W911SA-21-Q-3036 Attachment 4 (Sample Service Ticket).docx

On Site Service Ticket – Snow Removal Version 1.5; 01 May 2019 Contract number: _____________________ Location: _____________________ DATE: __________ Time Vendor Called: ____________ Snow Depth: ____________ Time Service Performed: ______________ SNOW REMOVAL TYPE (include all) ☐Type 1 (All – Roads, Sidewalks, POV Parking, MEP Parking) ☐Type 2 (Roads, Sidewalks, POV Parking only) ☐Type 3 (MEP Parking Only) ☐Type 4 (Sidewalks Only) ☐Type 5 (Plowing, Salting and Sanding – Ice Storm only) ☐Type 6 (Haul excess snow from site if required) ☐Type 8 (End of Season Cleanup, Sweep Parking lots & remove debris)

Comments

Check In/Out Employee(s) Name (print):___________________________________________________

Designated Rep. Signature: ___________________________________________________ Designated Rep. Print Name: _________________________________________________

This Service Ticket shall be filled out by the contracted vendor each time the service provider performs services on location. This service ticket does not provide proof of inspection or acceptance of services. The Government reserves the right to fully inspect work performance of all requirements under contract any time or place it deems necessary.