J-0200000-01 though 14.pdf

SECTION J

DOCUMENTS, EXHIBITS, AND OTHER ATTACHMENTS

TABLE OF CONTENTS

ATTACHMENT

NUMBER

ATTACHMENT TITLE

J-0200000-01 DEFINITIONS AND ACRONYMS

J-0200000-02 WAGE DETERMINATIONS

J-0200000-03 PNSY STATION REGULATIONS

J-0200000-04 DIRECTIVES, INSTRUCTIONS, AND REFERENCES

J-0200000-05 INVOICE FORM

J-0200000-06 FORMS

J-0200000-07 PNSY CONTRACTOR CRANE OPERATION AND MAINTENANCE

J-0200000-08 CONTRACTOR HAZARDOUS MATERIAL INVENTORY LOG

J-0200000-09 EXHIBIT LINE ITEM NUMBERS

J-0200000-10 PNSY CONTRACTOR CRANE

J-0200000-11 RECENT/RELEVANT EXPERIENCE DATA SHEET

J-0200000-12 PAST PERFORMANCE QUESTIONNAIRE

J-0200000-13 CONTRACTOR’S SELF-PERFORMANCE CERTIFICATION & NOTIFICATION OF

SUBCONTRACTING

J-0200000-14 OSHA 300A - SUMMARY OF WORK-RELATED INJURIES AND ILLNESSES

ATTACHMENT J-0200000-01

DEFINITIONS AND ACRONYMS

Definition Description Assessment A general term referring to either a survey or inspection of a facility to determine condition.

Asset A general term used to refer to an item, such as a component, system, building or facility, which is managed by an automated data management program.

Business Management System (BMS)

A web-based tool that provides a systematic method for the management of business processes, common practices, and process quality improvements that produce and support the most efficient and effective delivery of NAVFAC’s products and services.

Competent Person A person who has the professional experience and training necessary to identify existing and predictable hazards at a work or service environment, and who has the authority to take prompt and corrective action to eliminate or remove dangers from the environment.

One who can identify existing and predictable hazards in the working environment or working conditions that are dangerous to personnel and who has authorization to take prompt corrective measures to eliminate them.

Component Inventory Management Unit

(CIMU)

An organization of like-kind real property into manageable maintenance units. CIMU is a building component, group of components or component assemblies, serving a specific purpose in a facility that can be expected to follow a common and predictable lifecycle behavior. This class of non-equipment will include items such as exterior walls, exterior windows, interior finish, and roofs. This class of equipment will include items such as fan coil units, air handling units, lighting, and water closets. CIMUs can include one or more items of installed equipment typically subject to routine scheduled maintenance.

Confined Work Space A space that is large enough and so configured that a person may bodily enter a space (such as in tanks, vessels, silos, storage bins, hoppers, vaults, pits, and like spaces where there is limited means of entry) and is hindered or restricted from escaping during an emergency.

Contracting Officer

(KO)

That individual with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings. The term includes certain authorized representatives of the Contracting Officer acting within the limits of their authority as delegated by the Contracting Officer.

Contracting Officer’s Representative (COR)

The individual appointed by the KO responsible for monitoring the Contractor’s technical compliance and progress, relative to assigned contract(s)/orders(s), based on the contract requirements specified in the PWS and in accordance with the PAP. The COR performs a variety of contract administration duties that includes oversight of PA, documenting and rating Contractor performance, reviewing invoices, and acceptance of work. Assignment as a COR is a collateral duty typically performed by the FSCM or SPAR.

Contractor That entity or its representative responsible for the delivery of the services or materials specified in this contract, as designated by contract award. The term Contractor as used herein refers to both the prime Contractor and any subcontractors. The prime Contractor shall insure that subcontractors comply with the provision of this contract.

Contractor Representative

That individual appointed by the Contractor, either orally or in writing, who has been assigned responsibility for executing the requirements of this contract.

Direct Material Costs The actual vendor invoice charges for materials used for performance of work under this contract. Direct material costs shall include transportation charges when such charges are included on the invoice by the vendor, as well as any discounts allowed for prompt payment and discounts or rebates for core value or salvage value that accrue to the Contractor. When questions arise concerning the cost of materials, material costs will be based on the lowest of quotes provided by the Contractor from at least three different commercial vendors for the direct material cost. The Government retains the right to obtain additional quotes in questionable situations. The lowest price will be used.

Definition Description Electronic Operation And Maintenance And Support Information (eOMSI)

A set of consultant-prepared data and document files that contain detailed, as-built technical information that describes the efficient, economical and safe operation, maintenance and repair of a facility, plant, equipment or system throughout its life cycle.

Generally it is prepared during construction and submitted upon completion of a new facility or major facility upgrade. eOMSI’s typically include asset information, staffing and budgeting information, supply support including critical spare parts, operating procedures, troubleshooting and diagnostic guides, extended warranty data, maintenance task frequencies and documentation, technical data, repair procedures and manufacturer’s product data. eOMSI data and document files are provided in electronic formats.

Equipment Tangible asset that is functionally complete for its intended purpose, durable, and non-expendable.

Facility A building or structure designed and created to serve a particular function.

