EXHIBITS_(Revised).pdf

EXHIBIT A

RESERVED

EXHIBIT B

APPROXIMATE QUANTITIES BY AREA

Charles Mill Lake

Item Acres to be Maintained

Area A

Area B

Dike 1

Dike 2

Pavonia Levee

3.5 Tables 25 0 0 0 0 Trash Cans 20 0 0 0 0 Grills 11 0 0 0 0 Restrooms 1 0 0 0 0 Drinking Fountains 1 0 0 0 0 Benches 4 0 0 0 0 Shelters 0 0 0 0 0 Playground Area 1 0 0 0 0

B-1

Mohawk Dam

Area A

5.05 Area B

20.9 Area C

Area D

Tables 0 0 0 0 Trash Cans 6 0 0 0 Grills 0 0 0 0 Restrooms 0 0 0 0 Drinking Fountains 0 0 0 0 Benches 0 0 0 0 Shelters 0 0 0 0

B-2

Mohicanville Dam

Area A 3.5

Area B 10.5

Area C

Area D

Area E

Dike 1

Dike 2

Tables 0 0 0 0 0 0 0 Trash Cans 0 0 0 0 0 0 0 Grills 0 0 0 0 0 0 0 Restrooms 0 0 0 0 0 0 0 Drinking Fountains 0 0 0 0 0 0 0 Benches 0 0 0 0 0 0 0 Shelters 0 0 0 0 0 0 0

B-3

North Branch of Kokosing River Lake

Area A

Area B Area C Area D 40 1 3

Tables 0 0 0 0 Trash Cans 6 0 0 0 Grills 0 0 0 0 Restrooms 0 0 0 0 Drinking Fountains 0 0 0 0 Benches 0 0 0 0 Shelters 0 0 0 0

B-4

Pleasant Hill Lake

Item Area A Area B Area C

Acres to be Maintained 2 6 11 Tables 11 0 0 Trash Cans 8 1 0 Grills 4 0 0 Restrooms 1 0 0 Drinking Fountains 1 0 0 Benches 1 1 0 Shelters 1 0 0

B-5

8-6

EXHIBIT C

ITEMS TO BE PROVIDED ONE WEEK PRIOR TO PRE-WORK CONFERENCE

EXHIBIT C

Contractor shall provide the following, at least 1 week prior to the pre-work conference.

a. Schedule of Cleanings. The schedule provided by the Contractor shall be of sufficient detail to allow the Government to inspect all items of work covered under Section C-4 and Section C-9 of the contact as they are being performed (see Exhibit N). Schedule should include daily and non-daily items.

b. Quality Control P lan. A suggested outline for the Contractor’s Quality Control Plan is contained as Exhibit K.

c. Contractor Representatives. List of names of Contractor Representatives.

d. Contractor Quality Control Inspector. List of Quality Control Inspectors.

e. Contractor Safety Plan. A suggested outline for the Contractor Safety P lan is contained as Exhibit V.

f. Government Furnished Compound Area. A statement concerning the Contractors’ rejection or desire to use a Government furnished compound area.

Above documents shall be typed and legible.

Exhibit C

EXHIBIT D

EXHIBIT E

EXHIBIT F

PROJECT MAPS

(See Drawings)

Mohawk Area A (Red) = 5.05 Acres Area B (Green) = 20.9 Acres Area C (Blue) = 26 Acres Area D (Orange) = 21 Acres Total Mowing at Mohawk = 72.95 Acres

Charles Mill Area A (Red) = 9 Acres Area B (Blue) = 15 Acres

Charles Mill Dikes Dike 1 (Yellow) = 9 Acres Dike 2 (Purple) = 3 Acres

Charles Mill Pavonia Levee Pavonia Levee (Green) = 3.5 Acres

Total Mowing at Charles Mill Dam = 39.5 Acres

Mohicanville Dam Area A (Red) = 3.5 Acres Area B (Light Blue) = 10.5 Acres Area C (Green) = 6 Acres Area D (Orange) = 2 Acres Area E (Dark Blue) = 2 Acres

Mohicanville Dam Dike 1 Dike 1 (Yellow) = 2 Acres

Mohicanville Dam Dike 2 Dike 2 (Purple) = 14 Acres

Total Mohicanville Dam Mowing = 38 Acres

North Branch of Kokosing River Lake Area A (Red) = 6 Acres Area B (Blue) = 40 Acres Area D (Orange) = 3 Acres

North Branch Kokosing River Lake (Bateman Town) Area C (Green) = 1 Acre

Total North Branch of Kokosing Mowing = 50 Acres

Pleasant Hill Dam Area A (Red) = 2 Acres Area B (Blue) = 6 Acres

Pleasant Hill Dam (Fuse Plug) Area C (Orange) = 11 Acres

Total Pleasant Hill Mowing = 19 Acres

EXHIBIT G

EXHIBIT H

EXHIBIT I

EXHIBIT J

CONTRACT DISCREPANCY REPORT (CDR)

(CELRH Form 1104)

CONTRACT DISCREPANCY REPORT

1.CONTRACT NUMBER 2. WORK ORDER NUMBER(s)

3. TO (List Contractor or Manager's Name) 4. FROM (Contracting Officer's Representative)

ACTION DATES

5.PREPARED (YYYYMMDD) 6.ORAL NOTIFICATION

(YYYYMMDD)

7. RETURNED BY CONTRACTOR

(YYYYMMDD)

8. ACTION COMPLETE

9. DISCREPANCY OR PROBLEM (Describe in detail, including references in contract or work order, attach continuation sheets as necessary)

D en a :i:: o mm z -i -i zc z

10a. SIGNATURE DATE (YYYYMMDD) 10b. SIGNATURE OF CONTRACTING OFFICER OR AUTHORIZED REPRESENTATIVE

11. TO (Contracting Officer or Authorized Representative) 12.FROM (Contractor)

13. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT REOCCURENCE (Attach continuation sheet if necessary and cite applicable Quality Control program procedures or new Quality Control procedures).

