Technical Exhibit 12 Sample NCIR.docx
DOCX document 29 KB Posted
- Attached to
- Preventive Maintenance (PM), Repair, and Cleaning Service at Army Family Housing, Camp Walker
- Solicitation number
- W90VN924R0024
About this file
This document is a Nonconformance Inspection Report (NCIR) related to a federal contract for the Change of Occupancy Cleaning and Painting of Army Family Housing (AFH) at USAG Daegu.
The key details are:
- The report number is 00001, issued under Contract W91QVN-00-P-0000, Delivery Order 0001 for the Unit #Tower #1 at USAG Daegu.
- The report identifies nonconformance conditions that the contractor, Korean Construction Co. Ltd, must repair by 14 Sep 19 per the contract specifications.
- The contractor must correct the identified issues and return the completed NCIR form to the DPW Housing Facilities Management Branch at USAG Humphreys, Building 309.
- Upon completion, the Contracting Officer's Representative (COR) will review and provide comments on the report.
The related federal contract opportunity is for Preventive Maintenance (PM), Repair, and Cleaning Service at Army Family Housing, Camp Walker, with a solicitation number of W90VN924R0024. The solicitation closes on 28 Jun 2024.
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Text version
NONCONFORMANCE INSPECTION REPORT (SEE INSTRUCTIONS ON REVERSE)
PAGE____1____OF___1__PAGES
1. REPORT NUMBER
00001
| 2. CONTRACT NUMBER |
| 3. DELIVERY ORDER NUMBER |
| 4. BUILDING/FACILITY NUMBER |
| 5. CONTRACT NAME |
| 6. CONTRACTOR |
| W91QVN-00-P-0000 |
| 0001 |
| UNIT# |
Tower#1
| Change of Occupancy Cleaning and Painting of (AFH), USAG Daegu |
| Korean Construction Co. Ltd |
| 7. SPECIFICATION NUMBER |
| 8. SERVICE ORDER NUMBER |
| 9. LOCATION |
COP/COC
N/A USAG Daegu DPW, Housing Div
10. DESCRIPTION OF NONCONFORMANCE CONDITION(S) OR ITEM(S)
(Reference the specifications, page, para, drawing number, as applicable)
14. CONTRACTOR CORRECTIVE ACTION
(Identify date/time of completion; initial each item)
11.
This nonconformance report is issued to you on ________13 Sep 19_________. Contractor to repair Non-conformance items identified in “10”. Return this form to Family Housing, Facilities Management
15. CONTRACTOR REPRESENTATIVE (QC) SIGN AND DATE
Branch, DPW Housing, Building 309.
| 18/19. INSPECTOR’S SIGNATURE |
| DATE |
| by ____14 Sep 19_____________per contract specifications, page no.__234____, para no.____2b(1)_____. |
| Follow up Inspection |
20. COR COMMENTS
12. INSPECTED BY
| DATE/TIME |
| 13. TYPE OF INSPECTION |
17. REVIEWED BY
| DATE |
| 16. DATE/TIME RETURNED |
| 21. COR’S SIGNATURE |
| DATE |
INSTRUCTIONS FOR COMPLETING NONCONFORMANCE INSPECTION REPORT
INSPECTOR’S INSTRUCTIONS (when issuing Nonconformance Report to contractor).
| BLOCK 1-9 | - | Fill out all information in these blocks. Mark N/A in blocks which do not apply. |
| BLOCK 10 | - | Identify and list all nonconformance conditions of inspection. If additional sheets are needed use another Nonconformance Inspection Report and identify as next page. Reference the paragraph (para), page, and drawing number to the nonconformance condition, if applicable. Record any additional remarks pertinent to your inspection. |
| BLOCK 11 | - | Fill in the date and time you issued the Nonconformance Report to the contractor. Indicate the date and time the contractor has to repair the nonconformance conditions and to return the report to the Housing, Facilities Management Branch. Reference the contact specifications page and paragraph number as it applies to time limit for repairing and/or re-performing service. |
| BLOCK 12 | - | Sign and date the report. |
| BLOCK 13 | - | Identify the type of inspection (i.e., Final, Re-Inspection, Change of Occupancy Cleaning (COC), Flooring, Change of Occupancy Painting (COP) etc. |
CONTRACTOR’S INSTRUCTIONS (when correcting nonconformance items).
| BLOCK 14 | - | Correct nonconformance items. Indicate the date and time that each item/condition listed in Block 10 was corrected. Remark on any condition related to the repair such as extenuating circumstances which may prevent you from performing the corrective action. |
| BLOCK 15 | - | Contractor Q.C. representative sign and date after the repairs are made. Return the completed report to the Housing, Facilities Management Branch, within the time frame identified in the referenced contract specifications. The Housing, Facilities Management Branch is located at USAG Humphreys, Building 309, telephone (DSN) 753-5798. |
INSPECTOR’S INSTRUCTIONS (when receiving Nonconformance Report from contractor).
| BLOCK 16 | - | Identify the date and time the contractor returned the form or when the form was received at DPW Housing, Facilities Management Branch. |
| BLOCK 17 | - | This block is for supervisory review after the form is returned from contractor. |
INSPECTOR’S INSTRUCTIONS
| BLOCK 18 | - | Perform follow up inspection on rejected items. Indicate date and time of re-inspection (if applicable). Comment on any circumstances. If no follow up inspection is made, indicate not re-inspected. |
| BLOCK 19 | - | Sign and date. Forward to the COR. |
COR’S INSTRUCTIONS
| BLOCK 20 | - | Review this report. Add or attach comments. Coordinate input with Contracting Office if required. |
| BLOCK 21 | - | Sign and date the report. Forward this copy to 411th, CSB, Humphrey’s office, Contract Administrator if required. |
| - | Retain this copy in the COR, Facilities Management Branch files. |
ATTACHMENT 10A
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