B08 Appendices I-XII 0001.pdf

Electronic Invoicing Instructions for the USACE Finance Center

In lieu of submitting a hardcopy invoice to the USACE Finance Center (UFC) in Millington, TN via the United States Postal Service per the contract instructions in Block 18a, you may submit an electronic version via email per the instructions below:

1. Save or scan the invoice so that it is an electronic (pdf) file.

2. Circle the amount to be paid. See Attached Example.

3. File name of the INVOICE must be the obligation number. (ex: W911WN-00-X-0000).

4. Attach the Invoice (see # 3) to an email. Make sure the file name is the obligation number.

5. The subject line of the email should contain only the OBLIGATION number (same as the INVOICE file name)

6. Email the PDF file to: CEFC-H4 Invoices@usace.army.mil and CC your contracting POC as well as the USACE project POC to whom the goods or services were delivered to confirm receipt.

7. You can only submit 1 invoice per email to the UFC. If you need to submit 3 invoices then you must send 3 separate emails.

8. See below for a sample email submission to the UFC.

9. This process does not apply to ENG93 payments; i.e. Progress payments for construction and Architect/Engineer contracts.

Appendix I

Items to Note:

1. Circle the dollar amount to be paid on the invoice

2. If you are sending multiple invoices to the Finance Center, each invoice must be sent down in a separate email. Only 1 invoice per email.

3. The attached invoice’s file name must be the obligation number.

4. The subject of the email to the UFC must also be the obligation number.

5. Email is sent to CEFC-H4 Invoices@usace.army.mil AND

6. CC the USACE contracting POC and the USACE Project POC to whom the goods or services were provided.

7. This new process does not apply to ENG93 payments; i.e. Progress payments for construction and Architect/Engineer contracts.

Appendix I

Vendor Registration Page 1 of 17

Built with Tanida Demo Builder www.demo-builder.com

Intro

Welcome to Procurement Integrated Enterprise Environment (PIEE). This demonstration contains audio narrative. Please adjust your volume accordingly.

Step 1

This is an overview of the registration process for Vendor users in PIEE. Please note that all data entered in this demo do not reflect actual user requirements and are for purposes of example only.

Procurement Integrated Enterprise Environment (PIEE) Vendor Registration

Appendix II

Vendor Registration Page 2 of 17 www.demo-builder.com

Step 2

Vendors will need to take the following steps to establish an account in PIEE:

Complete Vendor activation requirements specified in the Vendors Getting Started section of the Help/Training page.

Self-register as a Vendor or Contractor with the user's CAGE code(s).

Step 3

Review the Privacy Statement and Warning messages and select the Accept button.

Vendor Registration Page 3 of 17 www.demo-builder.com

Step 4

To begin the Vendor registration process, select the Start the registration process link.

Step 5

Select the Agree button to accept the Privacy Act Statement.

Vendor Registration Page 4 of 17 www.demo-builder.com

Step 6

Select Vendor from the role type list.

Step 7

Select the appropriate authentication type from the dropdown list. For training purposes, this presentation demonstrates the use of user ID and password authentication.

Vendor Registration Page 5 of 17

Step 8

Enter a user ID in the User ID field. Enter and confirm the desired password in the Password and Password Confirmation fields.

Enter the CAPTCHA in the CAPTCHA Image field. Select the Next button to continue.

Step 9

Select the desired security questions from the Question dropdown menus and complete all Answer fields. Select the Next button to continue.

Vendor Registration Page 6 of 17

Step 10

Complete all required fields on the User Profile page. PLEASE NOTE: The data presented in the following demonstrations (CAGE Code, DoDAAC, user profile information, etc.) are for purposes of example only. All users must utilize their own personal information.

Step 11

Upon completion of the User Profile information, the user may save the registration by selecting the Save Registration button.

The user will have 30 days to complete the registration upon saving.

Vendor Registration Page 7 of 17 www.demo-builder.com

Step 12

Upon selecting the Save Registration button, the user may select Continue Registration or Exit Registration And Finish Later.

Step 13

Select the Next button to continue.

Vendor Registration Page 8 of 17 www.demo-builder.com

Step 14

Complete all required fields on the Additional Profile Information page. Select the Next button to continue.

Step 15

The Roles page is displayed. Expand the Application dropdown menu in Step 1 to view all applications available to Vendors within PIEE.

Vendor Registration Page 9 of 17 www.demo-builder.com

Step 16

Select the desired application from the dropdown menu.

Step 17

Upon selection of the desired application, a list of available roles will be displayed in Step 2. Select the appropriate role and select the Add Roles button.

Vendor Registration Page 10 of 17 www.demo-builder.com

Step 18

The selected role is displayed in the Roles Summary section. Enter the appropriate CAGE code in the Location Code field. If it is unknown which CAGE should be used, users should contact their Contractor Administrator (CAM).

Step 19

If the CAGE code has an extension, enter it in the Extension field.

Vendor Registration Page 11 of 17 www.demo-builder.com

Step 20

Multiple Vendor roles may be added simultaneously. To add another role, select the desired application and role in Steps 1 and

2. Select the Add Roles button.

Step 21

If the user adds a role for which additional information is required, an info message will direct the user to the Group Lookup tool. Select Group Lookup from the Action column for the role requiring additional information.