Fixed Burden Rate

(FBR)

The additional costs (expressed in percent of direct material cost) for ordering, handling, and stockpiling materials and repair parts. For example, if the offeror's Fixed Burden Rate for materials in the Base Period is 10% then:

$100,000.00 + ($100,000.00 x 10%) = $110,000.00

The Government will compensate the Contractor for the required parts and materials and not the total amount shown in Schedule of Indefinite Delivery Indefinite Quantity Work.

Frequency Of Service Annual (A). Services performed once during each 12-month period of the contract at intervals of 335 to 395 days.

Biennial (B). Services performed once during each 24-month period of the contract at internals of 670 to 790 days.

Daily (D5). Services performed once each calendar day, Monday through Friday, including holidays unless otherwise noted.

Daily (D7). Services performed once each calendar day, seven days per week, including weekends and holidays.

Monthly (M). Services performed 12 times during each 12-month period of the contract at intervals of 28 to 31 calendar days.

Quarterly (Q). Services performed four times during each 12-month period of the contract at intervals of 80 to 100 calendar days.

Semiannual (SA). Services performed twice during each 12-month period of the contract at intervals of 160 to 200 calendar days.

Semimonthly (SM). Services performed 24 times during each 12-month period of the contract at intervals of 14 to 16 calendar days.

Three times weekly (3W). Services performed three times a week, such as Monday, Wednesday, and Friday.

Twice weekly (2W). Services performed twice a week, such as Monday and Thursday or Tuesday and Friday.

Weekly (W). Services performed 52 times during each 12-month period of the contract at intervals of six to eight calendar days.

Government Furnished Property (GFP)

Property in the possession of, or directly acquired by, the Government and subsequently furnished to the contractor for performance of a contract. Government furnished property includes, but is not limited to, spares and property furnished for repairs, maintenance, overhaul, or modification. Government furnished property also includes contractor acquired property if the contractor acquired property is a deliverable under a cost contract when accepted by the Government for continued use under the contract.

Infrastructure Condition Assessment Program

(ICAP)

A Navy automated data management program that utilizes historical asset lifecycle data and a structured assessment process to evaluate the condition facilities and their components.

Definition Description Inspection A rigorous, detailed assessment of the condition of a facility performed to generate a fundable scope and cost estimate for prioritization and funding of maintenance and repair.

Job or Work Order An authorization for work that requires planning and estimating and has an individual line of accounting for financial and performance evaluation.

Load Handling Equipment

A term used to describe cranes, hoists and all other hoisting equipment (hoisting equipment means equipment, including crane, derricks, hoists and power operated equipment used WITH RIGGING to raise, lower and/or horizontally move a load.

Maintenance And Repair

The preservation or restoration of a piece of equipment, system, or facility to such condition that it may be effectively used for its designated purposes. Maintenance/repair may be adjustment, overhaul, reprocessing, or replacement of constituent parts or materials that are missing or have deteriorated by action of the elements or usage, or replacement of the entire unit or system if beyond economical repair.

NAVFAC MAXIMO A specially configured software version of MAXIMO®, a commercially available computerized maintenance management system (CMMS), adopted by NAVFAC for enterprise facility asset data management. The terms “MAXIMO”, “NAVFAC MAXIMO” or “Government’s MAXIMO” shall be used interchangeably in the document.

Performance Assessment

A method used by the Government to provide some measure of control over the quality of purchased goods and services received.

Performance Assessment Representative (PAR)

The individual(s) assigned as a Technical Point of Contact (TPOC) / Subject Matter Expert (SME) to the COR to perform duties as the on-site representative who assesses Contractor performance. The PAR periodically observes Contractor performance, reviews delivered services, reviews quality management corrective actions, periodically assesses and documents Contractor performance on PAWs and the MPAS, and communicates findings as necessary with the Contractor, SPAR, and COR.

Pre-Expended Bin Materials And Supplies

The minor materials and supplies that are incidental to the job, for which the total direct cost of any one material line item shown on the material estimate is $10.00 or less.

Examples of pre-expended bin materials and supplies include, but are not limited to, solder, lead, flux, electrical connectors, electrical tape, fuses, nails, screws, bolts, nuts, washers, spacers, masking tape, sand paper, solvent, cleaners, lubricants, grease, oil, rags, mops, glue, epoxy, spackling compound, joint tape, plumbers tape and compound, clips, welding rods, and touch up paint.

Property Administrator An authorized representative of the Contracting Officer who is responsible for administering contract property requirements, terms and conditions of the contract

Property Management Program

A Government program established for the purpose of reviewing and approving the Contractor’s Property Management Plan and System through performance of a system analysis whenever government property is in the possession of the Contractor.

Quality Assurance

(QA)

The planned and systematic activities implemented in a quality system so that quality requirements for a product or service will be fulfilled.

Quality Control (QC) The observation techniques and activities used to fulfill requirements for quality.

R. S. Means A data collection and organization system developed by R. S. Means Company which can be used to prepare accurate, dependable construction estimates and budgets in a variety of ways. The Contractor shall use the latest edition. Material prices are based on a national average and computed labor costs are based on a 30-city national average. An estimate prepared using this data is called a "Means estimate"; data may simply be referred to as "Means".

Real Property Inventory Equipment (RPIE)

A Government owned or leased individual pieces of equipment, apparatus, or fixture that are essential to the function of the real property (i.e. plumbing, electrical, heating, cooling and elevators). It is physically attached to, integrated into, and built in or on the property.

