A22.W912EK22T0060-0001 Amendment.pdf

96514721199637

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

This amendment is to change the schedule of prices and scope, please see attached. Bid response date is now 10:00 am on 3 June 2022.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 11

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 27-May-2022

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W912EK22T0060

X 9B. DATED (SEE ITEM 11)

18-May-2022

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer X is extended, is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

27-May-2022

CODE

CONTRACTING DIVISION

US ARMY CORPS OF ENGINEERS 1500 ROCK ISLAND D

ROCK ISLAND IL 61201

W912EK 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W912EK22T0060

SUMMARY OF CHANGES

SOLICITATION/CONTRACT FORM

The required response date/time has changed from 01-Jun-2022 02:00 PM to 03-Jun-2022 10:00 AM.

The following have been modified: SCHEDULE OF PRICES AND SCOPE

W912EK – Lake Red Rock Recreational Facilities Roof Replacements

Line Item Description Quantity Unit Total Amount

BASE

0001 Howell Station Campground - Restrooms 5 Job 0002 Howell Station Campground – Fee Booth 1 Job

BASE TOTAL (0001 thru 0002)

OPTION A

0003 Whitebreast Campground – Restrooms 4 Job 0004 Whitebreast Campground – Fee Booth 1 Job 0005 Whitebreast Campground – Shelters 4 Job 0006 Whitebreast Campground – Fish Cleaning Station 1 Job

OPTION A Total:

OPTION B

0007 South Overlook – Octagon Shelter 1 Job 0008 South Overlook - Restroom 1 Job 0009 South Overlook – Fish Cleaning Station 1 Job

OPTION B Total:

OPTION C

0010 South Tailwater - Restroom 1 Job 0011 South Tailwater – Fish Cleaning Stations 2 Job 0012 South Tailwater - Shelters 2 Job

OPTION C Total:

OPTION D

0013 North Tailwater - Restroom 1 Job 0014 North Tailwater - Shelters 2 Job 0015 North Tailwater – Fish Cleaning Station 1 Job

OPTION D Total:

OPTION E – Rubber Roofs

0016 South Overlook - Radio Tower 1 Job 0017 South Overlook – Rectangle Shelter 1 Job 0018 Whitebreast – Storage Building 1 Job

OPTION E Total:

BASE TOTAL + OPTIONS (Line items 0001 thru 0018)

JOB = LUMP SUM

ENSURE AMOUNT LINES FOR ALL ITEMS ARE COMPLETED.

THE GOVERNMENT RESERVES THE RIGHT TO EXERCISE OPTIONS AT THE TIME OF AWARD.

THE GOVERNMENT RESERVES THE RIGHT TO AWARD OPTION A, OPTION B, OPTION C, OPTION D, AND OPTION E OR ANY COMBINATION OF THE ABOVE AT TIME OF AWARD. ALL OPTIONS MAY BE EXERCISED NO LATER THAN 31

AUGUST 2022.

Statement of Work Supply with Installation of Metal and Rubber Roofs at Recreation Area Structures

Lake Red Rock 1105 N Hwy T15

Knoxville, IA 50138 Site Visit: Offerors who wish to request a site visit should contact Shawn Bonnet, Maintenance Worker Supervisor at the Lake Red Rock Office 641-828-7522, ext. 6450.

Background: The U.S. Army Corps of Engineers, Lake Red Rock is a flood control reservoir located in Marion County, Iowa.

Description of Work: The Contractor shall furnish all labor, management, tools, equipment, vehicles, fuel, materials and supplies as well as perform all work to remove the existing shingles for six (6) buildings under the base and option buildings as awarded and replace them with new standing seam metal roofs. Structures include up to twelve shower buildings/restrooms, nine picnic shelters, two fee booths and five fish cleaning stations. Under option E, remove existing rubber roofing and install a new rubber roof system. The rubber roofs consist of one picnic shelter, one radio control tower, and one storage building at Lake Red Rock in Marion County, Iowa. Work to be performed according to Statement of Work. Refer to Appendix A for location maps and Appendix B for rubber roof drawings.

Quality Assurance: All work shall be completed using EM 385-1-1 safety standards, professional, and in accordance with industry standards and installation techniques. Metal roof panel/rubber manufacturer shall have been in the business of manufacturing metal roof panels/rubber for a period of not less than five years. Contractor or his/her technical representative shall be thoroughly familiar with the products to be installed, installation requirements and practices. All work shall comply with latest industry building codes and regulations set forth by local and state authority. Roof installer shall be approved, authorized, or licensed by the roof manufacturer. Roof installer shall have a minimum of five years’ experience as an approved installer with that manufacturer. Installer must provide proof of certification from the manufacture meeting the above requirements and showing five years of installation experience prior to starting work.

