TE N - Hazardous Material Request.xlsm

XLSM spreadsheet 19 KB Posted

Attached to
Overhead Doors Federal contract opportunity
Solicitation number
W91151-19-R-0016
Issued by
Department of the Army Materiel Command Mission and Installation Contracting Command Fort Hood

About this file

This sources sought notice and attached documents outline requirements for overhead door preventative maintenance, repair, and replacement services at Fort Hood, Texas. The U.S. Army seeks these services on a small business set-aside basis provided two or more qualified small businesses respond by March 29, 2019 with past experience and capabilities statements. The anticipated NAICS code is 238290 for other building equipment contractors with a size standard of $15 million. The requirement was previously awarded in 2014 under contract W91151-14-C-0058. Respondents are asked to provide company and point of contact information, details on past similar work as a prime or subcontractor, commercially available pricing details, and recommendations to structure the requirement to facilitate small business competition. The attached draft performance work statement and technical exhibits performance requirement summary provide further requirement details.

Hazardous Material Request.xlsm

View the file

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Text version

HazMat Request

Technical Exhibit-"N" HAZARDOUS MATERIAL AUTHORIZATION REQUEST
REQUESTOR USE
1. NOMENCLATURE/TRADE NAME

2. STOCK NUMBER (NSN, LSN, MCN, etc.) 3. PART NUMBER

4. QUANTITY REQUESTED 5. MONTHLY REQUIREMENT

(estimate monthly usage or a one-time purchase)

6. UNIT OF ISSUE (EA, GL, CAN, etc.) 7. UNIT OF MEASURE (must be weight or volume)

8. UNIT OF USE (must be weight or volume, e.g., pounds, gallons, etc.) 9. TYPE CONTAINER (CAN, BOTTLE, TUBE, PLASTIC, METAL, GLASS, AEROSOL, etc.)

10. SUGGESTED SOURCE OF SUPPLY 11. MANUFACTURE INFORMATION

(complete if different than supplier)

COMPANY NAMECOMPANY NAME
ADDRESSADDRESS
PHONE/FAXPHONE/FAX
12. DESCRIBE THE WORK OR PROCESS IN WHICH THE MATERIAL WILL BE USED13. ESTIMATE WHAT PERCENTAGE OF THE PRODUCT ENDS UP IN THE LISTED LOCATIONS
%
A. ON THE END ITEM, EQUIPMENT, OR PRODUCT
B. INTO THE AIR
C. INTO A WASTE DRUM
D. INTO THE TRASH DUMPSTER
E. CENTRAL WASTE TREATMENT OR SEWER
F. OTHER
14. LIST BUILDING OR AREA WHERE THIS MATERIAL WILL BE USED15. COST CENTER/DODAC AUTHORIZED TO USE THIS MATERIAL16. PROCESS
(Circle or check (x) one)17. TECHNICAL REFERENCE REQUIRING SPECIFIC USE

NEW

CURRENT
18. REQUESTER NAME AND PHONE NUMBER19. TECHNICAL POC AND PHONE NUMBER20. ORGANIZATION21. DATE REQUESTED
(name)(phone)(name)(phone)
DPW-ENVIRONMENTAL USE ONLY
AUTHORIZATION CONTROL NUMBERMSDS SERIAL NUMBERREMARKS

(Alternate material available?)

NFPA 704 LABEL DATA HEALTH: FLAMMABILITY: REACTIVITY: SPECIAL INSTRUCTIONS:

TE-F-1 Form Dated: October 2003

Instructions Information required for your Hazardous Material Authorization Request.

NOTE: Contractors are strongly encouraged to purchase hazardous materials at the HazMart. On those rare occasions that short-term contractors use non-government furnished HAZMAT, they must use the Hazardous Material Authorization Request to notify Fort Hood of HAZMAT usage and submit an MSDS for all materials. In these cases, MSDS are used for tracking purposes and does not imply endorsement of any product by Fort Hood.

BlockDescriptionInformation Required
1NomenclatureIf not a government source NSN, enter a descriptive noun for the item you are purchasing, i.e., SAE 30 oil, yellow spray paint, lead acid battery…
2NSNEnter NSN if item is from a government source of supply. If it is, skip to block 4.
3Part NumberEnter as appropriate, using the most specific information available

4 Quantity Requested Make every effort to enter only how much you will need to sustain your process for 7-10 days. The only exceptions should be for those items where the smallest size procurable (UI) lasts longer in your process. If a weekly or monthly interval does not work in your process, contact the HMCG to establish special tracking requirements.

5Monthly RequirementHow much do you use per Month? Enter a quantity and select the appropriate unit: FL OZ, Gallon, Gram, KG, LB, Liter, OZ, Pint, Quart, Troy Oz. An example would be using 5 qts to change oil in car.
6Unit of IssueUnit of issue. Examples are ea, gal, qt, oz…
7Unit of MeasureEnter the quantity of the size, and select the appropriate measuring unit: Fluid Oz, Gallon, Gram, KG, LB, Liter, Oz, Pint, Quart, Troy Oz.
8Unit of UseIf decanting, what unit will you issue/use
9Type ContainerSelect the appropriate container description. Bottle, Box, Can, Cartridge, Drum. If not listed, fill in the container type next to “other”
10Suggested Source of SupplyName of Brand Name or source of supply
11Manufacturer InformationEnter the manufacturer information. This is very important to determine the correct MSDS and chemical formulation. You may also find this on the container.
12Work or process descriptionA full description of the work activity and process in which the HAZMAT is used. More detail in this block enhances your chances of approval, i.e.,
Application method, such as hand, brush, spray gun/nozzle, or vapor condensation
Type of industrial equipment, such as open tanks, closed tanks, vapor degreaser, spray booth, mechanical equipment, or other system
If the HAZMAT are transferred to industrial equipment, list the equipment number and specify whether the transfer will occur by pouring, pumping, or another method
The process codes located in Section 8.6 may help to identify the use or application of the HAZMAT. List the process code that best describes the application or use for the HAZMAT.
Method by which HAZMAT may be mixed or combined with other ingredients, such as hand, mixer, open container, closed container
Explain what will happen to the HAZMAT in the process, such as heated in an oven, soldering iron, torch, or heated to facilitate parts washing, or even used to facilitate removal of other HAZMAT by wire brush, sander, grinder.

The important thing here is to be as specific as possible, which can shave days off the approval process – use additional paper if necessary and remember your reviewers don’t do your work – explain it so they can understand it (some of them are not as smart as you).

13 Product Use Make a best estimate (%) for each item

14Where is the product usedProvide a building number or location
15DODAC/Cost CenterEnter your DODAC for your unit/activity
16ProcessCircle the appropriate answer
17Technical ReferenceWhere is the authorization to use this HAZMAT? I.E, TM,LO,Etc.
18Requestor NameYour name
19Technical POCWho can answer questions about the process using the HAZMAT
20OrganizationWhere do you come from
21Date RequestedDate HMAR form is completed

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