TE-J Example Annual Service Confirmation Form.xlsx
XLSX spreadsheet 124 KB Posted
- Attached to
- Fort Hood Installation Custodial Services
- Solicitation number
- W91151-26-R-A004
About this file
This file is an Annual Service Confirmation Form template for Installation Custodial Services at Fort Hood. The form documents annual and monthly facility maintenance services across multiple buildings and service categories. The annual services include carpet cleaning, floor stripping/scrubbing/sealing/refinishing, glass and blind cleaning, and high dusting (6 ft. to 10 ft. heights), with service durations ranging from one to five days depending on building requirements. Monthly services consist of dry buffing or spray buffing of floors. The form requires contractors to capture service dates, building identification, service duration in days, completion status for specific service areas (interior windows, exterior windows, gyms, high dusting), and point of contact information including name, signature, date, phone number, and email. Contractors are instructed to advise building occupants to remove personal items and electronic devices from floors prior to service performance to prevent damage.
The template serves as documentation and confirmation of service completion for the Fort Hood Installation Custodial Services contract (W91151-26-R-A004), which covers approximately 432 buildings totaling 3.65 million square feet, including the Warrior Transition Unit and Child Youth Services facilities. This form enables tracking and verification of custodial service tasks performed in accordance with the contract's Performance Work Statement sections 5.7 and 8.2.4.1, ensuring compliance with contracted service requirements and maintaining a record of completed maintenance activities across the installation.
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Text version
Annual Annual Service Confirmation
Building: Start Time:
| Service Dates: | Service Duration: | Day(s) |
| Annual Service Tasks |
| IAW PWS 5.7 The following tasks shall be completed each time the service is performed: | |
| 1) | Annual Carpet service |
| 2) | Annual Floor Service:Strip, Scrub, Seal and Refinish Resilient Floor Surfaces and Other Floor Surfaces |
| 3) | Annual Glass and Blind Cleaning |
| 4) | Annual High Dusting |
We strongly suggest to pick up all personal items/ electronic device i.e. laptops, cpu's, phone cords etc., from the floor to avoid any damages that may occur during services.
| Window Genie services required? No | ||
| Services Completed: | ||
| Interior Windows | Exterior Windows | |
| Gyms | High Dusting |
Additional Instructions/Notes/Comments:
Point of Contact Information
Print Name:
Signature: Date
Phone #
Email:
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BI Annual 5 Day BI Annual Service Confirmation -1st Service
Building: Start Time:
| Service Dates: | Service Duration: | Day(s) | |
| Annual Service Tasks | |||
| IAW PWS 5.7 The following tasks shall be completed each time the service is performed: | |||
| 1) | High Dusting - 6 ft. to 10 ft. | ||
| 2) | Clean Furniture | ||
| 3) | Wash Exterior Glass | ||
| 4) | Wash Interior Glass | ||
| 5) | Clean Window Treatments | ||
| 6) | Carpet Cleaning (Floor Team) | ||
| 7) | Stripping/Finishing Tile (Floor Team) | ||
| We strongly suggest to pick up all personal items/ electronic device i.e. laptops, cpu's, phone cords etc., from the floor to avoid any damages that may occur during services. |
Window Genie services required? N/A
Interior Windows Exterior Windows
Gyms High Dusting
Additional Instructions:
Point of Contact Information
Print Name:
Signature: Date
Phone #
Email:
&G
Monthly Monthly Service Confirmation
| Building: | |||
| Service Dates: | Service Duration: | Day(s) | |
| Monthly Service Tasks | |||
| IAW PWS 8.2.4.1The following tasks shall be completed each time the service is performed: | |||
| 1) | Dry Buff or Spray/Buff | ||
| We strongly suggest to pick up all personal items/ electronic device i.e. laptops, cpu's, phone cords etc., from the floor to avoid any damages that may occur during services. |
Window Genie services required? N/A
Interior Windows Exterior Windows
Gyms High Dusting
Additional Instructions:
Point of Contact Information
Print Name:
Signature: Date
Phone #
Email:
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File details come from the government source that posted it. Updated .