SOW B635 - Doors Repair Project Rev4.pdf

B635 Exterior Door Repairs Statement of Work 2 June 2026

STATEMENT OF WORK

FOR

CONSTRUCTION AGREEMENT – B635 – Exterior Doors Repair Project

PROJECT NO: M.0167585

Fort Leavenworth, KS

PROJECT M.0167585/ NAME: B635 Exterior Doors Repair Project

DATE: 02 June 2026

SW-1 DESCRIPTION OF WORK

a. General: The work consists of furnishing all plant, labor, equipment, and materials to perform all work in strict accordance with the plans and specifications to replace building 635’s exterior doors, frames and locking mechanisms. All work performed by the contractor shall result in a complete, functional door system.

Location: The site of the proposed work is Building 635, the main barracks facility at Fort Leavenworth.

b. Bonding: Individual task orders shall adhere to the requirements at FAR 28.102 to include requirements for bonding. Bonding will be included in a separate line item on the individual task orders.

c. Government Representatives: Representatives of the Directorate of Public Works will act as Project Oversight for the Contracting Officer/COR for each individual Task Order awarded under this agreement.

d. Key Personnel Staffing Plan: The contractor shall assign an employee other than the On-Site Superintendent who will serve as Project Manager for the course of this agreement. The official shall be responsible for being a liaison between the contractor and the Contracting Officer/COR or their designated representative. The designation shall be in writing and a copy furnished to the Contracting Officer/COR within ten (10) days after signature of this agreement.

e. Identification of Contractor Employees. The contractor shall provide each employee an identification (ID) badge on contract start date or on employment start date. Contractor personnel shall wear the ID badge at all times when performing work under this contract to include attending Government meetings and conferences. Contractor employee shall wear the ID badge in a conspicuous place on the front of exterior clothing and above the waist except when safety or health reasons prohibit such placement.

f. Wage Determinations: The location and type of work to be performed will dictate the applicable

Wage Determination to be associated with each individual Task Order.

g. Required Insurance Coverage: In conjunction with FAR Clause No. 52.228-5 entitled "Insurance Work on a Government Installation" the Contractor’s insurance coverage shall include the following types with the minimum amounts of liability indicated herein.

TYPE MINIMUM AMOUNT

Workmen's Compensation and Employer's $100,000 Liability Comprehensive General Liability $500,000 (Bodily Injury) Per Occurrence Comprehensive Automobile Liability

$200,000/$500,000 (Bodily Injury) Per Occurrence

h. Rough Order of Magnitude: In accordance with FAR 36.204 - Disclosure of the Magnitude of Construction Projects. Advance notices and solicitations shall state the magnitude of the requirement in terms of physical characteristics and estimated price range. In no event shall the statement of magnitude disclose the Government’s estimate. Therefore, the estimated price should be described in terms of one of the following price ranges: Between $250,000 and $500,000.

SW-2 PRINCIPLE FEATURES The work to be performed includes the following principal features:

a. Base, Section #1 – Main Floor Exterior Doors

1) The Contractor shall provide all labor, materials, equipment, supervision, and incidentals necessary to remove and replace twenty-one (21) exterior door assemblies on the main level, including associated frames, hardware, access control components, and adjacent infill systems. All work shall comply with WBDG 08 11 16, manufacturer requirements, and UFC life-safety provisions.

I. New exterior doors shall be commercial-grade aluminum stile-and-rail doors, fabricated from 6063-T6 architectural aluminum extrusions.

II. Frames shall be aluminum, factory-fabricated, and fully compatible with the door system.

III. Doors and frames shall be factory-finished/applied baked-on powder coating; field touch-up only.

IV. Finishes shall color match to existing conditions.

2) Door style: Half-light configuration replacing existing full-glass doors.

3) Minimum wall thickness, reinforcement, and hardware prep shall meet manufacturer standards for exterior use.

4) Hinges: Standard butt hinges only; no continuous hinges or pivot hinges permitted.

5) Closers: Heavy-duty closers with integral hold-open function.

