W912HN-22-B-4015_SPECS_VOL2_AMD0001.pdf

Fort Buchanan, Puerto Rico

Solicitation Number

W912HN-22-B-4015

Repair/Replace Antilles Middle School Chillers/HVAC Volume 2 of 2: Appendices August 2022

U.S. ARMY ENGINEER DISTRICT, SAVANNAH

CORPS OF ENGINEERS

100 WEST OGLETHORPE AVENUE

SAVANNAH, GEORGIA 31401-3640

US Army Corps Of Engineers Savannah District

Repair/Replace Antilles Middle School Chillers/HVAC 22B4015 Fort Buchanan, Puerto Rico

PROJECT TABLE OF CONTENTS

DIVISION 01 - GENERAL REQUIREMENTS

01 11 00 SUMMARY OF WORK

01 14 00 WORK RESTRICTIONS AND SPECIAL PROVISIONS

01 30 00 ADMINISTRATIVE PROCEDURES

01 32 01 PROJECT SCHEDULE

01 33 00 SUBMITTAL PROCEDURES

01 35 26 GOVERNMENTAL SAFETY REQUIREMENTS

01 42 00 SOURCES FOR REFERENCE PUBLICATIONS

01 45 00 RESIDENT MANAGEMENT SYSTEM CONTRACTOR MODE (RMS CM)

01 45 04 CONTRACTOR QUALITY CONTROL

01 45 35 SPECIAL INSPECTIONS

01 50 02 TEMPORARY CONSTRUCTION FACILITIES

01 52 10 CONTRACTING OFFICER'S FIELD OFFICE

01 55 26 TRAFFIC CONTROL

01 57 20 ENVIRONMENTAL PROTECTION

01 78 02 CLOSEOUT SUBMITTALS

01 78 23 OPERATION AND MAINTENANCE DATA

01 91 00.15 TOTAL BUILDING COMMISSIONING

DIVISION 05 - METALS

05 12 00 STRUCTURAL STEEL

DIVISION 09 - FINISHES

09 90 00 PAINTS AND COATINGS

DIVISION 23 - HEATING, VENTILATING, AND AIR CONDITIONING (HVAC)

23 05 15 COMMON PIPING FOR HVAC

23 05 48 VIBRATION AND SEISMIC CONTROLS FOR HVAC PIPING AND

EQUIPMENT

23 05 48.19 SEISMIC BRACING FOR HVAC

23 05 93 TESTING, ADJUSTING, AND BALANCING FOR HVAC

23 07 00 THERMAL INSULATION FOR MECHANICAL SYSTEMS

23 09 00 INSTRUMENTATION AND CONTROL FOR HVAC

23 09 13 INSTRUMENTATION AND CONTROL DEVICES FOR HVAC

23 09 23.02 BACNET DIRECT DIGITAL CONTROL FOR HVAC AND OTHER BUILDING

CONTROL SYSTEMS

23 30 00 HVAC AIR DISTRIBUTION

23 64 10 WATER CHILLERS, VAPOR COMPRESSION TYPE

23 64 26 CHILLED WATER PIPING SYSTEMS

23 81 00 DECENTRALIZED UNITARY HVAC EQUIPMENT

23 84 19 DESICCANT COOLING SYSTEMS

DIVISION 25 - INTEGRATED AUTOMATION

25 05 11 CYBERSECURITY FOR FACILITY-RELATED CONTROL SYSTEMS

DIVISION 26 - ELECTRICAL

26 20 00 INTERIOR DISTRIBUTION SYSTEM

26 29 23 ADJUSTABLE SPEED DRIVE (ASD) SYSTEMS UNDER 600 VOLTS

APPENDICES

PROJECT TABLE OF CONTENTS Page 1

Repair/Replace Antilles Middle School Chillers/HVAC 22B4015 Fort Buchanan, Puerto Rico

Appendix A Standard Forms

-- End of Project Table of Contents --

PROJECT TABLE OF CONTENTS Page 2

APPENDIX A

STANDARD FORMS

APPENDIX A - STANDARD FORMS

LIST OF FORMS

APPENDIX A - Page 1 (Revised By Amendment No. 0001)

*1 Army Project Sign

Safety Performance Sign

Corps of Engineers Logo

Accident Prevention Plan Checklist

Construction Quality Control Report

Weekly Temporary Electrical Inspection

Minimum Standard for Temporary Electrical Service (Ref. FAR 52.236-14)

