J_-_11_Dry_Dock_Evaluation_Form.docx

MSC DRYDOCK EVALUATION FORM

Ship name: USNS ROBERT E. PEARY

Hull No: T-AKE 5

PART A (to be completed by MSC)

PART B (to be completed by ALL shipyards)

Drydock Certification / Classification Info

Certified? Yes |_| No |_|

Certifying / Classifying Agency

Certificate No.

Date of expiration

Provide date in English and Metric Units:

Drydock Characteristics

Length, overall ft-in m

Breadth ft-in m

MT

44778 MT

Maximum dry-dock lift capability

LT

MT

Minimum Displacement/Draft

25230 MT

Maximum entry draft rating:

LT

MT

Max stern trim for graving dock ft -

Water depths around dock ft-in m area and approaches, tidal conditions, Anticipated Arrival Draft and any unusual conditions for entering/

Leaving the dry-dock

Depth Over Floor ft-in m

Positioning Clearances

Depth Over Blocks ft-in m

Depth Over Sill ft-in m

Depth Over KEEL ft-in m

Loading Pressures

Note: All blocks to be positioned under longitudinal strength members and transverse bulkheads.

Max Block Loading Capability

Blocking Requirements

Block Capability

LT/ft2

LT/m2

Keel & Side Block Information

Construction

Cap Material

Cap Thickness in cm

Block Age

Hardwood: White Oak, California Laurel, Oregon Myrtle, Iron bark, Height ft-in m

Blue Gum, American Rock Elm or Preserved Red Oak.

Width ft-in m

Softwood: Douglas Fir, Tamarack, Long Leaf Pine or Hemlock

Length ft-in m

MSC DRYDOCK EVALUATION FORM (cont’d)

PART A (to be completed by MSC)

PART B (to be completed by ALL shipyards)

Provide data in English and Metric units

Minimum Required Services

Electrical power

Minimum Available Services

Electrical power

AC volts

VAC

number of phases

amperage (total) amps

frequency

Hz number of lines

Ground connections

Ground connections

number cable size, each cir mils

Sewage connections

Sewage connections

number

pipe size inch ips cm capacity gal/day ltr/day

Fire Main

Fire Main

number of connections

connection size inch ips cm

pressure psig kg/m2 capacity gpm ltr/min

Aux Seawater

Aux Seawater

pressure psig kg/m2 capacity gpm ltr/min

Fresh Water

Fresh Water

pressure psig kg/m2 capacity gpm ltr/min

Compressed Air

Compressed Air

pressure psig kg/m2 capacity cfm ltr/min

Shore Steam

Shore Steam

pressure psig kg/m2 capacity lb/hr kg/hr

High Pressure Water Wash pressure psig kg per sq cm

Safety Response Plans Required

Safety Response Plans Available (circle correct answer)

MSC DRYDOCK EVALUATION FORM (cont’d)

PART C (to be completed by Shipyard if dry-dock is not certified by IACS or under MIL STD 1625C)

Dock master info

Contractor name

Dock master name

Certifying Agency

Certificate No.

Years experience

Drydock Insurance Info

Insurer

Policy No.

Amount Insured

Date of expiration

IS SNUBBING NECESSARY?

YES NO

IS FIRE PROTECTION AVAILABLE

ON BUILDING WAY?

YES NO

TIDAL RANGE (DIFF. OF M.L. M.H)

CERTIFICATION DATE &

CERTIFIED BY WHOM

LIFT CAPACITY

(std. tons)

TYPE

CRANES SERVING WAY

NO.

AT DROP

OFF

OVER

WAY END

DEPTH OF WATER

LENGTH OF LAUNCHING RUN DEPTH OF RUN AT M.L.W.

[ ] END LENGTH: LENGTH:

[ ] SIDE

[ ] BASIN WIDTH: WIDTH:

[ ] SLAB

DEPTH: DEPTH:

[ ] END LENGTH: LENGTH:

[ ] SIDE

[ ] BASIN WIDTH: WIDTH:

[ ] SLAB

DEPTH: DEPTH:

[ ] END LENGTH: LENGTH:

[ ] SIDE

[ ] BASIN WIDTH: WIDTH:

[ ] SLAB

DEPTH: DEPTH:

[ ] END LENGTH: LENGTH:

[ ] SIDE

[ ] BASIN WIDTH: WIDTH:

[ ] SLAB

DEPTH: DEPTH:

[ ] END LENGTH: LENGTH:

[ ] SIDE

[ ] BASIN WIDTH: WIDTH:

[ ] SLAB

DEPTH: DEPTH:

NO. LAUNCHING DIMENSIONS MAXIMUM SHIP SIZE

OF (check one) (ton 2,240 lbs)

WAY

[ ] END LENGTH: LENGTH:

[ ] SIDE

[ ] BASIN WIDTH: WIDTH:

[ ] SLAB

DEPTH: DEPTH:

BUILDING WAYS (M. I. W.)

SHIPYARD DATA

Telephone No:

Telex No:

Date Found:

SHIPYARD AND ADDRESS

Commander (Code M-4E3) Military Sealift Command Washington, DC 20390 NOTE: If survey form has been previously submitted, then enter changes only.

MSC SHIP REPAIR FACILITY SURVEY

LIST ANY OTHER RESTRICTIONS (include projects under construction which will after navigational restrictions) DISTANCE TO NEAREST DISTANCE TO NEAREST AIRPORT RAILROAD CONNECTION (identify)

MAXIMUM SHIP SIZE

ACCOMMODATED

LENGTH OA-BEAM

DOCK

NO.

