PWS - FYXX B1 Project TE-4 Service Order Forms YYYYMMDD.pdf

DRAFT

PWS Technical Exhibit 4 FYXX B1 <Contract Name> Service Order Forms

TE-4.1 General The Contractor shall submit the following Service Order Forms with Corrective Maintenance packages in accordance with Appendix H.

TE-4.1.1. Service Order Form This form is required for all Service Orders. An Excel version will be provided to the Contractor upon award.

TE-4.1.2. Service Order Sole Source Justification Form This form is required for all Service Orders where only one source was solicited for subcontractor or materials over $2,500.00.

The Contractor shall insert the following into the respective fields:

a. Site: The facility where work takes place for the respective Service Order.

b. Contract Number: The contract number. If this is a task order, provide the overarching contract number, followed by a “/”, and then the task order number.

c. Date: Insert the date.

d. Prime Contractor: The Prime Contractor on this contract/task order.

e. Service Order Scope of Work: The Scope of Work for the respective Service Order. (A summary of the SOW from the Service Order Form is acceptable)

f. Cost: The Service Order total cost.

g. Check Boxes: Check the applicable box for the respective Service Order. A Service

Order may only be sole sourced for one of the eight reasons included on this form.

h. Further Justification: This box must be filled out or the Service Order will be returned.

The Contractor shall include a further and detailed description of why competition could not be sought in addition to checking one of the eight boxes.

i. Prime Contractor Signature: A representative of the Prime Contractor shall sign this box certifying all information provided on this form is accurate.

TE-4.1.3. Statement of Competition & Price Reasonableness Determination Form This form is required for all service orders with materials and/or subcontractor quotes exceeding $2,500.00.

TE-4.1.3.1. Section 1 – Statement of Competition:

The Contractor shall insert the following into the respective fields:

a. Service Order No.: Include the Service Order number here.

b. Location: The facility where work takes place for the respective Service Order.

c. Total Service Order Cost: The Service Order total cost.

d. Scope of Work: The Scope of Work for the respective Service Order. (A summary of the

SOW from the Service Order Form is acceptable)

e. Competitive bids table: The Contractor shall list each subcontractor/material vendor solicited (or if material from a website, list the website/vendor), the total subcontract/material amount, and how long the bid is valid (if applicable). If a subcontractor declined to bid, the Contractor shall put “NO BID” in the bid amount. If a vendor declines to bid, the Contractor shall include an email of the vendor declining to bid in the Service Order package, or the email of the Prime Contractor asking for a quote if no response was received.

f. Comments: The Contractor shall include comments if necessary.

g. Justification for subcontractor selection:

a. Low Bid: The Contractor shall check this box if the lowest bid/amount is the selected choice.

PWS Technical Exhibit 4 FYXX B1 <Contract Name> Service Order Forms

b. Best Value: If the Contractor does not select the low bidder, the Contractor shall check this box and provide a detailed explanation as to why they did not select the low bidder. (Best solution, low bidder did not address all repairs, etc.)

TE-4.1.3.2. Section 2 – Price Reasonableness Determination:

The Contractor shall insert the following into the respective fields:

a. Checkboxes:

a. Competition: The Contractor shall check this box if two or more bids were received that meet the requirements of the SOW.

b. Historical Data: The Contractor shall check this box if previous similar work or past service orders were used to determine price reasonableness. This cannot be the only form of price reasonableness, if used it must be used along with another form of acceptable price reasonableness. If this box is checked, the referenced historical data must be included in the Service Order package.

c. Industry data: The Contractor shall check this box if catalogs, internet research, etc. were used to determine a fair and reasonable price. The Contractor shall include referenced data in the Service Order package.

d. R.S. Means: The Contractor shall check this box if R.S. Means or other estimating software was used to determine price reasonableness. The Contractor shall include referenced data in the Service Order package.

e. Other: If the Contractor uses another method to determine price reasonableness, include it here. The Contractor shall provide supporting documentation if necessary. The KO reserves the right to reject a Price Reasonableness Determination.

b. Signature: A representative of the Prime Contractor shall sign this form certifying all information provided on this form is accurate.

CONTRACTOR: CONTRACT NO.:

FACILITY NAME : TASK ORDER NO.:

FACILITY LOCATION: CMMS SERVICE ORDER NO:

HNC SERVICE ORDER NO: INITIATOR:

SERVICE ORDER DATE:

One of these boxes must be checked: ROUTINE URGENT EMERGENCY

Reg Labor Hours Reg Labor Rate Overtime Labor Hours OT Labor Rate Total

Description QTY Part # Manufacturer Unit Unit Price Amount each -$ -$ each -$ -$ each -$ -$ each -$ -$ each -$ -$

Trip Description Travelers Days Per Diem (Total) Roundtrip Mileage Mileage Rate Travel Cost $0.00 -$ -$

ME&I 0 0 -$ Roundtrip Airfare -$ ME&I @75% (first and last day) 0 0 -$ Lodging 0 0 -$

Lodging ME&I ME&I @ 75% Standard Rate -$ -$ -$

TOTAL TRAVEL COST -$

Cost Labor Total -$ -$ Materials Cost -$ -$ Tax 0.00% -$ -$ Shipping -$ -$ Travel Cost -$ -$ Prime Total -$ -$ Subcontract Total -$ -$ Prime Contractor SO Fee 0.00% -$ -$ Emergency SO Fee 0.00% -$ -$ Subcontractor Markup 0.00% -$

-$ TOTAL COST -$

I concur this is a valid requirement to meet operational needs covered by this contract.