D en a :i:: o m z m -i -i c z

14a. SIGNATURE DATE (YYYYMMDD) 14b.SIGNATURE OF CONTRACTOR REPRESENTATIVE

15. GOVERNMENT EVALUATION (Acceptable, Partial Acceptance, Rejection, attach continuation sheet if necessary). D en a m:i:: o mz-1 -1-c z

16. GOVERNMENT ACT IONS (Payment Reduction, Cure Notice, Show Cause or Other). D en () :i:: o mm z -1 --1 c z

CLOSE OUT 17a. NAME AND TITLE (First Ml. Last) 17b. DATE (YYYYMMDD) 17c. SIGNATURE

CONTRACTOR NOTIFIED

CONTRACTI NG OFFICER

REPRESENTATIVE (COR)

CONTRACTI NG OFFICER

(CO)

CELRH FORM 1104, APR 2010 PREVIOUS EDITIONS ARE OBSOLETE. VERSION 1 0

EXHIBIT K

SUGGESTED FORMAT, CONTRACTOR QUALITY CONTROL PLAN

CONTRACTORS QUALITY CONTROL PLAN (OUTLINE)

1. INSPECTION OF SERVICES. Define the method of inspection for each in the contract including, but not limited to:

a. The individual(s) who shall inspect the service (Quality Control Inspectors).

b. When or with what frequency inspections shall be performed (e.g. daily, following each cleaning, at the completion of each task, etc.).

c. A copy of the Contractor's inspection forms or other documents identifying the specific tasks involved in the service which shall be inspected.

2. DEFICIENCIES AND CORRECTIVE ACTION. Explain the procedures for identifying deficiencies in the quality of services provided and methods of correction, before the level of performance is unacceptable.

3. RECORDS. Define the method for maintaining records of inspections and records of corrective actions taken, the individual(s) responsible for the records, and the location where the records shall be kept.

4. QUALITY CONTROL INSPECTORS. A consolidated list of authorized Quality Control Inspectors .

5. CONTRACTOR REPRESENTATIVES. A list of names and phone numbers of authorized Contractor Representatives.

6. SECURITY. Define and explain the procedures and safeguards which shall be used to protect all equipment, materials, supplies, tools, and other resources provided by the Government to the Contractor including; but not limited to; Contractor audit procedures and inventory systems, if appropriate. Examples of procedures and safeguards include:

a. All pilferable materials shall be kept under constant surveillance and shall be collected at the end of each work day and secured under lock.

b. Keys shall be removed from all vehicles and equipment when not in use.

c. All gates and doors which were opened to allow Contractor personnel access for work shall be closed and locked. Only authorized Contractor personnel or Government personnel shall be permitted to enter secured areas. The COR or his representative shall be informed immediately if any unauthorized person enters a secured area.

7. CONTRACTOR WASTE REDUCTION PROGRAM. The Contractor shall provide a Waste Reduction Program as prescribed in Section I, Clause 52.223-10. The Contractor shall provide details on the program and state how the program will be complied with and enforced.

EXHIBIT K

EXHIBIT L

SAMPLE INVOICE FORMAT

SAMPLE INVOICE

FROM:

Contractor's Name Business Address Phone Number

INVOICE NO:

INVOICE FOR MONTH OF:

DATE OF INVOICE:

CONTRACT NUMBER: TASK ORDER NUMBER:

TO: US Army Corps of Engineers Walhonding Project Officer

36007 SR 715

Warsaw, OH 43844-9534 Phone: 330-365-4252

DATE TASK ORDER NUMBER AMOUNT

7-1-2003

Task Order Number 0001

Item No. 0154, Negotiated Work, Job for Sum $3,590.00

7-7-2003 Task Order Number 0002 Item No. 0035, Below Dam Area $ 400.00 Item No. 0036, Damsite $ 600.00 Item No. 0037, Office Area $ 75.00

TOTAL INVOICE $4,665.00

EXHIBIT M

EXHIBIT N

SAMPLE CONTRACTOR WORK SCHEDULE

SAMPLE

CLEANING SCHEDULE

AREA

8:00 a.m.

4:00 p.m.

8:00 AM - 9:00 AM

9:00 AM - 9:02 AM

9:02 AM - 9:40 AM

9:40 AM - 9:45 AM

9:45 AM - 10:15 AM

10:15 AM - 10:25 AM

10:25 AM - 11:15 AM

11:15 AM - 11:16 AM

11:16 AM - 11:55 AM

12:10 PM - 2:00 PM

Number one Campground , Level l

Number Two Restrooms, Level 1

Overlook Area, Level l

Travel to Damsite Area

Damsite Area, Level 3

Travel to Laurel Creek Campground

Laurel Creek Campground , Level 1

Travel to Lakeside Launch Ramp Area

Lakeside Launch Ramp Area, Level l

Travel to Lakeside Picnic Area

Lakeside Picnic Area, Level 1

Spillway, Access Road , Field and Outflow Strip, Level 3

NOTES: 1. Dam will be policed on last Wednesday of the month.

2. Shelter floors will be cleaned every Friday during morning cleaning.

EXHIBIT N

EXHIBIT O

PARTIAL LISTING OF SAFETY AND SECURITY REQUIREMENTS

PARTIAL LISTING OF SAFETY AND SECURITY REQUIREMENTS\

1. The following is a clarification of the Corps of Engineers' policy concerning the use of personal protective equipment for contract employees as defined in the EM 385-1-1, Safety and Health Requirements Manual. This is not meant to be a complete review of required safety equipment, but is simply provided to answer some of the more common questions concerning our safety policy.

The items of equipment listed below should be issued to each employee or made readily available for employee's use, when the work environment requires it:

a. Safety shoes - All employees except park aids performing traffic surveys and clerical personnel are to wear hard toe safety shoes at all times. For those not required to wear steel toed safety shoes, leather work shoes shall be worn.

b. Hard hats - Hard hats are to be worn when operating or working around equipment that lifts overhead (e.g. backhoe-endloader) or working at ground level around mowing equipment. Hard hats will not be required when operating a riding mower, unless other mowing equipment is present.

Hard hats will be required during construction type activities and wildfire suppression.

c. Safety glasses or goggles - Safety glasses with side shields or goggles are to be worn when operating equipment or working around equipment that may cause harm from flying debris (e.g.

weed eaters), and when using power or hand tools.

d. Welders - Full face welder's helmets are to be worn during electric arc welding operations, and appropriate shields or warning shall be given or posted to protect other persons from the flash.

During oxyacetylene welding or cutting, appropriate goggles or full face shield shall be worn.

e. Gloves - The proper type gloves are to be worn when there is a danger of burns, cuts, scrapes, scratches, wood splinters, or other injury to employee's hands.

f. Ear protection - Ear plugs or muffs shall be worn when operating any device that has been determined to produce 85 decibels or greater on a time-weighted average. It is your responsibility to determine the noise level of your equipment. Each piece of equipment that exceeds 85dB(A) rating should be labeled to indicate the need for hearing protection.

g Protective leg chaps - Protective leg chaps are to be worn when operating equipment such as a chain saw.

h. P.F.D's (Personal Flotation Device/Life Jacket) - P.F.D's are to be worn at all times when working around the water or on board watercraft.

i. Safety cans - Containers for flammable liquids shall be labeled and meet the requirements specified in Section O9.B.

j. Seat belts - Seat belts are to be worn at all times when operating, or being transported by motor vehicles and when operating mobile equipment with rollover protection.

k. Safety vests – High-visibility apparel meeting, at a minimum, ANSI/ISEA 07-2004

Performance Class 2 requirements, are to be worn when employees are working adjacent to project or public roadways.

l. Lock-Out/Tag-Out - Lock-Out/Tag-Out procedures will be used in accordance with EM385-1-

1, Section 12 and in coordination with project personnel.

m. Respiratory Protection - Areas with respiratory hazards (chemical, dust, etc) shall be identified. Employees shall have a properly fitting respirator, of the appropriate type, prior to working in a respiratory hazard area. All work requiring the use of respirators shall be performed in accordance with EM 385-1-1, Section O.3.B.

n. Confined Space - Procedures outlined in EM 385-1-1, Section 6.1, and OSHA 29, CFR 1910, 146, shall be developed and followed when working in confined space. Such procedures must be approved by the COR prior to initiating them.