Individual RPIE’s can be combined to make a CIMU to facilitate facilities management.

An individual RPIE can also be a CIMU if the equipment is complex enough to require its own management planning.

Definition Description Response Time The time allowed the Contractor after initial notification of a work requirement to be physically on the premises at the work site with appropriate personnel, tools, equipment, and materials, ready to perform the work required.

Unit Priced Labor (UPL) Hour

The unit price bid by the Contractor to perform one hour of work-in-place. With the exception of direct material and construction equipment costs, the unit price includes all indirect and direct costs associated with performing work. The price includes the Contractor’s hourly composite trade wage, adjusted to allow for workforce productivity;

costs for pre-expended bin materials, union agreements, crew sizes, hand tools, payroll burdens and fringes, overtime, job (field) overhead (including clerical support, supervision, inspection, fees, taxes, licenses, permits, and insurance), general and administrative (home office) overhead, and profit. Additionally, time for job preparation, safety standby personnel, and similar indirect labor elements are included.

Acronym Title ACO Administrative Contracting Officer BW Biweekly CDR Contract Discrepancy Report CIA Controlled Industrial Area CIMU Component Inventory Management Unit CMMS Computerized Maintenance Management System COR Contracting Officer Representative COR Condition of Readiness DBH Diameter at Breast Height DCR Direct Condition Rating DoD Department of Defense DoN Department of Navy DRMO Defense Reutilization Management Office EPA Environmental Protection Agency EPCRA Emergency Planning and Community Right-to-Know Act FAR Federal Acquisition Regulation FFP Firm Fixed Price FIFRA Federal Insecticide, Fungicide, and Rodenticide Act FSC Facility Support Contract FSCM Facility Support Contract Manager GIS Geospatial Information System GFE Government-furnished Equipment GFF Government-furnished Facilities GFM Government-furnished Materials HCA Head Contracting Agency ICAP Infrastructure Condition Assessment Program ICP Integrated Contingency Plan IDIQ Indefinite Delivery Indefinite Quantity iNFADS Internet Navy Facilities Asst Data Store IPM Integrated Pest Management IPMIS Integrated Pest Management Information System IPMP Integrated Pest Management Plan KO Contracting Officer LAN Local Area Network M Monthly MAP Maintenance Action Plan MDI Mission Dependency Index MEP Mechanical, Electrical and Plumbing MPAS Monthly Performance Assessment Summary MRI Mission Readiness Index MSDS Material Safety Data Sheets NAVFAC Naval Facilities Engineering Command NMCI Navy Marine Corps Intranet NOSC Navy-On-Scene Coordinator PAP Performance Assessment Plan PAR Performance Assessment Representative PAW Performance Assessment Worksheet PEO Program Executive Officer PM Project Manager PM Planned Maintenance or Preventative Maintenance

Acronym Title PRCSP Permit Required Confined Space Program PWS Performance Work Statement PWO Public Works Officer Q Quarterly QC Quality Control RPIE Real Property Inventory Equipment RSL Remaining Service Life SC Security Clearances SM Semimonthly SPAR Senior Performance Assessment Representative TE Technical Exhibit VIQ Variation in Quantity WBS Work Breakdown Structure

ATTACHMENT J-0200000-02

WAGE DETERMINATIONS

<<Note to Spec Writer: Placeholder for Service Contract Act and Davis-Bacon Act Determinations.>>

ATTACHMENT J-0200000-03

PNSY STATION REGULATIONS

See attachment J-0200000-03 PNSY Station Regs.docx

ATTACHMENT J-0200000-04

DIRECTIVES, INSTRUCTIONS, AND REFERENCES

Reference Title

EM 385-1-1 U.S. Army Corps of Engineers Safety and Health Requirements

P.L. 91-596 Occupational Safety and Health Act

ATTACHMENT J-0200000-05

INVOICE FORM

1. CONTRACTOR'S INVOICE

From Invoice Date Invoice Number

POC/Telephone/email for this invoice:

To: Contract Specialist:

Below is a Statement of Performance under Contract Task Order for at

The enclosure provides breakdown of this statement of performance.

A. Total value of contract/task order through change $ B. Percentage of performance complete % % C. Value of completed performance $ D. Less total of prior payments $ E. Amount of this invoice $

Signature and Title:

Date: Signature of Authorized Representative

Taxpayer Identification No. (TIN):

Electronic funds transfer (EFT) banking information (if applicable):

2. FIRST ENDORSEMENT

From: Accountable Official

To: Certifying Officer A. Amount of work completed to (date) $ B. Less:

Retention $

Other Deductions $ $ C. Subtotal $ D. Less previous payments $ E. Certified amount for payment # on TO # $

F. Elapsed contract time (if applicable)

ATTACHMENT J-0200000-05

INVOICE FORM

CONTRACT

Sheet __________ of __________

Period Ending

LOCATION:

TO BE COMPLETED BY CONTRACTOR GOVERNMENT USE ONLY

Cost Category

CLIN #,

SLIN #, or ACRN # Description Estimated Cost % Complete Value % Work in Place

Value Prior Report This Period

(1) (2) (3) (4) (5) (6) (7) (8) (9)

Totals

Undistributed Charges-Material

Other

Grand Totals Remarks:

Signature: Date:

Signature of Authorized Representative (Contractor)

Name and Title (typed):

Phone and address:

(iaw FAR 32.905)

ATTACHMENT J-0200000-06

FORMS

ATTACHMENT "A"

CONTRACTOR CRANE OPERATING CHECKLIST FOR CRITICAL LIFTS YES NO

1 Does the operator know the weight of the load to be lifted?

2 Is the load to be lifted within the crane manufacturer's rated capacity in its present configuration?

3 Is the crane level and on firm ground?

4 Are outriggers required?

5 If so, are outriggers fully extended and down, and the load off the wheels?

If blocking is required, is the entire surface of the outrigger pad supported, and is the blocking material of sufficient strength to safely support the loaded outrigger pad?

