Technical Eval Attachment - Service Order Form-v9_20250614 B.pdf
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- Solicitation number
- PANHES25P0000001179
About this file
This document is a Service Order Form for a routine maintenance task involving the replacement of a PRT pump/motor assembly at Tank #23 for a Fuel Storage facility. The service order, numbered 6AA4302, is part of a contract with XYZ-KTR-100 and focuses on replacing a defective pump and motor assembly at a JP-8 Fuel Tank location, with work to be performed across multiple terminals including Terminal 2, 3, 4, 5, and Pier 17.
The total cost of the service order is $6,811.00, which includes $5,500.00 for a Pump/Motor Assembly from R S Corcoran Co. with a 10% markup, $1,000.00 in labor costs for a site superintendent, and additional expenses for taxes and materials. The work requires a qualified electrician to handle electrical disconnects and terminations, and will be conducted in accordance with NFPA 780 article 500. The service order was initiated on 26-Oct-20 with a priority level of P2 and is categorized under the maintenance category of Pump, with funding from CLIN 0004AA.
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Text version
SERVICE ORDER NUM.: REV #
6AA
XXXX
T2-468
TEXTRA47
XYZ Navy
No No
FMSR FINAL VALIDATION:
NOYES
FMSR COMMENTS: Any box checked "NO" requires a comment, other comments encouraged. If contractor performed in a manner worth noting (positive or negative), please provide
Did contractor communicate with you prior to and upon completion of work? YES
Did contractor have all necessary certifications? YES NO Were there any issues with the work performed? YES NO
YES NO
X
Did contractor arrive with all parts, materials, and tools needed to complete the repair? YES NO
Was the work area kept clean during and upon completion of work?
E-SIGNED & DATED
By signing below, I certify that the services under the above Service Order have been satisfactorily completed.
YES
YES
FMSR INITIAL VALIDATION:
E-SIGNED & DATED
PART III - QUALITY OF WORK
Was work performed in a quality manner?
NO
NO
NO
SERVICE ORDER FORM
PART I - SERVICE ORDER INFORMATION
Contractor Name
FACILITY NUM./NAME:
(Use ALT-Enter to add rows)
CONTRACT NUMBER:CONTRACTOR:
RoutineSERVICE ORDER TYPE:
Contract # aaa
STOR JET FL
EXAMPLE NAME 2
JP-8 Fuel Tank Terminal 2 Terminal 3 Terminal 4 Terminal 5 Pier 17
XYZ-KTR-100
NO
Was work performed safely?
Was work performed in a timely manner? YES Did the prime contractor successfully manage the subcontractor?
Replace PRT Pump/Motor Assembly - CUIDs: ROB-4302-CENPT-0002 & ROB-4302-ELEMT-0002.
Per the FMSR, the PRT pump/motor assembly for Tank #23 (FAC 4302) requires replacement. It has been noted that the motor is defective as well as the pump.
Ktr to replace the defective pump/motor assembly. A qualified electrician will be present for all efforts to make electrical disconnects and final terminations as required. Work will be IAW NFPA 780 article 500.
MORE INFO
MORE INFO More and Better Info.
FMSR NAME (First and Last):
MAINTENANCE CATEGORY: Pump
DETAILED SO DESCRIPTION: (Use ALT-Enter to add rows or new paragraphs)
PART II - AUTHORIZATION
P2 Notice of Violation (NOV) Related?
Is the SO related to Natural Disaster? SO PRIORITY LEVEL:
POJSERVICE & PHASE:
FUNDING CLIN: 0004AA
SITE CODE/SITE NAME: Site Name SERVICE ORDER INITIATION DATE: 26-Oct-20
REV #
6AA
XXXX
T2-468
TEXTRA47
Navy
XYZ
SERVICE ORDER SUBMISSION DATE: 29-Mar-21 No Expected Deliver Date of LL item: 9-Mar-21 29-Apr-21
No CUID: ROB-4302-CENPT-000
ROB-4302-ELEMT-0002
No COMPLEXITY: Low Work Plan Required (Yes/No): No
RITM Used: (Yes/No): Yes ITEM(S) USED: CONTRACT RITM QUANTITY: 800 LF
Date:
CUSTOMER:
E-SIGNED & DATED
Contractor Safety Manager
E-SIGNED & DATED
CONTRACTOR:
E-SIGNED & DATED
CONTRACTING OFFICER OR SOA:
E-SIGNED & DATED
Prime 10.00 $100.00 $1,000.00
1,000.00$
Item Description Manufacturer Man. Part No. Vendor Part No. Catalog/Vendor Catalog # Vendor Price Markup (%) Pump/Motor Assembly R S Corcoran Co. 3000 D (AA05) R S Corcoran Co. $5,000.00 10% 1.00 $5,500.00 $5,500.00
$5,500.00
1.00 $70.00 $70.00
140.00$
5%
15%
JOINT SEALANT/CRACK REPAIR SO QUANTITY TOTAL: 200/800 or 900/800
Subcontractor Materials/Equipment/Other $140.00
$0.00 $171.00Tax (sample percentage)
QTY. UNIT COST TOTAL COST
Item Description
Item Description
Replace PRT Pump/Motor Assembly - CUIDs: ROB-4302-CENPT-0002 & ROB-4302-ELEMT-0002.