2. The Contractor shall conduct monthly safety meetings and weekly "tool box" safety meetings in accordance with EM 385-1-1, Safety and Health Requirements Manual. The Contractor may contact the COR about upcoming work planned, to determine appropriate subjects for the monthly safety meetings. The Government makes no guarantee that the list of upcoming work planned, will actually be ordered nor will work ordered be restricted to said list. The Contractor shall inform the COR of the date, time, and place of the monthly safety meeting, a minimum of 7 days prior to the meeting.

3. Great emphasis will be given to the development and proper use of Job Hazard Analysis (JHA).

When ordered, AHAs will be developed in detail, utilized during job performance, and available to employees at the job site.

4. Transporting employees and equipment to worksites:

a. Vehicles used to transport staff and equipment must be well maintained and never overloaded.

Each vehicle occupant must have a seat belt available to him or her and must wear the belt.

b. Personnel and tools must be kept apart during travel. Tools and tool boxes must be secured in a manner which will prevent their causing injury in case of a sudden stop or collision.

c. Tool box lids must be securely latched or locked.

5. Contractor vehicles involved in liter pick-up along project and public roads must be equipped with an orange rooftop revolving light, a rear mounted warning sign and reflective warning tape on the bumper. Employees performing liter pickup along public and project roads must wear orange safety vests.

SECURITY REQUIREMENTS

1. The Contractor shall cooperate with the Government in providing for the security of Government property. Some examples of the security measures expected include:

a. Closing and locking all gates and doors which were opened to allow Contractor personnel access for work.

b. Ensure that only Government personnel or authorized Contractor personnel enter secured areas. The COR or his representative shall be informed immediately if any unauthorized persons enter a secured area.

c. Secure or maintain constant surveillance on all pilfer able items to prevent theft. Provide control to ensure that Government furnished equipment, property, or materials are utilized only for contract-purposes.

EXHIBIT P

PLAYGROUND INSPECTION FORM, CELRH FORM 2788

PLAYGROUND INSPECTION

CHECKLIST

1.PROJECT

2. CONTRACT NUMBER

3.CONTRACTOR

4.WORK ORDER NUMBER

Sa. WEEK OF DATE

6. AREAS RATING CODES

(1) NO PROBLEMS,SAFE FOR PUBLIC USE.

(2) INADEQUATE, NEEDS CORRECTION, BUT NOT AN IMMEDIATE DANGER.

(3) UNACCEPTABLE, CONTRACTOR SHALL IMMEDIAT ELY TAKE ACTION TO

REMOVE THE PARTICULAR ITEM FROM PUBLIC USE AND NOTIFY COR.

7.FOR ANY RATING OF 2 OR 3, SEE PAGES 2

0 OF 3 AND 3 OF 3 FOR DESCRIPTION OF

PROBLEM, DANGER OR CORRECTION NEEDED.

Sb. THRU WEEK OF

DATE (YYYYMMDD)

SAT.

SUN.

MON.

TUE.

WED.

THU.

FRI.

VISIBLE CRACKS, BENDING,WARPING, RUSTING OR BREAKAGE OF ANY COMPONENT

DEFORMATION OF OPEN HOOKS,SHACKLES,RINGS, LINKS ETC.,

WORN SWING HANGERS AND CHAINS

MISSING, DAMAGED OR LOOSE SWING SEATS, HEAVY SEATS WITH SHARP EDGES OR CORNERS

BROKEN SUPPORTS AND ANCHORS

FOOTINGS EXPOSED,CRACKED OR LOOSE IN GROUND

ACCESSIBLE SHARP EDGES OR POINTS

EXPOSED ENDS OF TUBING THAT SHOULD BE COVERED BY PLUGS OR CAPS

PROTRUDING BOLT ENDS THAT DO NOT HAVE SMOOTH FINISH CAPS OR COVERS,LOOSE BOLTS, NUTS ETC., SPLINTERED,CRACKED OR OTHERWISE DETERIORATED WOOD

BROKEN OR MISSING RAILS,STEPS, RUNGS OR SEATS

SURFACING MATERIAL WORN OR SCATTERED (In landing pits, etc.,)

CHIPPED OR PEELING PAINT

VANDALISM (Broken glass, trash, etc.,)

PINCH CRUSH POINTS (Exposed Mechanisms, juncture of moving components, e.g., axis of seesaw)

TRIPPING HAZARDS SUCH AS ROOTS, ROCKS OR OTHER ENVIRONMENTAL OBSTACLES

POOR DRAINAGE AREAS

UNSAFE ACCESS

OTHER

ACTUAL TIME INSPECTION COMPLETED (using military time 0001 - 2400 hours)

INITIALS OF CONTRACTOR INSPECTOR

ALL PLAYGROUND

EQUIPMENT DESCRIBED

IN THE CONTRACT HAS

BEEN INSPECTED AS

INDICATED.

8a. DATE (YYYYMMDD) 8b. CONTRACTOR SIGNATURE 9a.DATE (YYYYMMDD) 9b. COR SIGNATURE

CELRH FORM 2788 , MAY 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 1of 3

VERSION 1.0

THIS NOTICE IS TO ADV ISE YOU OF DEFICIENCIES FOUND DURING INSPECTION .THE DEFICIENCIES FOUND ARE IN THE PERFORMANCE AND I OR QUANTITY OF WORK.THE

DEFICIENCIES ARE TO BE CORRECTED AS SPECIFIED.

10a. LOCATION

10b.COMMENTS AND DEFICIENCIES, WHICH SHALL BE CORRECTED BEFORE WORK WILL BE ACCEPTABLE AND SATISFACTORY ARE AS FOLLOWS:

10c. COMMENTS ON CORRECTIONS OF DEFICIENCIES:

11a.NAME (First Ml. Last) 11b. DATE (YYYYMMDD) I 11c.INSPECTOR SIGNATURE

CELRH FORM 2788C, MAY 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 2 of 3

VERSION 10

THIS NOTICE IS TO ADVISE YOU OF DEFICIENCIES FOUND DURING INSPECTION.

