Appendix_R_-_Reports_List.pdf

Solicitation FA4890-13-R-0007

Appendix R - 1 11 Dec 2013

APPENDIX R

REPORTS LIST

This appendix details reports called out within Section A of the PWS.

PWS para Short title of report CDRL

2.1.1.5.3 Communications-Electronics (C-E) Equipment Modification A006

2.1.2.2.1 Personnel Listing A013

2.1.2.3 Employee Training Operating Instructions A003

2.1.3 Financial Documentation A001

2.1.5.1 Existing Conditions One time report – NO CDRL

2.1.6 Special Reports A002

2.2.3.3 Operating Instructions (OIs) A003

3.1 Monthly Maintenance Schedule A005

3.1.1.3 Maintenance Control Plan (MCP) A003

3.2.1.8 MASS Summary Report A015

(Color code status for FAC Site Operations)

3.2.1.10 Site Logs A012

3.2.1.11 Trip Reports A002

3.3.1 CE Project Completion Report A008

3.3.7 Annual Facility Survey A009

3.3.8 Annual Test and Inspections A009

3.3.11.1 Environmental Protection Plan A016

Appendix R - 2

PWS para Short title of report CDRL

3.3.11.2 Spill Notification A010

3.3.12 Safety and Health Program A011

3.3.13 Mishap Notification and Reporting A007

3.3.13.1

4.1.1 Requisition Report A018

4.1.1.1 Repairable Tracking Report A021

4.1.1.1.1 Depot Support Report A023

4.1.1.1.2 Awaiting Parts Report A018

4.1.1.2 MICAP Report A020

4.1.1.4.2 Deficiency Report A019

4.1.1.5.4.1 Annual Inventories A004

4.2.3.1 Fatal Vehicular Accident Report A007

4.2.3.4 VDM/VDP Report A014

4.2.4.1 Chartered Airline Cost Report A022

4.3.1 Maintenance Analysis Report A017

4.3.3.2 Radar Status Report A025

4.3.3.3 Height Report A026

4.3.3.4 Reinforcement Rate Report A027

4.4.3 Site Security OIs A003

Appendix R - 3

PWS para Short title of report CDRL

4.4.6.4 List of Personnel Security Clearances A013

4.4.10 Security Incidents A002

PWS Addendum I paragraph Short title of report CDRL

2.2.1 Contractor CAP Report for Colombia A002

2.2.2 Daily MILGRP Personnel Status Report A002

2.2.3 Host Nation Contractor Report A002

3.1.3 Site Trip Report A002

3.1.5 FAC Location O&M Site Logs A012

The following is a listing of the CDRLs by number and title.

CRDL No. Title

A001 FINANCIAL REPORT

A002 REPORTS

Special Contractor CAP Report for Colombia MILGROUP Personnel Report Host Nation Contractor Report Site Trip Report Security Incidents A003 CONTRACTOR OIs Maintenance Control Plan Operating Instructions Security OIs Training Instructions

A004 GOVT-FURNISHED PROPERTY REPORT

A005 MONTHLY MAINTENANCE SCHEDULE

Appendix R - 4

CRDL No. Title

A006 C-E MODIFICATIONS

A007 MISHAP NOTIFICATION AND REPORTING

A008 CE PROJECT COMPLETION

A009 FACILITY SURVEY & INSPECTION

A010 SPILL NOTIFICATION

A011 SAFETY & HEALTH PLAN

A012 SITE LOGS

A013 PERSONNEL LISTING

A014 VDM/VDP REPORT

A015 DAILY SUMMARY & DSR

A016 ENVIRONMENTAL PLAN

A017 MAINTENANCE ANALYSIS REPORT

A018 PARTS REPORT

Awaiting Parts Report Requisition Report

A019 DEFICIENCY REPORT

A020 MICAP REPORT

A021 REPAIRABLE TRACKING REPORT

A022 CHARTER FLIGHT REPORT

A023 DEPOT SUPPORT REPORT

A025 RADAR STATUS REPORT

A026 RADAR HEIGHT REPORTS

A027 REINFORCEMENT REPORT

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours 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, Executive Services Directorate (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 it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP ________ TM _______ OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

Page of Pages

16. REMARKS (Continued)

DD FORM 1423-1, FEB 2001 Page of Pages

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package;

TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15.

Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.

