Attachment_07_DLA_SO_Form.xls

XLS spreadsheet 197 KB Posted Dec 27, 2016

Attached to: OFFICIAL Navy Phase 6 Solicitation
Solicitation number: W912DY-17-R-0003
Issued by: Department of the Army Corps of Engineers Engineering Support Center Huntsville

About this file

From the source

SO Form

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Other files

File	Type	Posted
DRAFT_RFP_ProjNet_FINAL.pdf	PDF	Feb 7, 2017
OFFICIAL_RFP_ProjNet_FINAL.pdf	PDF	Feb 7, 2017
AMEND_01_CONFORMED_Navy_Ph6_Solicitation_FINAL.doc	DOC document	Feb 7, 2017
AMENDMENT_01_Navy_Ph6_Solicitation_FINAL.doc	DOC document	Feb 7, 2017
DRAFT_RFP_ProjNet_FINAL.pdf	PDF	Jan 25, 2017
Attachment_06_Navy_Phase_6_Pricing_Worksheet_Template_FINAL.xls	XLS spreadsheet	Jan 25, 2017
Attachment_08_Japan_-_DBA_Waiver.pdf	PDF	Jan 25, 2017
Attachment_11_Japan_SOFA_Agreements.pdf	PDF	Jan 25, 2017
Attachment_04_Eng_Form_4025-R.pdf	PDF	Jan 25, 2017
Attachment_02_2016_07_08_-_Navy_Phase_6_QASP.pdf	PDF	Jan 25, 2017
Attachment_05_SB_Participation_Plan_Format.doc	DOC document	Jan 25, 2017
Attachment_07_DLA_SO_Form.xls	XLS spreadsheet	Jan 25, 2017
Attachment_09-Wage_Determinations_24Jan17.pdf	PDF	Jan 25, 2017
Attachment_03_20160923_N6_BLANK_PPQ_Fillable.pdf	PDF	Jan 25, 2017
OFFICIAL_Solicitation_Navy_Ph6_Solicitation_25JAN2017.pdf	PDF	Jan 25, 2017
Attachment_10_BOA_W912DY-12-R-0052_25_Mar_2016.pdf	PDF	Jan 25, 2017
Attachment_12_Agreement_UK_BIOT_(Diego_Garcia).pdf	PDF	Jan 25, 2017
Attachment_01_PWS_20170125_Navy_6_Binder.pdf	PDF	Jan 25, 2017
Attachment_02_2016_07_08_-_Navy_Phase_6_QASP.pdf	PDF	Dec 27, 2016
Attachment_06_Navy_Phase_6_Pricing_Worksheet_Template.xls	XLS spreadsheet	Dec 27, 2016
Attachment_04_Eng_Form_4025-R.pdf	PDF	Dec 27, 2016
Attachment_11_Japan_SOFA_Agreements.pdf	PDF	Dec 27, 2016
Attachment_01_PWS_20161219_Navy_6_Binder.pdf	PDF	Dec 27, 2016
Attachment_12_Agreement_UK_BIOT_(Diego_Garcia).pdf	PDF	Dec 27, 2016
Attachment_03_20160923_N6_BLANK_PPQ_Fillable.pdf	PDF	Dec 27, 2016
Attachment_08_Japan_-_DBA_Waiver.pdf	PDF	Dec 27, 2016
Attachment_10_BOA_W912DY-12-R-0052_25_Mar_2016.pdf	PDF	Dec 27, 2016
Attachment_05_SB_Participation_Plan_Format.doc	DOC document	Dec 27, 2016
Attachment_09-Wage_Determinations_18Nov16doc.pdf	PDF	Dec 27, 2016
Draft_Solicitation_W912DY-17-R-0003_(Navy_PH_6_Project).pdf	PDF	Dec 22, 2016

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Instructions

QAE Form:

All service order information should be put into this sheet. All other sheets will be populated from this sheet

Once sheet is filled out it must be converted to stand alone PDF document

The PDF QAE sheet needs to have text boxes, check boxes, and Digital signature fields added to the appropriate area