Materials: The Contractor shall provide all materials needed to complete the work. The Contractor shall furnish the Government a detailed materials list, which must be reviewed and approved prior to starting any work. This list shall identify all the materials to be used in the replacing of the roofs. The list shall include the manufacture’s name/brand items/part numbers.

Any missing or unacceptable materials shall be furnished/replaced by the Contractor at no additional cost to the Government.

METAL ROOFS:

Metal Roof Panels: Hidden fastener metal roof panels shall be Standing Seam 28-gauge or 24-gauge Galvalume steel sheet. Profile-major longitudinal ribs ¾” deep, spaced 9” on center; minor longitudinal rib centered between major ribs. Size-36” cover width, lengths indicated on drawings. Finish-polyvinylidene fluoride color coat, minimum 70% polyvinylidene fluoride resin content, applied to sight exposed face of sheet after pretreatment and priming in accordance with coating manufacturer’s recommendations. The Contractor shall submit manufacturer’s standard color selection charts for Government selection. Color will be a forest or hunter green and shall be approved by the Government prior to ordering.

Trim: Manufacturer’s standard sheet metal matching panel material and finish, break-formed to profiles. Trim will be installed according to manufacturer specifications.

Accessories:

a. Synthetic underlayment – shall be applied to roof deck per manufacturer’s standards.

b. Accessories - Shall be manufacturer's standard for intended purpose, compatible with metal roof system and approved for use by the metal roof panel manufacturer. All accessories shall be finished to match the roof, unless otherwise indicated.

c. Fascia - Contractor will remove and dispose of existing fascia boards. Install new fascia boards utilizing 2” pressure treated wood. New fascia boards will bewrapped with metal manufacturer’s standard coil stock, matching panel material and finish, break-formed to profiles.

d. Roof Vents – Provide a ridge cap that is manufactured and designed for use with the standing seam roof. Match the thickness and color of the other metal trim pieces or required by the manufacture. Provide new ridge vent on all areas that were removed. Use a ridge vent that is approved for use by the manufacture and installed per the manufacture’s recommendations. For building with Whirlybird vents, remove and replace with new whirlybird per manufacturers requirements for the metal roofing and whirlybird manufacture

e. Flashing – Replace pipe boots with new. Replace all disturbed flashing with new and required by the manufacture. When applicable, match color and thickness with other metal trim pieces being installed.

f. Caulking - Caulking shall match the color of the sheet metal being worked with. If there is no caulking that matches the color the Contractor shall notify the Government an alternative caulking may be selected.

Installation: Installation shall meet specified requirements and be in accordance with manufacturer’s installation instruction and shall comply with latest industry building codes and regulations set forth by local and State authority. Contractor shall correct defects or errors in materials and installation; not install stained, discolored or damaged materials, insulate by means of gaskets or insulating compounds dissimilar materials which are not compatible when contacting each other and keep exposed surfaces and edges clean and free from sealant, metal cuttings, hazardous burrs and other foreign material. Any damaged trusses, wood decking, etc. if visible should be included into the unit pricing. Any foreseen issues shall be immediately brought to the attention of the POC prior to making any repairs. Buildings to be dried-in at the end of each workday. For the fee booths, remove and reinstall the satellites in same location. The Government will realign as necessary. If awarded, under option C and D at each location has one shelter with an existing skylight. Demo existing skylight and build back as necessary to install metal roofing over the area.

RUBBER ROOFS:

Roof Membrane Manufacturer Warranty: Furnish the roof membrane manufacturer’s 20 year, no dollar limit warranty, including flashing, insulation, and accessories necessary for a watertight roof system construction. Provide warranty directly to the Government and commence warranty effective date at the time of Government’s acceptance of the roof work.

Roof Membrane: A flexible thermoplastic membrane reinforced with a non-woven polyester based scrim mat that will be white in color. Membrane thickness as required by manufacturer to achieve warranty requirements. A. Reflectivity (ASTM C1549): 0.76 minimum B. Emissivity (White Membrane, ASTM C1371): 0.90 minimum

C. Field Sheet Dimensions:

1- Width: 10 feet maximum 2- Length: 100 feet maximum

Accessories:

a. Inside Corners – Pre molded corner flashing for inside corners shall be 60 mil thick.

b. Outside Corners – Injection molder corner used for flashing outside corners shall be 60 mil thick.

c. Molded Vent Boots – A pre-molded flashing and clamping ring used for pipe penetrations shall be 75 mil thick. Available for 0.75 inch to 8 inch diameter pipes.