Vendor Registration Page 12 of 17 www.demo-builder.com

Step 22

The user may search the directory using Group Name or Location. Expand the Search dropdown and select the desired option.

Enter the search criteria in the Group Search field and select the Search button.

Step 23

The search criteria will return a list of matching groups. Select the appropriate group from the Group Name list.

Vendor Registration Page 13 of 17 www.demo-builder.com

Step 24

The group name is displayed in the Group column. When finished adding roles, select the Next button to continue.

Step 25

Enter appropriate data in the Justification field. Attachments are optional. Select the Next button to continue.

Vendor Registration Page 14 of 17 www.demo-builder.com

Step 26

The Registration Summary page is displayed. The user may review all data entered during the registration process. Upon confirming all registration information, select the Next button to continue.

Step 27

The Agreement page is displayed. Review the Statement of Accountability Agreement and Government /Contractor Admin Appointment Letter.

Vendor Registration Page 15 of 17 www.demo-builder.com

Step 28

When finished reviewing all Agreements, select the Signature button to confirm agreement and submit the registration.

Step 29

A systematically generated one-time password is required to complete submission of the registration. A notification will be displayed indicating the expiration time of the password.

Vendor Registration Page 16 of 17 www.demo-builder.com

Step 30

The one-time password will be sent to the email address provided during registration.

Step 31

Enter the one-time password in the OTP field. Select the Submit Registration button to complete the Vendor registration process.

Vendor Registration Page 17 of 17 www.demo-builder.com

Step 32

The Successful Registration page will be displayed to confirm successful completion of the Vendor registration process.

End

This concludes our demonstration.

Appendix III

(Put on Company Letterhead)

QUALITY CONTROL PLAN W911WN-23-D-

X3XXX

Building and Grounds Maintenance Service Shenango River Lake

Hermitage

COR

Appendix IV Contract Overview

Workbook

Month/Year:Contractor must maintain employee records per FAR 52.222-17.

Number of new employees placed on contract in the last month: Number of employees on contract:

Date of Monthly Safety Meeting:

Date of next Monthly Safety Meeting:COR is to be invited 7 days in advance Total Hours worked for the Month:

Contractor is to complete Sections a through m.

1 AT/OPSEC 1: All contractor employees, to include subcontractor employees, requiring access to Army installations, facilities, 2 controlled access areas, or require network access, shall complete AT Level I awareness training within 30 calendar days after 3 contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. Upon request, 4 the contractor shall submit submit certificate of completion for each affected contractor employee and subcontractor employee, 5 to the COR or to the Contracting Officer (if a COR is not assigned), within 5 calendar days after completion of training by all 6 employees and subcontractor personnel AT Level I awareness training is available at the following website:

7 https://jko.jten.mil/courses/atl1/launch.html; or it can be provided by the Contracting Officer Representative (COR) in presentation

8 form which will be documented via memorandum.

10 AT/OPSEC 2. The contractor and all associated subcontractors' employees shall comply with applicable installation, facility, and area 11 commander installation and facility access and local security policies and procedures (provided by the Government Representative).

12 The contractor shall also provide all information required for background checks to meet installation access requirements to be 13 accomplished by the installation the USACE Security Office. The contractor workforce must comply with all personal identity

14 verification requirements as directed by DoD, HQDA, and/or local policy. In addition to the changes otherwise authorized by the 15 Changes clause of this contract, should the Force Protection Condition (FPCON) at any individual facility or installation change, the

16 Government may require changes in contractor security matters or processes. The contractor must submit the full name, Social 17 Security Number, Date of Birth, and Place of Birth for all associated contractor or subcontractor employees to the USACE Security 18

Stephen Davidson, 412-395-7504, stephen.davidson@usace.army.mil. The District retains the right to deny any contractor and 19 subcontractor employee from working on one of its contracts based on final background investigation results.

21 AT/OPSEC 4. The contractor and all associated sub-contractors shall receive a brief/training (iWatch provided by the COR) on the local 22 suspicious activity reporting program. This locally developed training will be used to inform employees of the types of behavior to 23 watch for and instruct employees to report suspicious activity to the project manager, security representative, or law enforcement entity. 24 This training shall be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing 25 performance with the results reported to the COR NLT 5 calendar days after the completion of the training.

Subcontractors: AT/OPSEC 13. All contract employees, including subcontractor employees who are not in possession of the appropriate security clearance or access privileges, will be escorted in areas where they may be exposed to classified and/or sensitive materials and/or sensitive or

Solid Waste Subcontractor Name Contact Name Title Phone E-mail On Contract? restricted areas.

Contract Number:

Contract Name:

W911WN

Prime Contractor:

Roster of employees on predecessor contract provided to current KTR?

Contractor Employee Name: Contract

Date of

AT/OPSEC 15. The Contractor must pre-screen Candidates using the E-verify Program (http://www.uscis.gov/e-verify) website to meet the established employment eligibility requirements. The vendor must ensure that the candidate has two valid forms of Government issued identification prior to enrollment to ensure the correct information is entered into the E-verify system. An initial list of verified/eligible Candidates must be provided to the COR no later than 3 business days after the initial contract award.