12a. LOCATION

12b.COMMENTS AND DEFICIENCIES:

12c. COMMENTS ON ANY ACTION TAKEN

13a.NAME (First Ml. Last) 13b. DATE (YYYYMMDD) I 13c.CONTRACTORS INSPECTOR SIGNATURE

CELRH FORM 2788C, MAY 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 3 of 3

EXHIBIT Q

TASK ORDER FORM

DD FORM 1155

CODE I I

CALL

- 1

( YYV YMMMOO)

I

ORDER FOR SUPPLIES OR SERVICES

PAGE 1 OF

1.CONTRACT/PURCH ORDER/AGREEMENT NO 2. DELIVERY OROERICALL NO. 3.DATE OF ORDER/CALL 4. REQUISITION/PURCH REQUEST NO. 5. PRIORITY f YYY YMMMOO I

6. ISSUED BY CODE I 7.ADMINISTERED BY '" •••., •••• •1 CODE 8. DELIVERY FOB

DESTINATION

---< OTHER

----....J t S •• Schedule i f otlt.,I

9. CONTRACTOR FACILITY CODE 10.DELIVER Tu_ rv<> l'UINIt:IY vo101 11.X IF BUSINESS IS ( 'l"YYYMMMOD)

• • SMALL

12. DISCOUNT TERMS

NAME - VSAMN WA 8E%AD-

AND \NOMEN-OINNED

ADDRESS

13. MAIL INVOICES TO THE ADDRESS IN BLOCK

14. SHIP TO CODE I 15. PAYMENT WILL BE MADE BY CODE MARK ALL

PACKAGES AND

PAPERSW1TH

IDENTIFICATION

NUMBERSIN

BLOCKS 1AND 2.

16. DELIVERY/ This delivery order/call 1s issued on another Government agency or on accordance with and subject to terms and cond1hons of above numbered contract

TYPE

OF Reference your furnish the following on terms specified hereon

PURCHASE

ORDER A-.-.cr AN<.;E.THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS AND CONDITIONS SET FORTH. AND AGREES TO PERFORM THE SAME

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED

( YY Y Y M MM DD J

If this box rs marl<ed,supplier must sign Acceptance and return the following number of copies

17.ACCOUNTING AND APPROPRIATION DATA/LOCAL USE

20. QUANTITY 21. 18. ITEM NO. 19. SCHEDULE OF SUPPLIES/SERVICES ORDERED/ 22.UNIT PRICE 23. AMOUNT ACCEPTED• UNll

•11 quent1ty accepted by tit• Govetnmenl 1• 24.UNITED STATES OF AMERICA 25. TOTAL ••m• •• quanl 1 t y ordered 111d 1 c•t• by X It dl lloront enter ocluol quonllt y occoptod 26.

below quantify 01dorod end onc1rcl•

27a.QUANTITYIN COLUMN 20 HAS BEEN

BY CONTRACTING/ORDERING OFFICER

DIFFERENCES

hINSPECTED RECEIVED 11 TJflRtflEG,c<tN{p '1;SNbq.ED:

b SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE c DATE d PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

e MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 28.SHIP. NO. 29.D.0.VOUCHER NO. 30.INITIALS

I PARTIAL 32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR

f TELEPHONE NUMBER g E-MAIL ADDRESS FINAL

31. PAYMENT 34. CHECK NUMBER

36. ICERTIFY THIS ACCOUNTIS CORRECT AND PROPER FOR PAYMENT. I COMPLETE

a DATE

( Y Y Y YMMM00 )

b SIGNATURE AND TITLE OF CERTIFYING OFFICER j PARTIAL 35. BILL OF LADING NO.

FINAL

37. RECEIVED 38. RECEIVED BY '"""'' 39. DATE RECEIVED 40. TOTAL CON- 41. SIR ACCOUNT NUMBER 42. S R VOUCHER NO.

AT (V VY Y MMMDD ) TAINERS

DD FORM 1155, DEC 2001 PREVIOUS EDITION IS OBSOLETE . APO PE v1 00

EXHIBIT R

EXHIBIT S

EXHIBIT T

EXHIBIT U

EXHIBIT V

SUGGESTED FORMAT , ACCIDENT PREVENTION PLAN

EXHIBIT V

ACCIDENT PREVENTION PLAN

(OUTLINE)

APPENDIX A

MINIMUM BASIC OUTLINE FOR ACCIDENT PREVENTION PLANS

An Accident Prevention Plan (APP) is a safety and health policy and program document. The following areas are typically addressed in an APP, but an APP shall be job-specific and shall also address any unusual or unique aspects of the project or activity for which it is written.

The APP shall interface with the employer’s overall safety and health program, and a copy shall be available on the work site. Any portions of the overall safety and health program that are referenced in the APP shall be included as appropriate. ANSI/ASSE A10.38 should be referenced for Programmatic Issues.

> For LIMITED-SCOPE SERVICE, SUPPLY AND R&D CONTRACTS, for example, mowing (only), park attendant, rest room cleaning, the Contracting Officer and SOHO may allow an ABBREVIATED APP (customized APP requirements and waive the more stringent elements of this section). > See 01.A.11, and Appendix A, paragraph 11.

11. ABBREVIATED APP for LIMITED-SCOPE SERVICE, SUPPLY AND R&D CONTRACTS. If service, supply and R&D contracts with limited scopes are awarded, the contractor may submit an abbreviated Accident Prevention Plan. This AP P shall address the following areas at a minimum. If other areas of the EM 385-1-1 are pertinent to the contract, the contractor must assure these areas are addressed as well.

a. Title, signature, and phone number of the plan preparer.

b. Background Information to include: Contractor; Contract number; Project name; Brief project description, description of work to be performed, and location (map); The project description shall provide a means to evaluate the work being done (see AHA requirements in 01.A.13) and a s s oc ia te d ha za rds involve d. Contra c tor’s A P P s ha ll a ddre s s the ide ntifie d ha za rds involve d a nd the control measures to be taken.

c. Statement of Safety and Health Policy detailing their commitment to providing a safe and healthful workplace for all employees.

d. Responsibilities and Lines of Authorities – to include a statement of the employer’s ultimate responsibility for the implementation of his SOH program; Identification and accountability of personnel responsible for safety at all levels to include designated site safety and health officer (SSHO) and associated qualifications. The District SOHO will review the qualifications for acceptance.

e. Training - new hire SOH orientation training at the time of initial hire of each new employee and any periodic retraining/recertification requirements.

f. Procedures for job site inspections - assignment of responsibilities and frequency.

g. Procedures for reporting man-hours worked and reporting and investigating any accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative (CO/COR). An accident that results in a fatal injury, permanent partial or permanent total disability shall be immediately reported to the Contracting Officer.

h. Emergency Planning. Employees working alone shall be provided an effective means of emergency communication. This may be cellular phone, two-way radio or other acceptable means.