If outriggers are not used, is the crane rated for on-rubber lifts by the manufacturer's load chart?

Is the swing radius of the crane counterweight clear of people and obstructions and accessible areas within the swing area barricaded to prevent injury, damage and unplanned encroachment?

9 Has the hook been centered over the load in such a manner to prevent swing (deflection, side loading, load-moment)?

10 Is the load well secured and balanced in the sling or lifting device before it is lifted (free and clear) more than a few inches?

11 Is the lift swing path clear of obstructions?

12 If rotation of the load being lifted is hazardous, is tag line or restraint line being used?

13 Are personnel prevented from standing or passing under a suspended load?

14 Are personnel prevented from entering the load fall zone?

15 Is the crane operator's attention diverted?

16 Are proper signals being used at all times?

17 If radio communications are used is the frequency isolated to the crane team?

18 Do the operations ensure that side and tip loading is prohibited?

Are start and stop motions in a smooth fluid motion (no sudden acceleration or deceleration)?

20 If operating near electric power lines, are the rules and guidelines understood and adhered to as specified in NAVFAC P-307?

21 Is the lift a critical lift?

If so, are critical lift regulations understood, check-off sheets initialed and signed off, and was there an interactive brief conducted with associated personnel?

23 Is Attachment "A" current, filled out completely, and posted in the crane?

Contractor Name (Print Legibly):

Contractor Name (Signature):

Location: Date:

CRANE AND RIGGING GEAR ACCIDENT REPORT

Accident Category: Crane Accident Rigging Gear Accident From:

UIC:

To: Navy Crane Center Bldg. 491 NNSY Portsmouth, VA 23709 Fax: 757-967-3808

Activity: Report No:

Crane No: Category: Accident Date: Time: hrs:

Category of Service: SPS GPS Crane Type: Crane Manufacturer:

Was Crane/Rigging Gear Being Used in SPS: Yes No Was Crane/Rigging Gear Being Used in a Complex Lift/Critical

Non-Crane Rigging Operation: Yes No Location: Weather:

Crane Capacity: Hook Capacity: Weight of Load on hook:

Fatality or Permanent Disability? Yes No Material/Property Cost Estimate:

Reported to NAVSAFECEN? Yes No

Accident Type:

Personal Injury Overload Derail Damaged Rigging Gear

Load Collision Two Blocked Dropped Load Damaged Crane

Crane Collision Damaged Load Other: Specify

Cause of Accident:

Improper Operation Equipment Failure Inadequate Visibility

Improper Rigging Switch Alignment inadequate Communication

Track Condition Procedural Failure Other: Specify

Chargeable to:

Crane Walker Rigger Operator

Maintenance Management/Supervision Other: Specify

Crane Function:

Travel Hoist Rotate Luffing Telescoping Other N/A

Is this accident indicative of a recurring problem? Yes No

If yes, list Accident Report Nos.:

ATTACH COMPLETE AND CONCISE SITUATION DESCRIPTION AND CORRECTIVE/PREVENTIVE ACTIONS TAKEN AS ENCLOSURE (1). Include probable cause and contributing factors. Assess damages and define responsibility. For equipment malfunction or failure, include specific description of the component and the resulting effect or problem caused by the malfunction or failure. List immediate and long term corrective/preventive actions assigned and respective codes.

Preparer:

Phone:

E-mail:

Code:

Date:

Concurrences: (Include Code, Signature and Date) Code: Date:

Code: Date:

Certifying Official (Crane Accident Only):

Code:

Date:

CRANE AND RIGGING GEAR ACCIDENT REPORT INSTRUCTIONS

This form is designed for fax transmission without a cover page or by e-mail and, with enclosures and signatures, shall be the official document. Electronic submission will be accepted without signatures but the names of the preparer, concurring personnel, and certifying official (for crane accidents only) shall be filled in.

The e-mail address is m_nfsh_ncc_accident@navy.mil. The fax number is (757) 967-3808.