Subcontractor Name Contact Name Title Phone E-mail

Appendix III

For more information on Activity Hazard Analyses, see USACE Safety Manual:

https://www.publications.usace.army.mil/Portals/76/Publications/EngineerManuals/EM_385-1-1.pdf To be completed by COR

Activity Analysis on File

Appendix IV

Required Submittals

To be completed by COR

On File Notes n/a

NOTE: Only Solid Waste Subcontractor

Subcontractor Name employees are exempt

Contact Name from the AT/OPSEC requ

Title irements

Phone E-mail

Subcontractor Name Contact Name Title Phone E-mail

See tab.

See tab.

See tab.

7See tab.

9BASE OY1 OY2 OY3 OY4

10Date Submitted:

Quality Control Plan

Contractor Quality Control Inspector.

List of Quality Control Inspector(s) and contact information.

Contractor Representatives.

List of names of Contractor’s authorized representative(s) and contact information.

Accident Prevention Plan (APP).

A suggested outline for the Contractor’s Accident Prevention Plan is in Attachment 2. See Section C-1.9.b for APP requirements.

a. Accident History

b. Safety Deficiency Tracking Table

c. Emergency Response Plan

d. First Aid & CPR Certificates

e. Hazardous Material Communication Plan

f. Drug and Alcohol Abuse Prevention Program

Emergency Contacts.

A prioritized list, including phone numbers, of those persons (normally Contractor authorized representatives) to call in case of emergencies.

Certificates of Insurance

Does insurance meet requirements in PWS C-1.32?:

Workers's Compensation & Employer's Liability: $100,000 (PA) and as legally required by the state (OH and WV) Comprehensive General Liabilty: Bodily Injury $500,000 per occurrence & Property Damage $100,000

Automotive Liabilty: Bodily Injury $200,000 per person/$500,000 per occurrence & Property Damage $20,000

Security Requirements

A letter of compliance and a signed release from the dump site property owner.

A letter from either the sewage plant accepting sewage or the state environmental agency approval of an alternate dump site.

Annual Pest Control Plan by 12/1

For more information on Material Safety Data Sheets/Safety Data Sheets, see USACE Safety Manual:

https://www.publications.usace.army.mil/Portals/76/Publications/EngineerManuals/EM_385-1-1.pdf To be completed by COR

Product/Material On file

Appendix III

Contractor Representatives.

List of names of Contractor’s authorized representative(s) and contact information. To be completed by contractor.

Name Title Office Cell E-mail

Appendix III

Emergency Contacts.

A prioritized list, including phone numbers, of those persons (normally Contractor authorized representatives) to call in case of emergencies. To be completed by contractor.

Name Title Office Cell E-mail

PWS C-1.9 Safety and Security Requirements requires the Contractor to comply with the Occupational Health and Safety Act and USACE Manual EM 385-1-1.

Per 01.A.17 of EM 385-1-1, The Contractor Site Safety and Health Officer (SSHO) is:

Contractor Quality Control Inspector.

List of Quality Control Inspector(s) and contact information.

To be completed by contractor.

Name Title Office Cell E-mail

Appendix IV

Executive Order No. 11246, Equal Employment Opportunity, dated 24 September 1965, as amended; Section 503 of the Rehabilitation Act of 1973; and Section 402 of the Vietnam Era Veterans Readjustment Assistance Act of 1974

Your contract, (see FAR Clause 52.212-5) also requires you to display in conspicuous places, available to employees, applicants for employment, and representatives of each labor union with which you have a collective bargaining agreement, a poster setting forth the provisions of the "Equal Opportunity", the "Equal Opportunity for Workers with Disabilities," and the Equal Opportuniy for Veterans clauses. Your service contract also requires you to display (see FAR Clause 52.222-41) the Employees Rights on Government Contracts poster, WHD1313

Poster

Displayed

Business Union USACE Project - fill in where these are located.

Equal Opportunity

Equal Opportunity for Workers with Disabilities

Equal Opportunity for Veterans

Employee Rights on Government Contracts poster WHD1313

Appendix V

ACCIDENT PREVENTION PLAN

Building and Grounds Maintenance Services Shenango River Lake

Contract Number Contractor Name

1. SIGNATURE SHEET.

This Accident Prevention Plan was

Prepared By:

Name Title of corporate safety staff person

Approved By:

Name President

2. BACKGROUND INFORMATION

a. Contractor: Name Address City, State Zip

b. Contract Number W911WN-19-D-3###

c. Project Name: Shenango River Lake

d. Project Description: Building and Grounds Maintenance Service

e. Name of Company’s recent accident history is included as Attachment #__ to this Accident Prevention Plan. Information included includes EMR, OSHA 200 Forms and corporate safety trend analyses.

f. The Major definable features of work are: ______________________________. An Activity Hazard Analysis (AHA) will be prepared for each Major Definable Feature of Work. AHAs will be prepared in accordance with the format shown on page 4 of EM 385-1-1 and will be presented and discussed at the Preparatory Phase Inspection for the applicable feature of work.