6) Panic hardware: Surface-mounted vertical rod exit devices.

7) All hardware shall be ADA compliant and suitable for exterior conditions.

8) Remove all existing sidelight and toplight framing, glazing, and associated components.

9) Provide new insulated metal infill panels, factory-finished to match the adjacent door assembly.

10) Infill shall include:

I. Metal framing (tube steel or CFMF) II. Sheathing, insulation, vapor barrier

III. Exterior finish to match existing façade IV. Interior gypsum board, trim, and sealants

11) Doors and frames: factory-finished/applied baked-on powder coating aluminum; field touch-up as required.

12) Infill assemblies: Contractor-painted to match existing building color scheme.

13) All coatings shall meet exterior architectural paint standards.

14) Disconnect and reconnect access controls features as necessary to replace doors. Existing access controls are hard wired into the doors. Contractor shall maintain continuity of circuits.

I. Salvage existing door locking mechanisms for Government reuse.

II. Exterior door replacements shall be removed and reinstalled daily to ensure entry controls are maintained at all times.

(1) Should any opening require longer a longer period, unsecured entries must be boarded up with 5/8” or ¾” plywood and bracing at the end of day, if secure and lockable door and frame are not in place. The building will remain occupied during construction. The contractor will provide exit signage if alternative exit routes are proposed and maintain free and unobstructed egress from all parts of the building at all times. Coordinate egress requirements with the Government COR.

III. New access controls shall comply with and be compatible with the existing base Vanderbilt system for the Access Control System (ACS). All access control equipment must be 100% compatible with this system.

(1) Existing system utilizes AD302993R70FMK, SPA 626 L RR, door locks. (Seven pin BEST

System)

(2) Basis of Design – Schlage 302

15) Work performed on these doors shall be in accordance with the Manufacturers installation instructions, WBDG Specifications Section 08 11 16 aluminum doors and frames specifications, the statement of work. Doors shall be installed by an approved installer that is certified and trained by the door manufacturer.

I. Contractor to ensure all exterior door replacement work shall provide weather tight entrances and openings complete with weather stripping, gaskets, door sweeps and caulking as required at all exterior door replacements where in scope. Contractor to field verify door sizes. Contractor shall ensure proper clearances to allow installation of replacement doors either in retrofit or new frames as needed. Allow doors to swing freely and close positively.

(1) Contractor shall field-verify all dimensions and ensure proper clearances for free swing and positive latching.

II. Installation tolerances door frames (new or retrofit) shall be as follows:

(1) Squareness: ± 1/16” measured at rabbet on a line 90 degrees from jamb perpendicular to frame head

(2) Plumbness: ± 1/16” measured at jambs on a perpendicular line from the head to the floor

(3) Alignment: ± 1/16” measured at jambs on a perpendicular line from the head to the floor

(4) Twist: ± 1/16” measured at opposite face corners of jambs on parallel lines, perpendicular to the plane of the door rabbet.

b. Section #2 – Basement Floor Exterior Doors

1) Replace seven (7) additional exterior doors and associated frames on the basement level and associated door access controls.

I. Additional doors shall comply with all requirements in Section #1.

SW-3 PROJECT INSTRUCTIONS

a. Coordination: Before starting any work, the contractor shall coordinate said work through the

Contracting Officer/COR or their designated representative. Verbal notification shall be given to the Contracting Officer/COR or their designated representative prior to starting work. The Contractor shall take all reasonable measures necessary to minimize the disruption of the occupants during performance of contract work.

b. Normal Working Hours: The Contractor shall work on days and hours stated except as approved, in writing, by the Contracting Officer/COR. The Contractor shall schedule their working hours to coincide with the working hours of the military installation, 7:00am to 4:30pm, Monday through Friday, except not on legal holidays which include the following –

LEGAL PUBLIC HOLIDAYS

New Year’s Day (1st day of January) Martin Luther King Jr.'s Birthday (3rd Monday of January) Presidents’ Day (3rd Monday of February) Memorial Day (last Monday of May) Juneteenth (19th Day of June) Independence Day (4th day of July) Labor Day (1st Monday of September) Columbus Day (2nd Monday of October) Veterans Day (11th day of November) Thanksgiving Day (4th Thursday of November) Christmas Day (25th day of December)