SAD FL198 - Report of Safety Meeting

DA Form 5418-R - Cost Estimate Analysis

DD Form 1532 - Pest Management Report

DD Form 1532 - Pest Management Maintenance Record

DHS Form I-9 - Employment Eligibility Verification

ENG Form 16-1 - Certificate of Compliance for LHE and Rigging

ENG Form 16-2 - Standard Pre-Lift Plan (LHE)/Checklist

ENG Form 16-3 - Critical Lift Plan

ENG Form 2454 - Construction Progress Chart

ENG Form 3394 – Accident Investigation Report

ENG Form 4025 - Transmittal of Shop Drawings, Equipment Data, Material

Samples, or Manufacturer's Certificates of Compliance

Real Property Inventory and BIS Worksheet

Landfill Permit Application

Standard Form LLL-A - Disclosure of Lobbying Activities

Contractor Hazardous Material Inventory Log (EPRCA)

Contractor-Furnished Spoil, Disposal Areas

Safety Performance Sign EP 310-1-6a 01 Jun 06

16-3

Each contractor’s safety record is to be posted on Corps managed or supervised construction projects and mounted with the Construction Project Identification sign specified on page 16-2.

The graphic format, color, size and type-faces used on the sign are to be repro-duced exactly as specified below. The title with First Aid logo in the top section of the sign, and the performance record captions are standard for all signs of this type. Legend groups 2 and 3 below identify the project and the contractor and are to be placed on the sign as shown.

Safety record numbers are mounted on individual metal plates and are screw-mounted to the background to allow for daily revisions to posted safety perfor-mance record.

Special applications or situations not covered in these guidelines should be referred to the district Sign Program Manager.

Legend Group 1: Standard two-line title “Safety is a Job Requirement” with 8” (outside diameter) Safety Green first aid logo.

Color: To match Pantone system 347 Typeface: 3" Helvetica Bold Color: Black

Legend Group 2: One- to two-line project title legend describes the work being done under this contract and name of host project.

Color: Black Typeface: 1.5" Helvetica Regular Maximum line length: 42"

Legend Group 3: One- to two-line identifica-tion: name of prime contractor and city, state address. Color: Black Typeface: 1.5" Helvetica Regular Maximum line length: 42"

Legend Group 4: Standard safety record captions as shown.

Color: Black Typeface: 1.25” Helvetica Regular

Replaceable numbers are to be mounted on white .060 aluminum plates and screw-mounted to background.

Color: Black Typeface: 3" Helvetica Regular Plate size: 2.5" x 4.5"

All typography is flush left and rag right, upper and lower case with initial capitals only as shown. Letter- and word-spacing to follow Corps standards as specified in Appendix D.

3” 33.030” eq. 8” eq.

6”

4.5”

10.5”

2.25” 3”

2.25” 3”

4.875”

4.875”

6.75”

4.875” .75” 4.875”

4.5”

3”

3” 42” 3”

2.25” 2.25” 2.25” 2.25”

.75”

3”

.75”

Sign Legend Panel Post Specification Mounting Color Type Size (A) Size Size Code Height Bkg/Lgd

CID-02 various 4’x4’ 4”x4” HDO-3 48” WH/BK-SG

CORPS OF ENGINEERS LOGO

HALF SIZE

CESO Form A-02 MAR 15

Form A-02 U.S. Army Corps of Engineers

Accident Prevention Plan Checklist

Date of Inspection

Location (Plant or Facility) Contract Number

Contractor Name Project Name

Inspector Name (Print) Inspector Signature

This checklist serves as a guide only, it does not replace or eliminate the need to comply with the requirements set forth in Engineering Manual 385-1-1, Safety and Health Requirements Manual, dated 30 Nov 2014. The references included in this checklist correspond to the applicable sections of EM 385-1-1.

Item Description Yes No N/A Remarks (Any NO or N/A item)

a. Signature sheet

1. Includes the name, title, signature, telephone number, and qualifications of the Plan Preparer (Qualified person, i.e. corporate safety staff person, QC)

2. Includes the name, title, signature, telephone number, and qualifications of the Plan Approver (e.g. owner, company president, regional vice president) (HTRW activities require approval of a Certified Industrial Hygienist, a Certified Safety Professional may approve the plan for operations involving UST removal where contaminants are known to be petroleum, oils, or lubricants).

3. Includes the name(s), title(s), signature(s), telephone number(s), and qualifications for Plan Concurrence (provide concurrence of other applicable corporate and project personnel (contractor)) (e.g. Chief of Operations, Corporate Chief of Safety, Corporate Industrial Hygienist, project manager or superintendent, project safety professional, project QC.)

b. Background information

1. Includes the Contractor Name.

2. Includes the Contract Number.

3. Includes the Project Name.

4a. Includes the Brief Project Description.

4b. Includes a Discription of the Work to be Performed.

4c. Includes the Location of the Project (map).

4d. Includes the Equipment to be Used.

4e. Includes the Anticipated High Risk Activities.

