Deliverables_Pages 53-90_updated.pdf

MCB Butler 20-2001 0200000-F, Page 5 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.2.1.2, Request to Work Outside Contractor’s Regular Working Hours

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: X Hard Copy and X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The request shall be prepared using the form that the Contractor considers appropriate.

2. Purpose: For Government Acceptance.

3. Distribution List and Method of Submission: Electronic copy to KO/KS/COR.

1) If the KO accepts the request, the Government will notify the Contractor of Government acceptance. If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the request letter to the KO via email. Continue this cycle until the Government notifies the Contractor of the Government acceptance.

4. Content: The request shall contain but not be limited to:

contract number and title, Contractor name, date, day, and time of requesting workday, justification for necessity and occasion of working outside Contractor‘s regular working hours, as determined by the Contractor to include all applicable regulatory information.

5. Other Requirement: The submitted request shall accurately reflect their intended use.

6. Due Dates: The request letter shall be submitted at least 7 calendar days prior to requested day.

See DoDI 5200.48 for marking requirements (as applicable)

0200000-F, Page 6 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.3.1, Required Conferences and Meetings (Sign-In Sheets and Minutes)

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: X Hard Copy and X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The forms shall be prepared using the form that the Contractor considers appropriate.

2. Purpose: For Government Acceptance.

3. Distribution List and Method of Submission: Electronic copy to KO, KS, COR and all Attendees.

1) If the KO accepts the minutes, the Government will notify the Contractor of Government acceptance. If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the sheets and minutes to the KO via email.

Continue this cycle until the Government notifies the Contractor of the Government acceptance.

4. Content: The sign in and minutes shall contain but not be limited to:

date, day, and time of requesting work day, all Contractor and Government personnel in attendance, thorough notes / minutes of all agenda items discussed, a record of any additional discussions that may take place during the meeting.

5. Due Dates: The minutes shall be submitted within two working days following the meeting.

0200000-F, Page 7 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.3.1, Required Conferences and Meetings (Final Revision of Minutes)

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: X Hard Copy and X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The minutes shall be prepared using the form that the Contractor considers appropriate.

2. Purpose: For Government Acceptance.

3. Distribution List and Method of Submission: Electronic copy to KO, KS, COR and all Attendees.

1) If the KO accepts the minutes, the Government will notify the Contractor of Government acceptance. If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the sheets and minutes to the KO via email.

Continue this cycle until the Government notifies the Contractor of the Government acceptance.

4. Content: The minutes shall contain but not be limited to:

date, day, and time of requesting work day, all Contractor and Government personnel in attendance, thorough notes / minutes of all agenda items discussed, a record of any additional discussions that may take place during the meeting.

5. Due Dates: The minutes shall be submitted within two working days following Comments received from the KO.

0200000-F, Page 8 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.3.4, Permits and Licenses

Form Attachment No.: N/A Government Acceptance Required: Yes X No

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

1. Method of Submission: Via email. The copies of Permits and Licenses shall be converted to PDF file, Adobe Acrobat form.

2. Purpose: For Government acceptance.

3. Distribution List: KO/KS/COR

If the KO or the COR accept the Permits and Licenses, the Government will notify the Contractor of Government acceptance.

If the KO respond with review comments, then incorporate the Government’s comments and resubmit the copies of Permits and Licenses via email to recipients on the distribution list.

Continue this cycle until the Government notifies the Contractor of Government acceptance.

4. Other Requirement: The submitted copies of Permits and Licenses shall accurately reflect their intended use.

Note: As Spec Item 2.6.4, Deliverables of Annex 2 specifies that all submittals shall be translated in English,, the Contractor shall submit the copies of Permits and Licenses with English translation.

5. Due Dates: The copies of Permits and Licenses shall be submitted before work commences on contract, within 7 calendar days after the old ones expire, and as required.

0200000-F, Page 9 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.3.5, Certificate of Insurance

Form Attachment No.: N/A Government Acceptance Required: X Yes No

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

1. Method of Submission: Via email. The Certificate of Insurance shall be converted to PDF file, Adobe Acrobat form.

2. Purpose: For Government acceptance.

3. Distribution List: KO/KS/COR

If the KO or the COR accepts the Certificate of Insurance, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the Certificate of Insurance via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

4. Content: Copies of certificate of insurance listed under Spec Item 2.3.5.2, Minimum Insurance Amounts of Annex 2.

5. Other Requirement: The submitted Certificate of Insurance shall accurately reflect their intended use.

6. Due Dates: The Certificate of Insurance shall be submitted at least 30 calendar days prior to start of contract performance. Also, the Certificate of Insurance shall be submitted within 7 calendar days prior to expiration of the existing policy when the option period is exercised.