The selected means of communication must be readily available and must be in working condition.

i. Drinking Water provisions, toilet and washing facilities.

j. First Aid and CPR training (at least two employees on each shift shall be qualified/certified to administer first aid and CPR) and provision of first aid kit (types/size).

k. Personal Protective Equipment.

(1) Work Clothing - Minimum Requirements. Employees shall wear clothing suitable for the weather however minimum requirements for work shall be short-sleeve shirt, long pants (excessively long or baggy pants are prohibited) and leather work shoes. If analysis determines that safety-toed (or other protective) footwear is necessary (i.e., mowing, weed eating, chain saw use, etc), they shall be worn

(2) Eye and Face Protection. Eye and face protection shall be worn as determined by an analysis of the operations being performed HOWEVER, all involved in chain saw use, chipping, stump grinding, pruning operations, grass mowing, weed eating and blowing operations shall be provided safety eyewear (Z87.1) as a minimum.

(3) Hearing Protection. Hearing protection must be worn by all those exposed to high noise activities (to include grass mowing and trimming, chainsaw operations, tree chipping, stump grinding and pruning).

(4) Head Protection. Hard hats shall comply with ANSI Z89.1 and shall be worn by all workers when a head hazard exists. At a minimum, hard hats shall be worn when performing activities identified in (2) above.

(5) High Visibility Apparel shall comply with ANSI/ISEA 107, Class 2 requirements at a minimum and shall be worn by all workers exposed to vehicular or equipment traffic.

(6) Protective Leg chaps shall be worn by all chainsaw operators.

(7) Gloves of the proper type shall be worn by persons involved in activities that expose the hands to cuts, abrasions, punctures, burns and chemical irritants.

(8) If work is being performed around water and drowning is a hazard, PFDs must be provided and worn as appropriate.

l. Machine Guards and safety devices. Lawn maintenance equipment must have appropriate guards and safety devices in place and operational.

m. Hazardous Substances. When any hazardous substances are procured, used, stored or disposed, a hazard communication program must be in effect and MSDSs shall be available at the worksite. Employees shall have received training in hazardous substances being used. When the eyes or body of any person may be exposed to corrosives, irritants or toxic chemicals, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within 10 seconds of the worksite.

n. Traffic control shall be accomplished in accordance with DOT’s MUTCD.

o. Control of Hazardous Energy (Lockout/Tag Out). Before an employee performs any servicing or maintenance on any equipment where the unexpected energizing or startup of the equipment could occur, procedures must be in place to ensure adequate control of this energy.

p. Driving, working on (i.e., working with equipment/mowers) while on slopes, working from/in boats/skiffs, etc shall also be considered and dealt with accordingly.

EXHIBIT W

QUALITY ASSURANCE SURVEILLANCE PLAN

Muskingum Area Projects

Table of Contents

SECTION

SECTION I.

SECTION II.

Introduction.

A. General B. Acronyms and Definitions

Acceptance/Rejection of Services A. General B. Acceptance C. Rejection

SECTION III.

SECTION IV.

SECTION V.

Performance Requirements Summary Tables

Sampling Guides

Inspection Checklists A. Examples

1. Cleaning Services, Recreation Areas

2. Grass Mowing and Maintenance of Landscaped

Areas

3. Contractor's Quality Control Program

SECTION I

INTRODUCTION

SECTION I. Introduction

A. General. This plan will be used to assure the government that work specified under this contract is completed satisfactorily. The plan is included for information purposes only. It does not supersede any of the requirements in other sections of the contract. Surveillance or inspections will be primarily conducted in three ways; however, the Government has the right to change or modify inspection methods at its discretion. The three principle inspection methods are random, one-hundred percent, and planned. In conjunction with describing the principle methods used for providing surveillance (i.e., inspecting), this plan defines common terms and acronyms;

summarizes in table form the performance requirements for each contract section; summarizes in table form a "sampling guide" for each contract section;

explains how deductions are calculated; and, provides examples of Inspection Checklists.

B. Roles and Responsibilities.

The following personnel shall oversee and coordinate surveillance activities.

Procuring Contracting Officer (PCO) – The PCO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The PCO shall also ensure that the contractor receives impartial, fair, and equitable treatment under this contract.

Determine the final assessment of the contractor’s performance.

Assigned PCO: Ginny M. Morgan Organization or Agency: US Army Corps of Engineers, Huntington District Telephone: 304-399-5963 Email: ginny.m.morgan@usace.army.mil

Contracting Officer’s Representative (COR) The COR is responsible for providing continuous technical oversight of the contractor’s performance. The COR uses the QASP to conduct the oversight/surveillance process. The COR shall keep a Quality Assurance file that accurately documents the contractor’s actual performance. The purpose is to ensure that the contractor meets the performance standards contained in the contract. The COR is responsible for reporting early identification of performance problems to the KO. The COR is required to provide an annual performance assessment to the KO which will be used in documenting past performance. The QASP is the primary tool for documenting contractor performance. The COR is not empowered to make any contractual commitments or to authorize any contractual change on the Government’s behalf.

Other Key Government Personnel This may include performance monitors, inspectors, or others who provide information that helps the COR monitor contractor performance.

C. Authority.

Authority for issuance of this QASP is provided under Part 46 of the Federal Acquisition Regulation, Inspection of Services clauses, which provides for inspection, acceptance and documentation of the service called for in the contract or order. This acceptance is to be executed by the contracting mailto:ginny.m.morgan@usace.army.mil officer or a duly authorized representative.

D. Acronyms and Definitions.

1. List of Acronyms.

a. AQL Acceptable Quality Level

b. CDR Contract Discrepancy Report

c. COR Contracting Officer Representative d . co. Contracting Officer

e. PRS Performance Requirements Summary

f. PWS Performance Work Statement g . QA.

h . QAE

Quality Assurance

Quality Assurance Evaluator i . QASP. Quality Assurance Surveillance Plan j . QC.

k. QCP

1. N/A

Quality Control

Quality Control Plan

Non-Applicable

2. Definitions.

a. Acceptable Quality Level. Predetermined value used by the Government to distinguish between satisfactory and unsatisfactory performance.

