request must be reprocessed.

Enter date as Y Y Y Y M MD D.

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1. Clearance is requested to proceed with work at
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on Work Order Number
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Contract Number
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Field Other
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3. DATE CLEARANCE REQUIRED

Enter date as Y Y Y Y M M D D.

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OTH
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4. DATE OF CLEARANCE.

Enter date as Y Y Y Y M M D D.

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5. SIGNATURE OF REQUESTING OFFICIAL
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6. TELEPHONE Number.

Number will be formatted automatically.

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7. ORGANIZATION
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I. Zone. Organization.
Cass Shop
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J. Other. Specify.
GeoBase

Base Sprinkler System

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Other. Specify.
SCABN, Mr. Scott or Mr. Malone, Bldg 7612 Ph. 2209
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APPRVD
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17. TYPED NAME AND SIGNATURE OF APPROVING OFFICER. Chief of Operations Flight or Chief of Engineering Flight.
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17 ay. Date signed. Enter date as Y Y Y Y M M D D.

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SIGAUTH
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DATE PREPARED

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BASE CIVIL ENGINEERING WORK CLEARANCE REQUEST

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(See Instructions on Reverse)

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1. Clearance is requested to proceed with work at

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on Work Order No.

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, Contract No.

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, involving excavation or utility disturbance per

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attached sketch. This area

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has

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has not been staked or clearly marked.

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2. TYPE OF FACILITY/WORK INVOLVED

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G. AIRCRAFT OR VEHICULAR TRAFFIC FLOW

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A. PAVEMENTS

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D. FIRE DETECTION & PROTECTION SYSTEMS

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H. SECURITY

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B. DRAINAGE SYSTEMS

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E. UTILITY

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OVERHEAD

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UNDERGROUND

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I. OTHER

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C. RAILROAD TRACKS

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F. COMM

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OVERHEAD

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UNDERGROUND

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3. DATE CLEARANCE REQUIRED

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4. DATE OF CLEARANCE

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5. SIGNATURE OF REQUESTING OFFICIAL

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6. TELEPHONE NO.

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7. ORGANIZATION

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ORGANIZATION

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REMARKS

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(Use Reverse for additional comments)

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REVIEWER'S NAME AND INITIALS

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8.

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A. ELECTRICAL DISTRIBUTION

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B

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A

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S

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B. STEAM DISTRIBUTION

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E

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C. WATER DISTRIBUTION

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C

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I

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D. POL DISTRIBUTION

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V

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I L

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E. SEWER DISTRIBUTION

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E

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N

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F. ENVIRONMENTAL

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G

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I

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G. PAVEMENTS/ GROUNDS

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N

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E

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E

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H. FIRE PROTECTION

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R

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I

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I. ZONE

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N

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G

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J. OTHER

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(Specify)

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9. SECURITY POLICE

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10. SAFETY

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11. COMMUNICATIONS

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12. BASE OPERATIONS

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13. CABLE TV

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14. COMMERCIAL UTILITY COMPANY

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TELEPHONE

GAS

ELECTRIC

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15. OTHER

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(Specify)

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16. REQUESTED CLEARANCE

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APPROVED

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DISAPPROVED

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17. TYPED NAME AND SIGNATURE OF APPROVING OFFICER

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(Chief of Operations Flight or Chief of Engineering Flight)

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17a. DATE SIGNED

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PREVIOUS EDITIONS ARE OBSOLETE.

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AF FORM 103, 19940801

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(IMT-V1)

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2. TYPE OF FACILITY WORK INVOLVED.

Check box A. PAVEMENTS off

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Check box B. DRAINAGE SYSTEMS
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Check box C. RAILROAD TRACKS
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Check box D. FIRE DETECTION and PROTECTION SYSTEMS
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Check box E. UTILITY
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OVHA
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Check box OVERHEAD
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UNDGA
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Check box UNDERGROUND
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OVHA
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Check box F. COMMUNICATIONS
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OVHB
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Check box OVERHEAD
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Check box UNDERGROUND
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OVHB
GHI
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Check box G. AIRCRAFT OR VEHICULAR TRAFFIC FLOW
off
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Check box H. SECURITY
off
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Check box I. OTHER
off
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GHI_2
OTH
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extent
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14. COMMERCIAL UTILITY COMPANY.

Check box telephone off

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COMUTIL_2
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14. COMMERCIAL UTILITY COMPANY

Check box Gas off

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COMUTIL
COMUTIL_3
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14. COMMERCIAL UTILITY COMPANY

Check box electric off

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COMUTIL_2
REMKE
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FA4690-10-R-K102 Amendment 03.pdf PDF
Attach 15 - Revised Sample Project AF Form 3052(Page 2-3) 8 Mar 11.xlsx XLSX spreadsheet
Attach 15 - Revised Sample Project Contractor Bid Schedule —
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Attach 2 - AF Form 103.pdf PDF
Attach 24 - Past Performance Questionnaire - 24 Feb.pdf PDF
Attach 9 - Material Approval Submittal Form 3000.pdf PDF
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Attach 6 - Design Standards - 30 Oct 10.doc DOC document
Attach 22 - Wage Det SD100009 03-12-2010 SD9.pdf PDF
Attach 12 - ACC Mechanical Room Standards.doc DOC document
Attach 24 - Past Performance Questionnaire - 19 Jul 10.doc DOC document
Attach 20 - Wage Det SD100004 1-7-2011 SD4.pdf PDF
Attach 17 - Sample Project SOW.docx DOCX document
Attach 15 - Sample Project Contractor Bid Schedule.doc DOC document
Attach 3 - Submittal Schedule.xls XLS spreadsheet
Attach 18 - Wage Det SD100002 03-12-2010 SD2.pdf PDF
Attach 7 - Ellsworth AFB Fire Protection Standards.pdf PDF
Attach 8 - EAFB Sup 1 to ACC Instruction 32-1054 Exterior Signs - 10 Jun 05.pdf PDF
Attach 21 - Wage Det SD100006 01-07-2011 SD6.pdf PDF
Attach 13 - General Provisions MACC - 10 Feb 11.doc DOC document
Attach 19 - Wage Det SD100003 12-31-2010 SD3.pdf PDF
Attach 6 - Base Overview Analysis - 30 Oct 10.doc DOC document
Attach 6 - Executive Summary - 30 Oct 10.doc DOC document
Attach 6 - Appendix 2 Standards - 30 Oct 10.doc DOC document
Attach 16 - MACC Sample Project Drawings 001.tif TIF image
Attach 6 - Introduction Base Mission - 30 Oct 10.doc DOC document
Attach 6 - Appendix1 Plants - 30 Oct 10.doc DOC document
Attach 5 - Spec Section 01800 - 17 Nov 10.doc DOC document
Attach 6 - Table of Contents - 30 Oct 10.doc DOC document
Attach 10 - ACC Supplement 1 to AFI 32-1063 - 16 Oct 06.pdf PDF
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Attach 23 - NAF General Provisions - 10 Sep 07.doc DOC document
Attach 9 - Material Approval Submittal Form 3000.xfd —
Attach 11 - Ellsworth AFB Underground Electrical Rqmts.pdf PDF
Attach 4 - Spec Section 01000 - 30 Oct 10.doc DOC document
FA4690-10-R-K102 solicitation.doc DOC document
Attach 14 - Sample Project General Information and Project Requirements —
Attach 25 - Historical Data.xls XLS spreadsheet
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