M_AF IMT 103_Work Clearance Request.pdf
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- Attached to
- ATFP Construct West Gate ID Check Area Federal contract opportunity
- Solicitation number
- MXDP143001
About this file
This document contains a federal contract solicitation and a related work clearance request form. The solicitation seeks a contractor to demolish existing facilities and construct a new road, gatehouse, and ID check area at Laughlin Air Force Base in Texas. The project includes all necessary construction phasing and associated utilities to deliver a fully functional gate entrance. The North American Industry Classification System code is 236220 for commercial and institutional building construction, and the small business size standard is $39.5 million. The solicitation is set aside for Women Owned Small Businesses and will result in a firm-fixed price contract. The work clearance request form is used to coordinate required construction work that may disrupt base operations or utilities with key stakeholders, and identify potential safety hazards to prevent accidents. It requires description of specific precautions for work and approval from the Chief of Operations or Engineering Flight.
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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 .