3. STATEMENT OF SAFETY AND HEALTH POLICY

Enter statement which describes the company‘s commitment to safety.

4. RESPONSIBILITIES AND LINES OF AUTHORITIES

a. Name - Describe responsibility and accountability of personnel responsible for safety at corporate level.

b. Name - Describe responsibility and accountability of personnel responsible for safety at project level.

c. Lines of authority - Describe lines of authority (as related to safety) for this project.

5. SUBCONTRACTORS AND SUPPLIERS.

a. The following subcontractors will be working on this project:

1. List

b. The CQC System Manger (if someone else, identify) will be responsible for controlling and coordinating subcontractors and suppliers.

c. All subcontractors and suppliers performing work on site will be expected to conform to the requirements of this Accident Prevention Plan and to the requirements of EM 385-1-1.

6. TRAINING.

a. Each employee will receive a safety indoctrination consisting of a thorough review of applicable AHA’s.

b. The following is a list of mandatory training and certifications which are applicable to this project:

1. Vehicle Operator

2. Personal Protective Equipment)

3. Other

c. The following identifies requirements for periodic retraining or recertification relating to item b above.

1. List

d. The following individuals shall be trained in the contents of the Emergency Response Plan discussed in Section 12 of this Accident Prevention Plan:

1. List

e. Weekly toolbox safety meeting will be conducted at TIME every ENTER DAY OF WEEK. Each on site worker will be required to attend. Attendance will be documented. Name will be responsible for conducting these meetings.

7. SAFETY AND HEALTH INSPECTIONS.

a. Name will conduct site safety inspections on a daily basis. Any noted deficiencies will be identified on that day’s CQC Report. Deficiencies will be tracked using the table included as Attachment # __ to this Accident Prevention Plan.

b. The following external inspections/certifications are required for this project:

List or enter “None Required”.

8. SAFETY AND HEALTH EXPECTATIONS, INCENTIVE PROGRAMS, AND

COMPLIANCE

a. Provide a statement or statements describing the company's written safety program goals, objectives, and accident experience goals for this contract.

b. Provide a brief description of the company's safety incentive programs (if any). If none, so state.

c. Provide a discussion of the company’s policies and procedures regarding noncompliance with safety requirements (to include disciplinary actions for violation of safety requirements).

d. Provide written company procedures for holding managers and supervisors accountable for safety.

9. ACCIDENT REPORTING

a. Name will submit Monthly Manhour Exposure Reports to the Contracting Officer no later than the 5th work day of each month. The report encompasses on-site work including all hourly and salaried employees. The report will include all subcontractors working on this project.

b. Name will complete the report and submit it to the Contracting Officer within five (5) workdays.

c. Name will immediately notify the Contracting Officer and District Safety Officer of any incidents involving a fatality or permanent total disability, accidents in which three or more persons are hospitalized, accidents that result in property damage in excess of $100,000 or any accident regardless of the consequences, if it is suspected that it will result in unfavorable criticism of the Corps of Engineers..

10. MEDICAL SUPPORT

a. A list of emergency telephone numbers and a map of directions to the nearest hospital(s) is included in the Emergency Response Plan section of this Accident Prevention Plan.

b. First aid kits will be maintained on site as required in Section 3 of EM 385-1-1.

c. At least two employees on each shift will be qualified to administer first aid and CPR.

Individuals who are required to work alone in remote areas shall be trained in first aid. The following employees are certified in First Aid and CPR and a copy of their current certificates are included as Attachment # __ to this Accident Prevention Plan:

1. List

11. PERSONAL PROTECTIVE EQUIPMENT.

a. Outline procedures (who, when, how) for conducting hazard assessments and written certifications for use of personal protective equipment.

12. PLANS (PROGRAMS, PROCEDURES) REQUIRED BY THE SAFETY MANUAL (as applicable)

a. Hazard Communication (HAZCOM) Program (01.B.04)

Included as Attachment # __ to this Accident Prevention Plan is a written hazard communication program addressing as a minimum, the following: training (to include potential safety and health effects from exposure), labeling, current inventory of hazardous chemicals on site, and the location and use of Material Safety Data Sheets (MSDSs).

b. Emergency Response Plans (01.E.01, 01.E.05, 06.A.02, 19.A.04, 09.K.01 and 09.K.02)

An Emergency Response Plan is included as Attachment # __ to this Accident Prevention Plan.

This Emergency Response Plan includes:

An Emergency Response Plan to ensure employee safety in case of fire or other emergency.

Emergency telephone numbers and reporting instructions for ambulance, physician, hospital, fire, and police. Also included is a map of directions to the nearest hospital(s). This list and map shall be conspicuously posted at the work site.

c. Respiratory Protection Plan (05.E.01)

Name of Company‘s Respiratory Protection Plan is included as Attachment # __ to this Accident Prevention Plan.

d. Health Hazard Control Program (06.A.02)

Activity Hazard Analyses (AHA’s) shall consider all substances, agents and environments that present a hazard and will recommend hazard control measures. Engineering and administrative controls shall be used to control hazards. In cases where engineering or administrative controls are not feasible, PPE may be used. The AHA shall serve as certification that a hazard assessment has been conducted.

e. Plan for Prevention of Alcohol and Drug Abuse (Defense Federal Acquisition Regulation Supplement Subpart 252.223-7004, Drug-Free Work Force)

Name of Company‘s plan for prevention of Alcohol and Drug Abuse is included as Attachment # __ to the Accident Prevention Plan. This plan meets the minimum requirements of

DFAR 252.223-7004.