The QAE must digitally sign the form twice - once for initial validation and a second time for Final Validation

The QAE Form is the only for to be sent to the QAE

KO Form:

All labor rates shall be fully burdened labor rates (IAW contractor accepted proposal documents)

Once all pricing data is input into this sheet and the Sub sheet (if used) this sheet must be converted to a standalone PDF Document

Digital signature fields will be placed in the appropriate blocks

When ready to submit for approval the Contractor's authorized representative will digitally sign the form

Contractor will place the service order fee (%) in the block provided - Fee is calculated on Subcontractor costs and Materials only

For Emergencies the Appropriate Fee will be entered (IAW the accepted proposal)

SUB Form:

If using a sub, prior to inputting Prime Contractor pricing information this form can be sent to the sub

The Sub will input their company name in the block provided

The sub will input fully burdened labor rates in the appropriate blocks

The sub will input AT COST parts and materials in the appropriate section

The sub will put Markup (%) in the block provided (Markup is calculated on material costs only. Labor costs are fully burdened.)

When complete, the Prime contractor will convert this to a pdf document (if used) to be included with the service order

Complexity Matrix:

This is a guide to help the contractor determine the amount of supporting information that will be required as part of the SO

When form is complete it will be converted to a pdf document to be included with the service order

AHA:

Every Service order submitted must have a AHA tailored to the service order on this form

This form can be edited to add/remove lines as needed.

It will pull other information from other sheets as needed

When complete this AHA will be converted to a PDF to be included with the service order

SUBMITTING THE SERVICE ORDER:

The contractor will make a PDF Portfolio and add the following PDF documents to the portfolio:

QAE sheet with initial validation signature

KO Form with Contractors signature

Sub Form (If used)

Complexity matrix

AHA Sheet

This Excel file will also be included in its raw filled out state

Work Plan

QAE Form

SERVICE ORDER FORM
PART I - SERVICE ORDER INFORMATION
SERVICE ORDER NUM.:	XYZ-KTR-001		SERVICE ORDER TYPE:	Mobilization
CONTRACTOR:	Contractor Name		CONTRACT NUMBER:	W912DY-13-G-XXXX
FACILITY NAME/NUM.:	Fuel Station 1	FS1	TASK ORDER NUMBER:	0004
SITE CODE:	XYZ		SERVICE & PHASE:	Army	1
SERVICE ORDER DATE:	7/14/14		FUNDING CLIN:	XXXXX
SO DESCRIPTION:
Input service order Scope of Work in this block on the QAE Form sheet. All other sheets will be filled based on input on QAE Form sheet. Contractor shall fill out all available cells in Part I, II, and III on QAE Form sheet. Other sheets will auto fill based on input. Selecting service order type will grey out certain sections that aren't required.

The SUB sheet is only required if subcontractor is utilized. Subcontractor shall use fee/markup for his overhead and profit. Material/Equipment costs listed on SO shall match invoice from manufacturer.

PART II - AUTHORIZATION
QAE NAME (First and Last):
QAE INITIAL VALIDATION:
E-SIGNED & DATED
By signing below, I certify that the services under the above Service Order have been satisfactorily completed.
QAE FINAL VALIDATION:
E-SIGNED & DATED
PART III - QUALITY OF WORK
Was work performed in a quality manner?	YES	NO
Was work performed safely?	YES	NO
Was work performed in a timely manner?	YES	NO
Did the prime contractor successfully manage the subcontractor?	YES	NO
Did contractor have all necessary certifications?	YES	NO
Were there any issues with the work performed?	YES	NO
QAE COMMENTS: Any box checked "NO" requires a comment, other comments encouraged. If contractor performed in a manner worth noting (positive or negative), please provide comments.
Provide Comments Here