AQL may be stated in percent and is the maximum number of defects per 100 units that can be considered satisfactory. As long as the defective performance does not exceed the AQL, the total service will not be rejected by the Government. The contractor, however, must re-perform the defective service.

b. Defect. Any deficiency determined to be significant as to render the unit unsatisfactory.

c. Deficiency. Any inspection unit which does not meet the Contract requirements in their entirety.

d. Inspection Unit. For statistical sampling the unit is identified in the sampling guide. For all other work the inspection unit is the job. The inspection unit may include several tasks.

e. Inspector. Individual designated by the COR to perform Quality Assurance.

f. Item. The term item, when used with the Contract, refers to the Contract Line Item Number (CLIN) contained in the price breakout schedule.

g. Job. A job describes an individual, separate, and defined element of work to be performed. "Mowing the Below Dam Recreation Area" or "Painting the Number One Picnic Shelter in the Below Dam Area" are examples of jobs.

h. Lot Size. The total number of times the service is performed in a given period of time, such as the total number of cleanings per month.

Also called a population.

i. 100% Inspection. An inspection method requiring the examination of each completed job. It is not required that the inspector be at the job site 100 percent of the time while the job is occurring. This approach is best suited for monitoring contract requirements that occur infrequently or are of great importance.

j. Percent of Sample Found Defective.

number of defects by the sample size .

Determined by dividing the

k. Planned Sampling. An evaluation method designed to inspect some part but not necessarily all of the contract requirements. Sample selection is based on some subjective rationale and sample size is usually arbitrarily determined.

1. Quality Assurance. Those actions taken by the Government to insure goods or services meet the requirements of the contract.

m. Quality Assurance Evaluator. A Government official responsible for evaluating contractor's performance. Also, known as an inspector.

n. Quality Control.

control the production of goods requirements of the contract.

Those actions taken or services to insure by a that contractor to they meet the

o. Random Number Table. A table of numbers arranged in a random fashion. A table used to make random samples.

p. Random Sample. A sampling method whereby each service output in a lot has an equal chance of being selected, or where any occurrence of a contract requirement is as likely to be evaluated as any other occurrence.

q. Random Sampling. A method of looking at a few individual items in a lot to determine the quality of that lot against a standard.

r. Reject Level. The number of defects beyond which the total service for that lot is rejected by the Government and deductions are made.

The contractor must re-perform defective services, when possible, even if the number of defects is less than the reject level.

s. Sample. A sample consists of one or more service outputs drawn from a lot, the outputs being chosen at random. The number of outputs in the sample is the sample size.

t. Sampling Guide. The part of the surveillance plan which contains all the information needed to perform a random sample. A "how to inspect guide" for each type of work to be performed.

u. Service Requirement. A job to be performed to the specified standard and within the acceptable quality level. The contractor must do the specific job, meet the standard, and meet the acceptable quality level before performance is acceptable and contractor will be paid.

v. Surveillance Plan. An organized written Government

Document used for quality assurance surveillance.

x. Unscheduled Inspection. Impromptu inspections of contract requirements without a pre-planned schedule.

y. Validated Complaints. An evaluation method utilizing customer awareness.

z. Work. The general scope of services covered under the specifications of this contract.

SECTION II

ACCEPTANCE/REJECTION OF SERVICES

SECTION II. Acceptance/Rejection of Services

A. General. Inspection of all services performed under this contract will primarily be done in accordance with a schedule developed by the Government, and will primarily be done by using one or a combination of the surveillance methods cited in this plan. Tables are include at the end of this place to show the surveillance methods. Generally reduced surveillance is used, but if performance is not acceptable, normal or tightened surveillance may be used. The purpose of inspection is to document contractor performance and the quality of services or goods produced. Documentation of contractor performance will be done on the appropriate Inspection Checklist (see Section VI of this plan).

B. Acceptance.

1. Statistically Sampled Work. Whenever the defects exceed the reject level the Government will issue a CDR and effect a monetary deduction for unsatisfactory performance from the contractor’s invoice based on Section III B1 or B2.

2. 100% Inspection. Whenever the work does not conform to all requirements of the Task Order, the Government will issued a CDR and proceed in accordance with the contract clause 52.246-4.

C. Rejection.

1. Statistically Sampled Work. Whenever the defects exceed the reject level the Government will issue a CDR and effect a monetary deduction from the Contractor's invoice.

2. 100% Inspection. Whenever the work does not conform to all requirements of the Task Order, the Government will issue a CDR and proceed in accordance with the Inspection of Services Clause of the contract.

SECTION III

PERFORMANCE REQUIREMENTS SUMMARY TABLES

SECTION III. Calculating Deductions

A. General. Whenever work or parts of work are not performed or are rejected, deductions will be made. The following examples are given to demonstrate how deductions could be calculated.

B. Examples.

1. Random Sampling. The process used to determine what specific services that will be inspected using random sampling is defined in the Huntington District Random Sampling Manual. All the services that will be performed in the month are listed and numbered. A computer program is then used to pick at random the specific services that will be sampled based upon the number of samples required as defined in the surveillance tables at the end of the QASP.

Once a random sample has been taken of a lot or populations, and the number of defective items exceeds the AQL for that lot, a deduction will be made.

The following example demonstrates how a deduction would be calculated for excessive defects in restroom cleanings. In this example, the lot or population size (i.e., the number of restroom cleanings over a 30 day period) is 125.

IF: Quality of work for cleaning restrooms is found to be unsatisfactory (i.e., the AQL of 5% is exceeded).

AND: The calculated value of a restroom cleaning is $25 (based on Performance Requirements Summary Table, Bid Prices, and other factors).

AND: Sample size is 18 with a reject level of 3.

AND: Number of defects in sample is 5.

THEN: Deductions from the contractor's monthly invoice for performing Level 2 cleanings would be calculated according to the following equation:

No. of Defects No. of Contract Price Amount -------------------- X Cleanings X for = of Sample Size in Period Cleaning Services Deduction

Substituting in the numerical values (from the example) the deducted amount would be calculated as follows:

5/18 X 125 X $25 = $868.05

Therefore, $868.05 would be deducted from the contractor's monthly invoice.

2. Planned Sampling. This example shows how a deduction would be calculated when planned sampling documents deficiencies in Cleaning Services. In this example, planned sampling has documented non- performance on a beach cleaning. A CDR was issued and the Government chose to have the services performed by another contractor.

The actual cost to the government to correct the deficiency will be deducted from the Contractor’s invoice.

For example, if the actual cost to the Government to correct the deficiencies at the beach is $120.00, then $120.00 will be deducted from the Contractor's invoice for cleaning.

PERFORMANCE REQUIREMENTS SUMMARY

Required Services

Section Number

Paragraph Number

Maximum Allowable Degree of Deviation From Requirement(AQL)

Method of Surveillance

Deduction

Mowing Service C-2 C-2.2 All work must be per- 100% Inspection N/A (including init- formed in accordance ial mowing) with the work order.