0200000-F, Page 10 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.6.5, Service Interruption Notification

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: X Hard Copy and X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The notification shall be prepared using the form that the Contractor considers appropriate.

2. Purpose: For Government Information and Acceptance.

3. Distribution List and Method of Submission: Electronic copy to KO, KS, COR and all affected tenants.

a. If the KO or the COR accepts the outage notification, the Government will notify the Contractor of Government acceptance.

4. Content: The notification shall contain but not be limited to:

a. date, day, time and location of requested outage,

b. all tenants or customers affected,

c. the proposed duration of outage.

5. Due Dates: Minimum of 14 calendar days prior to the scheduled outage. If the outage is due to an emergency the Contractor shall notify the KO, COR, affected tenants and customers as soon as practicable.

0200000-F, Page 11 of 42

Deliverables Form Preparation Instructions Deliverable Title: 0200000/2.6.7.1, Quality Management (QM) Plan

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The QM Plan shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the QM Plan, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the QM Plan via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The QM Plan shall describe the QMS methodology and approaches used under this contract.

6. Other Requirement: The submitted QM Plan shall accurately reflect its intended use.

7. Due Dates: The QM Plan shall be submitted at least 30 calendar days prior to start of contract performance and within 15 calendar days prior to any changes.

0200000-F, Page 12 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.6.7.2, Quality Inspection and Surveillance File

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/CD) Direct System Input Instructions:

1. Required File Format: The Quality Inspection and Surveillance File shall be prepared using a form that the Contractor considers appropriate.

2. Method of Submission: The Quality Inspection and Surveillance File shall be converted to PDF file, Adobe Acrobat form, and burnt on to a CD or DVD.

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the Quality Inspection and Surveillance File; the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the Quality Inspection and Surveillance File via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The Quality Inspection and Surveillance File shall contain all scheduled and performed inspections and surveillances, inspection and surveillance results, dates, and details of corrective and preventive actions.

6. Due Dates: Within five calendar days of completion/ termination of the contract.

0200000-F, Page 13 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.6.7.3, Quality Inspection and Surveillance Report

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The Quality Inspection and Surveillance Report shall be prepared using a form that the Contractor considers appropriate.

2. Method of Submission: Via email. The Quality Inspection and Surveillance Report shall be converted to PDF file, Adobe Acrobat form.

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the Quality Inspection and Surveillance Report, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the Quality Inspection and Surveillance Report via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content

The Contractor Quality Inspection and Surveillance Report shall include a summary and results of the quality inspection and surveillance events performed and surveillance-driven corrective actions and process adjustments during the previous month(s).

As determined by the Contractor to include all applicable regulatory information.

6. Other Requirement: The submitted Quality Inspection and Surveillance Report shall accurately reflect their intended use.

7. Due Dates: The Quality Inspection and Surveillance Report shall be submitted first work day of each month. The Government may adjust the frequency of the submittal based on the Contractor’s quality of performance.

0200000-F, Page 14 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.6.8, Property Management Plan

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The plan shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the plan, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the plan via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The plan shall contain but not be limited to:

contract number and title;

Contractor name;

Contractor’s policies, procedures, and practices in repairing, maintaining, preserving, protecting, and reporting any damage of the government property; and as determined by the Contractor to include all applicable regulatory information.

6. Other Requirement: The Contractor shall establish and maintain a plan that meets the contract clause requirements of Spec Item 2.4, Government-Furnished Property, Materials and Services, of this Annex. The submitted request shall accurately reflect its intended use.

7. Due Dates: The request shall be submitted at least 30 calendar days prior to start of contract performance.

0200000-F, Page 15 of 42

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Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.7.1 , List of Key Personnel and Qualifications or Request to Appoint New Key Personnel and Interpreter

Form Attachment No.: N/A Government Acceptance Required: X Yes No

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

1. Required File Format: The Key Personnel and Qualifications (Resume) or Request to Appoint New Key Personnel and Interpreter shall be prepared using a Government specified form; The Resume Form will be provided by the Government after contract award.