5. Includes the Major Phases of Work Anticipated.

(Within these major phases of work identified, activities [includes Definable features of Work (DFOWs) and tasks] to be performed that will require an AHA shall be specifically highlighted. This information can then be used by QC, QA and Safety personnel to track AHA submittals. The AHAs for these activities, tasks of DFOWs are NOT submitted at this time (AHAs created/submitted at this time would not be activity-specific as they are intended to be). > See Sections 01.A.14 and 01.A.15.)

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Item Description Yes No N/A Remarks (Any NO or N/A item)

c. Statement of Safety and Health Policy.

1. Provide a copy of current corporate/company Safety and Health Policy Statement, detailing commitment to providing a safe and healthful workplace for all employees. (In addition to the corporate policy statement, a copy of the corporate safety program may provide a portion of the information required by the accident prevention plan.)

2. Includes Contractor’s written safety program goals.

3. Includes Contractor’s written safety program objectives.

4. Includes the Contractor Accident Experience (Copy of OSHA 300 Forms, or equivalent documentation).

d. Responsibilities and Lines of Authority.

1. Includes statement of the employer’s ultimate responsibility for the implementation of his SOH program for his own employees, all sub-contractors and all others on the worksite (includes the strict enforcement of the program).

2. Includes the identification and accountability of personnel responsible for safety and health at both the corporate and project level – including their resumes. Qualifications shall be in accordance with Section 01.A.17. (Only official OSHA 30-Hour cards will be accepted or, if equivalent training is provided, appropriate instructor qualifications.)

3. Includes equivalent training to the OSHA 30-Hour classes is being presented as qualification, the training shall cover, as a minimum, the areas discussed in Appendix A, Section 3.d.3.(a-d).

4. Includes the names of Competent (CP) and/or Qualified Person(s) (QP) and proof of competency/qualification to meet specific OSHA CP/QP requirements. (Must include copies of proof of CP/QP).

5. Includes requirements and details of the employer’s Risk Management Process. (USACE uses the Activity Hazard Analysis (AHA) as part of a total risk management process. Contractors and other individual employer’s may use the AHAs or their own version [Job Safety Analyses (JSAs), Job Hazard Analyses (JHAs), or similar Risk Management assessment tools]. These documents are considered equivalent to, and acceptable substitutes for, the USACE’s AHA provided the data collected is the same as that required by the AHA.)

6. Includes requirements for initial activity-specific AHAs to be submitted and accepted at preparatory meetings, prior to work being performed;

7. Includes requirements that no work by the Contractor shall be performed unless a designated Competent Person/SSHO is present on the job site.

8. Includes policies and procedures regarding non-compliance with safety requirements (to include disciplinary actions for violation of safety requirements).

9. Lines of authority.

10. Includes written company procedures for holding managers and supervisors accountable for safety.

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Item Description Yes No N/A Remarks (Any NO or N/A item)

e. Subcontractors and Suppliers.

1. Includes the list of subcontractors and suppliers.

(If not known at the time of initial APP submittal, the contractor shall include the following statement in their initial APP: “The subcontractors for the following DFOWs/activities are not known at this time, but additional information will be submitted to the APP for acceptance prior to the start of any activities listed”)

2. Includes safety responsibilities of subcontractors and suppliers.

f. Training

1. Includes requirements for new hire SOH orientation training at the time of initial hire of each new employee.

2. Includes requirements for mandatory training and certifications that are applicable to this project (e.g., explosive actuated tools, confined space entry, crane operator, diver, vehicle operator, HAZWOPER training and certification, PPE) and any requirements for periodic retraining / recertification.

3. Includes procedures for periodic safety and health training for supervisors and employees.

4. Includes the requirements for emergency response training.

g. Safety and Health Inspections

1. Includes specific assignment of responsibilities for a minimum daily jobsite SOH inspection during periods of work activity.

1a. Includes the name(s) of individual(s) responsible for conducting safety inspections. (e.g., PM, safety professional, QC, supervisors, employees) 1b. Includes proof of inspector's training / qualifications.

1c. Indicates when inspections will be conducted.

1d. Indicates procedures for documentation. (Furnished sample forms upon which inspections will be recorded.)

1e. Indicates deficiency tracking system and follow-up procedures.

2. Includes any external inspections / certifications which may be required. (e.g., US Coast Guard)

h. Mishap Reporting and Investigation

1. The plan identifies how, when, and who shall complete the Exposure data (man-hours worked).

2a. The plan identifies how, when, and who shall complete mishap investigations, reports, and logs. (The contractor shall report, thoroughly investigate, and analyze all mishaps occurring incidentally to an operation, project or facility for which this manual is applicable.)

2b. The plan identifies how, when, and who shall make immediate notification of major mishaps. (Mishaps shall be reported as soon as possible but not more than 24 hours afterwards to the KO/COR.)

2c. Includes how, when, and who will provide notice to the KO/COR when corrective actions are completed. (Implement corrective actions as soon as reasonably possible.)