KO Form

PRIME CONTRACTOR
PART I - SERVICE ORDER INFORMATION
SERVICE ORDER NUM.:	XYZ-KTR-001		SERVICE ORDER TYPE:	Mobilization
CONTRACTOR:	Contractor Name		CONTRACT NUMBER:	W912DY-13-G-XXXX
FACILITY NAME/NUM.:	Fuel Station 1	FS1	TASK ORDER NUMBER:	0004
SITE CODE:	XYZ		SERVICE & PHASE:	Army	1
SERVICE ORDER DATE:	7/14/14		FUNDING CLIN:	XXXXX
SO DESCRIPTION:
Input service order Scope of Work in this block on the QAE Form sheet. All other sheets will be filled based on input on QAE Form sheet. Contractor shall fill out all available cells in Part I, II, and III on QAE Form sheet. Other sheets will auto fill based on input. Selecting service order type will grey out certain sections that aren't required.

PART IV - Proposal Pricing
CUSTOMER:
E-SIGNED & DATED
CONTRACTOR:
E-SIGNED & DATED
CONTRACTING OFFICER OR OO:
E-SIGNED & DATED
TOTAL COST OF SERVICE ORDER:			$ 5,273.68
		FULLY BURDENED LABOR
		TOTAL MH	HOURLY RATE	TOTAL COST
DESCRIPTION:
		0.00	$ 500.00	$ - 0
Labor Sub-Totals				$ - 0
		MATERIAL/EQUIPMENT/OTHER
		QTY.	UNIT COST	TOTAL COST
DESCRIPTION:
		50.00	$32.00	$1,600.00
Material/Equipment Sub-Totals				$1,600.00
		TRAVEL/PER DIEM
		QTY.	UNIT COST	TOTAL COST
DESCRIPTION
		20.00	$ 30.00	$ 600.00
				$ - 0
Other/Travel Sub-Totals				$ 600.00
	Prime Subtotal		$ 1,600.00
	Subcontractor Subtotal		$ 2,488.80
	Subtotal		$ 4,088.80
	Service Order Fee	10%	$ 408.88
	Tax	10%	$ 176.00
	Travel		$ 600.00
	Labor		$ - 0
	Emergency Fee		$ - 0
	TOTAL		$ 5,273.68

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Subs

SUBCONTRACTOR
PART I - SERVICE ORDER INFORMATION
SERVICE ORDER NUM.:	XYZ-KTR-001		SERVICE ORDER TYPE:	Mobilization
CONTRACTOR:	Contractor Name		CONTRACT NUMBER:	W912DY-13-G-XXXX
FACILITY NAME/NUM.:	Fuel Station 1	FS1	TASK ORDER NUMBER:	0004
SITE CODE:	XYZ		SERVICE & PHASE:	Army	1
SERVICE ORDER DATE:	7/14/14		FUNDING CLIN:	XXXXX
SO DESCRIPTION:			SUBCONTRACTOR:	Subcontractor Name
Input service order Scope of Work in this block on the QAE Form sheet. All other sheets will be filled based on input on QAE Form sheet. Contractor shall fill out all available cells in Part I, II, and III on QAE Form sheet. Other sheets will auto fill based on input. Selecting service order type will grey out certain sections that aren't required.

PART IV - Proposal Pricing
TOTAL COST OF SUBCONTRACTOR WORK:			$ 2,488.80
		FULLY BURDENED LABOR
		TOTAL MH	HOURLY RATE	TOTAL COST
DESCRIPTION:
		1.50	$ 100.00	$ 150.00
		1.00	$ 10.00	$ 10.00
		2.00	$ 20.00	$ 40.00
Labor Sub-Totals				$ 200.00
		MATERIAL/EQUIPMENT/OTHER
		QTY.	UNIT COST	TOTAL COST
DESCRIPTION:
		1.00	$ 50.00	$50.00
		20.00	$ 50.00	$1,000.00
		1.00	$ 50.00	$50.00
		2.00	$ 50.00	$100.00
Material/Equipment Sub-Totals				$1,200.00
		TRAVEL/PER DIEM
		QTY.	UNIT COST	TOTAL COST
DESCRIPTION
Airfare (Each)		1.00	$ 500.00	$ 500.00
Rental Car		1.00	$ 350.00	$ 350.00
				$ - 0
Other/Travel Sub-Totals				$ 850.00
	Subtotal		$1,200.00
	Fee/Markup	10%	$120.00
	Tax	9%	$118.80
	Travel		$850.00
	Labor		$200.00
	TOTAL		$2,488.80

