SOW_Rev3_B246 Elevator Modernization.pdf

STATEMENT OF WORK

FOR

“Building 246 Elevator Modernization”

PROJECT NO: M.0169336

DATE: 2 September 2026 (Revision #1)

SW-1 DESCRIPTION OF WORK

a. General: The contractor shall provide all supervision, management, personnel, labor, equipment, transportation, supplies, and any other items necessary to complete the B246 Elevator Modernization project.

The work consists of furnishing all plant, labor, equipment, and materials to perform all work in strict accordance with the drawings and specifications to replace the existing electric traction elevator with an in-ground hydraulic elevator and equipment room. This acquisition will require a general contractor with experience and expertise capable of fully managing this task order simultaneously with their other work, which will require construction scheduling, cost estimating, quality control, and coordination of subcontractors in a wide variety of construction trades.

b. Government Representatives: Representatives of the Directorate of Public Works (Contracting Officer

Representative (COR), architect, engineer, etc.) will act as Project Oversight for the Contracting Officer for this Task Order agreement.

c. 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 and the COR and/or their designated representative.

The designation shall be in writing and a copy furnished to the Contracting Officer and COR within ten (10) days after signature of this agreement.

d. Identification of Contractor Employees. The contractor shall provide each employee working at the site an identification (ID) badge prior to their start date on this project. 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. 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.

e. 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.

f. 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

g. 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 is withing the following price range:

(a) Between $500,000 and $1,000,000.

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

a. Building 246 requires a full demolition and replacement of its existing MRL electric traction elevator and associated equipment. The record drawings for the most recent renovation and elevator repairs shall be provided in this solicitation. The new elevator shall be installed with a 100% non-proprietary system, being that when future maintenance is required, any elevator repair technician has the capability of performing repairs. The contractor shall provide a new in-ground passenger elevator with a 4,500 lb capacity, 3 front openings with capability of 24’3” of travel that opens at 100 FPM. The new cart interior shall be a minimum of 5’4” deep and 7’9” wide. The existing hoist way interior dimensions re 6’11” deep x 9’6” wide. The existing elevator hoist way shall be re-used. The contractor shall modify the hoist way and pit as necessary for the new elevator. To include but not limited to boring a hole beneath the elevator pit the depth of the elevator travel and installing PVC to encase the new jack. The contractor is also responsible for soil testing to determine the subsurface material. For bidding purposes, the contractor is to assume the subsurface material consists primarily of cohesive soils, silt, and clay. The contractor shall include a per linear foot price for hammer drilling through rock on their bid form for reference after award if some of the subsurface material is found to be rock. The contractor shall comply with ANSI A17.1-2016, NFPA 13, NFPA 72, UFC 3-600-01, and IBC Chapter 30 requirements. The contractor shall submit drawings for the new elevator design. Provide plastic sheeting across Hall 007 to section off the construction area and help prevent dust and debri from getting on the facility storage items.

b. Elevator Equipment Room

i. The contractor shall build an 8’x 9’ elevator equipment room adjacent to the elevator shaft. Refer to the drawings for the exact location and details.

c. Fire Sprinkler

i. The existing system shall be modified in accordance with NFPA 13, UFC 3-600-01, and IBC Chapter 30.

Sprinklers are required at the bottom of the pit.

ii. Modify the existing sprinkler piping to add a sprinkler head in the new elevator equipment room.

Activation of sprinkler waterflow switches shall shunt trip elevator power with no delay upon switch activation.

d. Fire Alarm

i. The existing system shall be modified in accordance with NFPA 72, UFC 3-600-01, and IBC Chapter 30.

ii. A new smoke detector and heat detector are required in the machine room. Activation of associated smoke detector must activate the facility fire alarm system and send the elevator to the designated floor per ASME A17.1 Phase I emergency recall operation and Phase II emergency in-car operation.

iii. The elevator shall be equipped to operate with a standardized fire service elevator key.

e. HVAC

i. The contractor shall install an air-cooled mini split system into the elevator equipment room.

1. The unit shall run under its own internal controls with a hardwired thermostat.

2. The contractor shall also install a hardwired room temperature sensor for BAS monitoring and alarming capabilities to the Automated Logic Frontend. Provide any programming and graphical changes for the new sensor.

3. The contractor shall install a standalone secondary condensate pump. Connect into the existing condensate piping in the basement.

f. Communication

i. The elevator emergency communication system is currently analog and shall remain analog for the new elevator.

g. Electrical

i. The contractor shall demo the existing fused disconnect in the electrical room and install a new fused disconnect switch in the elevator equipment room. The contractor shall also install a new shunt trip breaker for the new elevator.

ii. Demo the existing fused disconnect for the elevator cab lighting in the electrical room. Install a new fused disconnect for the elevator cab lighting inside the new elevator equipment room.

iii. Provide and install a 2x4 LED light with an emergency battery pack into the new elevator equipment room. The light shall be controlled by a switch that is placed near the door. Basis of Design – CPX 2x4

3000 LM 80 CRI 40K SWL

iv. Provide power and a fused disconnect for the new mini-split system being installed in the elevator equipment room. Also provide power to the secondary condensate pump for the mini-split.

SW-3 PROJECT INSTRUCTIONS

a. Coordination: Before starting any work, the contractor shall coordinate said work through the Contracting Officer and/or 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. Off road contractor staging/work site: 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 fenced area. 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.

c. Normal Working Hours: The Contractor shall work on days and hours stated except as approved, in writing, by the Contracting Officer and/or 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 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.

d. 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.

e. 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 and/or COR in the form of paper, hard copy, (1) digital PDF format copy, and AutoCAD (or Revit).

f. 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.

g. 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.

h. National Park Service - The Secretary of the Interior’s Standards: This facility or construction site is a part of the National Landmark Historic District.

i. 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.

j. 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.

k. 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.

l. 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 below SW-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 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 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_(Contract/Task order #)_Bldg_#56_tiles)

1 - Site Specific Safety Plan (SW-4b) 2 - Construction Schedule – Schedule shall be viewable in PDF (updated weekly or as changes happen) 3 - Key Personnel Staffing Plan (SW-1e) 4 - Quality Control Plan (SW-6) 5 - Submittal Registry / LOG for all submittals intended for project 6 - Project Signage (SW-7) 7 - Pre-Construction site photos 8 – Soil/Geotech Testing Report 9 - Elevator Product Info 10 – Elevator Shop Drawings 11 – Structural Drawings 12 – Fire Alarm Product Info 13 – Fire Alarm and Sprinkler Drawings 14 – Electrical Product Info 15 – Electrical Shop Drawings 16 – HVAC Product Info 17 – Doors and Hardware 18 – Wall Assembly Data 19 – Fire Sprinkler Product Info 20 - O&M/Warranty

• Operation and Maintenance Manuals (SW-3g)

• Warranty Information (SW-3j)

• Debris Recovery Statement Form (attached) (SW-3c)

• Builder Equipment Checklist (will be provided)

• As-Built Drawings (SW-3d)

• Draft DD 1354 Form & Final DD 1354 Form (SW-3i) (as necessary)

All other products, materials and equipment used in the project All serial #s, Model Number, Manufacturer information of items removed and installed. (Form provided)

SW-6 QUALITY CONTROL

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

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 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]

B246 Elevator Modernization Statement of Work 22 June 2026

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

B246 Elevator Modernization Statement of Work 22 June 2026

ADD PHOTOS ON THIS PAGE ADD ADDITIONAL PAGES IF

NEEDED