NOTE: Any of the above holidays falling on a Saturday will be observed on the preceding Friday. Holidays falling on a Sunday will be observed on the following Monday.

c. Sustainable Management of Waste: The contractor shall, at his/her own expense, ensure that 60% by weight of the demolition or deconstruction material or construction waste is diverted from landfill disposal. This may be accomplished through recycling, reuse of material (such as crushed concrete or asphalt), diversion (material which may be used on a future project) or waste minimization (accurate planning and ordering, proper material storage and handling, right-sizing). A consolidated report outlining the amounts of diverted and disposed waste resulting in the 60% diversion shall be provided to the Directorate of Public Works Environmental Division. The contractor shall use the DEBRIS RECOVERY STATEMENT – Post Demolition/ Construction Form located at the end of this Statement of Work. All waste reduction measures must be in full compliance of federal, state and local regulations and in full compliance with material specifications. All measures involving storage of material on the installation or future use of the material by the installation must be coordinated in advance with the Directorate of Public Works.

(1) Debris and Rubbish: The contractor shall dispose of all debris and rubbish in an off-post dump site at no additional cost to the Government per Sustainable Management of Waste defined above. The government landfill, dumpsters, or containers shall not be used for property disposal. All waste shall be disposed of in accordance with applicable Federal, State, and local laws. Wastewater from construction activities, such as onsite material processing, concrete curing, foundation and concrete clean-up, water used in concrete trucks, forms, etc. will not be allowed to enter water ways or to be discharged prior to being treated to remove pollutants. Dispose of the construction related wastewater off- Government property in accordance with all Federal, State, Regional and Local laws and regulations.

(2) Scrap and Salvageable Materials: The Contractor retains right and control of scrap and salvageable material generated from Government owned facilities unless otherwise defined by this contract. All Scrap and salvaged material retained by the contractor shall be removed from the Post daily at the Contractor’s expense. Weights shall be recorded and submitted according to the Sustainable Management of Waste defined above.

d. As-Built Drawings: Contractor is responsible to keep accurate records of the installation of all new equipment and to provide one set of as-built drawings illustrating all of the work, with changes, performed on this contract. Changes to all plans will be annotated in red ink on a set of drawings, called “Redlines” and maintained during construction and available for inspection. Drawings are to be supplied to the Contracting Officer/COR in the form of paper, hard copy, and (1) digital PDF format copy. AutoCAD drawings are required as part of the As-Built requirement: see submittal requirements.

e. Shop drawings: Contractor, or any lower tier subcontractor pursuant to a construction contract, to submit to the Government, Shop Drawings consisting of detailed drawings, diagrams, layouts, schematics, descriptive literature, illustrations, schedules, performance and test data, and similar materials furnished by the contractor to explain in detail specific portions of the work required by the contract. The Government may duplicate, use, and disclose in any manner and for any purpose shop drawings delivered under this contract.

f. Operation and Maintenance Manuals: Contractor is responsible to keep accurate records of the installation of all new equipment and to provide operation and maintenance (O&M) manuals for all equipment installed on this contract. O&M manuals are to be supplied in binders to the Contracting Officer/COR in the form of (3) paper, hard copy and (3) digital copy in PDF format upon completion for each Master Division. For example, O&M manuals shall be provided in separate binders for different items i.e. domestic plumbing items shall be in separate binders from HVAC equipment; fire alarms should be separate from access control.

g. National Park Service - The Secretary of the Interior’s Standards: This facility or construction site is a part of the National Landmark Historic District. All repairs will be made in accordance with the Secretary of Interior preservation standards and care should be taken to avoid damage to existing historical fabric. Historic features and fabric should be protected throughout the entire construction process. www.nps.gov/tps/standards.htm

h. Warranty: Provide a list of the material suppliers with names and phone numbers for all warranties to the Contracting Officer/COR or their designated representative.

i. All work will conform to standards as established by current publication of the Unified Facilities Criteria (UFC), International Building Code (IBC), International Plumbing Code (IPC), and the National Electric Code (NEC); unless otherwise noted or authorized by the COR.

j. The Contractor is responsible for: dimensions to be confirmed and correlated at the jobsite; information that pertains solely to the fabrication processes or to the means, methods, techniques, sequences and procedures of construction are in accordance with current codes; coordination of the work with that of all other trades and performing all work in a safe and satisfactory manner.

SW-4 SAFETY REQUIREMENTS

a. The Contractor shall comply with all safety measures outlined in the Occupational Safety and Health Administration (OSHA) safety standards 29 CFR 1910 and 29 CFR 1926 and the Army Corp of Engineers EM385-1-1 used for all construction on Army Installations. The Contractor will also comply with AR 385-10 and DA PAM 385-10 Chapter 4-4 a. thru g.

b. The contractor shall provide as their first submittal #01 a Site-Specific Safety Plan for each subsequent awarded Task Order (reference belowSW-5)

SW-5 SUBMITTALS

a. In accordance with UFGS-01 33 00 (August 2018) Change 4 - 02/21, Submittals include all preconstruction documentation, shop drawings, product data, samples, letters of certification, tests, plans, design data calculations, test reports, manufacturer’s instructions and other engineering information that may be required for quality control and quality assurance. Submittals will be reviewed only for general conformance with the design concept and the information given in the Construction Documents. Approval, acceptance, or corrections and comments made by the Government for a submittal does not relieve the Contractor of the responsibility for meeting the contract requirements or for any error that may exist, because under the Quality Control (QC) requirements of this contract, the Contractor is responsible for ensuring information contained within each submittal accurately conforms with the requirements of the contract documents, except with respect to variations described and approved. The Government estimates up to 10 working days to review Shop Drawings and provide approval, denial or other feedback.

b. Each submittal is to be complete and with sufficient detail to allow ready determination of compliance with contract requirements.

c. For variations, proposed by the contractor, that include design changes or some material or product substitutions, the Government may require an evaluation and analysis by a licensed professional engineer hired by the contractor. When proposing a variation, deliver a submittal, which is clearly marked as a "VARIATION" to the Contracting Officer/COR, with documentation illustrating the nature and features of the variation including any necessary technical submittals and why the variation is desirable and beneficial to Government. If lower cost is a benefit, also include an estimate of the cost savings. In addition to documentation required for variation, include the submittals required for the item.

d. Within 15 calendar days of contract award and before installation, the Contractor shall submit for approval for all Pre- Construction Submittals (SD-01) items listed. The government has 10 working days to review and return submittals once they are received. If the contractor submits an item for re-approval, the Government has 5 days to review and return once it is received. All submittals shall be approved before work requiring the materials can be used on the project. The Contracting Officer/COR may request submittals in addition to those listed below when deemed necessary to adequately describe the work covered in this contract.

e. Submittals shall be e-mailed to the Contracting Officer/COR at:

usarmy.leavenworth.acc-cc.mbx.construction@army.mil

f. Submittals shall be labeled utilizing the keyword “submittal” with the contract number, task order, building number, and submittal short description or number. Each task order will list its required submittals in the SOW or the applicable named construction specifications. Form Attached Below

(e.g., Submittal_17-G-0001-0001_Bldg_56_tiles)

SD-01 Pre-Construction Submittals

Material Safety Data Sheets (MSDS) for all hazardous chemicals used Construction Schedule – PDF format, updated weekly or as changes occur Key Personnel Staffing Plan (SW-1d) Site Specific Safety Plan (SW-4b) Quality Control Plan (SW-6) Project Signage (SW-7) Submittal Registry / LOG for all submittals intended for the project (prior to start of construction) Pre-Walk-Through Documentation (sequencing plan) Egress Maintenance Plan (required for door replacement work) Temporary Weather-Tight Protection Plan (doors) Temporary Security / Boarding Plan (for exterior doors requiring overnight protection)

SD-02 Shop Drawings Door and frame shop drawings: dimensions, tolerances, swing direction, hardware locations Access control wiring diagrams and integration drawings Flashing and sealant installation details Any required field-verified dimensions

SD-03 (SW-5) Product Data Door manufacturer data: make, model, material, gauge, finish Door frame product data: retrofit/new frame details Hardware product data: hinges, closers, thresholds, sweeps, weatherstripping, gaskets Access control equipment data: compatibility with Vanderbilt ACS, lockset model AD302993R70FMK, SPA 626 L RR

Sealants, flashings, foams, weather barriers – manufacturer data and compatibility statements All serial numbers, model numbers, and manufacturer information for items removed and installed

SD-04 Certificates (SW 5a) Installer certification for door manufacturer Compatibility certifications for sealants, flashings, foams, and weather barriers Warranty certificates (preliminary & final)

SD-05 Manufacturer's Installation Instructions (SW-5a) Door installation instructions Access control installation instructions Sealant, flashing, and weatherproofing installation instructions

SD-06 Manufacturer's Field Reports Door and hardware installation field reports Access control system testing and commissioning reports

SD-07 Operation and Maintenance Manuals (SW-3f) O&M manuals for exterior doors and frames O&M manuals for hardware (hinges, closers, thresholds, etc.)

O&M manuals for access control equipment Cleaning and maintenance instructions for all installed products

SD-08 Closeout Submittals Documentation:

Draft DD 1354 Form Final DD 1354 Form Warranty Information (SW-3h) –doors, hardware, access controls Debris Recovery Statement Form (SW-3c) As-Built Drawings (SW-3d) –doors, ACS wiring, field-verified dimensions Final Cleaning Certification Punch List Completion Documentation

SW-6 QUALITY CONTROL

This contract has a requirement for quality control. The Contractor must maintain adequate continuous quality control over each phase of his/her operation. When the Contractor signs the contract, he/she assumes the responsibility for producing the required end product within the time stated. The contractor must establish and implement a system for controlling his/her daily operations to comply with this commitment. The Quality Control Plan shall be brought to the pre-construction conference. Contractor quality control shall include the following items:

a. The Contractor shall provide and maintain an effective Quality Control Program (QC). Review of submittals for conformance to design concept and construction documents. Sufficient inspections to ensure conformance to the Statement of Work shall be performed on a continuing basis. After the contract is awarded, and prior to starting on-site construction, the Contractor shall meet with the Contracting Officer/COR at a pre-construction conference and discuss the quality control requirements.

b. The Contractor's quality control program shall include three phases of inspection and tests as follows:

1. Preparatory Inspection prior to beginning work on-site shall include but is not limited to performing a physical examination of materials existing conditions of surroundings and equipment to assure that they conform to approved shop drawings or submittal data and that all materials and/or equipment are on hand.

2. Initial Inspection shall be performed as soon as work begins on a representative portion of the particular feature of work and shall include examination of the quality of workmanship as well as a review of control testing for compliance with contract requirements.

3. Continuing Inspection shall be performed as any particular feature of work Progresses, including control testing, until completion of that feature of the work.

c. A daily inspection report shall be submitted the first workday following the date covered by the report.

The report shall be deemed late at the end of the following workday. The Contractor shall stop work, pending satisfactory correction of any deficiency noted by the quality control staff or by the Contracting Officer/COR. Contractor shall not proceed upon any feature of work containing uncorrected work. Upon any contract discrepancy found by the Contracting Officer/COR or their designated representative.

Notations on quality control reports will not be acceptable as a substitution for other written reports by the Contractor if required under Contract Clauses. No payment estimate will be processed under this contract until the entire Quality Control Plan has been approved and until overdue daily QC reports are properly executed and furnished.