1. Accident Category: Indicate either crane accident or rigging gear accident.

2. From: The naval activity that is responsible for reporting the accident and UIC number.

3. Activity: The naval activity where the accident took place.

4. Report No.: The activity assigned accident number (e.g., 95-001).

5. Crane No.: The activity assigned crane number (e.g., PC-5), if applicable.

6. Category: Identify category of crane (i.e., 1, 2, 3, or 4), if applicable.

7. Accident Date: The date the accident occurred.

8. Time: The time (24 hour clock) the accident occurred (e.g., 1300).

9. Category of Service: Check the applicable service (SPS as defined by NAVSEA 0989-030-7000).

10. Crane Type: The type of crane involved in the accident (e.g., mobile, bridge), if applicable.

11. Crane Manufacturer: The manufacturer of the crane (e.g., Dravo, Grove, P&H), if applicable.

12. SPS: Was the crane or rigging gear being used in an SPS lift?

13. Complex lift: Was the crane or rigging gear being used in a complex lift?

14. Location: The detailed location where the accident took place (e.g., building 213, dry dock 5).

15. Weather: The weather conditions at time of accident (e.g., wind, rain, cold).

16. Crane Capacity: The certified capacity of the crane (e.g., 120,000 pounds), if applicable.

17. Hook Capacity: The capacity of the hook involved in the accident at the max radius of the operation, if applicable.

18. Weight of Load on Hook: If applicable, the weight of the load on the hook.

19. Fatality or Permanent Disability?: Check yes or no.

20. Material/Property Cost Estimate: Estimate total cost of damage resulting from the accident.

21. Reported to NAVSAFECEN?: Self-explanatory.

22. Accident Type: Check all that apply.

23. Cause of Accident: Check all that apply.

24. Chargeable to: Check all that apply.

25. Crane Function: Check all functions in operation at time of accident. Check N/A if a rigging gear accident.

26. Is this a recurring problem?: Check yes or no. Identify any other similar accidents.

27. Situation Description/Corrective Actions: Self-explanatory.

28. Preparer: Self-explanatory.

29. Concurrences: Self-explanatory.

30. Certifying Official (Crane Accidents Only): Self-explanatory.

31. Brief Description: No more than one paragraph summarizing the resultant incident.

32. Background and Detailed Description: Provide the relevant background in a descriptive timeline of preconditions leading up to the event, as well as a detailed description of the event.

33. Corrective Actions: List all short term and long term corrective actions that are taken to prevent recurrence of the incident. Short Term Corrective Actions are those actions taken that will allow return to work in short time frame. Long Term actions are more ‘programmatic’ in nature and typically include: process revision, changes in training, ‘mistake proofing’, etc.

CRANE AND RIGGING GEAR NEAR MISS REPORT

Near Miss Category: Crane Near Miss Rigging Gear Near Miss

From:

UIC:

To: Navy Crane Center Bldg 491 NNSY Portsmouth, VA 23709 Fax (757) 967-3808 nfsh_ncc_accident@navy.mil

Activity: Report No:

Crane/Equipment No: Category: Near Miss Date: Time:

hrs

Category of Service: SPS GPS Crane /Equipment Type: Crane/Equipment Manufacturer:

Location: Weather:

Crane/Equipment Capacity: Hook Capacity: Weight of Load on Hook:

Is this near miss indicative of a recurring problem? Yes No

If yes, list report numbers:

In the space below, include a brief description of the event and corrective actions taken to prevent recurrence:

Preparer:

Phone and email

Code Date

CRANE AND RIGGING GEAR NEAR MISS INSTRUCTIONS

This form is designed for fax transmission without a cover page or by e-mail and, with enclosures and signatures, shall be the official document. Electronic submission will be accepted without signatures but the names of the preparer, concurring personnel, and certifying official (for crane accidents only) shall be filled in.

The e-mail address is nfsh_ncc_accident@navy.mil. The fax number is (757) 967-3808.

1. Near Miss Category: Indicate either crane or rigging gear near miss.

2. From: The naval activity that is responsible for reporting the near miss and UIC number.

3. Activity: The naval activity where the near miss took place.

4. Report No.: The activity assigned near miss number (e.g., 95-001).

5. Crane No.: The activity assigned crane number (e.g., PC-5), if applicable.

6. Category: Identify category of crane (i.e., 1, 2, 3, or 4), if applicable.

7. Near Miss Date: The date the near miss occurred.

8. Time: The time (24 hour clock) the near miss occurred (e.g., 1300).

9. Category of Service: Check the applicable service (SPS as defined by NAVSEA 0989-030-7000).

10. Crane Type: The type of crane involved in the near miss (e.g., mobile, bridge), if applicable.

11. Crane Manufacturer: The manufacturer of the crane (e.g., Dravo, Grove, P&H), if applicable.

12. Location: The detailed location where the near miss took place (e.g., building 213, dry dock 5).

13. Weather: The weather conditions at time of the near miss (e.g., wind, rain, cold).

14. Crane Capacity: The certified capacity of the crane (e.g., 120,000 pounds), if applicable.

15. Hook Capacity: The capacity of the hook involved in the near miss at the maximum radius of the operation, if applicable.

16. Weight of Load on Hook: If applicable, the weight of the load on the hook.

17. Is this a recurring problem?: Check yes or no. Identify any other similar near misses or accidents.

18. Situation Description/Corrective Actions: Self-explanatory.

19. Preparer: Self-explanatory.

T otals:

P rod u ct

N am e ( M anufact urer’s

N am e & roduct

Identificati on N am e

O r

N um ber)

C O

N T

R A

C T

O R

V O

C /H

A P T racking Form

E m ission D ata u ct

T yp e (I.E

P aint, S olvent, A dhesive

U sage (I

A

L n iq u e Id en tifie r N u m b er

Q u an tity sed

(G al) u ct

D en sity (L b./G al.