13. Detailed site specific hazards and controls will be provided in the activity hazard analysis (AHA) for each phase of the operation (each Major Definable Feature of Work as defined by the Contractor Quality Control Plan). The AHA’s will provide information on how the requirements of major sections of EM 385-1-1 will be met. Particular attention shall be paid to excavations, scaffolding, medical and first aid requirements, sanitation, personal protective equipment, fire prevention, machinery and mechanized equipment, electrical safety, public safety requirements, and chemical, physical agent, and biological occupational exposure prevention requirements.

AHA’s will be prepared utilizing the format shown on page 4 of EM 385-1-1.

Attachments Attachment # - Accident History Attachment # - Safety Deficiency Tracking Table Attachment # - Emergency Response Plan Attachment # - First Aid and CPR certificates Attachment # - Hazard Communication (HAZCOM) Program Attachment # - Emergency Response Plan Attachment # - Plan for Prevention of Alcohol and Drug Abuse

NAME (Last, First Middle) DOB (mm/dd/yyyy) SSN (no dashes)

CUI

Controlled by: USACE Controlled by: CELRP-SM Category: PRVCY Distribution: FED ONLY

POC: See below

CUI

CUI

Primary Contact: Ivan Russell - Security Specialist 412-395-7591 ivan.r.russell@usace.army.mil

Alternate Contact: Andrew Wasko - Security Specialist 412-395-7643 andrew.j.wasko@usace.army.mil

Chief of Security: Joe Bali 412-395-7162 joseph.m.bali@usace.army.mil

Contract Location: Company POC Name:

CUI

Contract Number: Army COR Name:

Please do not send multiple 1-2 person requests in a single day

Appendix VI

Appendix VII

Appendix VIII (For I REPORT NO. I EROC I UNITED ST ATES ARMY CORPS OF ENGINEERS I REQUIREMENT Safety CODE

ACCIDENT INVESTIGATION REPORT CONTROL SYMBOL:

Staff only) /For Use of this Form See Helo Menu and USACE Sunn/ to AR 385-40! CEEC-S-8(R2)

1. ACCIDENT CLASSIFICATION

PERSONNEL CLASSIFICATION INJURY/ILLNESS/FATAL PROPERTY DAMAGE MOTOR VEHICLE INVOLVED DIVING

GOVERNMENT

0 CIVILIAN □ MILITARY □ □

FIRE

□ OTHER □ □ INVOLVED

0 CONTRACTOR □ 0 FIRE

INVOLVED □ OTHER □ □

□ PUBLIC 0 FATAL 0 OTHER

2. PERSONAL DATA

a. Name (Last, First, Ml) b. AGE I

c. SEX d. SOCIAL SECURITY NUMBER l e.GRADE

□ MALE 0 FEMALE

f. JOB SERIES/TITLE g. DUTY STATUS AT TIME OF ACCIDENT h. EMPLOYMENT STATUS AT TIME OF ACCIDENT

□ ARMY ACTIVE □ ARMY RESERVE □ VOLUNTEER

0 ON DUTY □ TDY □ PERMANENT □ FOREIGN NATIONAL □ SEASONAL

□ TEMPORARY □ STUDENT

0 OFF DUTY □ OTHER (Specify)

3. GENERAL INFORMATION

a. DATE OF ACCIDENT b. TIME OF ACCIDENT c. EXACT LOCATION OF ACCIDENT d. CONTRACTOR'S NAME

(month/day/year) (Military time)

(1) PRIME:

hrs

e. CONTRACT NUMBER f. TYPE OF CONTRACT g. HAZARDOUS/TOXIC WASTE

ACTIVITY

CONSTRUCTION SERVICE

□ SUPERFUND □ DERP (2) SUBCONTRACTOR:

□ CIVIL WORKS 0 MILITARY □ A/E □ DREDGE

□ IRP □ OTHER (Specify)

□ OTHER (Specify) □ OTHER (Specify)

4. CONSTRUCTION ACTIVITIES ONLY /Fill in line and corresoondino code number in box from list - see helo menu/

a. CONSTRUCTION ACTIVITY (CODE) b. TYPE OF CONSTRUCTION EQUIPMENT (CODE)

I# I I#

5. INJURY/ILLNESS INFORMATION (Include name on line and corresoondino code number in box for items e f & o - see helo menu

a. SEVERITY OF ILLNESS/INJURY

e. BODY PART AFFECTED

PRIMARY

SECONDARY

f. NATURE OF ILLNESS/INJURY

6.

a. ACTIVITY AT TIME OF ACCIDENT

7.

b. ESTIMATED c. ESTIMATED

(CODE) DAYS LOST DAYS HOSPIT-

I# I

ALIZED

(CODE) g. TYPE AND SOURCE OF INJURY/ILLNESS

I# I

(CODE)

I# I TYPE

(CODE)

I# I

SOURCE

PUBLIC FATALITY /Fill in line and corresoondence code number in box - see helo menu/

I#

!CODE!

