Attach_(5b)_Performance_Work_Statement_(PWS)v1.pdf

Section J-0200000 Management and Administration

Attachment Number Attachment Title J-0200000-01 Definitions and Acronyms J-0200000-02 Directives, Instructions and References J-0200000-03 Contractor’s Significant Incident Report (CIRS) J-0200000-04 Invoice Forms J-0200000-05 USFJ Spill Report J-0200000-06 Contractor Waste Disposition and Disposal J-0200000-07 Contractor Hazardous Material Inventory Log J-0200000-08 Monthly Grounds Maintenance Report J-0200000-09 Pre Performance Checklist EXAMPLE J-0200000-10 Exhibit Line Item Numbers (ELINS) J-0200000-11 Weight Handling Equipment Accident Report.

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ATTACHMENT J‐0200000‐01

DEFINITIONS AND ACRONYMS

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 GIS Geospatial Information System GFE Government‐furnished Equipment GFF Government‐furnished Facilities GFM Government‐furnished Materials HCA Head Contracting Agency ICP Integrated Contingency Plan IDIQ Indefinite Delivery Indefinite Quantity IPM Integrated Pest Management IPMIS Integrated Pest Management Information System IPMP Integrated Pest Management Plan KO Contracting Officer M Monthly MAP Maintenance Action Plan 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 PRCSP Permit Required Confined Space Program

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PWS Performance Work Statement PWO Public Works Officer Q Quarterly QC Quality Control RPIE Real Property Inventory Equipment SM Semimonthly SPAR Senior Performance Assessment Representative

Acronym Title TE Technical Exhibit VIQ Variation in Quantity WBS Work Breakdown Structure

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ATTACHMENT J‐0200000‐02

DIRECTIVES, INSTRUCTIONS, AND REFERENCES

Reference Title

CFR Code of Federal Regulations Uhttp://www.gpo.gov/fdsys/browse/collectionCfr.action?collectionCode=CFR

COMNAVFORJAPANINST

11320.2B

Fire Prevention Regulation

DOD Instruction 1000‐18 Federal and State Occupational Safety and Health Inspection and Investigation at Contractor Workplace on Department of Defense Installations

EM 385‐1‐1 U.S. Army Corps of Engineers Safety and Health Requirements http://www.pennagc.com/EM‐385‐1‐1/EM385‐1‐1FINAL%5B1%5D.pdf

FAR Federal Acquisition Regulation (FAR) http://farsite.hill.af.mil/

JEGS Department of Defense (DOD) Japan Environmental Governing Standards

(JEGS)

http://www.usfj.mil/Documents/References/JEGS/2012%20Japan%20Environme ntal%20Governing%20Final.pdf

JISHA Japanese equivalent Industrial Safety and Health Law Japanese Law No.57‐1972 Industrial Safety and Health Act Japanese Law No.86‐1999 Act on Confirmation, etc. of Release Amounts of Specific Chemical Substances in the Environmental and Promotion of Improvements to the Management Thereof

Japanese Law No.91‐1993 Basic Environmental Act Japanese Law No.97‐1968 Air Pollution Control Act (Clean Air Act) Japanese Law No.137‐1970 Waste management and Public Cleaning Act Japanese Law No.138‐1970 Water Pollution Control Act Japanese Law No.186‐1948 Fire and Disaster Management Act NAVFACINST 11013.40A NAVFAC Partnering Policy NAVFACFEINST 11260.1G Weight Handling Equipment Program Manual https://www.navfac.navy.mil/content/dam/navfac/NAVFAC%20Pacific/NAVFA C%20Far%20East/PDFs/11260.1g.pdf

NFPA 70 (National Fire Protection Association) 70 National Electrical Code http://www.nfpa.org/aboutthecodes/AboutTheCodes.asp?DocNum=70

NFPA 101 (National Fire Protection Association) 101 Life Safety Code

SECNAV 5100.13 Navy and Marine Corps Tobacco Policy U.S Public Law 91‐596 P.L. 91‐596 Occupational Safety and Health Act https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=19007&p_tab le=INTERPRETATIONS

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

Note: Latest version of references shall be applied.