2. Method of Submission: Via Email. The resume form, qualifications (certificates and licenses if applicable), and/or request shall be converted to PDF file, Adobe Acrobat form.

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the qualifications, and/or request; the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the qualifications, and/or request via email to recipients on the distribution list.

Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The List of Key Personnel and Qualifications or Request to Appoint New Key Personnel and Interpreter shall contain the following:

First Submission and when the Government requests to revise the personnel: all items included in the Resume Form; their qualifications (copies of their certificates and licenses, and credentials of the Competent Person(s)); and any additional information requested by the KO or the COR to certify their qualifications.

When the Contractor intends to revise or appoint new personnel: request and justification of revising or appointing new Key Personnel and Interpreter; all items included in the Resume Form and their qualifications (copies of their certificates and licenses, and credentials of the Competent Person(s));

and any additional information requested by the KO or the COR to certify their qualifications.

* Note: These instructions continue on the following page.

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(Page 2 of 2)

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.7.1, List of Key Personnel and Qualifications or Request to Appoint New Key Personnel and Interpreter

Form Attachment No.: N/A Government Acceptance Required: X Yes No

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

* Note: Continued from the previous page.

6. Other Requirement

Technically, the interpreter is not included in the Key Personnel member, but the Contractor shall submit a resume for the interpreter as part of this deliverable when revised.

The submitted qualifications, and/or request shall accurately reflect their intended use.

7. Due Dates

Initial (for Government approval): At least 30 calendar days prior to start of contract performance and prior to appointing new personnel. (Note: first submission may be exempt when required to be included in the proposal submittals.)

Final (after Government approval): The Government may or may not require the Contractor to submit the Final revised list. If requested, the Contractor shall submit the list and their qualifications within five calendar days of changes and updates.

0200000-F, Page 17 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.7.1, Organizational Chart

Form Attachment No.: N/A Government Acceptance Required: X Yes No

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

1. Required File Format: The Organizational Chart shall be prepared using a form that the Contractor considers appropriate.

2. Method of Submission: Via Email. The Organizational Chart shall be converted to PDF file, Adobe Acrobat form.

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the Organizational Chart, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the Organizational Chart via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The Organizational Chart shall contain:

lines of authority of the Key Personnel and on-site supervisor(s), and the interpreter for this contract;

names of personnel including any subcontractors to be used, their position titles and qualifications in this contract; and as a minimum, include the Key Personnel, on-site supervisor(s), interpreter and who they will report directly to for this contract, to include pictures of personnel on Org. chart.

6. Other Requirement: The submitted chart shall accurately reflect their intended use.

7. Due Dates: The Organizational Chart shall be submitted at least 15 calendar days prior to start of contract performance and within five calendar days when revised or updated. (Note: first submission may be exempt when required to be included in the proposal submittals.)

0200000-F, Page 18 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.7.2.6, Proof of Legal Residency

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Method of Submission: Via email. The proof documents shall be converted to PDF file, Adobe Acrobat form.

2. Purpose: For Government acceptance.

3. Distribution List: KO/KS/COR

If the KO or the COR accepts the list, the Government will notify the Contractor of Government acceptance.

4. Content: Proof Documents for employee legal residency.

5. Due Dates: At least 30 days prior to start of work on this contract / prior to being admitted to the work site.

0200000-F, Page 19 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.7.3, Enterprise-wide Contractor Manpower Reporting Application (eCMRA)) Input

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy Electronic (PDF/email) X Direct System Input Instructions: Contractor Labor Hours (eCMRA) Input

1) Method of Submission: via a secure data collection site, eCMRA (direct system input); web address:

https://www.ecmra.mil .

2) Content: the Contractor is required to report all Contractor labor required for performance of services provided under this contract. Refer to the above web address and completely fill in all required data fields.

Labor hours during the period of performance during each Government fiscal year (FY), October 1st through September 30th of each calendar year.

3) Other Requirements: The submitted invoice shall accurately reflect their intended use.

4) Due Dates: Annually, no later than the 31st of October.

0200000-F, Page 20 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.8.1, Employee List and Vehicle List

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (Excel or PDF/email) Direct System Input Instructions:

1. Required File Format: The plan shall be prepared using Microsoft Office ® software.

2. Method of Submission: Via email. Attach either the specific Excel form or converted PDF file, Adobe Acrobat form.

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the list, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, incorporates any of the Government’s comments and resubmit the list via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The list shall include all employees’ names, titles, pass numbers, positions in the contract, contact numbers (in case of emergency), license numbers and insurance expiration dates of any vehicles to be used.