I

b. PERSONAL FLOATATION DEVICE USED?

0 YES O NO

MOTOR VEHICLE ACCIDENT

d. ESTIMATED DAYS

RESTRICTED DUTY

(CODE)

I#

(CODE)

I#

□ N/A

I

I

I

a. TYPE OF VEHICLE b. TYPE OF COLLISION c. SEAT BEL TS USED NOT USED NOT AVAILABLE

[I] PICKUP/VAN [I] AUTOMOBILE □ SIDE SWIPE □ HEAD ON 0 REAR END (1) FRONT SEAT

[I] TRUCK [I] OTHER (Specify) □ BROADSIDE □ ROLL OVER □ BACKING

□ OTHER (Specify) (2) REAR SEAT

8. PROPERTY /MATERIAL INVOLVED

a. NAME OF ITEM b. OWNERSHIP c. $ AMOUNT OF DAMAGE

(1)

(2)

(3)

9. VESSEL/FLOATING PLANT ACCIDENT /Fill in line and corresnondence code number in box from list - see heln menu/

a. TYPE OF VESSEL/FLOATING PLANT (CODE) b. TYPE OF COLLISION/MISHAP (CODE)

I# I I#

10. ACCIDENT DESCRIPTION /Use additional oaoer if necessaNI

I

ENG FORM 3394, MAR 99 Version 2 EDITION OF SEP 89 IS OBSOLETE. Page 1 of 4 pages (Proponent: CESO )

Base

O ctober

N ovem ber D ecem ber January

February M arch April

M ay

June July

August Septem ber Total

Type 1 M ow s

Type 2 M ow

Pruning

Brush Rem oval

Clearing Access Road

M ulch Shrub Beds

Leaf Rem oval

Trail M aintenance

Top Soil Placem ent

Turf G rass Establishm ent

H erbicide

Clean Park O ffice

Clean Control Tow er

Clean O utflow Restroom

Clean Concession Restroom

Clean Cam pground Restroom

Clean Beach Restroom

Clean H eritage &

Tall Tree Restroom s

Clean H ancock Bend Restroom

Clean Justice Restroom

W ax M aintenance Bldg Floor

Clean Park O ffice and Visitor Center Carpets

G rill and Fire Ring Cleaning

Clean Picnic Pavilions

Pressure W ash

Em ergency Cleaning

Exterior Trash Receptacles

Solid W aste Rem oval

Raw Sew age Rem oval

D rift Rem oval

Beach Inspection

Beach G room ing

Bold = m onths w ith 5 w eeks in 2023-2024

Appendix IX Actual Services Performed

ANTICIPATED USAGE REPORT ACTUAL USAGE REPORT DATE OF REPORT: .

FIELD OFFICE: . DISTRICT: PITTSBURGH .

APPLICATION INFORMATION:

APPLICATE ACCOMPLISHMENT: IN-HOUSE ___CONTRACT NEGATIVE REPORT ___

NAME OF APPLICATOR/CONTRACTOR: ________

APPLICATOR LICENSE NO. ________

PESTICIDE INFORMATION:

*PESTICIDE TRADE NAME: ______________ EPA REG. NO. _

EPA CLASS: GENERAL-USE PESTICIDE __ ___ RESTRICTED-USE PESTICIDE ______

% ACTIVE INGREDIENT: .

DILUTENT: ___ _________ MIXING RATE: .

APPLICATION RATE: _ _ METHOD OF APPLICATION: __

NO. OF APPLICATIONS . ACTIVITY HAZARD ANALYSIS WILL BE CONDUCTED: .

SITE INFORMATION:

DESCRIPTION OF TREATMENT SITE (S):

TOTAL ESTIMATED ACREAGE TREATED: . QUANTITY OF PESTICIDE USED: .

TARGET PEST (S): .

PLAN SUBMITTED BY: ___ _ PLAN APPROVED BY: _ ______

Pesticides include fungicides, herbicides, insecticides, larvicides and rodenticides (See ER 1130-2-540, dated 15 November 96).

Appendix X

ANNUAL PEST CONTROL PLAN

FOR CALENDAR YEAR ______

PESTICIDE APPLICATION RECORD 11. START DATE (YYYYMMDD)