DRY DOCKS (continued) LEGEND (abbreviation of services) Fresh Water --- F.W. - G.P.M. - P.S.I. Steam --- S - P/HR - P.S.I. Electric Power --- E - V - AC - AMP Fire Protection --- FP - G.P.M. - P.S.I.

Salt Water ----- S.W. - G.P.M. - P.S.I Air ------ A - C.F.M. - P.S.I. Electric Power --- E - V- DC - AMP Sanitary Sewer --SS - YES - NO

DATE CERTIFIED, CERTIFIED BY WHOM, &

DATE CERTIFICATION EXPIRES

LIFTING CAPACITY

(ton 2,240)

DEPTH/DRAFT

OVER OVER OVER

SILL FLOOR KEEL

(GD) BLOCKS

CLEAR WIDTH

at top cradle (MR), at keel at top inboard block wing wall (FD, GD) height

LENGTH

at coping (GD), at keel blocks OVERALL on cradle (MR), on PONTOON

(FD)

MATERIAL TYPE

Floating--(FD) Graving--(GD) Marine Railway (MR)

DOCK

SERVICES AVAILABLE

(Use abbreviation of service below)

USE

REPAIR/

OUTFIT-

ING

HEIGHT

OF

DOCK

(M.L.W.)

OUT-

BOARD

IN-

BOARD

WATER DEPTH

(M. L. W.)

LENGTH

(actual & usable)

ACT:

USE:

ACT:

USE:

ACT:

USE:

ACT:

USE:

ACT:

USE:

ACT:

USE:

TYPE

NAVIGATIONAL RESTRICTIONS (indicate at M.L.W.)

MINIMUM CHANNEL (depth width) MINIMUM HORIZONTAL AND VERTICAL BRIDGE CLEARANCES

BERTHING, SHOP OR YARD CRANES; STATIONARY, RAIL, MOBILE, OR BRIDGE (3 tons or over)

MAX REACH HEIGHT OF HOOK

NO TYPE CAPACITY MAX SPAN CAPACITY BOOM HEIGHT ABOVE BASE HEIGHT OF HOOK AREA SERVICE DATE CERTIFIED, CERTIFIED BY WHOM & (STD TONS) (BRIDGE) AT REACH LENGT HINGE ABOUT REACH (BRIDGE) DATE CERTIFICATION EXPIRES

ACREAGE LEGALLY CONTROLLED

IN USE DEVELOPED TOTAL

EXISTING LOCAL ORDINANCES LIMITING PRODUCTIVE USE

LIMITATION IMPOSED BY PROPERTY ZONING CLASSIFICATION

LIST TYPES OF WORK NORMALLY SUBCONTRACTED

RAW STEEL STORAGE (SQ. FT.) ___________________________________________________________

WELDING AND ASSEMBLY (SQ. FT.) _______________________________________________________

ALL OTHER SHOPS

(LIST NAMES AND DIMENSIONS)

LARGEST EXIT

WIDTH HEIGHT

DIMENSIONS OF

SHOP OR BUILDING

NAME OF SHOP

OR BUILDING

FABRICATING

PLATE

SHEET METAL

SUBASSEMBLY

WOOD WORKING

BOAT ASSEMBLY

OR MOLDING

BOILER

MACHINE

ELECTRICAL

ELECTRONIC

PIPE

FOUNDRY

RIGGER

STORAGE SPACE FOR COMPONENTS AND MATERIALS

(LIST DIMENSIONS FOR EACH AREA, PLUS TYPE MATERIAL STORED)

PRINCIPAL SHOPS AND BUILDINGS

NAME AND TITLE OF SENIOR SURVEYOR SIGNATURE DATE SIGNED

ARE YOU CERTIFIED AS A SMALL BUSINESS? YES NO

REQUIRED SUBMITTALS TO ACCOMPANY THIS FORM:

1. PLOT PLAN OF YARD.

2. CERTIFIED DEPTH OF WATER PLOT

3. FOR EACH SHOP LISTED ON SHEET 4, A LIST OF MACHINE TOOLS AND

EQUIPMENT WHICH INDICATES THE CAPACITIES OF THE SHOP.

4. A GENERAL STATEMENT (INCLUE, NAME OF SHIP, DATES, AND

DOLLAR AMONT OF JOB) OF SHIP REPAPIR WORK WHICH HAS BEEN

ACCOMPLISHED BY THE APPLICANT.

5. LISTING OF OFFICIALS AND THE QUALIFICATIONS OF EACH FOR SHIP

REPAIR (INCLUDE AS A MINIMUM JOBS HELD, YEARS, HELD, ONE LINE

6. IF FACILITIES ARE LOCATED AT MORE THAN ONE LOCATION THEN

LIST EACH FACILITY AND ITS LOCATION.

7. POINT OF CONTACT FOR INFORMATION SUBMITTED IN THIS FORM

(NAME/TITLE/PHONE NUMBER).

NORMAL

SHIFTS

NORMAL

MAXIMUM

POTENTIAL MAXIMUM

CURRENT

CURRENT

EMPLOYMENT

MANAGEMENT, ADMINISTRATION

PROFESSIONAL ENGINEERING

PRODUCTION SKILLED

PRODUCTION UNSKILLED

NONPRODUCTION

TOTAL:

LIST ANY EQUIPMENT OR CAPABILITY NOT OTHERWISE DESCRIBED IN THIS FORM

SHIPYARD:

MSC SHIP REPAIR FACILITY SURVEY (continued)

PART D (to be completed by ALL Shipyards)

1. The Offeror shall provide a list of the vessels (and their principal characteristics) drydocked in this drydock over the past 2 years. (Attach a separate page)

I hereby certify that the above information is true and accurate.

Name and Title of Shipyard Official

Signature of Shipyard Official

Date

Attachment J – 11

ATTACHMENT J - 11