6. Due Dates: The list shall be submitted at least 30 calendar days prior to contract start, , within 15 calendar days of each option period exercise, and within 7 calendar days of updates or changes.

0200000-F, Page 21 of 42

(page 1 of 2)

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.1, 2.9.2, 2.9.3 – 2.9.3.5, Accident Prevention Plan (APP): incorporate the Activity Hazard Analyses (AHAs), and Safety and Occupational Health (SOH) Risks and Compliance Plans Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The APP shall incorporate the AHAs and SOH Risks and Compliance Plans, and be formatted as addressed in Appendix A of the EM-385-1-1. The AHAs shall follow format of Figure 1-2 of the EM-385-1-1. The Government will provide the blank AHA form after contract award.

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

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the APP, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the APP via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content

The APP shall include, as a minimum, elements addressed in paragraph 3 of Appendix A in the

EM385-1-1.

* Note: These instructions continue on the following page.

0200000-F, Page 22 of 42

(page 2 of 2)

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.1, 2.9.2, 2.9.3 – 2.9.3.5, Accident Prevention Plan (APP): incorporate the Activity Hazard Analyses (AHAs), and Safety and Occupational Health (SOH) Risks and Compliance Plans Form Attachment No.:

Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

* Note: Continued from the previous page.

6. Other Requirements

APP

The APP shall incorporate AHAs (refer to the Spec Item 2.9.2 of Annex 2) and SOH Risks and

Compliance Plans (Spec Item 2.9.3 through 2.9.3.5) that are relevant to the site specific hazards and controls for each activity and type of work that may be encountered in the performance of this contract.

The APP shall be revised and resubmitted for any changes.

The Contractor shall review, update, and submit revisions to the APP whenever a change in work conditions, hazards, or activities occur.

Per Spec Item 2.10.2.5, Hazardous Material Management of this Annex, include the plan if any hazardous materials will be brought on the Installation.

The submitted APP and SOH Risks and Compliance Plans shall accurately reflect their intended use.

AHA

AHAs shall be updated as work activities or conditions change and additional AHAs prepared as new work activities are required.

Whenever the service environment or required task is different from the Recurring Work services; and for modifications where changes are germane to the original Recurring Work portion of the contract, the Contractor shall revise applicable AHAs or prepare new AHAs and submit to recipients on the distribution list.

If changes to the AHAs are required, such changes shall be submitted to recipients on the distribution list for Government review and acceptance.

The submitted AHA shall accurately reflect their intended use.

7. Due Dates

General: The APP including AHAs and SOH Risks and Compliance Plans shall be submitted at least 30 calendar days prior to start of contract performance, within 15 calendar days of any changes, and at least 2 working days prior to the start of work for changes and additions.

AHAs for modifications, non-recurring UPL work and one-time work occurrences:

For modifications and where changes are germane to the original Recurring Work and/or Non-recurring UPT work portion of the contract: within 15 calendar days after the modification is signed and at least 2 working days prior to the commencement of work.

For UPL work task orders to include construction task orders: submit with the associated proposal (within seven calendar days from the issuance of each potential Task Order RFP).

0200000-F, Page 23 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.5, NAVFAC Contractor Incident Reporting System (CIRS) Report Form Attachment No.: J-0200000-04 Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The NAVFAC CIRS Report shall be prepared using the specific form, which will be provided by the Government after contract award. A sample form is provided in J-0200000-04.

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

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the report, the Government will notify the Contractor of Government acceptance.

If the KO or the COR 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 Government acceptance.

5. Content: The items in the NAVFAC CIRS Report form where applicable.

6. Other Requirement: The submitted reports shall accurately reflect their intended use.

7. Due Dates:

Initial CIRS Report: within 12 hours of mishap occurrence.

Follow-up CIRS Report: within five days of mishap occurrence.

Final CIRS Report: within 30 days of mishap occurrence.

0200000-F, Page 24 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.5, NAVFAC Mishap Notification Report

Form Attachment No.: J-0200000-04 Government Acceptance Required: Yes X No

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

1. Required File Format:

Initial Report: The NAVFAC Initial Mishap Notification Report shall be prepared using the specific form, which will be provided by the Government after contract award. A sample form is provided in J-0200000-04.