Raking C-2 C-2.3 All work must be per- 100% Inspection N/A formed in accordance with the work order.

PERFORMANCE REQUIREMENTS SUMMARY

Required Services

Section Number

Paragraph Number

Maximum Allowable Degree of Deviation From Requirement(AQL)

Method of Surveillance

Deduction

Restrooms and C-3 C-3.2 a 5% Random Sampling N/A Vault Toilet Cleaning Policing Grounds, C-3 C-3.2 g, h 10% Random Sampling N/A Roads Grills and C-3 C-3.2 c, d, e, f 10% Random Sampling N/A Receptacles, Picnic tables, Park benches, and Drinking Fountains Playground C-3 C-3.2 i, j 10% Random Sampling N/A equipment, Bulletin boards, signs Extra cleaning of C-3 C-3.2 b All work must be per- 100% Inspection N/A restrooms formed in accordance with the work order.

SECTION IV

SAMPLING GUIDES

1. Service Requirement: Grass Mowing Service.

2. Corresponding Contract Section: C-3.

3. Method of QA: 100% Inspection.

4. Acceptable Quality Level: N/A

5. Lot Size for Sampling: N/A

6. Sampling Size: N/A

7. Reject Level: N/A

8. Sampling Procedures: The Government will inspect all work at the completion of each area when notified by the Contractor and perform intermediate inspections daily. The COR will determine the times the intermediate inspections will be made.

9. Inspection Procedures: The inspector will get a copy of the work order, maps, and measuring devices needed to verify work and record all aspects of the work on an inspection checklist form. The Contractor will be informed of deficiencies in his performance.

10. Performance Criteria: The Contractor shall perform all work as specified in the individual work orders. For all identified deficiencies the Contractor will be allowed to re-perform if the work order and contract specifications allow. Defects in Contractor performance may be addressed by issuance of a CDR. A CDR will be issued should the Contractor fail to correct deficiencies by re-performance, or for any defects/rejects in service requirements. Should the reject level be exceeded, a deduction for unsatisfactory performance will be made.

1. Service Requirement: Raking

2. Corresponding Contract Section: C-3.

3. Method of QA: 100% Inspection.

4. Acceptable Quality Level: N/A

5. Lot Size for Sampling: N/A

6. Sampling Size: N/A

7. Reject Level: N/A

8. Sampling Procedures: The Government will completion of each work order and the COR may periodically inspected during performance.

inspect elect all work at the to have the work scope of work, any measuring devices needed to verify work and record all aspects of the work on an inspection checklist form. The Contractor will be informed of deficiencies in his performance.

10. Performance Criteria: The Contractor shall perform all work as specified in the individual work orders. For all identified deficiencies the Contractor will be allowed to re-perform if the work order and contract specifications allow. Defects in Contractor performance may be addressed by issuance of a CDR. A CDR will be issued should the Contractor fail to correct deficiencies by re-performance, or for any defects/rejects in service requirements. Should the reject level be exceeded, a deduction for

1. Service Requirement: Restroom and Vault Toilet Cleaning.

2. Corresponding Contract Section: C-4.

3. Method of Q A: Random Sampling.

4. Acceptable Quality Level: 5%

5. Lot Size for Sampling: 30 - 60

6. Sampling Size: 13

7. Reject Level: 3

8. Sampling Procedures: The COR will randomly select restrooms or washhouses to be inspected each month, and inform inspectors of the schedule.

9. Inspection Procedures: The inspection will be performed in accordance with the Contractors approved work schedule. Each restroom or washhouse selected will be inspected and results recorded on an inspection checklist. The Contractor will be informed of deficiencies in his performance.

10. Performance Criteria: The Contractor shall perform all work as specified in the work order. For all identified deficiencies the Contractor will be allowed to re-perform if the work order and contract specifications allow. Defects in Contractor performance may be addressed by the issuance of a CDR. A CDR will be issued should the Contractor fail to correct deficiencies by re-performance, or for any defects/rejects in service

EX-W-20

1. Service Requirement: Policing Grounds and Roads.

2. Corresponding Contract Section: C-4.

3. Method of QA: Random Sampling.

4. Acceptable Quality Level: 10%

5. Lot Size for Sampling: 30 - 31

6. Sampling Size: 13

7. Reject Level: 4

8. Sampling Procedures: The COR will randomly select areas to be inspected each month, and inform inspectors of the schedule.

9. Inspection Procedures: The inspection will be performed in accordance with the Contractors approved work schedule. Each area selected will be inspected and results recorded on an inspection checklist. The Contractor will be informed of deficiencies in his performance.

allowed to re-perform if the work order and contract specifications allow. Defects in Contractor performance may be addressed by the issuance of a CDR. A CDR will be issued should the Contractor fail to correct deficiencies by re-performance, or for any defects/rejects in service

EX-W-21

1. Service Requirement:

Drinking Fountains.

Picnic Tables, Benches, Grills, Receptacles, and

3. Method of QA: Random Sampling.

4. Acceptable Quality Level : 10%

5. Lot Size for Sampling: 30 - 31

6. Sampling Size: 13

7. Reject Level: 4

8. Sampling Procedures: The COR will randomly select picnic tables, benches, grills, receptacles, traffic counters and water meters to be inspected each month, and inform inspectors of the schedule.

the Contractors approved work schedule. Each item selected will be inspected allowed to re-perform if the work order and contract specifications allow. Defects in Contractor performance may be addressed by the issuance of a CDR. A CDR will be issued should the Contractor fail to correct deficiencies by re-performance, or for any defects/rejects in service

EX-W-22

1. Service Requirement: Playground Equipment, bulletin boards and signs.

2. Corresponding Contract Section: C-4.

3. Method of QA: Random Sampling.

4. Acceptable Quality Level: 10%

5. Lot Size for Sampling: 30 - 31

6. Sampling Size: 13

7. Reject Level: 4

8. Sampling Procedures: The COR will randomly select shelters, bulletin boards, signs, and playground equipment to be inspected each month, and inform the inspectors of the schedule.

the Contractors approved work schedule. Each item selected will be inspected allowed to re-perform if the work order and contract specifications allow. Defects in Contractor performance may be addressed by the issuance of a CDR. A CDR will be issued should the Contractor fail to correct deficiencies by re-performance, or for any defects/rejects in service

1. Service Requirement: Extra Cleaning of Restrooms.

3. Method of Q A: 100% Inspection.

4. Acceptable Quality Level: N/A

5. Lot Size for Sampling: N/A

6. Sampling Size: N/A

7. Reject Level: N/A

8. Sampling Procedures: The Government will completion of each work order and the COR may periodically inspected during performance.

inspect elect all work at the to have the work scope of work, and technical instruments needed to verify work and record all aspects of the work on an inspection checklist form. The Contractor will be in the individual work orders. For all identified deficiencies the Contractor will be allowed to re-perform if the work order and contract specifications allow. Defects in Contractor performance may be addressed by issuance of a CDR. A CDR will be issued should the Contractor fail to correct deficiencies by re-performance, or for any defects/rejects in service requirements. Should the reject level be exceeded, a deduction for

SECTION V

INSPECTION

CHECKLISTS

INSPECTION CHECKLIST GRASS MOWING AND MAINTENANCE

Routine Uses:Validation of Services and Maintenance Performed to the Contractual

Standard.