DESIGNATED GOVERNMENT REPRESENTATIVE:

DATE

SIGNED:

CONTRACTOR

I certify the services described above have been satisfactorily completed

PART II - COST SUMMARY

Contractor confirms there is an USACE accepted AHA associated with the work being performed in this SO included in the APP.

AHA identifier or tracking

SERVICE ORDER FORM

PART I - SERVICE ORDER INFORMATION

SERVICE ORDER SOW:

Contractor acknowledges there is NOT an AHA associated with the work being performed in this SO included in the APP. AHA is attached for review with the SO.

Contractor acknowledges there is an activity associtated with the SO that requires an additional plan or program that will be included in an APP addendum.

CEHNC Safety Compliance

Contractor Signature:_____________________

SCA/CBA or DBA (Select One) SCA/CBA DBA

QUALITY ASSURANCE EVALUATOR

PART IV - CERTIFICATION OF SERVICES

SIGNED:

PART III - AUTHORIZATION

$0.00

Not To Exceed (NTE)Firm-Fixed Price (FFP)FUNDING CLIN:

DATE

$0.00

Contractor acknowledges receipt of KO/SOA approved Service Order

DATE

Notice To Proceed to perform this SO is authorized:

CONTRACTING OFFICER/SERVICE ORDER ADMINISTRATOR

SUBCONTRACTORS

PRIME CONTRACTOR LABOR UTILIZED (add rows if necessary)

TOTAL REGULAR LABOR

TOTAL MATERIALS

Totals

Labor Classification

PRIME CONTRACTOR TRAVEL

Check all applicable boxes:

Inbrief Conducted: Date Work Completed: Outbrief Conducted:

Subcontractor Total

Subcontractor

PRIME CONTRACTOR PARTS/MATERIALS/EQUIPMENT (add rows if necessary)

DRAFT Bid Amount Valid Until

(signature) (date) (printed name)

** PROPOSAL INFORMATION **

** REQUIRED for all service orders with materials and/or subcontractor quotes exceeding $2,500.00 **

Competitive bids were solicited & results are as follows:

SECTION 1 - STATEMENT OF COMPETITION

Service Order No.:

Location:

Total Price for Approval:

Scope of Work

Comments:

Completed by:

SECTION 2 - PRICE REASONABLENESS DETERMINATION

Justification for subcontractor selection:

Low Bid Best Value (complete scope of work, best technical solution, value added, etc)

Please explain:

How did you determine price reasonableness? * if other than Competition, PRD documentation must be provided

Competition (PRD not needed if two or more valid quotes received) Historical Data (previous similar work, past service orders) Industry Data (catalog/internet research, etc) R.S. Means Other (please explain):

Subcontractor

DISCLOSURE STATEMENT

This proposal includes data that shall not be disclosed outside the Government and shall not be duplicated, used, or disclosed – in whole or in part – for any purpose other than to evaluate this proposal or quotation. If, however, a contract is awarded to this offeror as a result of – or in connection with –the submission of this data, the Government shall have the right to duplicate, use, or disclose the data to the extent provided in the resulting contract. This restriction does not limit the Government’s right to use information contained in this data if it is obtained from another source without restriction.

The data subject to this restriction are contained in all sheets of this proposal.

Contractor Logo Here

Sole Source * Sole Sorce Justification Form Provided. **Not required if multiple bids solicited and only one received**

Comments:

STATEMENT OF COMPETITION &

PRICE REASONABLENESS DETERMINATION

a0edsdfk Rectangle

SOLE SOURCE JUSTIFICATION

SITE:

DATE:

CONTRACT No:

VENDOR:

SERVICES REQUESTED:

ESTIMATED COST:

Utility services available from only one source. IAW FAR 6.302-1(b)(3)

Engineering or R & D capability to be provided by an educational or non-profit institution or federally funded R & D Center. IAW FAR 6.302-3

Only known source of supply. IAW FAR 6.302-1

Compatibility – Unique supplies or services available from only one source or supplier with unique capabilities. IAW FAR 6.302-1(1)(b)(1) Example: direct replacement for a component part; material / equipment / component is required for use in existing equipment; and substitutes cannot be used because of electrical, mechanical, or physical reasons.

Unusual or compelling urgency. IAW FAR 6.302-2 Example: delay of an award would result in serious injury, financial or other, to the government.

Justification provided.

Agency standardization program dictates that only specified makes and models of technical equipment and parts will satisfy the agency’s need for additional units or replacement items, and only one source is available. IAW FAR 6.302- (b) (4)

Limited rights in data, patent rights, copyrights, or secret process. IAW FAR 6.302-1(b)(2)

Repair/maintenance by original manufacturer or authorized agency to preserve conditions of warranty.

FURTHER JUSTIFICATION: **REQUIRED** (if space is not enough, attach additional sheet)

Contract Maintenance Manager

REASON FOR LACK OF COMPETITION: