STATEMENT OF WORK

FOR

B1146 - USDB TEXTILES WAREHOUSE EXPANSION & RENOVATION

PROJECT NO: M.0139724

1251 USD Road, Fort Leavenworth, KS 12 Mar 2025, (Revision #1, 12 March 2026)

SW-1 DESCRIPTION OF WORK

a. General: This Agreement is for the sole award for specific Sustainment, Restoration, and Modernization

(SRM) of the USDB Textiles Warehouse (Building B1146 – 1251 USDB Road, Fort Leavenworth, Kansas 66048) for the Directorate of Public Works (DPW) on Fort Leavenworth, KS. The contractor shall provide all supervision, management, personnel, labor, equipment, transportation, supplies, and any other items necessary to complete various construction projects. This work may include but is not limited to the following: addition of an approximate 1,280 SF metal building office addition and new recessed truck dock;

repair or replacement of mechanical, electrical and fire protection and detection systems; repairs related to building renovation or demolition; interior remodeling work including carpentry, painting, floor and wall covering or finishes. This acquisition will require a general contractor with experience and expertise capable of managing numerous task orders at the same time, which will require construction scheduling, cost estimating, quality control, and coordination of subcontractors in a wide variety of construction trades.

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 working on the site an identification (ID) badge prior to the start date on this contract. Contractor personnel shall wear the ID badge at all times when performing work under this contract to include attending Government meetings and conferences. Contractor employees 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. Any worker without a badge may be asked by the Contracting Officer or COR to leave the site until they have the badge properly displayed.

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 $20,000 (Property Damage) 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:

(a) Between $1,000,000 and $5,000,000.

(Revision #1)

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

a. General: The USDB Textiles Warehouse project is an approximate 1,283 SF+/- Office Addition to the south side of an existing 9,350 SF existing metal building warehouse, including a new south side recessed truck dock and adjacent paving. Contractor to provide stamped structural engineered drawings for the building addition and related foundations, existing metal building modifications, and slab, truck dock and retaining walls.

1) Fire Sprinkler – Building is sprinklered. Contractor to modify the existing sprinkler system to meet UFC-3-600-01 and NFPA 13 codes within the new and existing building. Contractor to provide in rack sprinkler heads with guards between all new and existing racks such that they do not obstruct rack storage space. Contractor to calculate the required fire pump size and replace the existing pump if required. Contractor shall submit load, pump calculations, and shop drawings for the fire sprinkler design. (Revision #1)

2) Fire Alarm – Contractor to add and/or relocate smoke and fire detectors and alarms, and to reprogram the fire alarm system for relocated and new added devices as required by applicable codes and regulations. New work to conform to UFC-3-600-01 and NFPA 72. (Revision #1)

3) Miscellaneous Architectural, Plumbing and Electrical modifications. Re: Addendum 1, Revision 1 3/12/2026.

b. Contractor Notification to DPW of Start of On-Site Activities: Once contract is awarded, the Contractor will set up a meeting with the DPW COR, Project Manager and the USDB, at a mutually agreeable time, to notify them of the Contractor’s expected On-Site Start Date and go over which items the USDB is expecting to remove from the site and which items. The USDB plans to remove all office furnishings from the existing northeast office as well as the scanner in the rear, prior to the start of work, along with pallets on the racks that are shown to be moved in the Contract. With the Contractor’s notice and after the meeting, the USDB of the will have 15 working days to remove items required for the USDB to provide their services without the need to enter the project site during construction.

c. Off-Road Contractor Staging/Work Site: Staging areas and any on-site contractor office accommodations outside the construction area will need to be proposed by the Contractor to the COR and approved by DPW prior to on-site construction activities. No part of the work shall obstruct use of the adjacent road unless approved by the COR. If the Government approved staging area, haul route or parking for the contractor is permitted to be on turf, the contractor will install fencing along the drip lines of all trees within this area. No parking, driving, storage of equipment or material will be permitted within the drip line of the trees fenced area(s). If the scope of work includes work within the drip line, the contractor shall bore any required utilities below or through the root system, avoiding the largest roots near base of the tree, in lieu of trenching. If the grade is to be changed within the drip line per the SOW, tree wells or root boxes shall be constructed depending on whether the new grade is a fill or cut respectively.

Upon completion of any required work within the drip line, the contractor shall loosen any compacted soil to a depth of 8 inches and restore any damaged turf in the area.

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 or the 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 federal holidays which include the following –

FEDERAL 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 3rd Friday 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 maybe 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. Preparation of DD Form 1354 (Transfer of Real Property): The Contractor is responsible for submitting a final DD 1354 upon completion of construction. The Government will furnish the Contractor with a DD Form 1354 checklist to use to produce a draft Form 1354. The completed checklist and prepared draft Form DD 1354 shall be submitted to the Government prior to completion of construction for review and comments. The Government shall have two (2) weeks for review of the draft to provide comments back to the Contractor. The Contractor shall make revisions, as necessary, to the DD1354 before final submission upon completion of the construction.

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 15 Para 15-4 c, Per the standards in paragraph 15–4a, construction contracts should include the requirement for the contractor to have a site-specific safety plan. Tailor the plan to the project based on the size and complexity of the construction project.

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 hall 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_(Contract/Task order #)_Bldg_#56_tiles)

SD-01 Pre-Construction Submittals Material Safety Data Sheet shall be provided when hazardous chemicals are used.

Construction Schedule – Schedule shall be viewable in PDF (updated weekly or as changes happen) Key Personnel Staffing Plan (SW-1e) Site Specific Safety Plan (SW-4b) Quality Control Plan (SW-6) Project Signage (SW-7) Submittal Registry / LOG for all submittals intended for project SD-02 Shop Drawings (Specify –as required) SD-03 Product Data (SW-5):

All products, materials and equipment used in the project All serial #s, Model Number, Manufacturer information of items removed and installed. (Form provided) Purchase dates and proposed delivery dates provided from manufacturer/subcontractor on their letterhead without pricing SD-04 Samples (SW-5a): (Specify –as required) SD-05 Design Data Calculations (SW-5a): (Specify –as required) SD-06 Test Reports SW-5a): (Specify – as required) SD-07 Certificates (SW 5a): (Specify – as required) SD-08 Manufacturer's Instructions (SW-5a) SD-09 Manufacturer's Field Reports: (Specify – as required) SD-10 Operation and Maintenance Manuals (SW-3g) SD-11 Closeout Submittals Documentation:

Draft DD 1354 Form & Final DD 1354 Form (SW-3i) Warranty Information (SW-3j) Debris Recovery Statement Form (attached) (SW-3c) As-Built Drawings (SW-3d)

[LIST ALL OTHER REQUIRED SUBMITTALS HERE]

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 mailto:usarmy.leavenworth.acc-cc.mbx.construction@army.mil 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, T-Mobile, 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 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:

mailto:usarmy.leavenworth.imcom-central.mbx.dpw-utilities@army.mil http://www.kansasonecall.com/

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

ADD PHOTOS ON THIS PAGE ADD ADDITIONAL PAGES IF NEEDED

ASBESTOS ABATEMENT SPECIFICATIONS

PART 1 GENERAL

1.1 REFERENCES

1.1.1 The publications listed below form a part of this

specification to the extent referenced. The publications are referred to within the text by the basic designation only.

AMERICAN INDUSTRIAL HYGIENE ASSOCIATION (AIHA)

AIHA Z88.6 (2006) Respiratory Protection – Respirator Use- Physical Qualifications for Personnel

AIHA Z9.2 (2006) Fundamentals Governing the Design and Operation of Local Exhaust Ventilation Systems

AMERICAN SOCIETY OF SAFETY ENGINEERS (ASSE/SAFE)

ASSE/SAFE Z87.1 (2003) Standard for Occupational and Educational Eye and Face Protection

ASTM INTERNATIONAL (ASTM)

ASTM E1368 (2011) Visual Inspection of Asbestos Abatement Projects

EM 385-1-1(2003) Safety -- Safety and Health Requirements

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH (NIOSH)

NIOSH 94-113(1994; 4th Ed) NIOSH Manual of Analytical Methods

U.S. NATIONAL ARCHIVES AND RECORDS ADMINISTRATION (NARA)

29 CFR 1910.134 Respiratory Protection

29 CFR 1910.141 Sanitation

29 CFR 1910.147 Control of Hazardous Energy (Lock Out/Tag Out)

CFR

1926.1101 Asbestos

29 CFR 1926.32 Safety and Health Regulations for Construction – Definition

40 CFR 61 National Emission Standards for Hazardous Air Pollutants

40 CFR 763 Asbestos

42 CFR 84 Approval of Respiratory Protective Devices

49 CFR 107 Hazardous Materials Program Procedures

49 CFR 171 General Information, Regulations, and Definitions

49 CFR 172 Hazardous Materials Table, Special Provisions, Hazardous Materials Communications, Emergency Response Information, and Training Requirements

49 CFR 173 Shippers - General Requirements for Shipments and Packagings

UNDERWRITERS LABORATORIES (UL)

UL 586 (2009) Standard for High-Efficiency Particulate, Air Filter Units

1.2 DEFINITIONS

1.2.1 Adequately wet

Sufficiently mix or penetrate with liquid to prevent the release of particulates. If visible emissions are observed coming from asbestos-containing material, then that material has not been adequately wetted. However, the absence of visible emissions is not sufficient evidence of being adequately wet.

1.2.2 Amended Water

Water containing a wetting agent or surfactant with a maximum surface tension of 0.00042 psi.

1.2.3 Asbestos Containing Material (ACM)

Any materials containing more than one percent asbestos.

1.2.4 Area Sampling

Sampling of asbestos fiber concentrations which approximates the concentrations of asbestos in the theoretical breathing zone but is not actually collected in the breathing zone of an employee.

1.2.5 Asbestos

The term asbestos includes chrysotile, amosite, crocidolite, tremolite asbestos, anthophyllite asbestos, and actinolite asbestos and any of these minerals that has been chemically treated or altered. Materials are considered to contain asbestos if the asbestos content of the material is determined to be at least one percent.

1.2.6 Asbestos Control Area

That area where asbestos removal operations are performed which is isolated by physical boundaries which assist in the prevention of the uncontrolled release of asbestos dust, fibers, or debris.

1.2.7 Asbestos Fibers

Those fibers having an aspect ratio of at least 3:1 and longer than 5 micrometers as determined by National Institute for Occupational Safety and Health (NIOSH) Method 7400.

1.2.8 Asbestos Permissible Exposure Limit

0.1 fibers per cubic centimeter of air as an 8-hour time weighted average measured in the breathing zone as defined by 29 CFR 1926.1101 or other Federal legislation having legal jurisdiction for the protection of workers health.

1.2.9 Authorized Person

Any person authorized by the Contractor and required by work duties to be present in the regulated areas.

1.2.10 Background

The ambient airborne asbestos concentration in an uncontaminated area as measured prior to any asbestos hazard abatement efforts.

Background concentrations for other (contaminated) areas are measured in similar but asbestos free locations.

1.2.11 Class II Asbestos Work

Activities defined by OSHA involving the removal of ACM which is not thermal system insulation or surfacing material. This includes, but is not limited to, the removal of asbestos -containing wallboard, floor tile and sheeting, roofing and siding shingles, and construction mastic. Certain "incidental" roofing materials such as mastic, flashing and cements when they are still intact are excluded from Class II asbestos work.

Removal of small amounts of these materials which would fit into a glove-bag may be classified as a Class III job.

1.2.12 Clean Room

An uncontaminated room having facilities for the storage of employees' street clothing and uncontaminated materials and equipment.

1.2.13 Competent Person

A person meeting the requirements for competent person as specified in 29 CFR 1926.1101 including a person capable of identifying existing asbestos hazards in the workplace and selecting the appropriate control strategy for asbestos exposure, who has the authority to take prompt corrective measures to eliminate them, and is specifically trained in a training course which meet the criteria of Environmental Protection Agency (EPA)'s Model Accreditation Plan (40 CFR 763) for project designer or supervisor, or its equivalent. The competent person shall have a current asbestos contractors or supervisors license.

1.2.14 Contractor/Supervisor

Individual who supervises asbestos abatement work and has EPA Model Accreditation Plan "Contractor/Supervisor" training; has EPA/State certification as a "Contractor/Supervisor".

1.2.15 Critical Barrier

One or more layers of plastic sealed over all openings into a regulated area or any other similarly placed physical barrier sufficient to prevent airborne asbestos in a regulated area from migrating to an adjacent area.