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable safety and occupational health risks and associated compliance plans. Using the EM 385-1-1 as a guide, plans, programs, procedures (assessments and evaluations), may include but not be limited to:

(1)Include a project-specific compliance plan, as applicable to the work being performed, and as identified below. The plans shall incorporate project-wide procedures to control hazards to which the employees of all project employers may be exposed.

(2) These procedures shall be coordinated with all project employers and shall include project-specific, project-wide emergency response and evacuation procedures, PPE requirements, recordkeeping and reporting requirements, and training requirements.

(3) The plans shall be prepared prior to the start of any work activities on the job site (as much as the information can be known at that point in time). The plans shall be updated throughout the life of the project to include changes in personnel, equipment, conditions, etc. Additional revisions shall be incorporated as necessary to reflect changing site conditions, construction methods, personnel roles and responsibilities and construction schedules.

(4) No activity (DFOW) shall be started on site until the APP is revised and submitted to the GDA for acceptance, with the site-specific plans, programs and procedures required to complete the project.

Item Description Yes No N/A Remarks (Any NO or N/A item)

i. Plans (Programs, Procedures, Assessments, and Evaluations) required by the Safety Manual

1. Fatigue Management Plan (01.A.20)

2. Emergency Plans (01.E):

(a) Procedures & Test (01.E.01)

(b) Spill Plans (01.E.01, 06.A.02)

(c) Fire Fighting Plan (01.E.01; 19.A)

(d) Posting of Emergency Telephone Numbers (01.E.05)

(e) Man overboard/abandon ship (19.A.04)

(f) Plan for prevention of alcohol and drug abuse (01.C.02 & Specs)

3. Site Sanitation/Housekeeping Plan (02.B)

4. Medical Support Agreement. Outline on-site medical support and off-site medical arrangements including rescue and medical duties for those employees who are to perform them, and the name(s) of on-site Contractor personnel trained in first aid and CPR. A minimum of two employees shall be certified in CPR and first-aid per shift/site (03.A.01, 03.A.03)

5. Blood-borne Pathogen Program (03.A.05)

6. Exposure Control Plan (03.A.05)

7. Automatic External Defibrillator (AED) Program (03.B.04)

8. Site Layout Plan (04.A)

9. Access/Haul Road Plan (04.B)

10. Hearing Conservation Program (05.C)

11. Respiratory Protection Plan (05.G)

12. Health Hazard Control Program (06.A)

13. Hazard Communication Program (06.B.01)

14. Process Safety Management Plan (06.B.04)

15. Lead Compliance Plan (06.C.02 & Specifications)

16. Asbestos Abatement Plan (06.C.03 & Specifications)

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans, programs, procedures (assessments and evaluations), may include but not be limited to:

Item Description Yes No N/A Remarks (Any NO or N/A item)

i. Plans (Programs, Procedures) continued.

17. Radiation Safety Program (06.F)

18. Abrasive Blasting Plan (06.I)

19. Heat Stress Monitoring Plan (HSMP) (06.J.02)

20. Cold Stress Monitoring Plan (CSMP) (06.J.04)

21. Indoor Air Quality Management Plan (06.L)

22. Mold Remediation Plan (06.L.04)

23. Chromium (VI) Exposure Evaluation (06.M)

24. Crystalline Silica Assessment (06.N.02)

25. Lighting Plan for Night Operations (07.A.06)

26. Traffic Control Plan (08.C.05)

27. Fire Prevention Plan (09.A.01)

28. Wild Land Fire Management Plan (09.L)

29. Arc Flash Hazard Analysis (11.B)

30. Assured Equipment Grounding Control Program (AEGCP), (11.D.05, Appendix E)

31. Hazardous Energy Control Program and Procedures (12.A.01)

32. Standard Pre-Lift Plan – LHE (16.A.03)

33. Critical Lift Plan – LHE (16.H)

34. Naval Architectural Analysis – LHE (Floating) (16.L)

35. Floating Plant Inspection and Certification (19.A.01)

36. Severe Weather Plan for Marine Activities (19.A.03)

37. Emergency Plan for Marine Activities (19.A.04)

38. Man Overboard/Abandon Ship Procedures (19.A.04)

39. Float Plan for Launches, Motorboats, Skiffs (19.F.04)

40. Fall Protection and Prevention Plan (21.D)

41. Demolition/Renovation Plan (to include engineering survey) (23.A)

42. Rope Access Work Plan (24.H)

43. Excavation/Trenching Plan (25.A.01)

44. Fire Prevention and Protection Plan for Underground Construction (26.D.01)

45. Compressed Air Work Plan for Underground Construction (26.I.01)

46. Erection and Removal Plan for Formwork and Shoring (27.C)

47. Precast Concrete Plan (27.D)

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Based on a risk assessment of contracted activities and on mandatory OSHA compliance programs, the Contractor shall address all applicable occupational risks and compliance plans. Using the EM 385-1-1 as a guide, plans, programs, procedures (assessments and evaluations), may include but not be limited to:

Item Description Yes No N/A Remarks (Any NO or N/A item)

i. Plans (Programs, Procedures) continued.