Follow-up Report: The Follow-up Mishap Notification Report form shall be prepared using a format that the Contractor considers appropriate.

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

3. Purpose: For Government information.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the report, the Government will notify the Contractor of Government acceptance.

If the KO or the COR 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 Government acceptance.

5. Content:

Initial Report: Refer to the form provided in J-0200000-04 and the blank form provided after contract award.

Follow-up Report:

Any updates and additional information, Information on primary cause of the mishap (unsafe conditions, personal error, etc.)

Light or Restricted Duty offered and performed by the employee, if applicable, and Photos of mishap site including sources of injury such as tools, equipment, materials, etc., if not included in the initial report.

6. Other Requirement: The submitted report shall accurately reflect its intended use.

7. Due Dates:

Initial Report: within four hours of mishap occurrence.

Follow-up Report: within 12 hours of mishap occurrence.

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Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.5, Weight Handling Equipment (WHE) Accident Report Form Attachment No.: J-0200000-04 Government Acceptance Required: Yes X 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, which will be provided by the Government after contract award. A sample form is provided in J-0200000-04.

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

3. Purpose: For Government information.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the report, the Government will notify the Contractor of Government acceptance.

If the KO or the COR 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 Government acceptance.

5. Content: Refer to the form provided in J-0200000-04 and the blank form provided after contract award.

6. Other Requirement: The submitted report shall accurately reflect their intended use.

7. Due Dates: This report shall be submitted within 15 working days of the WHE accident.

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Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.5, Near Miss Notification Report

Form Attachment No.: J-0200000-04 Government Acceptance Required: Yes X No

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

1. Required File Format: The Near Miss Notification Report shall be prepared using a form that the Contractor considers appropriate or the sample form for the Initial Near Miss Notification Report Form provided in J-0200000-04.

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

3. Purpose: For Government information.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the report, the Government will notify the Contractor of Government acceptance.

If the KO or the COR 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 Government acceptance.

5. Content: Refer to the form provided in J-0200000-04 and the blank form provided after contract award.

6. Other Requirement: The submitted report shall accurately reflect its intended use.

7. Due Dates: The Near Miss Notification Report shall be submitted within 24 hours of the near miss occurrence.

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Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.5, Crane and Rigging Gear Near Miss Report Form Attachment No.: J-0200000-04 Government Acceptance Required: Yes X No Media: Hard Copy X Electronic (PDF/email) Direct System Input

Instructions:

1. Required File Format: The Crane and Rigging Gear Near Miss Report shall be prepared using the specific form provided in J-0200000-04. The Government will provide the blank form after contract award.

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

3. Purpose: For Government information.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the report, the Government will notify the Contractor of Government acceptance.

If the KO or the COR 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 Government acceptance.

5. Content: Refer to the form provided in J-0200000-04 and the blank form provided after contract award.

6. Other Requirement: The submitted report shall accurately reflect its intended use.

7. Due Dates: This report shall be submitted within 15 working days of the near miss.

0200000-F, Page 28 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.7, Monthly On-Site Labor Report

Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1) Method of Submission: The report shall be prepared using Microsoft Office ® software.

2) Distribution List: KO/KS/COR

3) Content: The purpose of this report is to document the hours performed by contractor employees (prime and sub-contract) as required by NAVFAC Safety Office.

All labor hours for the previous month’s performance (Prime and Sub KTR’s).

4) Due Dates: Monthly. Shall be included with the contractors monthly invoice package.

0200000-F, Page 29 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.8, OSHA Citations and Violations Corrective Action Report

Form Attachment No.: N/A Government Acceptance Required: X Yes No

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

Instructions:

1. Required File Format: The OSHA Citations and Violations Corrective Action Report shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the report, the Government will notify the Contractor of Government acceptance.

If the KO or the COR 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 Government acceptance.

5. Content:

Copy of the OSHA Citation Corrective Action to be taken Preventive Action to be taken Any other information considered necessary by the Contractor

6. Other Requirement:

The submitted report shall accurately reflect its intended use.

The Contractor may be required to submit follow-up documentation.

7. Due Dates: This report shall be submitted within 48 hours after receiving an OSHA citation.

0200000-F, Page 30 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.8.1, LSIO Citations and Violations Corrective Action Report

Form Attachment No.: N/A Government Acceptance Required: X Yes No

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

1. Required File Format: The LSIO Citations and Violations Corrective Action Report shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the report, the Government will notify the Contractor of Government acceptance.