1.2.16 Decontamination Area

An enclosed area adjacent and connected to the regulated area and consisting of an equipment room, shower area, and clean room, which is used for the decontamination of workers, materials, and equipment that are contaminated with asbestos.

1.2.17 Demolition

The wrecking or taking out of any load-supporting structural member and any related razing, removing, or stripping of asbestos products.

1.2.18 Disposal Bag

A doubled bagged consisting of 6 mil thick, leak-tight plastic bag, pre-labeled in accordance with 29 CFR 1926.1101, used for transporting asbestos waste from containment to disposal site.

1.2.19 Disturbance

Activities that disrupt the matrix of ACM, crumble or pulverize ACM, or generate visible debris from ACM. Disturbance includes cutting away small amounts of ACM, no greater than the amount which can be contained in 1 standard sized glove-bag or waste bag, not larger than 60 inches in length and width in order to access a building component.

1.2.20 Equipment Room or Area

An area adjacent to the regulated area used for the decontamination of employees and their equipment.

1.2.21 Friable Asbestos Containing Material

A term defined in 40 CFR 61, Subpart M and EPA 340/1-90/018 meaning any material which contains more than 1 percent asbestos, as determined using the method specified in 40 CFR 763, Polarized Light Microscopy (PLM), that when dry, can be crumbled, pulverized, or reduced to powder by hand pressure.

1.2.22 High-Efficiency Particulate Air (HEPA) Filter Equipment

High efficiency particulate air (HEPA) filtered vacuum and/or exhaust ventilation equipment with a filter system capable of collecting and retaining asbestos fibers. Filters shall retain

99.97 percent of particles 0.3 microns or larger as indicated in

UL 586.

1.2.23 Intact

ACM which has not crumbled, been pulverized, or otherwise deteriorated so that the asbestos is no longer likely to be bound with its matrix. Removal of "intact" asphaltic, resinous, cementitious products does not render the ACM non-intact simply by being separated into smaller pieces.

1.2.24 NESHAP

National Emission Standards for Hazardous Air Pollutants. The USEPA NESHAP regulation for asbestos is at 40 CFR 61, Subpart M.

1.2.25 Negative Pressure Enclosure (NPE)

That engineering control technique described as a negative pressure enclosure in 29 CFR 1926.1101. May be of any configuration. At least 4 air changes per hour shall be maintained in the NPE.

1.2.26 Negative Initial Exposure Assessment

A demonstration by the Contractor to show that employee exposure during an operation is expected to be consistently below the OSHA Permissible Exposure Limits (PELs).

1.2.27 Non-friable ACM (Category II)

A NESHAP term defined in 40 CFR 61, Subpart M and EPA 340/1- 90/018 meaning any material containing more than 1 percent asbestos that, when dry, cannot be crumbled, pulverized or reduced to powder by hand pressure.

Material that contains asbestos in which the fibers have been immobilized by a bonding agent, coating, binder, or other material so that the asbestos is well bound and will not normally release asbestos fibers during any appropriate use, handling, storage or transportation. It is understood that asbestos fibers may be released under other conditions such as demolition, removal, or mishap.

1.2.28 Permissible Exposure Limits (PELs)

Shall not exceed 0.1 fiber per cubic centimeter of air during an 8 hour Time-Weighted Average.

1.2.29 PEL-Time Weighted Average (TWA)

Concentration of asbestos not in excess of 0.1 fibers per cubic centimeter of air (f/cc) as an 8 hour time weighted average

(TWA).

1.2.29.2 PEL-Excursion Limit

An airborne concentration of asbestos not in excess of 1.0 f/cc of air as averaged over a sampling period of 30 minutes.

1.2.30 Personal Sampling

Air sampling which is performed to determine asbestos fiber concentrations within the breathing zone of a specific employee, as performed in accordance with 29 CFR 1926.1101.

1.2.31 Phase Contrast Microscopy (PCM)

Phase Contrast Microscopy (PCM) is a technique using a light microscope equipped to provide enhanced contrast between the fibers collected and the background filter material.

1.2.32 Private Qualified Person (PQP)

The qualified person hired by the Contractor to perform the herein listed tasks.