48. Lift-slab Plans (27.E)

49. Masonry Bracing Plan (27.F.01)

50. Steel Erection Plan (28.B)

51. Explosives Safety Site Plan (ESSP) (29.A)

52. Blasting Plan (29.A; 26.J)

53. Dive Operations Plan (30.A.14, 30.A.16)

54. Safe Practices Manual for Diving Activities (30.A.15)

55. Emergency Management Plan for Diving (30.A.18)

56. Tree Felling/Maintenance Program (31.A.01)

57. Aircraft/Airfield Construction Safety & Phasing Plan (CSPP) (32.A.02)

58. Aircraft/Airfield Safety Plan Compliance Document (SPCD) (32.A.02)

59. Site Safety and Health Plan (HTRW) (33.B)

60. Confined Space Entry Procedures (34.A.05)

61. Confined Space Program (34.A.06)

j. Risk Management Processes (AHAs). Detailed project-specific hazards and controls shall be provided by Activity Hazard Analysis for each activity (DFOW). No work will begin on an activity (DFOW) until the initial AHA has been accepted by the GDA addressing the project-specific hazards. (01.A.14 & 01.A.15) Note: USACE uses the Activity Hazard Analysis (AHA) as part of a total risk management process. Contractors and other individual employer’s may use the AHAs or their own version [Job Safety Analyses (JSAs), Job Hazard Analyses (JHAs), or similar Risk Management assessment tools].

These documents are considered equivalent to, and acceptable substitutes for, the USACE’s AHA provided the data collected is the same as that required by the AHA.

Remarks:

U.S. Army Corps of Engineers

Accident Prevention Plan Checklist (cont’d)

Date of Inspection

Other Remarks:

CONTRACTOR'S NAME

(Address)

DAILY CONTRACTOR QUALITY CONTROL REPORT

Date: ______________ Report No. _____

Contract No. _____________________________

Description and Location of Work: ___________________________________________

Weather: (Clear) (P. Cloudy) (Cloudy); Temperature: ___ Min. ___ Max; ___

Rainfall ______ inches

Contractor/Subcontractors and Area of Responsibility

1. Work Performed Today: (Indicate location and description of work performed. Refer to work performed by prime and/or subcontractors by letter in table above.)

2. Results of Surveillance: (Include satisfactory work completed, or deficiencies with action to be taken.)

3. Tests required by Plans and/or Specifications Performed and Results of tests:

4. Verbal Instructions Received: (List any instructions given by Government personnel on construction deficiencies, retesting required, etc., with action to be taken.)

5. Remarks: (Cover delays and any conflicts in plans, specifications, or instructions.)

6. Safety Inspection: (Report violations noted; corrective instructions given; and corrective actions taken.)

7. Equipment Data: (Indicate items of construction equipment, other than hand tools, at jobsite, and whether or not used.)

CONTRACTOR'S VERIFICATION: The above report is complete and correct and all material and equipment used and work performed during this reporting period are in compliance with the contract plans and specifications except as noted above.

Contractor's Approved Authorized Representative

WEEKLY TEMPORARY ELECTRICAL INSPECTION

Week ending ________________

Contract No. __________________________

Contract Description _______________________________________________________

The following items were inspected in accordance with requirements in National Electrical Code and Corps of Engineers Safety and Health Requirements Manual, EM 385-1-1.

1. Wire (size, type, condition).

2. Systems and devices (polarity, continuity of ground, resistance to ground).

3. Resistance of ground rods (25 OHMS) measured and recorded.

4. Check GFI for 15/20 amp 120 volt circuits.

5. Plugs and receptacles (type, NEMA rating).

6. Circuit breakers and disconnect (size, type, weatherproof).

7. Extension cords (type, UL listed, insulation condition, splices, location).

8. Open wiring on insulators, nonmetallic sheathed cable, outside clearance (600 volts or less), Festoon lighting (as applicable).

Signature Electrician/Electrical Engineer

MINIMUM STANDARD FOR TEMPORARY ELECTRICAL SERVICE

(DIMENSIONS ARE APPROXIMATE)

A. The backboard for temporary service shall consist of not less than 1/2 inch plywood of exterior grade.

B. Numbers above correspond to the item below:

Item 1 - NEMA 3R circuit breaker type panelboard. This panelboard shall consist of 1 two-pole 60 amp main circuit breaker, 4* one pole 20 AMP branch circuit breakers, and 1* two pole 20 AMP branch circuit breaker. Breakers shall meet Federal Specifications Standards for Class 1A breakers and shall be plug-in type. (*Number of breakers to be adjusted to suit the job requirements.)