If the KO or the COR 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 Government acceptance.

5. Content:

Copy of the LSIO Citation The contents in the LSIO citation translated in English Corrective Action to be taken Preventive Action to be taken Any other information considered necessary by the Contractor

6. Other Requirement:

a. The submitted report shall accurately reflect its intended use.

b. The Contractor may be required to submit follow-up documentation.

7. Due Dates: This report shall be submitted within 48 hours after receiving a LSIO citation.

0200000-F, Page 31 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.9.10, Safety Certifications Form Attachment No.: N/A Government Acceptance Required: Yes X No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Method of Submission: Via email. The Safety Certification shall be converted to PDF file, Adobe Acrobat form.

2. Purpose: For Government information.

3. Distribution List: KO/KS/COR

If the KO or the COR accepts the Safety Certification, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the copies of Safety Certification via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

4. Other Requirements

The Contractor shall submit new versions of certifications as the old certifications expire.

The submitted copies of Safety Certification shall accurately reflect their intended use.

5. Due Dates: The copies of Safety Certification shall be submitted within 15 calendar days prior to start of contract performance and prior to expiration of certifications.

0200000-F, Page 32 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.10.1 Water Conservation Plan Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The request shall be prepared using a form that the Contractor considers appropriate.

2. Method of Submission: Electronic (one copy via Email) - The plan shall be converted to PDF file, Adobe Acrobat form.

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the request, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the request via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The request shall contain the Contractors plan for water conservation during the performance of work under this contract.

6. Due Dates: The request shall be submitted at least 30 calendar days prior to start of contract performance and 15 calendar days prior to any changes.

0200000-F, Page 33 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.10.2.7, Spills on Government Property Report Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The report shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government notification and acceptance.

4. Distribution List: Environmental Branch via KO/KS/COR

If the Environmental Branch and KO or the COR accept the plan, the Government will notify the Contractor of Government acceptance.

If the Environmental Branch, KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the request via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The report shall contain, but not be limited to, the following:

Pre-cleanup sampling data and methodology to establish spill boundaries.

A description of the solid surfaces cleaned.

Description of disposal method for contaminated spill material and equipment (e.g.

contaminated soil, booms, etc.).

Post-cleanup verification sampling data and a brief description of the sampling methodology and techniques used.

6. Due Dates: The report shall be within 48 hours of spill occurrence.

0200000-F, Page 34 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.10.2.8, Hazardous Material Management Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The report shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government notification and acceptance.

4. Distribution List: Environmental Branch via KO/KS/COR

If the Environmental Branch and KO or the COR accept the plan, the Government will notify the Contractor of Government acceptance.

If the Environmental Branch, KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the request via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The request shall contain, but not be limited to, the following:

Name of hazardous material and Safety Data Sheets (SDS).

A description of use for the material.

Description of disposal method.

The Contractor shall ensure that procedures are in place to deal with hazardous materials, pursuant to the FAR Clause 52.223-3, HAZARDOUS MATERIAL

IDENTIFICATION AND MATERIAL SAFETY DATA.

6. Due Dates: Hazardous Material Management report shall be due a minimum of 10 working days for processing the request.

0200000-F, Page 35 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.10.2.12 Asbestos Containing Material (ACM) Form Attachment No.: N/A Government Acceptance Required: Yes X No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The request shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government information.

4. Distribution List: KO/KS/COR

5. Content: If ACM is encountered or suspected in the performance of work, the Contractor shall provide details of material and location, etc.

6. Due Dates: Verbal notification to the KO/COR within one hour and written notification within 24 hours of discovery.

0200000-F, Page 36 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.10.3, Sustainable Procurement and Practices Plan Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input

Instructions:

1. Required File Format: The Sustainable Procurement and Practices Plan shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the plan, the Government will notify the Contractor of Government acceptance.

If the KO or the COR responds with review comments, then incorporate the Government’s comments and resubmit the plan via email to recipients on the distribution list. Continue this cycle until the Government notifies the Contractor of Government acceptance.

