Technical Exhibit 6 Forms.docx

TECHNICAL EXHIBIT 6

Forms and Format Table of Contents

The Contractor may reproduce the Government forms identified below or may provide the information required on the Government forms in any other format acceptable to the Contracting Officer.

CONTRACT DISCREPANCY REPORT

DATES

7. Discrepancy or Problem (Describe in detail: include reference to PMS/Directive: attach continuation sheet if needed.

8. Signature of Contracting Officer

10. Contractor response as to cause, corrective action and actions to prevent recurrence. Attach continuation sheet if needed (Cite applicable QC program procedures(s) or new QC procedures(s).)

12. Government Evaluation (Acceptance, rejection: Attach continuation sheet if needed)

13. Government Action (Payment deductions, cure notice, show cause, other)

14. Final Disposition

CLOSE OUT

Name – Title

Signature

Date

Contractor Notified

QAE

Contracting Officer

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PERFORMANCE EVALUATION MEETING RECORD

1. Date of Meeting:

2. Persons in Attendance (Representing)

1) 2) 3) 4) 5) 6)

3. Contract Discrepancy Reports Discussed (List):

4. Other Discrepancies, Problems or Topics Discussed (Describe in detail. Attach continuation sheet if needed)

5. Contractor Actions Required. (Attach continuation sheet if needed)

6. Government Actions Required. (Attach continuation sheet if needed)

7. Signature of Contractor’s Project Manager Date

8. Signature of Government Representative Date (Contracting Officer, COTR, or QAE)

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Sample Work Order Work Order Details // 278010

Replace approximately 40 apron lights, past the end of their service life.

Parent:

Work Type: CM

Reported By:

Report Date: 8/23/2005 10:38:00 AM PM:

Phone:

Manufacturer:

Problem Code:

GL Account:

Supervisor:

Person Group:

Lead Person:

Lead Craft:

Crew:

Work Remarks:

Workers(s) Names(s): Actuals:

Labor: Materials:

Job Plan:

*****FOR OFFICIAL USE ONLY*****NOT FOR PUBLIC DISPLAY*****FOR OFFICIAL USE ONLY*****

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FACILITIES ENGINEERING PERFORMANCE MEASUREMENT LETTER

From: (Unit Name) To: Commandant (G-SEC)

Subj: FY-XX FACILITIES ENGINEERING PERFORMANCE MEASUREMENTS

Ref: (a) Civil Engineering Manual, COMDTINST MI 1000.11 A

1. Per reference (a), the following Facility Engineering performance measurement data is provided for fiscal year XXXX.

2. Unit Staffing and Facilities:

A. Attach copy of organization chart for the Facilities Engineering Division.

B. Total Building Square Footage (SF) as maintained by Facility Engineering and as listed in CEDS at end of fiscal year.

C. Total Plant Replacement Value (PRV), as listed in CEDS at end of the fiscal year.

D. List of all OPFACs (shore and afloat) for which you are funded to provide FE maintenance responsibility.

3. Key Performance Measures:

A. Non-Recurring Maintenance Rate = A (1)/ PRV

(1) Total AFC43 obligated at facilities under FE maintenance responsibility = _ This includes all AFC43 funds obligated at your facility including funds obligated by servicing CEUs or FDCC. Also includes AFC-43 funds obligated for design and construction support. This does not include in-house (Coast Guard) salary and overhead costs.

B. Recurring Maintenance Rate = B(1)/PRV

(1) AFC30 maintenance obligations and associated salaries = . This includes staff (WG/GS/Mil) salary costs computed from Standard Personnel Costs (SPC). Includes all AFC30 material costs and maintenance contract costs.

Maintenance is NOT: Janitorial. Pest Control, Fuel Ops, Crane Ops, Window Cleaning, Security, Fire Fighting, Snow Removal, Refuse Removal, Recycling, Enviro/HazWaste Management, Water Sewer Ops, Vehicles, Telephone Services. and other comparable operating costs.

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C. Preventative Maintenance Rate = C(1)/C(2)

(1) Total Hours of PMS Completed =

(2) Total Hours of PMS in Annual PMS Cycle = PMS requirements are non-standardized, count those entered in FEDS CMMS or similar system. Includes all PMS (daily, weekly, monthly, quarterly, annual. etc.)

D. Family Housing Maintenance Rate = D(1)+D(2)

(1) Annual AFC30 maintenance obligations = Includes maintenance salaries, materials, and contracts for family housing units and for infrastructure required primarily to support family housing. Excludes utility and housing administration costs.

(2) Annual AFC43 contract and material obligations =

Includes contract and material costs for family housing units and infrastructure required primarily to support family housing.

(3) Number of Family Housing Units =

E. Maintenance Priority Distribution = E(1)/E(2)

(1) Total number of Work Orders completed within each Work Order priority category during the FY =

(2) Total number of Work Orders completed during FY =

Note: Provide a definition for each work order category. Data shall be provided for each Work Order category.

F. Responsiveness Rate = F(1)/ F(2)

(1) Total number of Work Orders completed on-time (as defined within each priority category) within each Work Order priority category =

(2) Total number of Work Orders completed during FY, within each Work Order priority category =

Note: Data shall be provided for each work order category

G. Energy Consumption Rate = BTU/SF

BTU = Consumption reported in Quarterly Energy Reports.

H. Recapitalization Rate = [ H(l) + H(2) ] / PRV

(1) Rebuilding (R) portion of AC&I projects awarded for your facility during the past year, as taken from PPRA estimates =

(2) Rebuilding (R) AFC43 projects awarded for your facility during the past year, as taken from CEDS =

I. Human Recapitalization Rate = I(1)/# of FE Billets

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(1) Includes professional training hours for all FE employees, including GS. WG, Military = hrs

Note: Does not include mandatory unit training (example: CDAR, Ethics, Human Relations, etc.), nor OJT.

J. Remarks or Comments

Prepared by: Phone Number

GENERATOR TEST REPORT

Engine Number

Check Prior to Running

Check Under Load Condition Monthly

Date

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Note:

Ensure all areas affected by Generator Testing/Power Loss are notified prior to and after testing. Ensure all equipment is reset after Generator is on line and after Generator is secured.

Comments: (List items that are not otherwise addressed) Performed

By:

Date:

Reviewed

By:

Date:

Department of Transportation U.S. Coast Guard CG-5367A

MOTOR VEHICLE DISPATCH LOG

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