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Complexity Matrix

COMPLEXITY DETERMINATION SHEET

Instructions: Contractor should initially estimate the complexity of the service order. PLACE AN "X" IN THE BOX FOR LOW, MEDIUM, OR HIGH FOR EACH FACTOR. Depending on complexity, ensure the cooresponding required content is submitted with service order.

This is meant to be a guide only. Final determination of complexity as well as what is required to be included with each service order will be determined by USACE.

TASK COMPLEXITY DETERMINATION MATRIX
FACTOR	LOW	MEDIUM	HIGH
Coordination with other trades, other contractors, customer, or owner/operators	X
Likelihood of outage of utilities and/or systems		X
Level of unknowns or undefined conditions		X
Level of interaction with regulatory entities			X
Level of urgency	X
Logistical difficulty		X
OVERALL COMPLEXITY OF TASK		X
Required Content	*Complexity
	Low	Medium	High
Scope of Work	Yes	Yes	Yes
Pictures	A/R	Yes	Yes
Cost Proposals	Yes	Yes	Yes
SSAPP	Yes	Yes	Yes
AHA	Yes	Yes	Yes
WORK PLAN REQUIRED FOR MEDIUM AND HIGH COMPLEXITY
Table of Contents		Yes	Yes
Work Plan Narrative		Yes	Yes
Manufacturers Data	A/R	Yes	Yes
Sketches		Yes	Yes
Detailed Drawings		A/R	Yes
Project Specific Schedule		A/R	Yes
Specifications		A/R	Yes
Project Specific Quality Control Plan			Yes
Work Plan Review Meeting/Pre-Con			Yes
Site Investigation Report			Yes

AHA

Activity Hazard Analysis (AHA)
AHA Number			Overall Risk Assessment Code (RAC) - Use Highest RAC from Tasks Below								M
SERVICE ORDER NUMBER	XYZ-KTR-001		Risk Assessment Code (RAC) Matrix
NAME & DATE ACCEPTED BY GDA:
CONTRACT NUMBER:	W912DY-13-G-XXXX		Severity		Probability
TASK ORDER/DELIVERY #:	0004
PRIME CONTRACTOR:	Contractor Name				Frequent	Likely	Occasional	Seldom		Unlikely
SUBCONTRACTOR:	Subcontractor Name
DATE OF PREPARATORY MEETING:			Catastrophic		E	E	H	H		M
DATE OF INITIAL INSPECTION:			Critical		E	H	H	M		L
CONTRACTOR COMPETENT PERSON:			Marginal		H	M	M	L		L
SITE SAFETY and HEALTH OFFICER			Negligible		M	L	L	L		L
RAC CHART and ACCEPTANCE BY GOVERNMENT DESIGNATED AUTHORITY			Review each “Hazard” with identified safety “Controls” and determine (RAC)
E = EXTREMELY HIGH (PWO/OICC/ROICC)			Identify the RAC (Probability/Severity) as E, H, M, or L for each “Hazard”. Place the highest RAC at the top of AHA. This is the overall risk assessment code for this activity
H = HIGH RISK (FEAD DIRECTOR)			“Severity” is the outcome/degree if an incident, near miss, or accident did occur and identified as: Catastrophic, Critical, Marginal, or Negligible after controls are in place
M = MODERATE RISK (CM or ET or PAR)			“Probability” is the likelihood to cause an incident, near miss, or accident did occur and identified as: Frequent, Likely, Occasional, Seldom, or Unlikely after controls are put in place.
L = LOW RISK (ET or PAR)
Job Steps		Hazards		Controls					RAC
									E
									H
									M
									L

File details come from the government source that posted it. Updated Nov 14, 2017.