DD FORM 1423-1 (BACK), FEB 2001

data_item: A004 title: Equipment Inventory Records sub: Government Furnished Property Report auth: DI-ILSS-81251 ref: See Block 16 req_ofc: ACC AMIC/PSU dd250: XX appcode:

dist: B freq: Annually asof: See Blk 16 firstsub: See Blk 16 subsub: 15 Mar addressee1: ACC AMIC/PLG draft1:

reg1:

repro1: 1 addressee2: ACC AMIC/PSUR draft2:

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total_draft: 0 total_reg: 0 total_repro: 6 remarks: 4) Report shall be in an electronic format compatible with Microsoft Office with the following file name structure: CDRL A004 - Government Furnished Property. The delivery method is electronic posting to the PMIS with e-mail notification of posting to receivers in block 14. Final documents may be stored on the PMIS in Adobe PDF format. Delete block 10 of DD Form 1664 in its entirety and see block 16 of this form.

5) PWS, Section A, Para 4.1.1.6.1.1 The Government Furnished Property Report shall be in Excel Spreadsheet format and shall include the following fields at a minimum:

• Nomenclature

• Part Number/National Stock Number (NSN)

• Unit of Issue

• Quantity

• Unit Price

• Authorized Quantity

• Property Location (site/Location on site)

• Equipment Category, (i.e. consumable, reparable, equipment, ADPE, TMDE)

• Date of Last Inventory (DOLI)

• Asset Disposal Date (if Applicable)

• Warranty data (if active warranty)

• Date Property Assigned to Inventory List

• Estimated Life Cycle/Replacement year

• Estimated replacement cost

8) The document will be accept or rejected by the government within 30 working days after receipt. If rejected the contractor shall revise and resubmit the document within 10 working days after receipt unless otherwise directed by the CO.

11) The data contained in the report shall be current through 1 July of each subsequent year.

12) The first delivery of the report shall be 15 Mar 15.

15) Repro is via MIS.

group:

total_price:

prep_name:

prep_sign:

prep_date:

app_by:

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app_date:

Page:

app: Adobe Professional 7.0 line_item:

exhibit:

xtdp: Off xtm: Off othercat: Admin/Management Data system: Mobile Air Surveillance System (MASS) ctr_no: RFP FA4890-13-R-0007 contr:

remarksb:

Page2:

of_pages:

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The public reporting burden for this collection of information is estimated to average 110 hours 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, Executive Services Directorate (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 it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A006 title: ENGINEERING CHANGE PROPOSAL sub: MASS C-E AF Form 1067 Modification Proposal auth: DI-CMAN-80639C ref: See Block 16 req_ofc: ACC AMIC/PSU dd250: XX appcode:

dist: TBD freq: See Blk 16 asof: See Blk 16 firstsub: See Blk 16 subsub: See Blk 16 addressee1: ACC AMIC/PKC draft1:

reg1:

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total_draft: 0 total_reg: 0 total_repro: 6 remarks: 3) Subtitle shall be as that data requires in the corresponding paragraph.

4) Report shall be provided using MS Office suite and posted on contractor's MIS.

Contractor shall notify the addressees in block 14 via e-mail once report is posted and attach a copy of the report to the notification e-mail. File name should be formatted in this manner. Example: MASS-SUR 14-01: "Title"

5) PWS Sec A Paragraph 2.1.1.5.2. All requests to modify MASS C-E equipment shall be submitted through the CO using an AF Form 1067, Modification Proposal IAW AFI 63-1101 Modification and PWS Para. 2.1.1.5.2.

8) Approval/disapproval/comments shall be provided by the Government within 180 working days after receipt of each submittal.

9) Contractor shall recommend a distribution statement based on technical content.

10 - 13) Submit as mission needs dictate.

15) Repro is via MIS.

group:

total_price:

prep_name:

prep_sign:

prep_date:

app_by:

app_sign:

app_date:

Page:

app: Adobe Professional 7.0 line_item:

exhibit: A xtdp: Off xtm: Off othercat: Engineering Data system: Mobile Air Surveillance System (MASS) ctr_no: RFP FA4890-13-R-0007 contr:

remarksb:

Page2:

of_pages:

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The public reporting burden for this collection of information is estimated to average 110 hours 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, Executive Services Directorate (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 it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A007 title: ACCIDENT/INCIDENT REPORT sub: SAFETY MISHAP NOTIFICIATION auth: DI-SAFT-81563 ref: See Block 16 req_ofc: ACC AMIC/PSU dd250: XX appcode:

dist: B freq: See Blk 16 asof: See Blk 16 firstsub: See Blk 16 subsub: See Blk 16 addressee1: ACC AMIC/PKC draft1:

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total_draft: 0 total_reg: 0 total_repro: 4 remarks: 4) Report shall be provided using MS Office suite. The delivery method is electronic posting to the MIS with e-mail notification of posting to receivers in block 14. Final documents may be stored on the Project Management Information System in Adobe PDF format.

5) Sec A PWS Para 3.3.13, 3.3.13.1 & 4.2.3.1.

3) Submit mishap\event information IAW AFI 91-204, Chapter 5 with follow-up information IAW Chapter 6 of this publication. Mishaps\events to be classified in accordance with paragraph 1.8 AFI 91-204 and PWS Sec A paragraph 3.2.3.13.

9) Distribution authorized to U.S. Government agencies only. Other requests for this document shall be referred to ACC AMIC/PKC.

10 - 13) Report shall be submitted within 24 hours of occurrence and updates shall be provided as an addendum to the CDRL. Government will have 10 days to order an investigation. If an investigation is directed by the Government, a final report will be due within 15 calendar days of the order of the investigaton.

15) Repro is via MIS.

group:

total_price:

prep_name:

prep_sign:

prep_date:

app_by:

app_sign:

app_date:

Page:

app: Adobe Professional 7.0 line_item:

exhibit: B xtdp: Off xtm: Off othercat: Admin/Management Data system: Mobile Air Surveillance System (MASS) ctr_no: RFP FA4890-13-R-0007 contr:

remarksb:

Page2:

of_pages:

Reset:

The public reporting burden for this collection of information is estimated to average 110 hours 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, Executive Services Directorate (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 it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A008 title: Installation Completion Notification sub: Project Completion Report auth: DI-CMAN-81245A ref: Sec A, PWS Para 3.3.1 req_ofc: ACC AMIC/PSU dd250: XX appcode:

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total_draft: 0 total_reg: 3 total_repro: 0 remarks: 4) Report shall be provided using MS Office suite and posted on contractor’s web-site. Contractor shall notify the Government via E-mail once report is posted. Final documents may be stored on the Project Management Information System in Adobe PDF format.

5) The contractor shall provide a project completion report within 30 days of project completion. Information will be submitted using a completed project checklist. CE Project Completion Report shall contain the information shown in the attached Project Completion Report Work Sheet. In addition, photographs of completed work shall be included in the report.

9) Distribution authorized to U.S. Government agencies only. Other requests for this document shall be referred to ACC AMIC/PKC.

10 – 13) As required group:

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The public reporting burden for this collection of information is estimated to average 110 hours 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, Executive Services Directorate (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 it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the

David.Coburn

Sticky Note

Unmarked set by David.Coburn conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A009 title: Site Survey Report (SSR) sub: Facility Survey and Inspection Report auth: DI-MISC-81381 ref: See Block 16 req_ofc: ACC AMIC/PSU dd250: see Blk 16 appcode:

dist: B freq: ANNUALLY asof: 30 May firstsub: 15 Jul subsub: 15 Jul addressee1: ACC AMIC/PSUR draft1:

reg1: 1 repro1:

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total_draft: 0 total_reg: 3 total_repro: 0 remarks: Block 5) PWS Section A paragraph 3.3.7, 3.3.8. The contractor shall provide an Annual Facility Survey and Inspection report detailing facility and system deficiencies in the structural, electrical, mechanical, and environmental areas, with an introductory overview of issues/concerns from a CE/real property viewpoint for those sites listed in Appendix J. The Survey and Inspection report shall, at a minimum, include the conditions of facilities (interiors and exteriors), slabs and foundations, airfields, roads, grounds, drainage systems, sanitary sewage system, water supply, electrical system, POL system, other utility systems, power generation equipment, fire protection/detection equipment, and physical security aides. The Survey/Inspection report shall include photographs of the above items at each site in sufficient detail to document all deficient conditions as well as the overall condition of the sites. These photos will be organized into a single file for viewing along with individual photo files in a supporting sub folder on the submitted CD.

The report will be organized by site and include required Testing and Inspection information for the HNCC, Bogota, Colombia and the TADIL site at Cerro Azul, Costa Rica. At a minimum, this will encompass the date of the test and/or inspection, the procedures used, the facility number, the site, test/inspection results, and recommendations for any future work. For power generation, also include a spreadsheet of current status of all power generation equipment. This status will include hours operated since last overhaul for planning purposes.

The report will also include, for those sites listed in Appendix A for which the contractor has facility O&M responsibility, the contractor’s listing of real property and RPIE, corresponding to the official government facility number, so that there will a single document that provides a single overview of contractor maintained facilities.

Block 7: The report will be accepted or rejected by the Government within 30 working days after receipt. If rejected, the contractor shall revise and resubmit within 10 working days after receipt unless otherwise directed by the Contracting Officer.

Block 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only for administrative or operational data. Other requests shall be referred to ACC AMIC/PKC.

Block 14 Report shall be submitted electronic format. The electronic format shall be on CD compatible with Microsoft Office in multiple files. CD will be turned in to ACC AMIC/PCE. This report, minus the subfolders will be posted to the contractor’s MIS with e-mail notification to the addressees.

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The public reporting burden for this collection of information is estimated to average 110 hours 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, Executive Services Directorate (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 it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any

CDRL-A015 Spill Report

Spill Report Form

Site Reporting Spill:

Reporter's Name, Organization, Duty Phone:

Date and Time of Release:

Location of release:

Notification of Fire Department

Yes

No

Notification of NRC:

Yes

No

Notification of State Environmental Regulators:

Yes

No

Equipment/Facility involved:

Root cause of release (when determined, not necessary with initial report):

Type of material released:

Release Classification (circle one)

Class I

Class II

Class III

Class I - Involves an area less than 2 lineal feet in any plane dimension

Class II - Involves area not over 10 lineal feet in any plane dimension, or not over 50 square feet, and not of a continuous nature

Class III - Involves an area over 10 lineal feet in any plane dimension, or over 50 square feet, or of a continuous nature

Estimated quantity in gallons:

Released:

Recovered:

Spills on a hard surface: 2 ft. diameter = .25 gal; 4 ft. diameter = 1 gal; 6 ft. diameter = 2 gal; 8 ft. diameter = 4 gal; 10 ft. diameter = 6 gal

Corrective action taken:

Was the release contained on a hard surface (concrete, asphalt)?

Yes

No

Est. Quantity (gallons)

Did the release enter the storm drain or surface water?

Yes

No

Est. Quantity (gallons)

Did the release enter the sanitary drain?

Yes

No

Est. Quantity (gallons)

Did the spill reach and soak into any soil?

Yes

No

Est. Quantity (gallons)

Was the spill cleaned with in 24 hours?

Yes

No

Did the process owner have sufficient cleanup capabilities?

Yes

No

Is the spill reportable?

Yes

No

Any continuing threat to the environment?

Yes

No

Estimated cost to cleanup (including man hours):

data_item: A010 title: Pollution Incident Report sub: Spill Report auth: DI-SAFT-80494A ref: Sec A PWS paragraph 3.3.11.2 req_ofc: ACC AMIC/PSU dd250: see Blk 16 appcode:

dist: B freq: See Blk 16 asof: See Blk 16 firstsub: See Blk 16 subsub: See Blk 16 addressee1: ACC AMIC/PKC draft1:

reg1: 1 repro1:

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total_draft: 0 total_reg: 3 total_repro: 0 remarks: Block 4: Report shall be provided using MS Office suite and posted on contractor’s website. Contractor shall notify the Government via e-mail, with report attached, once report is posted. Final documents may be stored on the Project Management Information System in Adobe PDF format.

The contractor will report all spills to the CO. The pollution spill report, with the addition of the categories “actual damage/potential threat, findings and causes, management actions taken to prevent reoccurrence, casualties or injuries including personnel information and assistance required” shall constitute submission in IAW the OEBGD, Chapter 18. Report all fields in the attached “CDRL A010 Spill Report”.

Block 7: The document will be accepted or rejected by the Government within 5 business days. Contractor shall revise and resubmit the document within 10 working days after receipt unless otherwise directed by the CO.

Block 9: Distribution authorized to U.S. Government agencies only (administrative or operational data, 22 May 07). Other requests for this document shall be referred to the CO.