1. PROJECT (Location)

2.DATE SERVICE PERFORMED

3.CONTRACT NUMBER 4. CONTRACTOR 5.WORK ORDER NUMBER 6. WEATHER CONDITIONS

7a. SERVICE CONTRACT REQUIREMENT RATING CODES 11 ACCEPTABLE 12UNACCEPTABLE 13IN PROGRESS 14 NOT STARTED

8.COMPLETE BLOCKS BELOW ONLYIF

DEFICIENCIES ARE NOTED

GRASS MOWING AND MAINTENANCE

7b.ITEM

NUMBER

7c. SPECIFIC TASK(SJ OR ITEMS(SJ LIST

1. SAFE WORKING HABITS Ba. DATE (YYYYMMDD)

2. SERVICEABLE EQUIPMENT

3.

MOWING: 8b.TIME (0001 - 2400 Hours)

4. GENERAL APPEARANCE

Sc.SIGNATURE (CR or QC/ IMlo Reviewed)

5.

HEIGHT OF CUT

6. PREVENTION OF SCALPING

7. TIRE DAMAGE TO TURF

8. RAKING

9. TRASH AND LITIER REMOVAL Sd. DATE (YYYYMMDD)

10. SWEEPING SIDEWALKS AND PAVED AREAS

11. TRIM WORK : Se.TIME (0001 - 2400 Hours)

12. DITCH LINES AND ROADWAYS

13. RIPRAP (Foundation of Large Stones) Sf.SIGNATURE (CR or QC/ IMlo Received a Copy) 14.

CREEK BANKS

15. SHORELINE

16.

PIEZOMETERS (Measures Pressure and or Compressibility)

17. PLANT BEDS Sg. SEE PAGE 2 FOR NOTED

18.

LANDSCAPED MOUNDS 0 DEFICIENCY DESCRIPTION(SJ (If

Applicable)

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SECTION 7 (Continuation)

7a.SERVICE CONTRACT REQUIREMENT

GRASS MOWING AND MAINTENANCE

RATING CODES 11 ACCEPTABLE 12 UNACCEPTABLE 13IN PROGRESS 14NOT STARTED

11.THIS NOTICE IS TO ADVISE YOU OF

DEFICIENCIES FOUND DURING

INSPECTION. THE DEFICIENCIES FOUND

ARE INTHE PERFORMANCE AND OR

QUANTITY OF WORK.THE

DEFICIENCIESARE TO BECORRECTED

AS SPECIFIED. (See Item Numbers 11b.

and 11c.)

7b.ITEM

7c. SPECIFIC TASK(S) OR ITEMS(S)LIST

19. TREES AND SHRUB CONDITION

20. PREVENTION OF DAMAGE TO DAM

INSTRUMENTATION

21.

UNIFORMED EMPLOYEES AND MARKED

VEHICLES

22. 11a. PROJECT (Location)

23.

7d.TIME

9a. DATE (YYYYMMDD) 9b.SIGNATURE (Inspector) 10a.DATE (YYYYMMDD) 10b. SIGNATURE (COR)

11b.COMMENTS AND DEFICIENCIES,WHICH SHALL BE CORRECTED BEFORE WORK WILL BEACCEPTABLE AND SATISFACTORY ARE AS FOLLOWS

11c.COMMENTS ON CORRECTION OF DEFICIENCIES.

11d. INSPECTOR EMAIL 11e. DATE (YYYYMMDD) 11f.SIGNATUR E FINAL (Inspector)

CELRH FORM 2773-SC, MAY 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 2 of 2

VE RSION 10

1. PROJECT (Location)

INSPECTION CHECKLIST, CLEANING SERVICES RECREATIONAL AREAS

Routine Uses: Validation of Services and Maintenance Performed to the Contractual Standard.

2.DATE SERVICE PERFORMED

3. CONTRACT NUMBER 4.CONTRACTOR 5.WORK ORDER NUMBER 6. WEATHER CONDITIONS

7a. SERVICE CONTRACT REQUIREMENT

CLEANING SERVICES RECREATIONAL AREAS

RATINGCODES 11 ACCEPTABLE 2 UNACCEPTABLE 13 IN PROGRESS 14NOTSTARTED

8. COMPLETE BLOCKS BELOW ONLYFI

DEFICIENCIES ARE NOTED

7b.TEM

7c. SPECIFIC TASK(SJ ORITEMS(S) LIST

1. SAFE WORKING HABITS Ba. DATE (YYYYMMDD)

2. SERVICEABILITY OF EQUIPMENT

3. RESTROOMS AND PICNIC SHELTERS Bb.TIME (0001 - 2400 Hours)

4. PLUMBING AND LIGHTING FIXTURES

5. INSECTS AND THEIR NESTS

COMMODES , URINALS, LAVATORIES AND

TOILET TISSUE

Be. SIGNATURE (CR or QC/ Who Reviewed)

6.

7. CREEK BANKS,RIPRAP AND SHORELINE

B.

9.

WALLS (Inside and Out), FLOORS,CEILINGS, ROOFS,WINDOWS AND MIRRORS

Bd . DATE (YYYYMMDD)

CLEANING COMPOUNDS AND SANITARY

METHODS

10. FISHING PIERS Be.TIME (0001 - 2400 Hours)

11. RECEPTACLES

12.

UNIFORMED EMPLOYEES AND MARKED

VEHICLES

Bf. SIGNATURE (CR or QC/ Who Received a Copy)

13.

GROUNDS, ROADS,PARKINGLOTSAND PAVED

AREAS

14.

PICNIC SHELTERS,PICNIC TABLES AND PARK

BENCHES

15. GRILLS AND COOKERS Bg. SEE PAGE 2 FOR NOTED

16. DRINKING FOUNTAINS

0 DEFICIENCY DESCRIPTION(S) (If

Applicable)

CELRH FORM 2773-2, MAY 2010 PREVIOUS EDITIONS ARE OBSOLETE. Page 1of 2

ERS ION 1.0

SECTION VII

RANDOM SAMPLE TABLES

Table A-1

Sample Sizes and Reject Levels