Item 2 - Duplex grounding type convenience outlets in standard utility type outlet boxes with covers, meeting the NEC and NEMA requirements for wet locations.

Connections to the branch circuit breakers shall be grounded by two conductors #12 NMC cable.

Item 3 – (Optional) A single three-conductor grounding type outlet rated for 250 volt service meeting the NEC and NEMA requirements for wet locations. Connections from this outlet to the two pole breaker shall be by two conductor grounded type NMC cable.

Item 4 - 3/4 inch PVC. This shall be used to support extension cords.

Item 5 – NEMA 3R service disconnect safety switch – 60 amp minimum.

C. The panelboard shall be grounded by #6 copper wire connected to a 3/4 inch by 10-foot long ground rod.

D. Service to the panel shall consist of three copper conductor #6 minimum service entrance cable. This cable may enter the top or side of the panelboard.

E. Periodic inspections of systems and devices will be made by the Contractor at intervals not to exceed 1 week, and a report will be submitted indicating the results.

F. All receptacle outlets that provide temporary electrical power during construction, remodeling, maintenance, repair, or demolition shall have ground-fault circuit-interrupter (CFCI) protection for personnel. GFCI protection shall be provided on all circuits serving portable electric hand tools or semi-portable electric power tools (such as block/brick saws, table saws, air compressors, welding machines, and drill presses). See EM 385-1-1 for exceptions.

G. Per EM 385-1-1 all temporary power distribution systems shall be submitted to the field office before installation.

REPORTING OF SAFETY MEETING _________________________________________

(INSTALLATION, FIELD OFFICE, JOB, ETC.)

THRU EN

CD

OP

RE

TO SO

FROM:

DATE: _____________________________ TIME: _________________ (A.M./P.M.)

NO. EMPLOYEES PRESENT _____________ DURATION: _________________________

Old Business: (Review report of last meeting. Follow up on action taken or anticipated to correct any safety deficiencies brought up at last meeting. Discuss any unfinished business.)

New Business: (Discuss any unsafe acts or conditions observed since last safety meeting and any mishaps or injuries which occurred during the week.)

Safety Presentation: (Safety talk, movie, or slide presentation on subject that is relevant to operation at hand.)

DATE AND TIME OF NEXT MEETING

(Signature and Title)

SAD FL 198, 1 APR 80

# OF

UNITS

UNIT

AREAS

MIN

UNIT

TOTAL

HRS

UNIT

PRICE

COST

UNIT

PRICE

COST

UNIT

PRICE

COST

UNIT

WT

TOTAL

WT

TOTAL THIS SHEET

DA Form 5418-R

MATERIAL

TASK DESCRIPTION TOTAL

SHIPPING

COST ESTIMATE ANALYSIS

PROJECT

LOCATION

INVITATION/CONTRACTOR

CODE (Check one) ____A ____B ____C ____Other _________________

EFFFECTIVE PRICING DATE

QUANTITY LABOR EQUIPMENT

DRAWING NO.

ESTIMATOR

DATE PREPARED

SHEET OF SHEETS

CHECKED BY

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Date:

Location:

A. TOTAL LOAD

lbs lbs lbs lbs lbs lbs lbs lbs lbs.

ft.

ft.

ft. G. PRE-LIFT CHECKLIST (YES) N/A ft.

lbs.

lbs.

deg.

deg.

lbs.

12. Lift is % of the Crane's rated capacity

13. If Jib/Ext. is to be used:

Length ft.

Offset ft.

14. Rated Capacity of Jib/Ext. lbs C. HOIST ROPE Main Aux 1

Size:

lbs.

lbs.

6. Shackle Rated Capacity(s) _________________

Aux 2

1. # of Parts

2. Rope Diamter

3. Capacity

5. Shackle Size(s):

8. Signal Person Qualifications

2. Rigging Inspected

3. Crane Set-up

4. Overhead Hazard Check

5. Swing Check

6. Counterweight Check

7. Operator Qualifications

15. Site Control

16. Signatures

14. Traffic Hazard Check

11. Load Test

12. Tag Lines

13. Wind Conditions

(NO)

1. Crane Inspected

YES / NO

1. Certified Operator?

2. Option?

3. Certified for Type, Class & Capacity?

4. Designated in writing by emp

YES / NO

YES / NO

B. CRANE F. OPERATOR QUALIFICATIONS

YES / NO

Note: Bearing Pressure Calculations must be attached on Page 3.

Note: If Obstructions are present they must be shown on Page 4.

E. CRANE PLACEMENT (Mobile Cranes Only)

YES / NO

YES / NO

1. Load Weight

3. Wt. of Main Block

Note: Source of load weight (Drawings, Calcs, etc.) must be attached on Page 2.