2 INSTALLATION

3 SITE TREATED

4. PEST TREATED

5. PURPOSE

SECTION I - CONDITIONS DURING TREATMENT

1. AIR TEMPERATURE (Fahrenheit Degrees) 12. WATER TEMPERATURE (Fahrenheit Degrees if applicable)

3. OVERCAST (Percentage %) 14. WIND DIRECTION (N, NE, E, SE, S, SW, W or NW) 15. WIND VELOCITY (mph)

SECTION II - PESTICIDE RECORD

1. COMMON NAME

2. ACTIVE INGREDIENT AND PERCENTAGE%

3. MANUFACTURER 14. REGISTRATION NUMBER

5. REGISTRERED USE

6. MATERIAL SAFETY DATA SHEETS (MSDS) AVAILABLE 0 YES ONO

7. PERSONAL PROTECTION EQUIPMENT DEVICE WORN DURING APPLICATION O MASK (Dust Unfiltered)□ BREATHING APPARATUS

0 MASK (Filtered) 0 EYEWEAR 0 GLOVES O BOOTS 0 HOOD O PROTECTIVE SUIT 0 TREATED AREA ENCLOSED

0 TREATED AREA OPEN (Ventilated) 0 NONE REQUIRED OR WORN PER MSDS DATA 0 OTHER SAFETY REQUIREMENTS

8. MIXTURE OR FORM APPLIED (e.g., 20 to 1, Spray, paste, poured, fumigation or Solid)

9. APPLICATION RA TE 110. APPLICATION METHOD

11. SPECIAL PRECAUTIONS TAKEN (if none so state)

12. NUMBER OF PERSONNEL USED IN APPLICATION (list other personnel in remarks below)

13. OTHER EQUIPMENT USED NOT PREVIOUSLY LISTED

14. ACCUMULATIVE TREATMENT (Quantity of Pesticide applied to a 15. COOPERATING AGENCIES given area during the calendar year)

a. UNITS TREATED b. QUANTITY USED

(1) PREVIOUS (1) PREVIOUS

(2) PRESENT (2) PRESENT

(3) TOTAL (3) TOTAL

16. REMARKS

SECTION 111- CERTIFIED APPLICATOR'S SIG�ATURE CERTIFICATION

I HEREBY CERTIFY THAT THIS INFORMATION IS A TRUE AND CORRECT RECORD OF THE PESTICIDE APPLICATION.

1. OTHER DOCUMENTATION ATTACHED

0 YES 0 NO

CELRI FORM 1031, APR 2010

2a. DATE (YYYYMMDD) b. SIGNATURE (Certified Applicator)

PREVIOUS EDITIONS ARE OBSOLETE. VERSION 11

Appendix XI

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ATTACHMENT 6

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Form PPQ -0 (9/30/11)

NAVFAC/USACE PAST PERFORMANCE QUESTIONNAIRE (Form PPQ-0) CONTRACT INFORMATION (Contractor to complete Blocks 1-4)

CAGE Code: ______________ DUNs Number: _______________________

1. Contractor Information Firm Name: _______________________________________________ Address: ________________________________________________ Phone Number: __________________________________________ Email Address: ____________________________________________ Point of Contact: ___________________________________________ Contact Phone Number: ______________

Sub Contractor Joint Venture Other (Explain)2. Work Performed as: Prime Contractor Percent of project work performed: _________ If subcontractor, who was the prime (Name/Phone #): ___________________________________________________

Cost Reimbursement Other (Please specify):

3. Contract Information Contract Number: ____________________________________ Delivery/Task Order Number (if applicable): ________________________________________ Contract Type: Firm Fixed Price ____________________ Contract Title: ______________________________________________________________________ Contract Location: __________________________________________________________________

Award Date (mm/dd/yy): ________________________ Contract Completion Date (mm/dd/yy): _________________ Actual Completion Date (mm/dd/yy): ___________________ Explain Differences: _______________________________________________________________________________

Original Contract Price (Award Amount): _________________ Final Contract Price (to include all modifications, if applicable): ___________________ Explain Differences: _______________________________________________________________________________

4. Project Description:

Complexity of Work High Med Routine How is this project relevant to project of submission? (Please provide details such as similar equipment, requirements, conditions, etc.) __________________________________________________________________________________

CLIENT INFORMATION (Client to complete Blocks 5-8)

5. Client Information Name: _________________________________________ Title: __________________________________________ Phone Number: _________________________________ Email Address: ______________________________________________

6. Describe the client’s role in the project: ___________________________________________________________

7. Date Questionnaire was completed (mm/dd/yy): _____________________

8. Client’s Signature: ______________________________________________

NOTE: NAVFAC/USACE requests that the client completes this questionnaire and submits directly back to the offeror.

The offeror will submit the completed questionnaire to USACE with their proposal, and may duplicate this questionnaire for future submission on USACE solicitations. Clients are highly encouraged to submit questionnaires directly to the offeror. However, questionnaires may be submitted directly to USACE. Please contact the offeror for USACE POC information. The Government reserves the right to verify any and all information on this form.

Appendix XII

NAVFAC / USACE Past Performance Questionnaire (PPQ)

ADJECTIVE RATINGS AND DEFINITIONS TO BE USED TO BEST REFLECT

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE

RATING DEFINITION NOTE

(E) Exceptional Performance meets contractual requirements and exceeds many to the Government/Owner’s benefit.

The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor was highly effective.

An Exceptional rating is appropriate when the Contractor successfully performed multiple significant events that were of benefit to the Government/Owner. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

(VG) Very Good Performance meets contractual requirements and exceeds some to the Government’s/Owner’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

A Very Good rating is appropriate when the Contractor successfully performed a significant event that was a benefit to the Government/Owner. There should have been no significant weaknesses identified.