d. Asphalt Primer – ASTM D41/D41M. Quick drying asphalt primer as recommended to prepare concrete deck.

e. Cut Edge Sealant – A medium solids content, free flowing polymeric material designed for sealing cut edges (exposed fabric reinforcement) of reinforced field membrane.

f. Water Block – A one component, high viscosity, Butyl based mastic used as a compression sealing agent between membrane and applicable substrates.

g. Seam Cleaner – Clear, solvent based cleaner used to loosen and remove contaminants from the surface of exposed membrane prior to heat welding aged or dirty material.

h. Caulk – A high viscosity elastomeric sealant specifically designed to adhere to TPO membranes, used to seal the exposed lip of compression fittings such as termination bars, pipe clamping rings, and exposed fasteners.

i. Insulation Coverboard – High Density Polyisocyanurate rigid board with glass coated fiber reinforced facers on both sides, meeting or exceeding the requirements of ASTM C1289.

Compression strength shall be 120 PSI, thickness shall be ½” and the attachment method shall be by manufacturer’s recommendations. Insulation adhesive shall be applied in a ribbon pattern spaced a maximum of 12 inches on center.

Installation: Do not begin installation until substrates have been properly prepared. Verify that the surface and site conditions are ready to receive work. Verify that the deck is clean and smooth, free of depressions, waves, or projections, and properly sloped to drains, valleys, eaves, scuppers or gutters. Inspect existing deck surface for damaged areas and report to the POC any areas found. Apply asphalt primer to dry smooth concrete deck at a rate of ½ gallon per 100 square foot and allow to dry. Prepare surfaces using the methods recommended by manufacturer.

Stagger joints in one direction unless joints are to be taped. Install insulation boards snug. Gaps between board joints shall not exceed ¼ inch. Fill all gaps more than ¼ inch with expanding foam. Securely attach insulation to the vapor barrier using foam insulation adhesive. Apply ½ inch ribbons of adhesive 12 inches on center and walk in insulation boards ensuring a positive attachment to the substrate. Membrane placement and attachment, seam welding, and flashing should all be completed per manufactures installation instructions. When the completion of flashings and termination is not achieved by the end of the workday, a daily night seal must be installed according to manufacturer’s requirements to temporarily close the membrane to prevent water infiltration.

Work Hours: All work shall be performed between 0800 and 1630 hours Monday through Friday.

No work will be allowed on weekends or government holidays, specifically Memorial Day (May 30th), July 4th, or Labor Day (September 5th), Veterans Day (November 11th). Any deviation from the schedule must be provided in writing and approved forty-eight (48) hours in advance by POC.

Work Plan: Provide a work plan describing in detail, how the job will be performed and in what order with equipment list.

Site Verification: Verify substrate conditions, which have been previously installed, are acceptable for product installation in accordance with manufacturer’s instructions to include but not limited to panel support systems are ready for construction activities and within specified tolerances. Submit written notification of unacceptable conditions and potential delays in construction activities until undesirable conditions have been corrected.

Preparation: Coordinate roofing with other work including drainage, flashing and trim, deck substrates, parapets, copings, walls, and other adjoining work to provide a noncorrosive and leak proof installation. Prevent galvanic action of dissimilar metals.

Jobsite Cleanliness: Work site will be closed to the public during normal working hours.

Contractor shall be responsible for keeping the public from entering the work site. At the conclusion of each workday, individual job sites will be cleaned of all tools, materials, and debris, and re- opened for public use. All tools and materials will be secured and stages in an approved location and barricaded off.

Storage: The Contractor is responsible for taking the action necessary to protect all supplies and property against damage, theft, or loss. The Government assumes no responsibility for loss or damage to any material, supplies or property. Storage areas to be approved with Government at time of award.

Water and Sanitation Facilities: The Contractor will be responsible for water and sanitation facilities.

Electricity: The Contractor will be responsible for electric power.

Protection of government and private property and natural features: The Contractor shall be responsible for any damage to Government or private property and/or injury to any person due to his/her operation and shall notify the POC immediately. The Contractor shall advise the POC of any damage to Government facilities due to vandalism. The contractor shall take measures to protect the existing campground amenities that are not to be removed. Contractor shall take precautions to limit impact to turf, landscape trees and shrubs located within the work area. Trucks, trailers, and other equipment shall be operated on existing roads and parked in designated parking areas. Damage caused by the contractor to existing facilities or natural features shall be replaced or repaired by the contractor at no cost to the Government.

