J-1601000-08 EXCAVATION-UTILITY MARKING AUTHORIZATIONS REQUEST FORM.xlsx
XLSX spreadsheet 27 KB Posted
- Attached to
- Base Operations Support Services For NSA Annapolis and US Naval Academy, Annapolis, Maryland
- Solicitation number
- N6247026R0017
About this file
This is an Excavation and Utility Marking Authorizations Request Form used by the U.S. Naval Academy and NSA Annapolis to control and approve all ground-disturbing activities on the installation. The form must be completed and approved by the Public Works Utilities, Energy & Utilities Management (UEM) Outage/Dig Coordinator before any excavation, utility marking, digging, or utility service interruptions can commence. Requestors must provide detailed information including the points of contact, environmental concurrence status, permit acquisition confirmation, description of any required Base Operations Support (BOS) contractor involvement, specific work dates and times, affected areas, excavation types, and the business justification for the work. A minimum of 21 calendar days is required for routing and final approval. The form specifies that hand digging is mandatory within 24 inches of utilities, contractors assume liability for damage to government property caused by negligence, and immediate notification to Public Works is required for any property damage or service interruptions. Unknown or unrecognizable items discovered during excavation cannot be removed from the site without government approval. The approving authority provides final signature authorization on the form, with options to approve or disapprove and request resubmission.
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Text version
V.111924 USNA/NSA Annapolis Excavation/Utility Marking Authorizations Request Form
| INSTRUCTIONS: |
| 1. This form shall be completed, with final approval granted, prior to any planned work at the U. S. Naval Academy/NSA Annapolis that |
requires any digging, excavating, underground utility marking, or interruptions to base utility services.
2. Requestor must complete sections 1, 2, and 3, and submit for review prior to beginning any work. Clarity and details are required. Any vague or incomplete requests will be disapproved and returned to the requestor. Sections 4 and 5 are for Official Use Only.
3. Requestor will be notified when they can proceed with utility markings only. When markings are completed, requestor will notify Public Works UEM Outage/Dig Coordinator requesting a site review.
4. Requestor cannot proceed with excavation/utility outage until final approval has been received in writing from Public Works UEM Outage/Dig Coordinator on this authorization form.
5. A minimum of 21 calendar days will be required for routing and final approval.
| 1. REQUESTOR (POC) | ORGANIZATION | CONTACT INFORMATION |
| PRIMARY: | Phone: | |
| Email: | ||
| ALTERNATE: | Phone: | |
| Email: |
| 2. REQUEST TYPE | 2A. Environmental Concurrence Obtained? | 2B. Is BOS Contractor Support Required? | |||
| Excavation & Utility Locating | After speaking with Environmental, is it determined that all applicable permits have been obtained? | ||||
| (If no permits are required check Yes) | If Yes, fill in block 2C. |
If No, Proceed to block 3.
YES NO N/A YES NO
| 2C. Detailed description of BOS contractor support needed (who/what/when/where/why). | (OFFICE USE ONLY) |
| LOG# | |
| Date Received: | |
| SERVICE# | |
| WORK ORDER# |
| 3. DETAILS: (Dates/times/locations/excavation type/details/include JON etc.) |
| Date: |
| Time/s: |
| Excavation Type(s): |
| Aeras Affected Details: |
Reason for Excavation Work & any Additional Information:
| 4. OFFICIAL USE ONLY | |
| Affected Facilities were Notified | Date: |
| 5. REMARKS/COMMENTS/REQUIREMENTS TO REQUESTOR |
| 1. Once Approved for Excavation Purposes, the following applies: (Hand Digging Required within 24 inches of Utilities) |
a. Contractors must ensure that all excavation work planned below grade is conducted in a manner that will limit the possibility of damage or destruction to Government property, utilities, personnel.
b. Contractors will assume Responsibility for any Government property damaged due to negligence or careless work performance on site.
Contractors will be responsible for providing immediate notifications to the Government as listed below. Utility Markings on site give approximate locations not exact locations. Exercise caution!
2. The PWD Trouble Desk must be notified in the event any Government property is damaged, destroyed, or experiences unplanned service interruption in conjunction with requested work. This includes all buried utilities known and unknown.
3. PWD Energy & Utilities must be notified if any unknown, unmarked, or unrecognizeable relics or potentially historic items are unearthed or damaged, or if concerns or questions arise as to the known utilities and markings on site. It is a violation of Federal Code to remove excavated items from project site w/o Government approval. Contact PWD Energy & Utilities Branch: (410) 293-1034 Trouble Desk: (410) 293-4594 USNA Emergency Response (Fire/Ambulance/Security): (410) 293-3333
| FINAL | ||||
| APPROVAL | DISAPPROVED/RESUBMIT | Signature of Approving Authority | Date |
| X_____________________________ | |
| DOCUMENT VERSION 111924 |
File details come from the government source that posted it. Updated .