Note: If Elelctrical Hazards are present they must be shown on Page 4.

Note: Ground Condition Calculations must be attached on Page 3.

1. Hitch Type(s)

2. No. of Slings:

3. Sling Type:

4. Sling Assembly Capacity:

D. RIGGING

9. Rigger Qualifications

10. Load Chart in Crane

6. Wt. of Jib/Ext. (erected/stowed)

7. Wt. of Hoist Rope

8. Other:

1. Type of Crane

3. Radius (Maximum)

4. Radius (Minimum)

5. Boom Length (Maximum)

6. Boom Length (Minimum)

8. Crane Capacity (Min Radius)

9. Boom Angle (Maximum)

USACE District:

Prepared By:

CRITICAL LIFT PLAN

U.S. Army Corps of Engineers

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

6. Other?

Apr-13 Page 1 of 6

PSF

H. SIGNATURES

2. Rigger

1. Crane Operator

3. Signal Person

4. Lift Supervisor

5. Other

6. Other

7. Crane Capacity (Max Radius)

5. Travel with Load Required?

4. Obstructions to Lift or Swing?

3. High Voltage or Electrical Hazards?

2. Ground Conditions Suitable for Load?

1. Maximum Bearing Pressure

11. Gross Load of Crane

4. Wt. of Lifiting Beam

5. Wt. of Sling/Shackles

TOTAL WEIGHT

Mobile Hydraulic Truck

10. Boom Angle (Minimum)

2. Wt. of Aux. Block

2. Maximum Crane Capacity

A "critical lift" can be defined as any non-routine crane lift requiring detailed planning and additional or unusual safety precautions.

Critical lifts include lifts made where the load weight is greater than 75% of the rated capacity of the crane; lifts which require the load to be lifted, swung or placed out of the operator's view (except Change 6 exemption) ; lifts made with more than one crane; lifts involving non-routine or technically difficult rigging arrangement; hoisting personnel with a

FORM 16-3

Critical Lift Plan

Show here or attach calculations, drawings, etc.

CRITICAL LIFT PLAN

U.S. Army Corps of Engineers

Page 2 of 6Apr-13

LOAD CALCULATIONS

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

Show here or attach calculations, drawings, etc.

U.S. Army Corps of Engineers

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

BEARING PRESSURES & GROUND CONDITIONS

Apr-13 Page 3 of 6

Show here or attach load chart

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

LOAD CHART

Apr-13 Page 4 of 6

Show here or attatch operator qualifications

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

OPERATOR, RIGGER, SINGAL PERSON QUALIFICATIONS

Apr-13 Page 5 of 6

Show here or attach site plan and sequencing

CRITICAL LIFT PLAN

For use of this form, see EM 385-1-1, Section 16. Proponent agency is Crane HHWG.

SITE PLAN

Apr-13 Page 6 of 6

REAL PROPERTY INVENTORY

ITEM TALLY TOTAL

COMMODES

LAVATORIES

URINALS

EXHAUST FAN (9")

EXHAUST FAN

(OTHER)

WATER COOLER

HOTWATER HEATER

MOP SINK

AC PLANT

LS 5 TN. 5-25 TN. 25-100 TN. OVER 100 TN.

AS (WINDOW TYPE)

FIRE ALARM SYSTEM

MANUAL HALON SPRINKLER

EMERGENCY LIGHTS

UNIT HEATER

STRIP HEATER

COOLING TOWER

WALK-IN COOLER

AIR CURTAIN

EYE WASH

SHOWERS

BOILER

GAS FIRED OIL FIRED STEAM

FUEL TANK

UNDERGROUND OUTSIDE

WASH BASIN

AIR COMPRESSOR

HOISTS

INVENTORY BY: DATA:

RECONCILED BY: DATA:

INVENTORIED BY: DATE:

RECONCILED BY: DATE:

AFZA-DE-RJ (420-10c) Date: _________________

MEMORANDUM FOR DEH ENVIRONMENTAL OFFICE

SUBJECT: Landfill Permit Application

1. Fill in the following information for each Contractor vehicle:

a. Landfill to Be Used: Sanitary _____ Demolition _____ Both _____

b. Company Name: ___________________________________________________

c. Contract Number: _______________________________________________

d. Project Title: _________________________________________________

e. Project Location: ______________________________________________

f. Date of Notice to Proceed: _____________________________________

g. Project Length (In Days): ______________________________________

h. Vehicle Make: __________________________________________________

i. Vehicle License Plate Number: __________________________________

j. Contract Inspector: ____________________________________________

2. Note: Applications must be forwarded to the Environmental Office by a Government Official (e.g., Contracting Officer's Representative or Project Inspector). Applications delivered on any working day will be processed and available for pickup the following workday by 0830.