SW-7 PROJECT SIGNAGE

a. Contractor shall provide all necessary signage to notify installation personnel of construction. If during construction signage is damaged due to weather, it will be the contractor’s responsibility to replace.

b. Signage shall be 2’ x 3’. Signage size may change depending on project and proposed location. Size changes must be requested through the Contracting Officer/COR.

c. Signage shall be installed at a minimum 1 week prior to start of construction. If signage is to be placed in the ground, plan ahead for utility locates through Kansas One-Call. If possible, install signage on existing structures.

d. Exact verbiage for the signage shall be approved by the Contracting Officer/COR prior to installation.

All text shall be black and at an appropriate size in proportion to the individual signs. The following are items required as a minimum to be included on the signage:

1. Basic title

2. Purpose of project

3. General time frame of project, i.e., Spring 2017

4. Use phrases such as: Pardon our dust, thanks for your patience or watch for construction equipment when appropriate to the project.

e. If relevant to the project, a picture shall be used to convey the project to the public. DPW can assist with providing an appropriate image for the signage.

SW-8 UTILITY SERVICES & LOCATES

All interruptions to electrical, water or other utilities must be coordinated with the Contracting Officer/COR.

The Contractor shall notify the Contracting Office seven (7) days prior to the disruption of utility services.

Unanticipated interruptions of utilities will be reported to the Contracting Officer/COR immediately.

a. The Contractor is responsible for checking with and locating all the utilities in the field before construction for the Fort Leavenworth owned utilities excluding fiber/telephone and communications.

The Contractor will be provided utility drawings, as required, to aid in locating storm sewer and natural gas. Water lines and Sanitary Sewer lines are owned by American Water. Electric power distribution lines are owned by Free State Co. The utilities that are of nonconductive construction such as plastic, or Transit and have no tracer wire or other means of applying a signal are to be located from the utility maps. The utilities that are located from maps that appear to be in the vicinity of the excavation are to be hand dug for location purposes.

b. The Contractor shall contact Kansas One-Call for utility Locates for Southern Star Central Gas Pipeline, Sprint, AT&T, Time Warner Cable, American Water, and Free State.

c. Free State and American Water will be involved in all projects that are affecting exterior water, sewer, and electric. They will be allowed to inspect all work pertaining to these utilities as they are to be notified by the contractor when as work proceeds on these projects.

d. The Fort Leavenworth telephone and communication lines are responsibility of the Network Enterprise

Center (NEC) and will be located by Fort Leavenworth personnel. The Contractor shall visit the sites and mark his proposed route or limits to his excavation on a map and take this marked up map to Directorate of Public Works (DPW) Help Desk before any excavation. NEC will mark lines in the field within 10 working days, after which the Contractor shall proceed with actual excavation. If the Contractor damages any lines during excavation the Contractor shall contact DPW Inspector immediately.

e. The Fort Leavenworth Natural Gas lines are the responsibility of the Directorate of Public Works (DPW) and will be located by DPW personnel. The Contractor shall visit the sites and mark his proposed route or limits to his excavation on a map and take this marked up map to Directorate of Public Works (DPW) Help Desk before any excavation. DPW will mark lines in the field within 10 working days, after which the Contractor shall proceed with actual excavation. If the Contractor damages any marked lines during excavation, the Contractor shall contact DPW Help Desk immediately.

f. After all utility locations or existence of any utility for the site are completed, the contractor shall pick up their copy of the dig permit at the DPW Help Desk (Bldg. 304, OMD Office). The contractor will provide a copy of the summary and dig permit to the Construction Representative for his review prior to the start of any excavation as a daily report.

g. After DPW marks the Fort Leavenworth’s owned utilities, the Contractor is responsible for maintaining the marks.

-- End of Statement of Work --

DEBRIS RECOVERY STATEMENT – Post Demolition/Construction

Project Address:

Contractor:

Date:

Contact:

Phone:

Email:

Project:

Identify which materials were reused, recycled or disposed by completing the table below. You must recycle at least 60% of all waste generated.

Check the designated box and provide the name of each facility or service provider and weight of materials. If the materials were reused on site, describe the reuse application under the facilities/service provider column. Salvaged materials from deconstruction should be designated as reuse.