Blocks 10-13: Report shall be submitted NLT COB next business day and updates shall be provided as an addendum to the CDRL.

group:

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The public reporting burden for this collection of information is estimated to average 110 hours 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, Executive Services Directorate (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 it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A011 title: Environmental Health and Safety Plan (EHSP) sub: Safety and Health Plan (S&HP) auth: DI-ENVR-81375 ref: See Blk 16 req_ofc: ACC AMIC/PSU dd250: XX appcode:

dist: B freq: Annually asof: See Blk 16 firstsub: 90 DAC subsub: See Blk 16 addressee1: ACC AMIC/PKC draft1: 1 reg1: 1 repro1:

addressee2: ACC AMIC/PSUR draft2: 1 reg2: 1 repro2:

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total_draft: 3 total_reg: 3 total_repro: 0 remarks: 4) Report shall be provided using MS Office suite and posted on contractor’s website. Contractor shall notify the Government via Email once report is posted. Final documents may be stored on the Project Management Information System in Adobe PDF format.

5) Sec A PWS Para 3.3.12 Plan shall at a minimum include: Confined Space Management, Lock/Out-Tag/Out, Hazardous Communications (HAZCOM), Fire Protection/Prevention, Job Safety Training, Safety Inspections, Mishap Notification and Reporting Procedures, Hazard Abatement Procedures, Hazard Prevention and Control Procedures, Safety Supplies and Equipment, Safety Reviews, and Mishap Prevention as applicable.

7) The document will be accepted or rejected by the Government within 30 business days after receipt. Contractor shall revise and resubmit the document within 10 business days after receipt unless otherwise directed by the CO.

9) Distribution authorized to U.S. Government agencies only. Other requests for this document shall be referred to ACC AMIC/PKC.

10, 11, 13) The contractor shall review and update their plans IAW with the approved QMS. When a plan is revised it shall be submitted to the CO for Government acceptance NLT 10 business days after revision. Revised plans shall include a revision page clearly delineating what has changed.

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The public reporting burden for this collection of information is estimated to average 110 hours 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, Executive Services Directorate (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 it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A012 title: CONTRACT FIELD SERVICE REPORT sub: OPERATIONS & MAINTENANCE SUPPORT LOGS auth: DI-MGMT-81238 ref: SEE BLK 16 req_ofc: ACC AMIC/PSU dd250: XX appcode:

dist: C freq: WEEKLY asof: SEE BLK 16 firstsub: 5 Oct 2014 subsub: MONDAYS addressee1: ACC AMIC/PKC draft1:

reg1:

repro1: 1 addressee2: ACC AMIC/PSUR draft2:

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total_draft: 0 total_reg: 0 total_repro: 5 remarks: 4) Electronic format shall be compatible with Microsoft Office via the ACC AMIC LAN electronic mail system. Final documents may be stored on the Project Management Information System in Adobe PDF format.

5) Sec A PWS paragraph 3.1.5 The contractor shall provide a Site Log chronologically documenting on a daily basis. MASS O&M actions conducted at each contractor and FAC manned operating location. The Government recognizes that Site Log information can be conditional to what the Host Nation provides the contractor. The Site Log shall document the following information:

• The initial entry of each Julian date shall provide the current operational site status, calculated Comm Er for the month, personnel on duty and fuel status

• Projected equipment downtime/delays and reason for downtime/delays

• Preventive Maintenance Inspections (PMI) completed. Provide: PMI #, Equipment Control Number (ECN) #, Start (Z), Stop (Z), WO #, Status, and initials

• Initials of person notified at the CC, and all actions taken to return equipment to operation

• WOs opened and closed (0001Z to 2400Z)

• Noun, Part/Number (P/N), quantity, and supply document number of all MICAP parts shipped, received, and installed

• Visitors on site: Provide name, organization, arrival and departure date, and reason for visit of all contractor personnel and all visitors

• Message traffic: Message traffic sent and received by site

• JIATF-S calls: Provide call time (Z) and initials of all personnel contacted

• HRS CC mission related calls: Provide call time (Z) and initials of personnel contacted

• Fuel deliveries, including fuel level before and after delivery

• Significant events

• The final entry for each month will have the calculated monthly Comm Er for that site

9) Distribution authorized to U.S. Government agencies and their contractors. Other requests for this document shall be referred to ACC AMIC/PSUR.

11) Once a week on Mondays covering Saturday 0001Z through Friday 2400Z of the previous week.

14) E-mail address for AFSOUTHA60: AFSOUTHA6O@dm.af.mil.

15) Repro is electronic mail.

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