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ATTACHMENT J-0200000-03

NAVY CONTRACTOR INCIDENT REPORTING SYSTEM (CIRS)

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NAVFAC 7300/30 (rev NOV 2010)

1. CONTRACTOR'S INVOICE

From

POC/Telephone/email for this invoice:

To: Contract Specialist:

Below is a Statement of Performance under Contract N40084 Task Order # for

The enclosure provides breakdown of this statement of performance.

A. Total value of contract/task order through change ¥0 B. Percentage of performance complete % C. Value of completed performance ¥0 D. Less total of prior payments ¥0 E. Amount of this invoice ¥0

Signature and Title:

Date: Signature of Authorized Representative

Taxpayer Identification No. (TIN):

Electronic funds transfer (EFT) banking information (if applicabl

2. FIRST ENDORSEMENT

From: Accountable Official To: Certifying Officer

1. Payment is recommended as follows:

A. Amount of work completed to (date) ¥0 B. Less:

Retention ¥ Other Deductions ¥ ¥0

C. Subtotal ¥0 D. Less previous payments ¥0 E. Certified amount for payment # on TO # ¥0 F. Elapsed contract time (if applicable)

NAVAL FACILITIES ENGINEERING COMMAND

at

Invoice Date Invoice Number

Attachment J-0200000-04

INVOICE FORM

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ATTACHMENT J‐0200000‐05

USFJ SPILL REPORT

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ATTACHMENT J‐0200000‐06

CONTRACTOR WASTE DISPOSITION AND DISPOSAL

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ATTACHMENT J‐0200000‐07 CONTRACTOR

HAZARDOUS MATERIAL INVENTORY LOG

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Attachment J-0200000-08 Monthly Grounds Maintenance Report

Contractor's Name:

Month:

Contract #:

POC & Telephone #:

Installation Incinerated Tons

Landfilled Tons

Disposal Cost

Recycled Tons

Recycled Cost

Material Description

Comments:

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Attachment J-0200000-09

PERFORMANCE ASSESSMENT WORKSHEET

Attachment: QMS Pre-performance Review Checklist

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GENERAL INFORMATION

NAME PHONE EMAIL

CONTRACTOR Project Manager

CONTRACTOR Quality Manager

SUB‐CONTRACTOR QC

SUB‐CONTRACTOR QC

PERFORMANCE ASSESSMENT

REPRESENTATIVE (PAR)

SUPERVISORY PAR / COR

CONTRACT INFORMATION

TITLE:

Contract #: TO# LOCATION:

START: END: CONTRACT PRICE:

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ACCEPTANCE OF CONTRACTOR’S QUALITY APPROACH DOES NOT LIMIT CONTRACTING

OFFICER FROM REQUIRING ADDITIONAL MEASURES IF PERFORMANCE IS UNACCEPTABLE.

QUALITY MANAGEMENT BRIEFING CHECKLIST

CHECKPOINT (Y/N) COMMENTS

QUALITY ORGANIZATION:

Is the QM plan submitted in accordance with Annex 0200000 and Section F requirements?

Is the Quality organization clearly identified (e.g., org chart) and a list of all Quality personnel provided?

Are the responsibilities of Quality personnel detailed and lines of authority explained (e.g., Quality staff and Quality Manager reports directly to Prime Contractor management)?

Are the training and qualification requirements for Quality staff specified and does the Contractor’s staff meet these requirements?

Does the Quality organization show relationship between the Prime Contractor’s Quality staff and Subcontractor’s management or Quality?

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DOCUMENTATION AND RECORDS MANAGEMENT:

Does the Contractor have a process for the control and retention of Quality documentation and records?

Does the Contractor provide the controls in place to ensure all Quality records are documented, maintained reviewed and properly filed?

Does the QM plan have a process for the review of documentation for completeness, accuracy, and consistency?