5. Content: The plan shall specifically address the following components.

Recycled contents products, Energy/Water efficiency, Energy Efficient Tools and Equipment Alternate Fuels and Alternate Fuel Vehicles, Bio-Based Products, None-Ozone Depleting Products, Environmental Preferred Products and Services, Low/Non-Toxic and Hazardous Materials, and as determined by the Contractor to include all applicable regulatory information.

6. Other Requirement: The submitted plan shall accurately reflect its intended use.

7. Due Dates: At least 15 calendar days prior to start of contract performance and within 15 calendar days after exercised option periods.

0200000-F, Page 37 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.10.3, Sustainable Delivery of Services Report Form Attachment No.: N/A Government Acceptance Required: Yes X No Media: Hard Copy X Electronic (PDF/email) Direct System Input

Instructions:

1. Required File Format: The Sustainable Procurement and Practices Plan shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government information.

4. Distribution List: KO/KS/COR

5. Content: As determined by the Contractor to include all applicable regulatory information.

6. Other Requirement: The submitted report shall accurately reflect its intended use.

7. Due Dates: The report shall be submitted within five calendar days after each contract period.

0200000-F, Page 38 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.10.3.2, Recovered Material Certification Form Attachment No.: N/A Government Acceptance Required: Yes X No Media: Hard Copy X Electronic (PDF/email) Direct System Input

Instructions:

1. Required File Format: The Recovered Material Certification shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government information.

4. Distribution List: KO/KS/COR

5. Content: As determined by the Contractor to include all applicable regulatory information.

6. Other Requirement: The submitted report shall accurately reflect its intended use.

7. Due Dates: When a product containing recovered materials is equal to or better that the original and could be used; and at least 14 calendar days prior to use.

0200000-F, Page 39 of 42

Deliverables Form Preparation Instructions

Deliverable Title: Annex/Spec Item: 0200000/2.11 Disaster Preparedness

Form Attachment No.: N/A Government Approval Required: X Yes No Media: X Hard Copy and X Electronic (PDF/email) Direct System Input

Instructions:

1. Required File Format: The request shall be prepared using the form that the Contractor considers appropriate.

2. Cover Sheet: The Government specified cover sheet is required. The cover sheet will be provided by the Government after contract award.

3. Purpose: For Government approval.

4. Distribution List and Method of Submission: COR via PAR via all affected divisions and/or activities. / Via email and hard copy as necessary and as indicated below.

1) Take the request letter form (hard copy) to all affected divisions and/or activities for their approval as/if necessary.

2) The endorsed (approved / acknowledged) request letter by all affected divisions and/or activities shall be converted to Portable Document Format (PDF) file, Adobe Acrobat form and submitted to the PAR via email.

3) The request letter will be routed internally to the COR.

4) If the COR accepts the request, the PAR will notify the Contractor of Government acceptance and send the approved letter back to the Contractor. If the COR responds to the request with review comments, then incorporate the Government’s comments and resubmit the request letter via email and/or hard copy to recipients on the distribution list. Continue this cycle until the PAR notifies the Contractor of FSC’s acceptance.

5. Content: The request shall contain but not be limited to:

contract number and title, Contractor name, date, day, and time of requesting work day, justification for necessity and occasion of working outside Government‘s regular working hours, affected divisions and/or activities endorsement (if necessary), and as determined by the Contractor to include all applicable regulatory information.

6. Other Requirement: The submitted request shall accurately reflect their intended use.

7. : The endorsed request or request shall be submitted at least 15 calendar days prior to requested day.

0200000-F, Page 40 of 42

Deliverables Form Preparation Instructions

Deliverable Title: 0200000/2.14.1, Notification to the Government for Work Above the Recurring Limits Form Attachment No.: N/A Government Acceptance Required: X Yes No Media: Hard Copy X Electronic (PDF/email) Direct System Input Instructions:

1. Required File Format: The Notification shall be prepared using a form that the Contractor considers appropriate.

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

3. Purpose: For Government acceptance.

4. Distribution List: KO/KS/COR

If the KO or the COR accepts the report, the Government will notify the Contractor of Government acceptance.

If the KO or the COR 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 Government acceptance.

5. Content: The Notification to the Government for Work Above the Recurring Limits shall include but not limited to:

Contract number and title, an estimate that includes the full scope of work, and clearly shows the deductions for the applicable recurring work limit of liability.

6. Due Dates: Within two work days of need to exceed limit is discovered.

0200000-F, Page 41 of 42

Deliverables Form Preparation Instructions

De…