Technical_Exhibit_E_-_Surveillance_Activity_Checklist.pdf

15 September 2016

TECHNICAL EXHIBIT E

Surveillance Activity Checklist

1. GENERAL:

Contract No __________________________

DO# _______________

Location ____________________________ Date Accomplished _______________

2. SURVEILLANCE METHOD (Check):

Random Sampling 100% Inspection Periodic Inspection Customer Complaint

3. LEVEL OF SURVEILLANCE (Check):

Inspection during the period of performance Final inspection Re-inspection

4. TYPE OF SEVICES INSPECTED (Check):

Interior painting (PWS C-5.4 & sub) Hardwood Floor (PWS C-5.5 & sub) PVC Floor (PWS C-5.5 & sub) Cleaning (PWS C-5.3)

5. Service Provider’s Performance (Check):

Meets Standards Does Not Meet Standards

Comments:

QUARTERS CLEANING

The required services have been inspected IAW PWS, Section C-5.3 The following deficiencies have been observed as marked below:

PARA SPECIFIC TASK ACCEPTED REMARKS

5.3.2 Floors, Baseboards YES / NO / N/A

5.3.3 Rugs, Carpet YES / NO / N/A

15 September 2016

5.3.4 Walls, Ceilings / Woodwork YES / NO / N/A

5.3.5 Windows YES / NO / N/A

5.3.6 Shutters YES / NO / N/A

5.3.7 Interior / Exterior Doors YES / NO / N/A

5.3.8 Lighting Fixtures YES / NO / N/A

5.3.9 Cabinets, Closets, Drawers, Shelves YES / NO / N/A

5.3.10 Mirrors YES / NO / N/A

5.3.11 Furniture YES / NO / N/A

5.3.12 Upholstered Furniture YES / NO / N/A

5.3.13 Beds (Bedsprings, Box-springs, YES / NO / N/A

Bedframes, Mattresses)

5.3.14 Carports, Garages, Patios, Balconies YES / NO / N/A

5.3.15 Radiators and Pipes YES / NO / N/A

5.3.16 Entrances YES / NO / N/A

5.3.17 Dishwashers, Washers/Dryers YES / NO / N/A

5.3.18 Washers and Dryers YES / NO / N/A

5.3.19 Refrigerators YES / NO / N/A

5.3.20 Ranges YES / NO / N/A

5.3.21 Kitchen, Bathrooms, Toilets, YES / NO / N/A

Laundry-room

5.3.22 Ventilators, Range Hoods YES / NO / N/A

5.3.23 Fireplaces YES / NO / N/A

5.3.24 Storage, Basement, Attic YES / NO / N/A

5.3.25 Insects in Quarters YES / NO / N/A

PREPARED BY

Typed Name and Signature

Contractor’s Representative

Typed Name and Signature