A.07.23_Attachment_G_-_Sample_SO_Submission_Form.xlsm
XLSM spreadsheet 41 KB Posted
- Solicitation number
- W912GB19R0007
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A.07.23 Attachment G - Sample SO Submission Form
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Service Order
| CORRECTIVE MAINTENANCE SERVICE ORDER FORM | ||
| PART I - SERVICE ORDER INFORMATION | ||
| CONTRACTOR: | CONTRACT NO.: | W912GB-XX-D-XXXX |
| CUSTOMER ORGANIZATION: | SERVICE ORDER NAME: | |
| FACILITY NAME/NUMBER: | SO REQUEST NO: | |
| SERVICE ORDER DATE: | CLIN TO BE CHARGED: | |
| SO DESCRIPTION: (include LOCATION - attach additional sheets as required): |
| 2 | |||||||
| FALSE | |||||||
| One of these boxes must be checked: | ROUTINE | EMERGENCY | |||||
| Safety Verification to be completed by Contractor | CENAU Safety Initial | ||||||
| One of these boxes must be checked: | Contractor confirms there is an AHA associated with the work being performed in this SO included in the Accident Prevention Plan (APP) | NA | |||||
| Contractor acknowledges there is NOT an AHA associated with the work being performed in this SO included in the APP. AHA is attached for review with the SO. | |||||||
| Check if applicable: | Contractor acknowledges there is an activity associtated with the SO that requires an additional plan or program that will be included in an APP addendum. | ||||||
| PART II - COST SUMMARY | |||||||
| LABOR UTILIZED | |||||||
| Labor Classification | Reg Labor Hours | Reg Labor Rate | Reg Labor Amount | OT Hours | Contr O/T Rate | OT Amount | |
| Program Manager | 2.00 | $0.00 | $0.00 | 0.00 | $0.00 | $0.00 | |
| 0.00 | $0.00 | $0.00 | 0.00 | $0.00 | $0.00 | ||
| 0.00 | $0.00 | $0.00 | 0.00 | $0.00 | $0.00 | ||
| 0.00 | $0.00 | $0.00 | 0.00 | $0.00 | $0.00 | ||
| 0.00 | $0.00 | $0.00 | 10.00 | $0.00 | $0.00 | ||
| $0.00 | $0.00 | $0.00 | $0.00 | ||||
| Labor Notes: | Total Regular Labor | $0.00 | |||||
| Safety Officer will inspect before, during and after work. Quality Control Officer will inspect during testing. | Total OT Labor | $0.00 | |||||
| Profit On Labor: 0% | $0.00 | ||||||
| TOTAL LABOR COST | $0.00 | ||||||
| MATERIALS/SUPPLIES/EQUIPMENT | |||||||
| Description | Qty | Unit | Unit Price | Amount | |||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| MSE Notes: | Freight/Shipping | ||||||
| Subtotal MSE | $0.00 | ||||||
| MSE Charge Rate: 0% | $0.00 | ||||||
| Tax: 0% | $0.00 | ||||||
| Fully Burdened MSE | $0.00 | ||||||
| Profit On MSE: 0% | $0.00 | ||||||
| NOTE: Profit shall not be applied to GSA/JCI Catalog Materials. | TOTAL MSE COST | $0.00 | |||||
| SUBCONTRACTOR COSTS | |||||||
| Description | Amount | ||||||
| $0.00 | |||||||
| $0.00 | |||||||
| SUB Notes: | Freight/Shipping | $0.00 | |||||
| SUB Charge Rate: 0% | $0.00 | ||||||
| TOTAL SUB COST | $0.00 | ||||||
| OTHER DIRECT COSTS | |||||||
| Description | Amount | ||||||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| ODC Notes: | G&A: 0% | $0.00 | |||||
| Equipment room flooded. Need to remove excess water for safety purposes. | Profit on Outside Vendor: 0% | $0.00 | |||||
| TOTAL ODC COST | $0.00 | ||||||
| TRAVEL | |||||||
| Description | Amount | ||||||
| $0.00 | |||||||
| $0.00 | |||||||
| $0.00 | |||||||
| Travel Notes: | G&A: 0% | $0.00 | |||||
| TOTAL TRAVEL COST | $0.00 | ||||||
| TOTAL SO COSTS TO BE INVOICED | $0.00 | ||||||
| PART III - AUTHORIZATION | |||||||
| CONRACTOR: Receipt & Acceptance Acknowledged. | |||||||
| E-SIGNED & DATED: | |||||||
| CUSTOMER: SO is accepted and requests NTP from USACE. | |||||||
| E-SIGNED & DATED: | |||||||
| CENAU COR: May approve SOs up to $10,000 or as otherwise authorized by the Contracting Officer. | |||||||
| E-SIGNED & DATED: | |||||||
| CONTRACTING OFFICER: Service Orders over $10,000 or as otherwise specified by Contracting Officer. | |||||||
| E-SIGNED & DATED: | |||||||
| This is a cost reimbursable service order and the initial prices submitted reflect the Contractor's best estimate to complete the work necessary to satisfy the requriement. This SO is considered technically acceptable and within scope. | |||||||
| PART IV - CERTIFICATION OF SERVICES | |||||||
| I certify that the services under the above Service Order have been satisfactorily completed. |
| QUAILITY ASSURANCE EVALUATOR: |
| E-SIGNED & DATED: |
| DATE/TIME WORK COMPLETED |
Add Row Add Row Add Row Add Row Add Row
Admin Page
| Rates: | Non-Emergency | Emergency |
| Profit on Labor: | 0.0% | 0.0% |
| Profit on MSE: | 0.0% | 0.0% |
| Profit on Outside Vendor: | 0.0% | 0.0% |
| Indrect Rate (applied to Direct Labor): | 0.00% | <-- year 1 |
| Escalation Rate (applied to Direct Labor): | 0.00% | <-- year 1 |
| Country: | ||
| Tax Rate: | 0.00% | |
| MSE Handling Charge Rate: | 0.00% | |
| SUB Handling Charge Rate: | 0.00% | |
| G&A Rate: | 0.00% | |
| Labor Classification | BASE RG | BASE OT |
| Program Manager | € - 0 | € - 0 |
| Project Manager | € - 0 | € - 0 |
| Contract Administrator | € - 0 | € - 0 |
| Maintenance Manager | € - 0 | € - 0 |
| Administrative Assistant | € - 0 | € - 0 |
| General Engineer | € - 0 | € - 0 |
| Mechanical Engineer | € - 0 | € - 0 |
| Electrical Engineer | € - 0 | € - 0 |
| Electronic Security Engineer | € - 0 | € - 0 |
| Systems Engineer | € - 0 | € - 0 |
| Network Specialist | € - 0 | € - 0 |
| Data Manager | € - 0 | € - 0 |
| CADD Operator | € - 0 | € - 0 |
| Engineering Technician/Technical Writer | € - 0 | € - 0 |
| Estimator | € - 0 | € - 0 |
| Quality Control Officer | € - 0 | € - 0 |
| Safety Officer | € - 0 | € - 0 |
| Planner/Scheduler | € - 0 | € - 0 |
| General Clerk | € - 0 | € - 0 |
| Maintenance Supervisor | € - 0 | € - 0 |
| Trades Supervisor | € - 0 | € - 0 |
| Active Vehicle Barrier Technician | € - 0 | € - 0 |
| Electronic Security Systems Technician | € - 0 | € - 0 |
| Electrical Technician | € - 0 | € - 0 |
| Mechanical Technician | € - 0 | € - 0 |
| Fire Alarm Technician | € - 0 | € - 0 |
| € - 0 | € - 0 |
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