V O

C on ten t

(lb./gal.)

T otal

V

W eigh t (lbs.)

R E

P O

R T

IN

G

P E

R

IO

D (M on th

H

N am e (N

O if none present in product) t of

H A in u ct t of

H

(lb s.)

(N /A if N present)

NAVSHIPYD-PTSMH-6240/3 NAVSHIPYD PTSMHINST

5090.1 CH-1 (121)

DATE: ____________________________________ 1 Mar 88

CONTRACT NO: N62472-____________________

EXCAVATION/DEMOLITION MATERIAL REMOVAL PASS

EXCAVATED SOIL SHALL NOT BE REMOVED FROM THE PORTSMOUTH NAVAL SHIPYARD

CONTRACTOR/HAULER: ________________________________________________________________

MATERIAL DESCRIPTION: ________________________________________________________________

SOURCE OF MATERIAL: ________________________________________________________________

APPROVED DESTINATION: ________________________________________________________________

Permit/Authorization Obtained Truck Number:___________________________________________

The signatures below verify that an on site visual inspection of the material has been performed, and that this form is a record of the facts agreed upon:

Contractor Signature: _________________________________________________________

Contracting Officer’s Representative Signature: _____________________________________ Code: ___________

Gate Sentry Signature: _________________________________________________________

CODE 1700 RETURN THIS PASS TO CODE 495

Facility Investment and Industrial Utilities Support Services N40085- 22-R-2625 Portsmouth Naval Shipyard, Kittery, Maine Source Selection Plan & Other Areas of Responsibility (AOR).

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

Contractor Incident Report System (CIRS) Report Type (REQUIRED)

Injured Property Injured & Property Near Miss

1. Contract Information Incident Information

Prime Contractor: Cage Code:

Contract Number: Occurred On Base:

Yes No

Task Order #:

Contractor Contact Information

Last Name First Name Phone #:

Email Address: Date Notified:

Ex: MM/DD/YYYY

2. Incident Type(REQUIRED) (Please Check All That Apply)

Assault/Violent Act Extreme Environmental Exposure Man over the side (No water entry)

Diving Falls, slip, trip, or bodily exertion Man Overboard - Water Entry

Electrical Shock/Burns Fires - All Types Material Handling Equipment

Equipment Installation/Repair Hazardous Material (any type) Ordnance-Related (Explosive)

Explosion, Non-Ordnance Industrial (Select Additional Below) Vehicle (Government or Private)

Industrial Incident Additional Information (Please Check All That Apply)

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

Confined Space Hand and Power Tools Work Platforms and Scaffolding

Underground Construction, Shafts, and Demolition/Renovation Rigging

Caissons

Concrete, Masonry, Steel Erection and Trenching/Entrapment Cranes and Hoisting Equipment

Residential Construction

Traffic Control Floating Plant and Marine Activities Tree Maintenance and Removal

Welding and Cutting Pressurized Equipment and System Airfield and Aircraft Operations

Control of Hazardous Energy Fall Protection

3. General Information Incident Information

Date of Incident: Ex:

MM/DD/YYYY Time of Incident: :

Describe the incident in detail in your words:

Exact Location of Incident:

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

Was Hazardous Material(s) Involved: Yes No

If Yes, Explain What Hazardous Materials Were Involved and Why:

Activity at Time of Incident:

Personal Protective Equipment:

Available and used Available and not used Not Required

Not related to Mishap Wrong PPE for job List PPE

List PPE Used: (required only if List PPE checked)

Who Provided Cleanup? Onsite Base Public

4. Fully Explain What Allowed or Caused the Incident Incident Information

Direct Cause:

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

Indirect Cause:

Additional Action Taken: (Please Include a Begin Date and Est. End Date in Description)

5. Contributing Factors

Was Visibility Restricted? Yes No Distance Visibility was restricted:

Unit of Measure: Feet Yards Meters Miles Nautical Miles

Visibility Restricted By:

Fog Smoke Rain Sleet Snow

Mist Dust Sandstorm Unknown Object Other:

Lighting Conditions at Incident Site:

Adequate Inadequate

Unknown

Was Noise Level a Factor:

Yes No

Unknown

Was Carbon Monoxide (CO) a Factor:

Yes No

If Yes, CO Alarm Manufacturer:

1. Injured Data Person (if applicable) Age: Gender:

Male Female

Subcontractor Company Name:

2. General Information

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

Drug or Alcohol Involved:

None Unknown Alcohol Drugs Alcohol and Drugs

Who Provided First Aid? Onsite Base Public

Was Ergonomics a Factor: Yes No

Type of Ergonomic Injury:

Lifting Equipment Placement Office Repetitive Motion Positioning

Bending Equipment Placement Industrial Impact Strain

3. Injury Illness/Fatality Information

Severity of Injury/Illness:

Fatality Lost Workday Case Involving Days Away From Work

Permanent Total Disability Light/Limited Duty or Restricted Work (No Lost Work Days)

Permanent Partial Disability Other Reportable & Medical Treatment/No Lost Time

First Aid Treatment Only/First Aid Case

Were There Days Lost: Were There Days Hospitalized: Were There Days Restricted Duty:

Yes No Yes No Yes No

Part of Body Affected:

Nature of Injury or Illness:

Event or Exposure:

Source of Injury or Illness:

Injury Activity Code:

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

4. License Person (if applicable)

Are Appropriate License and Certification/Medical Current:

If yes, explain:

Yes No

5. Training

Was all the contract-required training provided to the employee:

If yes, explain:

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

4. License (if applicable) Property Damage

Are Appropriate License and Certification/Medical Current:

If yes, explain:

5. Training

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

Was all the contract-required training provided to the employee?

