Atch__16_-_BLANK_SAMPLE_Master_Utility_Outage.pdf
PDF 614 KB Posted
- Attached to
- Mechanical Electrical IDIQ Federal contract opportunity
- Solicitation number
- FA8501-18-R-0003
About this file
This document contains a utility outage request form template and information on the FA8501-18-R-0003 solicitation for the Mechanical Electrical IDIQ contract at Robins Air Force Base.
The utility outage request form template requires information on the type of outage, facility numbers, dates and times for the requested outage, reason for outage, requester details, and signatures for approval. It is to be used to coordinate utility outages for maintenance, repairs or construction work.
The Mechanical Electrical IDIQ contract solicitation provides for maintenance, repair, alteration, and new construction work on real property facilities at Robins Air Force Base. The broad scope of work includes HVAC, controls and distribution systems, fuel distribution including underground lines and tanks, boiler repairs and replacements, airfield and exterior lighting, fire suppression and alarm systems. The contractor will provide all materials, equipment, labor and general conditions to complete task orders issued against the IDIQ contract for mechanical and electrical maintenance support of base facilities.
Attachment #16 - Blank Master Utility Outage
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Text version
UTILITY OUTAGE REQUEST
DATE:
CHECK OUTAGE TYPE: Electrical Water Steam Chilled Water Other
IF OTHER, EXPLAIN:
FACILITY NUMBER(S):
FACILITY MANAGER SIGNATURE AND ANY REQUIRED USER COORDINATION
LABOR RELATIONS COORD REQUIRED: YES NO
(DATE) AT REQUEST OUTAGE BEGINNING:
SIGNATURE:
ENDING ON: (DATE) AT (TIME)
REASON FOR
OUTAGE:
REQUESTER:
PROJECT NUMBER:
COMPANY:
PHONE NUMBER:
PROJECT/CONTRACT MONITOR NAME:
PHONE NUMBER:
SHOP COORDINATION Facilities Super Infrastructure Super Utilities Super INITIAL AS NEEDED Alarms Industrial Mechanical Utilities
Interior HVAC Fire Dept Exterior Zone 1 Other Power Production
78 CES/CEPC (SERVICE CALL MUST COORDINATE ON ALL OUTAGES AND RECEIVE A COPY OF
SIGNED OUTAGE REQUEST)
OUTAGE IS APPROVED/DISAPPROVED:
This form effective 03/17/2006
(TIME) AND
78 CES/CL
After electronically completing top portion of form, print for coordination initials and approval signature.
UTILITY OUTAGE REQUEST
DATE:
CHECK OUTAGE TYPE:
IF OTHER, EXPLAIN:
FACILITY NUMBER(S):
FACILITY MANAGER SIGNATURE AND ANY REQUIRED USER COORDINATION
LABOR RELATIONS COORD REQUIRED:
YES
NO
(DATE) AT
REQUEST OUTAGE BEGINNING:
SIGNATURE:
ENDING ON:
(DATE) AT
(TIME)
REASON FOR
OUTAGE:
REQUESTER:
PROJECT NUMBER:
COMPANY:
PHONE NUMBER:
PROJECT/CONTRACT MONITOR NAME:
PHONE NUMBER:
SHOP COORDINATION
Facilities Super Infrastructure Super Utilities Super
INITIAL AS NEEDED
Alarms Industrial Mechanical Utilities Interior
HVAC
Fire Dept Exterior Zone 1 Other Power Production
78 CES/CEPC
(SERVICE CALL MUST COORDINATE ON ALL OUTAGES AND RECEIVE A COPY OF
SIGNED OUTAGE REQUEST)
OUTAGE IS APPROVED/DISAPPROVED:
This form effective 03/17/2006
(TIME) AND
78 CES/CL
After electronically completing top portion of form, print for coordination initials and approval signature.
UTILITY OUTAGE REQUEST
Preferred Customer Normal.dot william.fowler Microsoft Office Word
3/10/2006 1:32:00 PM
3/10/2006 1:30:00 PM
3/10/2006 1:32:00 PM
Dell Computer Corporation 28672
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