Per the FMSR, the PRT pump/motor assembly for Tank #23 (FAC 4302) requires replacement. It has been noted that the motor is defective as well as the pump.
Ktr to replace the defective pump/motor assembly. A qualified electrician will be present for all efforts to make electrical disconnects and final terminations as required. Work will be IAW NFPA 780 article 500.
MORE INFO
MORE INFO More and Better Info.
Site Superintendant - 1-10 hr day Labor Category / Description: Confirm All Rates are in Accordance with TO Proposed Rates.
Prime/Sub
Included in SOSHO PROOF OF QUALIFICATION?
Included in SO
By signing below, I certify that I have reviewed the safety documents for this service order and they meet all contract, OSHA, and regulatory requirements.
TASK ORDER SAFETY MANAGER SIGNATURE: (MUST BE E-SIGNED AND DATED)
Yes LIST INCLUDED AHAs:
Service Order Revision Log:
FULLY BURDENED LABOR
Description:
FACILITY NUM./NAME:
Contract #
Sections 7-2 through 7-10
SO Priority Level: P2
MAINTENANCE CATEGORY:
0004AA
Pump
UFC REFERENCE:
PRIME CONTRACTOR
PART I - SERVICE ORDER INFORMATION
PART III - SERVICE ORDER PRICING
TOTAL MH HOURLY RATE TOTAL COST
SO DESCRIPTION:
TOTAL COST OF SERVICE ORDER: $6,811.00
SERVICE ORDER TYPE:
CONTRACT NUMBER:Contractor NameCONTRACTOR:
SITE CODE/SITE NAME: FUNDING CLIN:
PART II - SERVICE ORDER SAFETY INFORMATION
QUALIFIED/COMPETENT PERSON'S NAME: John Doe
LIST INCLUDED PLANS (SEE EM385-1-1 APPENDIX A):
SERVICE ORDER NUM.:
TOSM NAME:
Sub-Contractor Name
Routine
QP/CP PROOF OF QUALIFICATION?
ALL AHAs ARE PREACCEPTED? Yes
Is the SO related to Natural Disaster?
Notice of Violation Related?
L2 - Dual Hatted Safety
DUID:
EXAMPLE 1
EXAMPLE 2
EXAMPLE 3
XYZ-KTR-100
Site Name
JUSTIFICATION FOR LEVEL OF SHO:
REQUIRED SHO LEVEL:
SERVICE & PHASE:
Does SO Include Long Lead Items?
Expected Start Work Date:
SUB-CONTRACTOR(S):
POJ
aaa
STOR JET FL
EXAMPLE NAME 2
JP-8 Fuel Tank Terminal 2 Terminal 3 Terminal 4 Terminal 5 Pier 17
ANY NEW PLANS REQUIRE SAFETY REVIEW?
TOTAL $6,811.00
Subtotal $5,640.00 Labor $1,000.00
Tax (sample percentage) $275.00
John DoeJOBSITE SHO NAME:
PRIME Material/Equipment/Other Sub-Totals
SUBCONTRACTOR MATERIAL/EQUIPMENT/OTHER
John Doe
Prime Materials/Equipment/Other $5,500.00
Pump/Motor Assembly Subcontractor Material/Equipment/Other Sub-Totals
PRIME MATERIAL/EQUIPMENT/OTHER
QTY. UNIT COST TOTAL COST
Labor Sub-Totals
Last Revision
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