If yes, explain:

Solid Waste Management Report

Solid Waste Recycled

Description Amount

(lbs./tons) Cost Revenue Glass Metal (aluminum, circuit boards, steel) Paper & Paper Board Plastic Food (cooking grease & oil, discarded food) Wood (packaging, pallets, plywood) Yard/Green Waste (mulch, trees, trimmings) Concrete Asphalt

Select Waste

Description Amount

(lbs./tons) Cost Revenue Construction and Demolition Debris Used Oil Ethylene Glycol Antifreeze Lead-Acid Batteries

Other Waste

Description Amount

(lbs./tons) Cost Revenue Sewage Sludge (land applied) Sewage Sludge (disposed) Oil Water Separator Liquids OWWO Oil OWWO Sludge Lift Station Grease Other Waste (SPECIFY)

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

ATTACHMENT J-0200000-07

PNSY CONTRACTOR CRANE OPERATION AND MAINTENANCE

See Attachment J-0200000-07 PNSY Contractor Crane.docx

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

ATTACHMENT J-0200000-08

CONTRACTOR HAZARDOUS MATERIAL INVENTORY LOG

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

ATTACHMENT J-0200000-09

EXHIBIT LINE ITEM NUMBERS

See attachment “J-0200000-09 ELINs Commercial.xls”

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

J-0200000-11

RECENT/RELEVANT EXPERIENCE DATA SHEET

CORPORATE EXPERIENCE PROJECT DATA SHEET

Project No. (check one) : #1 #2 #3 #4 #5

1. Experience for: Offeror Joint-Venture Other (Explain)

Firm Name:

Address:

Phone Number:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain)

Percent of project work performed:

If subcontractor, who was prime (Name/Phone #):

3. Contract Number: Delivery/Task Order Number:

Title:

Location:

4. Award Date (mm/dd/yy): Completion Date (mm/dd/yy):

If the contract contains a Base Period with Options, state which contract/option periods have been completed:

5. Type of work:

Maintenance Repair Alteration Minor Construction Other (explain):

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

6. Type of Contract/Task Order: (Check ALL that apply)

Firm-Fixed Price Indefinite Delivery/Indefinite Quantity Other (explain):

7. Award Amount: Final Price:

Type of Contract/Task Order: (Check ALL that apply)

Delivery/Task Order (IDIQ) Other (explain):

8. Provide a detailed description of the project and the relevancy to the project requirements of this RFP

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

9. Provide a detailed description of what work your firm self-performed on this project:

10. Other Information:

Facility Investment and Industrial Utilities Support Services N40085-

Portsmouth Naval Shipyard, Kittery, Maine Source

J-0200000-12

1. The NAVFAC Form PPQ shall be utilized for all evaluations that require a Past Performance Questionnaire (PPQ).

2. Solicitations Submittal Requirements: IF A COMPLETED CPARS EVALUATION IS

AVAILABLE, IT SHALL BE SUBMITTED WITH THE PROPOSAL. IF THERE IS NOT A

COMPLETED CPARS EVALUATION, the Past Performance Questionnaire (PPQ) included in the solicitation is provided for the offeror or its team members to submit to the client for each project the offeror includes in its proposal for Factor (insert applicable factor number, usually Factor 2, and insert factor title, usually Recent/Relevant Experience). AN OFFEROR SHALL

NOT SUBMIT A PPQ WHEN A COMPLETED CPARS IS AVAILABLE.

IF A CPARS EVALUATION IS NOT AVAILABLE, ensure correct phone numbers and email addresses are provided for the client point of contact. Completed PPQs should be submitted with your proposal. If the offeror is unable to obtain a completed PPQ from a client for a project(s) before proposal closing date, the offeror should complete and submit with the proposal the first page of the PPQ (Attachment ___), which will provide contract and client information for the respective project(s). Offerors should follow-up with clients/references to ensure timely submittal of questionnaires. If the client requests, questionnaires may be submitted directly to the Government's point of contact, Matthew Collins, via email at matthew.a.collins51.civ@us.navy.mil prior to proposal closing date. Offerors shall not incorporate by reference into their proposal PPQs or CPARS previously submitted for other RFPs. However, this does not preclude the Government from utilizing previously submitted PPQ information in the past performance evaluation.

J-0200000-12 NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0)

CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

1. Contractor Information Firm Name: CAGE Code:

Address: Entity Identifier Number:

Phone Number:

Email Address:

Point of Contact: Contact Phone Number:

2. Work Performed as: Prime Contractor Sub Contractor Joint Venture Other (Explain) Percent of project work performed:

If subcontractor, who was the prime (Name/Phone #):

3. Contract Information Contract Number:

Delivery/Task Order Number (if applicable):

Contract Type: Firm Fixed Price Cost Reimbursement Other (Please specify):

Contract Title:

Contract Location:

Award Date (mm/dd/yy):

Contract Completion Date (mm/dd/yy):

Actual Completion Date (mm/dd/yy):

Explain Differences:

Original Contract Price (Award Amount):

Final Contract Price (to include all modifications, if applicable):

Explain Differences:

4. Project Description:

Complexity of Work High Med Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.)

