ATTACHMENT 1.1 DRAFT - APPENDIX A - SERVICE ORDER FORM.pdf
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- Solicitation number
- W912DY25RRMMR
About this file
This document is a Service Order Form related to a federal contract opportunity. The Service Order describes the replacement of a defective pump/motor assembly for a fuel tank at a Defense Department facility. The form includes details about the service request, authorization, and quality of work performed by the contractor. The related federal contract opportunity is a pre-solicitation for the Fuel Program Recurring Maintenance and Minor Repair (RMMR) program, which provides maintenance and repair services for government petroleum facilities and systems. The RMMR program is divided into recurring maintenance and minor repair services, with the work required to comply with Unified Facilities Criteria and applicable laws and regulations. This acquisition does not include architect/engineering or construction services.
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Text version
SERVICE ORDER NUM.: REV #
6AA
XXXX
T2-468
TEXTRA47
XYZ Air Force
No No
QAE FINAL VALIDATION:
SAD-AF2SERVICE & PHASE:
FUNDING CLIN: 0004AA
SITE CODE/SITE NAME: Site Name SERVICE ORDER INITIATION DATE: 26-Oct-20
Replace PRT Pump/Motor Assembly - CUIDs: ROB-4302-CENPT-0002 & ROB-4302-ELEMT-0002.
Per the QAE, the PRT pump/motor assembly for Tank #23 (FAC 4302) requires replacement. It has been noted that the motor is defective as well as the pump.
Ktr to replace the defective pump/motor assembly. A qualified electrician will be present for all efforts to make electrical disconnects and final terminations as required. Work will be IAW NFPA 780 article 500.
MORE INFO
MORE INFO More and Better Info.
QAE NAME (First and Last):
MAINTENANCE CATEGORY: Pump
DETAILED SO DESCRIPTION: (Use ALT-Enter to add rows or new paragraphs)
PART II - AUTHORIZATION
P2 Notice of Violation (NOV) Related?
Is the SO related to Natural Disaster? SO PRIORITY LEVEL:
NO
Was work performed safely?
Was work performed in a timely manner? YES Did the prime contractor successfully manage the subcontractor?
SERVICE ORDER FORM
PART I - SERVICE ORDER INFORMATION
Contractor Name
FACILITY NUM./NAME:
(Use ALT-Enter to add rows)
CONTRACT NUMBER:
TASK ORDER NUMBER:
CONTRACTOR:
RoutineSERVICE ORDER TYPE:
Contract #
Task Order # aaa
STOR JET FL
EXAMPLE NAME 2
JP-8 Fuel Tank Terminal 2 Terminal 3 Terminal 4 Terminal 5 Pier 17
XYZ-KTR-100
YES NO
Was the work area kept clean during and upon completion of work?
E-SIGNED & DATED
By signing below, I certify that the services under the above Service Order have been satisfactorily completed.
YES
YES
QAE INITIAL VALIDATION:
E-SIGNED & DATED
PART III - QUALITY OF WORK
Was work performed in a quality manner?
NO
NO
NO
NOYES
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
Did contractor communicate with you prior to and upon completion of work? YES
Did contractor have all necessary certifications? YES NO Were there any issues with the work performed? YES NO
YES NO
X
Did contractor arrive with all parts, materials, and tools needed to complete the repair?
QAE Form
File details come from the government source that posted it. Updated .