(S) Satisfactory Performance meets minimum contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

A Satisfactory rating is appropriate when there were only minor problems, or major problems that the contractor recovered from without impact to the contract. There should have been NO significant weaknesses identified. Per DOD policy, a fundamental principle of assigning ratings is that contractors will not be assessed a rating lower than Satisfactory solely for not performing beyond the requirements of the contract.

(M) Marginal Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor's proposed actions appear only marginally effective or were not fully implemented.

A Marginal is appropriate when a significant event occurred that the contractor had trouble overcoming which impacted the Government/Owner.

(U) Unsatisfactory Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element contains serious problem(s) for which the contractor's corrective actions appear or were ineffective.

An Unsatisfactory rating is appropriate when multiple significant events occurred that the contractor had trouble overcoming and which impacted the Government/Owner. A singular problem, however, could be of such serious magnitude that it alone constitutes an unsatisfactory rating.

(N) Not Applicable No information or did not apply to your contract Rating will be neither positive nor negative.

TO BE COMPLETED BY CLIENT

PLEASE SELECT THE ADJECTIVE RATING WHICH BEST REFLECTS

YOUR EVALUATION OF THE CONTRACTOR’S PERFORMANCE.

1. QUALITY

a) Quality of technical data/report preparation efforts E VG S M U N

b) Ability to meet quality standards specified for technical performance E VG S M U N

c) Timeliness/effectiveness of contract problem resolution without extensive customer guidance E VG S M U N

d) Adequacy/effectiveness of quality control program and adherence to contract quality assurance requirements (without adverse effect on performance)

E VG S M U N

2. SCHEDULE/TIMELINESS OF PERFORMANCE

a) Compliance with contract delivery/completion schedules including any significant intermediate milestones. (If liquidated damages were assessed or the schedule was not met, please address below)

E VG S M U N

b) Rate the contractor’s use of available resources to accomplish tasks identified in the contract E VG S M U N

3. CUSTOMER SATISFACTION

a) To what extent were the end users satisfied with the project? E VG S M U N

b) Contractor was reasonable and cooperative in dealing with your staff (including the ability to successfully resolve disagreements/disputes;

responsiveness to administrative reports, businesslike and communication)

E VG S M U N

c) To what extent was the contractor cooperative, businesslike, and concerned with the interests of the customer? E VG S M U N

d) Overall customer satisfaction E VG S M U N

4. MANAGEMENT/ PERSONNEL/LABOR

a) Effectiveness of on-site management, including management of subcontractors, suppliers, materials, and/or labor force? E VG S M U N

b) Ability to hire, apply, and retain a qualified workforce to this effort E VG S M U N

c) Government Property Control E VG S M U N

d) Knowledge/expertise demonstrated by contractor personnel E VG S M U N

e) Utilization of Small Business concerns E VG S M U N

f) Ability to simultaneously manage multiple projects with multiple disciplines E VG S M U N

g) Ability to assimilate and incorporate changes in requirements and/or priority, including planning, execution and response to Government changes E VG S M U N

h) Effectiveness of overall management (including ability to effectively lead, manage and control the program) E VG S M U N

5. COST/FINANCIAL MANAGEMENT

a) Ability to meet the terms and conditions within the contractually agreed price(s)? E VG S M U N

b) Contractor proposed innovative alternative methods/processes that reduced cost, improved maintainability or other factors that benefited the client

E VG S M U N

c) If this is/was a Government cost type contract, please rate the Contractor’s timeliness and accuracy in submitting monthly invoices with appropriate back-up documentation, monthly status reports/budget variance reports, compliance with established budgets and avoidance of significant and/or unexplained variances (under runs or overruns)

E VG S M U N

d) Is the Contractor’s accounting system adequate for management and tracking of costs? If no, please explain in Remarks section. Yes No

e) If this is/was a Government contract, has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations? Indicate if show cause or cure notices were issued, or any default action in comment section below.

Yes No

f) Have there been any indications that the contractor has had any financial problems? If yes, please explain below. Yes No

6. SAFETY/SECURITY

a) To what extent was the contractor able to maintain an environment of safety, adhere to its approved safety plan, and respond to safety issues?

(Includes: following the users rules, regulations, and requirements regarding housekeeping, safety, correction of noted deficiencies, etc.)

E VG S M U N

b) Contractor complied with all security requirements for the project and personnel security requirements. E VG S M U N

7. GENERAL

a) Ability to successfully respond to emergency and/or surge situations (including notifying COR, PM or Contracting Officer in a timely manner regarding urgent contractual issues).

E VG S M U N

b) Compliance with contractual terms/provisions (explain if specific issues) E VG S M U N

c) Would you hire or work with this firm again? (If no, please explain below) Yes No

d) In summary, provide an overall rating for the work performed by this contractor. E VG S M U N

Please provide responses to the questions above (if applicable) and/or additional remarks. Furthermore, please provide a brief narrative addressing specific strengths, weaknesses, deficiencies, or other comments which may assist our office in evaluating performance risk (please attach additional pages if necessary):

LRP Annual Pest Control Plan