(This may include management reviews or internal audit plan.)

Does the QM Plan provide a process for tracking and ensuring all submittal requirements are met?

COMMUNICATION WITH GOVERNMENT:

Does the QM plan address the level, format, and frequency of communications with the government? This could include:

a. Routine, yet informal communications between contractor, quality staff, and Government PARs

b. Established meeting requirements between Contractor Quality and/or management staff with Government PA and/or contracting personnel.

c. Progressive reporting and communicationbased on the frequency or severity of the issue being addressed (e.g., Quality staff to PAR, Quality Manager to SPAR/FSCM, Project Manager to PWO)

d. Details of protocol for attendance at meetings required by contract, including partnering sessions.

REVIEW SIGNATURES

PAR: DATE:

SPAR/COR: DATE:

CONTRACTOR QUALITY MANAGER: DATE:

CONTRACTOR PROJECT MANAGER: DATE:

SUBCONTRACTOR: DATE:

SUBCONTRACTOR: DATE:

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CUSTOMER COMMENT RECORD

ANNEX/SUB-ANNEX:

Attachment D: Customer Comment Record

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Attachment D

QMS IN-PROCESS REVIEW CHECKLIST

Attachment E: QMS In-process Review Checklist

CONTRACT #: TITLE:

PAR NAME: DATE:

ANNEX/SUB‐ANNEX:

SPEC ITEM: TITLE:

QMS REVIEW CHECKLIST

If observed defects warrant evaluation of QMS, the initial review should be limited to the Spec Items and/or location where defects have been found. This process begins with Part A & B below.

CHECKPOINT (Y/N) COMMENTS

A. QUALITY SURVEILLANCE ANDINSPECTIONSCHEDULES

1. Is there a quality surveillance and inspection schedule?

Does it include:

a. Surveillance and inspections to be performed?

b. Frequencyofsurveillanceandinspections?

2. Is there a current schedule?

3. Does the schedule reflect all contractual requirements?

4. Are the number and frequency of surveillance and inspections sufficient?

5. Do the schedules match the QM plan?

6. Is the schedule being followed?

B DOCUMENTATION AND ANALYSIS OF QUALITYDATA

1. Are the results of all surveillance and inspections properly documented?

2. Are quality deficiencies properly resolved and tracked?

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3. Is quality documentation of deficiencies analyzedfortrends and rootcause?

4. Is appropriate action taken or planned toprevent recurrence ofqualityissues?

5. Is there verification processto ensurecorrective and preventative actionsareeffective?

6. Are appropriate continuous improvement plans in place and communicated to workforce?

Attachment E

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ATTACHMENT J-0200000-10

EXHIBIT LINE ITEM NUMBERS (ELINs)

SOLICITATION #N40084-19-R-2008

THIS WILL BE ON A SEPARATE ATTACHMENT.

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J-0200000-11

Weight Handling Equipment Accident Report.

The following will be delivered every time an accident or near miss occurs: Weight Handling Equipment Accident Report, Initial Accident Reporting Notification Report, Follow-on Accident Reporting Notification Report, and Final Accident Reporting Notification Report.

Government Approval Required: X Yes No

Media:

Hard Copy X Electronic (PDF/email) Direct System Input

Instructions:

1. Required File Format: The WHE Accident Report shall be prepared using the specific form that the Government will provide after award thecontract.

2. Method of Submission: Via email. The report shall be converted to PDF file, Adobe Acrobat form.

3. Purpose: For Government reviewandcomment.

4. Distribution List: KO via CS

1) If the KO accepts the report, the Government shall notify the Contractor of Government acceptance.

2) If the KO responds with review comments, then incorporate the Government's comments and resubmit the report via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Governmentacceptance.

5. Content: Refer to the provided form afterawardthecontract.

6. Other Requirement: The submitted report shall accuratelyreflect theirintendeduse.

7. Due Dates: This report shall be submitted within 4 hours of the WHE accident.

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