Weather Limitations: No work shall be conducted when weather conditions are detrimental to the quality of the finished product. At the end of each day or before a rain event, protect all materials and buildings from possible damage due to weather.

Final Clean-Up: Prior to the contract being accepted as complete by the Government; the contractor shall clean the work area which includes but is not limited to removing all scrap or excess materials including wood, metal, shingles, and hardware. Magnetic pickup tool shall be utilized to retrieve nails, screws, and metal pieces. All materials, debris, tools, and equipment shall be removed. Debris shall be disposed of off-site and is the contractor’s responsibility.

Contractor shall pay all fees and comply with all applicable environmental laws and regulations for the disposal of the debris.

Accident Prevention Plan: Contractor shall provide safety plans that address the procedures in case of emergencies, location of nearest emergency facilities, and phone numbers. Plan shall address the pertinent provisions of "Safety and Health Requirements Manual, "EM 385-1-1 and with Occupational Safety and Health Act (OSHA) standards. OSHA standards are subject to change. It is the Contractor's responsibility to maintain familiarity with current OSHA standards.

Warranty: All materials are guaranteed to be as specified and all work shall be performed in accordance with specifications above. Contractor will provide manufacturer’s warranty in compliance with industry standards.

Sustainability:

A. Bio-based: the United States Department of Agriculture (USDA) designates certain biobased products for federal procurement and specifies minimum biobased content levels for those products. Any designated product that is being offered or supplied under this contract shall meet USDA BioPreferred’s minimum biobased content level. Visit the BioPreferred web site for the complete list of designated products and the associated minimum biobased content level requirements.

B. EPA Designated (CPG): Under the Comprehensive Procurement Guidelines (CPG) program, the Environmental Protection Agency (EPA) designates products that are or can be made with recovered materials, and recommends practices for buying these products. Any designated product that is being offered or supplied under this contract shall meet the minimum recommended content levels as identified under the CPG program. Visit http://www.epa.gov/epawaste/conserve/tools/cpg/products for a complete list of designated products and the associated recommended content levels. Offerors must be able to demonstrate that each offered product meets minimum content levels upon request.

Delivery: C ompletion of work no later than (NLT) 01 April 2023 for base and options, if awarded.

Technical POC: Any questions concerning the specifications should be addressed to Shawn http://www.epa.gov/epawaste/conserve/tools/cpg/products

Bonnett, Maintenance Worker Supervisor at the Lake Red Rock Office 641-828-7522, ext. 6450.

**NOTE: To protect the privacy of the Contractor, all Contractor employees, and all sub-contractor employees, background checks, OPSEC SOPs, E-verify, and I-9 forms shall be submitted with a coversheet stating the contract number (e.g. W912EK-15-C-XXXX), title of project, and the company's point of contact information, in a sealed envelope/container and mail:

Security Office U.S. Army Corps of Engineers Rock Island District 1500 Rock Island Drive Rock Island, IL 61201

Security Clause 1.

AT Level 1 Training. All Contractor and sub-contractor employees requiring access to non-public or private Government property must complete Anti-Terrorism (AT) Level 1 Training within 30 calendar days after notice to proceed date. AT Level 1 Training is available at the following website: https://jkodirect.jten.mil/Atlas2/faces/page/login/Login.seam. The required training is under the heading “JS-US007-14: Level 1 Antiterrorism Awareness Training.”

Contractor employees who have a Common Access Card (CAC) may log in with their CAC.

Contractor employees without a CAC shall log into the “Non-CAC users” link and need to complete the training all at once, as no record of training shall be maintained aside from the certificate that is printed upon completion. All AT Level 1 Training certificates must be submitted to the Contracting Officer within 5 calendar days of completion.

Security Clause 2(b).

For Access and General Protection Policy and Procedures. All Contractors and sub-contractor employees shall comply with installation and facility access guidelines and rules as stated herein. Contractor workforce must comply with all personal identity verification requirements as directed by Department of Defense, Department of the Army Headquarters, Rock Island District and/or local policy. In addition to the changes otherwise authorized by the Changes clause of this contract, should the Force Protection Condition (FPCON) at any installation or facility change, the Government may require changes in Contractor security matters or processes.

In support of Rock Island District evaluation of personnel authorized for access to federal facilities, the Contractor shall submit background checks that have been conducted by a bonded third party within the last 6 months of Notice to Proceed date and authorize reports to be provided to the Rock Island District Security and Law Enforcement Office by the third party.

The background check will cover, at a minimum, the ten years covering states the employee has lived in, national criminal records check which includes felony and misdemeanor offenses, Department of Motor Vehicles records, and a national sex offender registry check, submitted 14 days prior to accessing the project site.