Attach copies of receipts, gate tags, or other verifying documentation.

Material Reuse Recycle Dispose Facility Service Provider

Weight (tons)

Asphalt

Brick

Cardboard

Carpet

Concrete

Dirt/Clean Fill

Dry Wall

Metal

Pallets

Plastics

Plant Debris

Roofing - asphalt composition shingle, tile, wood shake, tar or gravel

Wood - clean

Wood - treated

Other

Other

MATERIAL GENERATION SYNOPSIS

A. Total tons of materials generated for the project:

B. Total tons of materials disposed (not recycled):

C. Total tons of materials salvaged, reused, or recycled:

D. Percentage of materials recycled/reused (divide C by A): %

For assistance in recovering materials at the jobsite, visit the following websites for a Builders Guide to Reuse and Recycling.

http://www.cdrecycling.org/find.html

UTILITY LOCATE REQUEST FORM

DPW FORT LEAVENWORTH

440 MCPHERSON AVE, LOWER LEVEL, DOOR #3

FORT LEAVENWORTH, KS 66027

(p) 913-684-5555 (f) 913-684-2033 usarmy.leavenworth.imcom-central.mbx.dpw-utilities@army.mil

CUSTOMER IS RESPONSIBLE FOR CALLING KANSAS ONE FOR PRIMARY UTILITY CHECKS

1-800-344-7233 http://www.kansasonecall.com/ KANSAS ONE TICKET #:

**MUST BE SUBMITTED SEVEN BUSINESS DAYS IN ADVANCE

**A REMARK REQUIRES SEVEN BUSINESS DAYS ADVANCE NOTICE

*DATE:

*POC NAME: *PHONE:

*COMPANY NAME:

*OFFICE EMAIL ADDRESS: OFFICE FAX:

*EXPLOSIVES? YES_ _NO _

*TRENCHLESS EXCAVATION? YES_ _NO

*DURATION?

*TYPE OF WORK:

*WORK BEING DONE FOR:

CITY/STATE: FORT LEAVENWORTH, KANSAS

COUNTY: LEAVENWORTH

*ADDRESS:

*NEAREST INTERSECTING STREET:

*DRIVING DIRECTIONS/LOCATION OF WORK/MARKING INSTRUCTIONS:

*REMARK (repeat of markings done in the last 15 days): YES NO

* SPECIFIC DATE NEEDED:

(CANNOT BE EARLIER THAN 7 BUSINESS DAYS FROM THE DATE REQUESTED.)

***ONCE PROJECT IS COMPLETE, PLEASE REMOVE ALL UTILITY FLAGS FROM AREA

FOR DPW USE ONLY DATE RECEIVED:

Fax: Email:

GAS: PHONE/COAX/FIBER:

ELECTRIC: ENVIRONMENTAL:

NEC TICKET #: GEOTHERMAL:

AM WATER: LJEC:

NOTIFIED POC OF COMPLETION ON____________________________

Spoke with:_____________________

Left message:

MATERIAL APPROVAL SUBMITTAL

(See Instructions on Reverse)

Form Approved OMB No 9000-0062 Expires May 31, 2005

Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project OMB No 9000-0062, Washington DC 20503. Please DO NOT RETURN your form to either of these addresses. Send your completed form to: SAF/AQCP, 1060 Air Force Pentagon, Washington DC 20330-1060.

TO: (Contracting Officer) FROM: (Contractor) DATE (YYYYMMDD)

CONTRACT NUMBER SUBMISSION NUMBER SUBMITTAL

NEW RESUBMITTAL

PREVIOUS SUBMISSION NUMBER PROJECT NUMBER

TO BE COMPLETED BY CONTRACTOR FOR GOVERNMENT USE ONLY

ITEM

NO.

SPECIFICATION SECTION/

PARA NO./DRAWING NO.

DESCRIPTION OF MATERIAL

(Include Type, Model Number, Catalog Number, Mfg., etc.)