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name:

Title:

Phone Number:

Email Address:

6. Describe the client’s role in the project:

7. Date Questionnaire was completed (mm/dd/yy):

8. Client’s Signature:

NOTE: NAVFAC REQUESTS THAT THE CLIENT COMPLETES THIS QUESTIONNAIRE AND SUBMITS DIRECTLY BACK TO THE OFFEROR. THE OFFEROR WILL SUBMIT THE COMPLETED QUESTIONNAIRE TO NAVFAC WITH THEIR PROPOSAL, AND MAY DUPLICATE THIS QUESTIONNAIRE FOR FUTURE SUBMISSION ON NAVFAC SOLICITATIONS.

CLIENTS ARE HIGHLY ENCOURAGED TO SUBMIT QUESTIONNAIRES DIRECTLY TO THE OFFEROR. HOWEVER, QUESTIONNAIRES MAY BE SUBMITTED DIRECTLY TO NAVFAC. PLEASE CONTACT THE OFFEROR FOR NAVFAC POC INFORMATION. THE GOVERNMENT RESERVES THE RIGHT TO VERIFY ANY AND ALL INFORMATION ON THIS FORM.

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING DEFINITION NOTE

(E) Exceptional Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

(VG) Very Good

Performance meets contractual requirements and exceeds some to the Government’s/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been no significant weaknesses identified.

(S) Satisfactory Performance meets minimum contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract. There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

(M) Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor's proposed actions appear only marginally effective or were not fully implemented.

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

(U) Unsatisfactory

Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating.

(N) Not Applicable

No information or did not apply to your contract

Rating will be neither positive nor negative.

Contractor Information (Firm Name): ________________________________________________ Client Information (Name): ________________________________________________________

TO BE COMPLETED BY CLIENT

PLEASE CIRCLE THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY:

a) Quality of technical data/report preparation efforts

E VG S M U

N

b) Ability to meet quality standards specified for technical performance

E VG S M U

N

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance

E VG S M U

N

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance)

E VG S M U

N

2. SCHEDULE/TIMELINESS OF PERFORMANCE:

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below)

E VG S M U

N

b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract

E VG S M U

N

3. CUSTOMER SATISFACTION:

a) To what extent were the end users satisfied with the project?

E VG S M U

N

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes; responsiveness to administrative reports, businesslike and communication)

E VG S M U

N

c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer?

E VG S M U

N

d) Overall customer satisfaction

E VG S M U

N

4. MANAGEMENT/ PERSONNEL/LABOR

a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force?

E VG S M U

N

b) Ability to hire, apply, and retain a qualified workforce to this effort

E VG S M U

N

c) Government Property Control

E VG S M U

d) Knowledge/expertise demonstrated by contractor personnel E VG S M U

N

e) Utilization of Small Business concerns

E VG S M U

N

f) Ability to simultaneously manage multiple projects with multiple disciplines

E VG S M U

N

g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes

E VG S M U

N

h) Effectiveness of overall management (including ability to effectively lead, manage and control the program)

E VG S M U

N

5. COST/FINANCIAL MANAGEMENT

a) Ability to meet the terms and conditions within the contractually agreed price(s)?

E VG S M U

N

Contractor Information (Firm Name): ________________________________________________ Client Information (Name): ________________________________________________________

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

E VG S M U

N

c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns)

E VG S M U

N

d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section.

Yes No

e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

Yes No

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below.

Yes No

6. SAFETY/SECURITY

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues? (Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

E VG S M U

b) Contractor complied with all security requirements for the E VG S M U project and personnel security requirements. N

7. GENERAL

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

E VG S M U

N

b) Compliance with contractual terms/provisions (explain if specific issues)

E VG S M U

N

c) Would you hire or work with this firm again? (If no, please explain below)

Yes No

d) In summary, provide an overall rating for the work performed by this contractor.

E VG S M U

Please provide responses to the questions above (if applicable) and/or additional remarks.

Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

J-0200000-13 Contractor’s Self-Performance Certification & Notification Of Subcontracting

Attachment E From:

To: Matthew Collins, NAVFAC Mid-Atlantic, Contracting CON32

Subj: Solicitation/Contract No. N40085-22-R-2625

1. In accordance with the provisions of FAR Clause 52.219-14, Limitations on Subcontracting, the Contracting Officer is hereby notified that ________________________(Company) intends to subcontract the following portion(s) of the requirements of this contract:

SUBCONTRACTOR INFORMATION

TYPE OF WORK TO

BE

SUBCONTRACTED

PERCENT (%) OF

TOTAL CONTRACT

VALUE

NAME:

ADDRESS:

CAGE/DUNS:

PRIMARY

NAICS:

COMPANY

SIZE:

POC:

PHONE:

EMAIL:

NAME:

ADDRESS:

CAGE/DUNS:

PRIMARY

NAICS:

COMPANY

SIZE:

POC:

PHONE:

EMAIL:

* * Table may be expanded as needed.

2. Furthermore, in accordance with the provisions of FAR 52.219-14, Limitations on…