7. AIR FORCE FORM 103 - Base Civil Engineering Work Clearance Request - Dig Permit.pdf
PDF 16 KB Posted
- Attached to
- Sustain Pad 5, Phase III Federal contract opportunity
- Solicitation number
- FA9401-12-R-0019
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Attachment 7
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Addendum 1 FA9401-12-R-0019.pdf | ||
| FA9401-12-R-0019 Amendment 1.pdf | ||
| Response to Pad 5 Questions.pdf | ||
| 4a. Corrected AF Form 3052 Contractor Proposal Form.xlsx | XLSX spreadsheet | |
| FA9401-12-R-0019 Site Visit Sign In.pdf | ||
| 12. Past Performance Information Form.docx | DOCX document | |
| 9. AF Form 66 Schedule of Material Submittals.pdf | ||
| 2. Drawings 070054B-C1-Layout1.pdf | ||
| 5. AF 3065 Progress Report.pdf | ||
| 4. AF Form 3052 Government Price Schedule Summary.xlsx | XLSX spreadsheet | |
| 1. Statement of Work | — | |
| FA9401-12-R-0019.pdf | ||
| 14. AF Form 3064 Progress Schedule.xls | XLS spreadsheet | |
| 3. Sustain Pad 5 Phase III Specs.pdf | ||
| 13. KAFB Map for Site Visit Location | — | |
| 8. AF Form 3000 Material Aprroval Submittal.pdf | ||
| 6. Permit Requirements Memo.pdf | ||
| 10. Wage Determination- NM120013- NM13-Heavy.pdf | ||
| 11. Wage Determination- NM120047- NM47- Highway.pdf |
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Text version
DATE PREPAREDBASE CIVIL ENGINEERING WORK CLEARANCE REQUEST
(See Instructions on Reverse)
1. Clearance is requested to proceed with work at on Work Order No. , Contract No. , involving excavation or utility disturbance per attached sketch. This area has has not been staked or clearly marked.
2. TYPE OF FACILITY/WORK INVOLVED
G. AIRCRAFT OR VEHICULAR TRAFFIC FLOWA. PAVEMENTS D. FIRE DETECTION & PROTECTION SYSTEMS
H. SECURITYB. DRAINAGE SYSTEMS E. UTILITY OVERHEAD UNDERGROUND
I. OTHERC. RAILROAD TRACKS F. COMM OVERHEAD UNDERGROUND
3. DATE CLEARANCE REQUIRED 4. DATE OF CLEARANCE
5. SIGNATURE OF REQUESTING OFFICIAL 6. TELEPHONE NO. 7. ORGANIZATION
ORGANIZATION REMARKS (Use Reverse for additional REVIEWER'S NAME AND INITIALS
8.
A. ELECTRICAL DISTRIBUTION
B A
S B. STEAM DISTRIBUTION
E
C. WATER DISTRIBUTION
C I
D. POL DISTRIBUTIONV
I L
E. SEWER DISTRIBUTION
E N
F. ENVIRONMENTAL
G
I
G. PAVEMENTS/ GROUNDSN
E
E H. FIRE PROTECTION
R
I
I. ZONEN
G
J. OTHER (Specify)
9. SECURITY POLICE
10. SAFETY
11. COMMUNICATIONS
12. BASE OPERATIONS
13. CABLE TV
14. COMMERCIAL UTILITY COMPANY
TELEPHONE
GAS
ELECTRIC
15. OTHER (Specify)
16. REQUESTED CLEARANCE APPROVED DISAPPROVED
17. TYPED NAME AND SIGNATURE OF APPROVING OFFICER (Chief of Operations Flight or Chief of Engineering Flight) 17a. DATE SIGNED
PREVIOUS EDITIONS ARE OBSOLETE.AF IMT 103, 19940801, V3
INSTRUCTIONS
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.
18. REMARKS. (This section must describe specific precautionary measure to be taken before and during work accomplishment. Specific comments concerning the approved method of excavation, hand or powered equipment, should be included.)
AF IMT 103, 19940801, V3 (REVERSE)
File details come from the government source that posted it. Updated .