AP-

PROVED

DISAP-

PROVED

SEE

REVERSE

INITIAL

BY COMPLETING THIS FORM, THE UNDERSIGNED CONTRACTOR CERTIFIES THAT

THE MATERIAL COMPLIES WITH ALL SPECIFICATIONS OF SUBJECT CONTRACT.

DATE (YYYYMMDD) TYPE OR PRINT NAME AND TITLE SIGNATURE

FOR GOVERNMENT USE ONLY

TO: (Base Civil Engineering Officer)

For Evaluation and Action

DATE (YYYYMMDD) TYPE OR PRINT NAME AND GRADE SIGNATURE

TO: (AF Contracting Office)

RECOMMEND APPROVAL DISAPPROVAL AS INDICATED ABOVE AND SUBJECT TO ANY APPLICABLE COMMENTS ON THE REVERSE

DATE (YYYYMMDD) TYPE OR PRINT NAME AND GRADE SIGNATURE

TO: (Contractor)

APPROVED

DISAPROVED AS INDICATED ABOVE AND SUBJECT TO ANY APPLICABLE COMMENTS ON THE REVERSE SIDE. REQUEST

RESUBMITTAL ON DISAPPROVED ITEMS WITHIN DAYS OF DATE SHOWN BELOW.

DATE (YYYYMMDD) TYPE OR PRINT NAME AND GRADE SIGNATURE

AF IMT 3000, 20030901, V1 PREVIOUS EDITION IS OBSOLETE.

COMMENTS

(Number to correspond with applicable Item Number on reverse)

INSTRUCTIONS TO CONTRACTORS

1. The term "material" is defined as articles, supplies, raw materials, equipment, parts, components, and end items that are to be incorporated into the work required by the contract.

2. This form is to be used by contractors for submitting Shop Drawings, Equipment Data, Manufacturer's Literature and Certificates and samples of Materials to the Government for approval in accordance with the provisions of this contract. Unless otherwise specified, it is to be prepared in 4 copies, signed, and provided to the contracting officer with appropriate attachments.

3. Item(s) to be approved will be clearly tabbed or identified. Data pertaining to item(s) to be approved will be clearly identified or tabbed, particularly where documents are voluminous, in order to properly evaluate the materials or articles to be incorporated in the work. Each attachment will be numbered to correspond with the item number shown on the face of this form.

4. Requests submitted shall be numbered consecutively, by contract, in the space entitled "Submission No.". This number, in addition to the Contract No., will be used to identify each Material Approval Submittal. Resubmissions will be indicated in the appropriate block and the insertion of previous submission number and data in addition to a new submission number. A single submission should be used for all work of a section of the specifications, but in NO instance should the submission include work for more than one (1) contract. Submittals requiring priority handling will be submitted by separate submittal using the form and so marked across the face of the form.

5. This Material Approval Submittal is not valid unless it is signed by the contracting officer. This approval is required as called for by the contracting officer under the terms of this contract.

AF IMT 3000, 20030901, V1 (REVERSE)

Contractors shall provide the following information listed below as it pertains to the project. This form is a contract document and shall be part of your close out binder, as a required document it must be completed before the final invoice can be approved.( Form shall be typed not hand written)

HVAC: Manufacturer, Warranty, Model and Serial #, Attach Photo of Data Plate.

PLUMBING: Manufacturer, Warranty, Model and Serial #, Attach Photo Of Data Plate.

FINISHES: Manufacturer, Warranty, Color Name and # or Formula if

Custom Color (paint) Carpet LVT VCT Wood Other

ELECTRICAL: Manufacturer, Warranty Model and Serial #, Attach Photo

Of Data Plate.

[Type here]

ROOFING: Manufacturer, Warranty, Gutter Downspouts, Roof Openings.

MOD Bit Asphalt Metal Slate BUR

Slope / Pitch Sq. Ft.

FIRE

PROTECTION: Manufacturer, Warranty, Model and Serial #, photo of all

Data plates.

Compressor Fire Alarm Control Pan

Mass Notification Smoke Detector

Heat Detector Duct Detector

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