1.2.33 Qualified Person (QP)

A Registered Architect, Professional Engineer, Certified Industrial Hygienist, consultant or other qualified person who has successfully completed training and is therefore accredited under a legitimate State Model Accreditation Plan as described in 40 CFR 763 as a Building Inspector, Contractor/Supervisor Abatement Worker, and Asbestos Project Designer; and has successfully completed the National Institute of Occupational Safety and Health (NIOSH) 582 course "Sampling and Evaluating Airborne Asbestos Dust" or is an accredited asbestos Air Monitoring Professional. The QP must be qualified to perform visual inspections as indicated in ASTM E1368.

1.2.34 Regulated Area

An OSHA term defined in 29 CFR 1926.1101 meaning an area established by the Contractor to demarcate areas where Class I, II, and III asbestos work is conducted; also any adjoining area where debris and waste from such asbestos work accumulate; and an area within which airborne concentrations of asbestos exceed, or there is a reasonable possibility they may exceed, the permissible exposure limit.

1.2.35 Removal

All operations where ACM is taken out or stripped from structures or substrates, and includes demolition operations.

1.2.36 Time Weighted Average (TWA)

The TWA is an 8-hour time weighted average airborne concentration of asbestos fibers.

1.2.37 Wetting Agent

A chemical added to water to reduce the water's surface tension thereby increasing the water's ability to soak into the material to which it is applied. An equivalent wetting agent must have a surface tension of at most 0.00042 psi.

1.2.38 Worker

Individual (not designated as the Competent Person or a supervisor) who performs asbestos work and has completed asbestos worker training required by 29 CFR 1926.1101, to include EPA Model Accreditation Plan (MAP) "Worker" training;

accreditation if required by the OSHA Class of work to be performed or by the state where the work is to be performed.

1.3 MEDICAL REQUIREMENTS

Provide medical requirements including but not limited to medical surveillance and medical record keeping as listed in 29

CFR 1926.1101.

1.3.1 Medical Examinations

Before exposure to airborne asbestos fibers, the Contractor shall provide workers with a comprehensive medical examination as required by 29 CFR 1926.1101 or other pertinent State or local directives. This requirement must have been satisfied within the 12 months prior to the start of work on this contract. The same medical examination shall be given on an annual basis to employees engaged in an occupation involving asbestos and within 30 calendar days before or after the termination of employment in such occupation. Specifically identify x-ray films of asbestos workers to the consulting radiologist and mark medical record jackets with the word

"ASBESTOS."

1.3.2 Medical Records

The Contractor shall maintain complete and accurate records of employees' medical examinations, medical records, and exposure data for a period of 50 years after termination of employment and make records of the required medical examinations and exposure data available for inspection and copying to: The Assistant Secretary of Labor for Occupational Safety and Health (OSHA), or authorized representatives of them, and an employee's physician upon the request of the employee or former employee.

1.3.3 Medical Certification

The Contractor shall provide a written certification for each worker and supervisor, signed by a licensed physician indicating that the worker and supervisor has met or exceeded all of the medical prerequisites listed herein and in 29 CFR 1926.1101 and 29 CFR 1926.103 as prescribed by law. The Contractor shall submit certificates prior to the start of work but after the main abatement submittal.

1.4 EMPLOYEE TRAINING

The Contractor shall submit certificates, prior to the start of work but after the main abatement submittal, signed by each employee indicating that the employee has received training in the proper handling of materials and wastes that contain asbestos in accordance with 40 CFR 763; understands the health implications and risks involved, including the illnesses possible from exposure to airborne asbestos fibers; understands the use and limits of the respiratory equipment to be used; and understands the results of monitoring of airborne quantities of asbestos as related to health and respiratory equipment as indicated in 29 CFR 1926.1101 on an initial and annual basis.

The Contractor shall insure his/her employees, who shall be removing the Non-Friable ACM floor tile, shall receive at a minimum, eight hours of Class II ACM floor tile training from a state certified Asbestos trainer BEFORE properly removing any Non-Friable ACM floor tile. All Class II ACM floor tile work shall be supervised by a competent person as defined in paragraph (b) of 29 Code of Federal Regulation (CFR) 1926.1101.

The Contractor shall train all personnel involved in the asbestos control work in accordance with EPA Asbestos Hazard Emergency Response Act (AHERA) training criteria or State training criteria whichever is more stringent.