Identification Badges: The Contractor shall be responsible for furnishing a photo identification badge/card to each employee prior to the employee's work on-site, and for requiring each https://jkodirect.jten.mil/Atlas2/faces/page/login/Login.seam employee engaged on the work to display identification. At a minimum, the badge shall have the following items shown, the employee’s picture, employee’s name, and company name working for. The badge will be prominently displayed unless restricted for safety concerns, in which case it will be available for immediate display upon request (carried on person).

As employees are added or deleted from the submitted and approved Access Control List (ACL), this information will be reported immediately to the Contracting Officer (KO). Added employees will not be permitted on-site until requirements of this paragraph are completed, submitted, and approved.

Disqualifying factors include, but are not limited to:

(1) Criminal conduct, in particular violent crime and sex offenders;

(2) Habitual use of intoxicating beverages to excess as evidenced by Driving under the influence or public intoxication records; or

(3) Any illegal activity or other disqualification which makes the individual unfit for service (e.g. drug trafficking or procurement fraud).

In addition to the submitted background checks, supplemental agency checks may be performed at the discretion of the Rock Island District security personnel. The Contractor agrees to cooperate and ensure that Contractor personnel provide any documentation required to complete these checks. Any person lacking proper identification credentials or deemed a security threat may be denied access to the project. Such action in no way relieves the Contractor from performance of the Contract. The Rock Island District retains the right to deny any Contractor and sub-contractor employee from working on a contract awarded by the Rock Island District based on final background investigation results. All information received as a result of a background check will be handled according to Privacy Act regulation.

In the event that an unexpected change in personnel is required, due to sudden absence of a critical path employee, the Contractor shall immediately contact the Contracting Officer to coordinate obtaining written approval from the Security Office for new/additional personnel to be brought on site prior to background check acceptance. Contractor shall submit Personnel Change Request Form and will receive written authorization from the Security Office prior to bringing new personnel on site, and ensure a background check is sent to the Rock Island District Security Office no later than ten days from written notice of approval. The Rock Island District reserves the right to terminate access of the employee upon completion of the Government’s review of the background check and the Contractor shall be notified immediately of any such Government decision.

In the event of an unforeseen change in work site conditions which may require a contract modification, and the contractor is required to immediately add personnel, a Personnel Change Request Form will be submitted to and approved by the Security Office prior to bringing new personnel on site, and ensure a background check is sent to the Rock Island District Security Office no later than ten days from written notice of approval. The Rock Island District reserves the right to terminate access of the employee upon completion of the Government’s review of the background check and the Contractor shall be notified immediately of any such Government decision.

Subcontractor personnel not expected to be on the worksite for more than 15 days may be allowed on site with the following conditions:

1) Employee will be on site a total of 15 days or less, for the duration of the project.

2) Employee is added to the ACL as a short term employee.

3) Employee is escorted while on site. This is defined as being in the line of sight of an identified contractor employee who has a background check on file with the Rock Island District (as noted on the ACL).

4) Each contractor employee can sponsor only five short term employees at a time.

Foreign National employees: Due to a difference in background check procedures for long term foreign national employees, all such employees must provide a photocopy of their passport to the Rock Island District Security Office NLT 30 days prior to arrival on site. Short term foreign national employees (e.g. specialists with a two week period of performance) may work on site with the following conditions:

1) Foreign national employee will be on site a total of 15 days or less, for the duration of the project.

2) Foreign national employee will comply with E-verify requirements E-verify paragraph).

3) Approved and identified contractor employee shall escort the foreign national employee at ALL times while on site.

4) Each contractor employee can sponsor only one short term foreign national at a time.

Personnel Change Request Form Contract #_______________ Date___________ We, _____________________, respectfully request to add/replace (circle one) personnel to the jobsite due to the following situation:

Personnel to be conditionally added to the ACL (escorted by):

Background checks (if required for a long term employee) shall be submitted by close of business on (insert proposed date): ________________

(Insert signature block)

Security Clause 15.

Pre-screen candidates using E-Verify Program. The Contractor must pre-screen Candidates using the E-verify Program website (http://www.uscis.gov/e-verify) to meet the established http://www.uscis.gov/e-verify employment eligibility requirements. The Contractor 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. Documentation of company enrollment in E-verify, via a print screen of the company profile within the E-verify system, must be submitted to the Security Office no later than 3 business days after the initial Notice to Proceed.

*When contracts are with individuals, the individuals will be required to complete a Form I-9, Employment Eligibility Verification must be given/coordinated with the designated Government representative. This Form will be provided to the Security Office after Notice to Proceed is given.

(End of Summary of Changes)