J-1601000-12_Outage request.pdf
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- Attached to
- DRAFT Solicitation, Base Operations Support (BOS) Services at Naval Station Guantanamo Bay, Cuba
- Solicitation number
- N6945022R0032
About this file
This document is a system outage request form for facilities at Naval Station Guantanamo Bay. The form requires requestors to provide details of the proposed outage such as type, location, start and end times, and justification. It must be submitted at least 15 days in advance to the Public Works Department for approval. Signatures are then required from the contractor, Base Operating Support contractor, Utility Energy Manager for initial and final notification, and the facility manager. If the outage is not approved, signatures are also required from the affected tenant to document their disapproval and the requestor's justification.
The related federal contract opportunity is a draft solicitation for Base Operations Support services at Naval Station Guantanamo Bay, Cuba. The services include family housing, facility management, facility investment, custodial services, pest control, integrated solid waste management, grounds maintenance and landscaping, utilities such as electrical, wastewater and water, and base support vehicles and equipment. The solicitation is issued by the Naval Facilities Engineering Command of the Department of the Navy.
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Text version
PWD Guantanamo Bay – SYSTEM OUTAGE REQUEST
PWD GTMO 4330/18 (REV. JAN 2018)
Requestor: Organization:
Office#: Cell #: Contract #:
Project Title:
Date of Request:
ALL REQUESTS FOR OUTAGES MUST BE SUBMITTED FIFTEEN (15) CALENDAR DAYS
PRIOR TO OBTAINING SUCH OUTAGE TO THE PUBLIC WORKS DEPARTMENT FOR
APPROVAL.
Type of Outage (Electrical/Water/Wastewater/Other (explain)):
Outage Requested: Start Date/Time: Finish Date/Time:
Safe Clearance Form Attached: Yes No (15 Day Timeframe Will Not Start Until Submitted) (Check One)
AREA AFFECTED BY OUTAGE (PROVIDE SPECIFIC FACILITY NUMBERS FOR ALL AFFECTED):
(FOR ALL OUTAGES) SYSTEM INTERUPTION POINT:
Include pole numbers, transformer information, and valve locations, i.e., all applicable field knowledge. This section should clarify which facilities are affected by the outage.
Justification/Reason for Outage:
- Approval Routing -
Contractor: (Mat’l/Equip/Manpower Verified) Title/Signature/Date
BOS Contractor:
Title/Signature/Date
UEM: (Initial Notification) Title/Signature/Date
PAR Notification: (Electric/Water) Title/Signature/Date
UEM: (Final Notification) Title/Signature/Date
Facility Manager: Service Call #:
Title/Signature/Date
PWD Guantanamo Bay – SYSTEM OUTAGE REQUEST
PWD GTMO 4330/18 (REV. JAN 2018)
-Disapproval Routing- (DISAPPROVAL ROUTING SHALL ONLY BE USED IF AN ALTERNATE OUTAGE DATE CANNOT BE NEGOTIATED
BETWEEN REQUESTOR AND TENANT(S))
Tenant: (DISAPPROVAL ONLY) Title/Signature/Date
Justification (Must explain mission impacts and non-availability of alternate accommodations.)
Requestor: (FOR TENANT DISAPPROVAL ONLY) Title/Signature/Date
Justification (Must explain inability to accommodate an alternate outage date.)
Additional Information:
| Requestor: |
| Organization: |
| Office: |
| Cell: |
| Contract: |
| Project Title: |
| Date of Request: |
| Type of Outage ElectricalWaterWastewaterOther explain: |
| Start DateTime: |
| Finish DateTime: |
| Service Call: |
| Text1: |
| Text2: |
| Text3: |
| Title: |
| Date: |
| Check Box1: Off |
| Check Box2: Off |
| Text4: |
| Text5: |
| Text6: |
| Additional Comments: |
File details come from the government source that posted it. Updated .