Quarters Checklist.docx

DOCX document 75 KB Posted

Attached to
Facility Assessment Federal contract opportunity
Solicitation number
IHS1467714
Issued by
Department of Health and Human Services Indian Health Service

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1. Amended Instructionns to Offerors.pdf PDF
3. Amended Clauses and Provisions.docx.pdf PDF
4 FCAP Work Sheet.xlsx XLSX spreadsheet
3 Clauses and Provisions.pdf PDF
1 Instructions to Offerors.pdf PDF
2 PAIHS FCAP and Quarters SOW.pdf PDF
5 IEE Representation Form.pdf PDF

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Rating of Item: 1. Excellent 2. Good 3. Fair 4. Poor 5. Obsolete 6. Unsure 7. N/A 8. Yes 9. No

Exterior*Bold Items Must Be Supported By Documentation & Photos
Item
Rating
Remarks/Comments
Est. Repair/Replacement $

Are there any notable signs indicating problems with the Roof (e.g., shingles curling or buckling, missing shingles, etc.)?

Rain Gutters/Downspouts/Drains

Damage to Exterior Walls /Siding

Damage to Exterior HVAC Heat/Air Unit Or Heat Source Unit Or Window Unit

Exterior Doors/Storm Door/Screens

Y

Y-

No significant deficiencies noted, nearing end of service life.

Functioning Windows/Screens (e.g., lock, open or close properly)

Are Porch/Steps/Fence Or Patio Damaged or Need Repair?

Y

Are Sidewalk/Driveway/Pathways Damaged or Need Repair?

Is there any known Asbestos or Lead Based Paint at the unit?

Are there indications of Moisture Issues, Water Damage Or Mold Issues at this unit?

Are there Radon Fans or reports of Radon at the unit?

Any signs of Chimney/Boiler Stack/Fire Place damaged or in need of repair?

Condition of Garage/Carport

Condition Of Outside Shed

Flammable Liquids Stored/Gas or Charcoal Grill Located Close To Quarters

Any Indications of Rodents/Insects Or Other Pests

Condition Of Lawn & Landscaping

Other

Item
Rating
Remarks
Est. Repair/Replacement $

Basement Used For Storage. Is there an egress and ingress?

Basement Used for Other than Storage Is the basement used for bedrooms Is there Egress Windows; Write Remarks

Are there any moisture issues or visual signs of damage or leaks in the basement? If so, where?

Is there a sump pump? If so, is it operational? What is the condition of sump pump?

Is the furnace operational? If so, define its condition and the date of last filter change.

Is the Heating/Cooling System Operational? Define condition and type of system

Quarters Deficiency Checklist Installation Name: Installation Number: Quarters No.

Visual Inspection Performed By:

Date Unit Status: Vacant Maintenance Improvement/Renovation Demolition** Revocable

Rating of Item:1. Excellent 2. Good 3. Fair 4. Poor 5. Obsolete 6. Unsure7. N/A 8. Yes 9. No
What is the date the Heating/Cooling System filters were changed?

Smoke Detector/Carbon Monoxide Detectors (Operate and Function Properly)

$4,360.50

Living/Dining Room

Item
Rating
Remarks:
Est. Repair/Replacement $

Walls/Ceilings/Floor Finishes

Are the electrical outlets, lighting features, and switches properly working?

Kitchen

Item
Rating
Remarks
Est. Repair/Replacement $

Condition of Cabinets/Counter Tops

Conditions of Refrigerator (e.g., damaged, not properly cooling, etc.)

Is the Stove/Microwave/Range Hood Vents properly working

Any problems with the Kitchen Plumbing/Sink/ Dishwasher/Garbage Disposal

Is Washer/Dryer operational?

Are the kitchen electrical outlets, lighting fixtures, and switches properly working?

All Bedrooms

Item
Rating
Remarks
Est. Repair/Replacement $

Walls/Ceiling/Floor Finishes

Any damage to Closets Adequate/In Good Condition, doors, shelves

Are the electrical fixtures, outlets, and switches working properly?

All Bathrooms

Item
Rating
Remarks
Est. Repair/Replacement $

Condition of Bathroom fixtures e.g., tub/shower/cabinets/counter tops, Mirror, etc.

Condition of Bathroom Wall/Ceiling/Floor and signs of water damage

Are the electrical fixtures, Outlets and switches properly working

OVERALL INTERIOR RATING Excellent Good Fair Poor Obsolete OVERALL EXTERIOR RATING Excellent Good Fair Poor Obsolete

It is critical for this checklist to be filled out as accurately and completely as possible regarding the condition of the quarters.

By signing this document below, the parties agree upon the condition of the property and the required repairs. This Deficiency Checklist document must be completed and signed by the Tenant Manager, Maintenance Staff and Housing Manager and a copy provided to Tenant within 30 days.

Tenant Manager Maintenance Staff Housing Manager ** Note: Please coordinate quarter’s demolitions with the Area Realty Management Officer.

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