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden disclosure.)

1. Type of Federal Action:

a.

b.

c.

d.

e.

f.

contract grant cooperative agreement loan loan guarantee loan insurance

2. Status of Federal Action:

a.

b.

c.

bid/offer/application initial award post-award

3. Report Type:

a.

b.

initial filing material change

For Material Change Only:

year quarter date of last report

4. Name and Address of Reporting Entity:

Congressional District, if known:

Prime Subawardee Tier , if known:

5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Congressional District, if known:

6. Federal Department/Agency:

7. Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

9. Award Amount, if known:

10. a. Name and Address of Lobbying Entity (if individual, last name, first name, MI):

b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI):

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

11. Amount of Payment (check all that apply):

$ actual planned

12. Form of Payment (check all that apply):

a.

b.

cash in-kind; specify: nature value

13. Type of Payment (check all that apply):

a.

b.

c.

d.

e.

f.

retainer one-time fee commission contingent fee deferred other; specify:

14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment indicated in Item 11:

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

15. Continuation Sheet(s) SF-LLL-A attached: Yes No

Information requested through this form is authorized by title 31 U.S.C section 1352. This disclosure of lobbyig activities is a materia representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352 . This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to

Signature:

Print Name:

Title:

Telephone No.: Date:

Federal Use Only: Authorized for Local Reproduction

Approved by

OM

0348-0046

16.

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C.

section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with a covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

Identify the status of the covered Federal action.

Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier.

Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

If the organization filing the report in item 4 checks “Subawardee”, then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known.

Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., “RFP-DE-90-001.”

For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

(a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individuals(s) performing services, and include full address if different from 10 (a).

Enter Last Name, First Name, and Middle Initial (MI).

Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.

Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment.

Check the appropriate box(es). Check all boxes that apply. If other, specify nature.

Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503.

DISCLOSURE OF LOBBYING ACTIVITIES

CONTINUATION SHEET

Authorized for Local Reproduction Standard Form - LLL-A

Approved by

OM

0348-0046

Reporting Entity: Page of

*U.S. G.P.O. 1990-260-708:00012

CONTRACTOR HAZARDOUS MATERIAL INVENTORY LOG

(EPRCA)

PRIME COMPANY NAME: _____________________________________ CONTRACT NO: __________________________

PROJECT TITLE / LOCATION: _______________________________________________________________________

Material Name Manufacturer MSDS Number

State (i.e. Liquid, Solid, Gas)

Storage Quantity

Average Max Daily Daily

Quality (lbs/gals) used in Calendar Year [ ]

Contractor(s) certifies that the hazardous material(s) removed from installation will be used/reused for its intended purpose.

Compa ny Using Material Listed Above Compa ny Representative’s Signature

Submitted By: ________________________ Phone: ______________ Fax: __________ Date: _________ Printed Name

Contracting Officer _______________________ Phone: ______________ Fax: __________ Pag e ____ of ____

CONTRACTOR HAZARDOUS MATERIAL INVENTORY LOG

(EPRCA)

Continuation Sheet

PRIME COMPANY NAME: _____________________________________ CONTRACT NO: __________________________

PROJECT TITLE / LOCATION: __________________________________________________________________________

Material Name Manufacturer MSDS Number

State (i.e. Liquid, Solid, Gas)

Storage Quantity

Average Max Daily Daily

Quality (lbs/gals) used in Calendar Year [ ]

Page ____ of ____

CONTRACTOR-FURNISHED SPOIL, DISPOSAL AREAS

This bid under Invitation No. ___________________________ Fill in solicitation Number for ___________________________________________________________________ List Title of solicitation is based on using the following spoil disposal area(s) which are not shown on the contract drawings.

1. DESCRIPTION:

2. LOCATION:

3. OWNER AND ADDRESS:

4. SIZE OF AREA(S):

5. FILL HEIGHT OR OTHER SPOILING RESTRICTIONS:

6. CAPACITY OF AREA(S) (Cu. Yds.):

7. TIME LIMITATION FOR USE OF AREA(S):

8. NUMBER AND TYPE OF ROAD CROSSING(S) REQUIRED:

9. DIKING REQUIRED:

10. PLANNED LOCATION OF SPILLWAY(S):

Written evidence of consent by owner(s) for use of spoil disposal area(s) is attached.

Written evidence of the consent of the owner(s) for use of property involved in obtaining access to the spoil disposal areas is attached.

Written evidence of consent for the use of such disposal area(s) by applicable conservation and pollution agencies are attached.

Sketch(es), to the same scale as the contract drawings, showing the loca-tion(s) of spoil area(s) to be used and access thereto are attached.

Name of Company

Signature of Bidder

Date

APPENDIX B

DPW FT. BUCHANAN

REQUIREMENTS

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