Specifications.pdf

US Army Corps Of Engineers ® Nashville District

CONSTRUCTION OF MOORING CELLS

Site 1:

Wheeler Lock Lauderdale County, Alabama Tennessee River Mile 274.9

Site 2:

Pickwick Lock Hardin County, Tennessee Tennessee River Mile 206.7

Site 3:

Kentucky Lake Humphreys County, Tennessee Tennessee River Mile 97.4

Technical Specifications

Nashville, Tennessee

July 2009

Construction of Mooring Cells Wheeler Lock, Pickwick Lock and Kentucky Lake

PROJECT TABLE OF CONTENTS

DIVISION 01 - GENERAL REQUIREMENTS

01 00 00 GENERAL REQUIREMENTS

01 00 50 FORMS AND ATTACHMENTS

01 10 01 WHEELER LOCK SCOPE OF WORK

01 10 02 PICKWICK LOCK SCOPE OF WORK

01 10 03 KENTUCKY LAKE SCOPE OF WORK

01 22 00 MEASUREMENT AND PAYMENT

01 33 00 SUBMITTAL PROCEDURES

01 35 26 GOVERNMENTAL SAFETY REQUIREMENTS

01 42 00 SOURCES FOR REFERENCE PUBLICATIONS

01 45 01 USACE QUALITY CONTROL

01 45 02 USACE QUALITY CONTROL SYSTEM (QCS)

01 57 20 ENVIRONMENTAL PROTECTION

01 78 02 AS-BUILT DRAWINGS

-- End of Project Table of Contents --

PROJECT TABLE OF CONTENTS Page 1

SECTION TABLE OF CONTENTS

DIVISION 01 - GENERAL REQUIREMENTS

SECTION 01 00 00

GENERAL REQUIREMENTS

PART 1 GENERAL

1.1 SCOPE

1.2 REFERENCES

1.3 MEASUREMENT AND PAYMENT

1.4 PROJECT SIGNS

1.5 ACCIDENT PREVENTION

1.6 SUBMITTALS

1.7 PARTNERING

1.8 FACILITY ACCESS SECURITY REQUIREMENT

1.8.1 General

1.8.2 Investigation Package

1.8.3 Foreign Nationals

1.9 EVALUATION OF CONTRACTOR PERFORMANCE

PART 2 PRODUCTS (Not Used)

PART 3 EXECUTION

3.1 PROJECT SCHEDULE

3.2 AVAILABILITY AND USE OF UTILITY SERVICES

3.2.1 Contractor Responsibilities

3.2.2 Alterations to Utilities

3.2.3 Interruptions of Utilities

-- End of Section Table of Contents --

SECTION 01 00 00 Page 1

SECTION 01 00 00

GENERAL REQUIREMENTS

PART 1 GENERAL

1.1 SCOPE

This section comprises an explanation of the general contract requirements needed to accomplish the work for the items described in the bidding schedule. This section is not intended to be all encompassing in the descriptions. All work specified herein shall be accomplished in accordance with the procedures prescribed the specifications and contract drawings.

1.2 REFERENCES

The publications listed below form a part of this specification to the extent referenced. The publications are referred to within the text by the basic designation only.

U.S. ARMY CORPS OF ENGINEERS (USACE)

EP 310-1-6a (2006) Sign Standards Manual, VOL 1

ER 380-1-18 (1996) Technology Transfer, Disclosure of Information and Contacts with Foreign Representatives

ER 415-1-17 (1993) Contractor Performance Evaluations

1.3 MEASUREMENT AND PAYMENT

No separate payment will be made for the work covered under this section.

The costs thereof shall be included in the item to which the work most closely pertains

1.4 PROJECT SIGNS

a. General. The Contractor shall furnish and erect within 30 days after issue of the Notice to Proceed at the locations directed, a PROJECT IDENTIFICATION SIGN and a SAFETY PERFORMANCE SIGN at each of the 3 sites. The signs shall be lettered on one side only and shall conform to EP 310-1-6a and to the details and colors shown on the sketches attached at the end of Section 01 00 50 FORMS AND ATTACHMENTS. The names of the project at each site shall be as follows:

Site 1:

CONSTRUCTION OF MOORING CELLS

AT WHEELER LOCK

Site 2:

CONSTRUCTION OF MOORING CELLS

AT PICKWICK LOCK

SECTION 01 00 00 Page 2

Site 3:

CONSTRUCTION OF MOORING CELLS

AT KENTUCKY LAKE

b. Materials. Each sign shall be constructed with a face sheet of 3/4 inch exterior grade plywood mounted on a substantial framework of treated 4-inch by 4-inch material. Screws shall be commercial quality and of sizes shown.

c. Painting. The signs and posts shall be given one prime coat and two finish coats of exterior oil paint before lettering. Letters and trim shall be applied to one side only using one coat of enamel of color, style, and size shown.

d. Erection and Maintenance. The signs shall be erected at the designated locations. Signs shall be plumb and backfill of post holes shall be well tamped to properly support the signs for the life of the contract. The signs shall be maintained in good condition until completion of the contract, shall remain the property of the Contractor, and shall be removed from the site upon final acceptance of the contract work.

e. ARRA Funded Projects. Projects or Task Orders funded by the American Recovery and Reinvestment Act (ARRA) shall display the primary ARRA emblem on the project identification sign. The ARRA emblem shall be placed in the sign as shown in the project identification sign sketch. The ARRA emblem shall not be displayed at a size less than 6 inches in diameter, and can be down-loaded from the following website:

http://www.recovery.gov/?q=content/president-and-vice-president-unveil-new-recovery-emblem-download-available.

1.5 ACCIDENT PREVENTION

Accident prevention requirements for this project are stated in Section

01 35 26 GOVERNMENTAL SAFETY REQUIREMENTS.

1.6 SUBMITTALS

Government approval is required for submittals with a "G" designation;

submittals not having a "G" designation are for information only. When used, a designation following the "G" designation identifies the office that will review the submittal for the Government. The following shall be submitted in accordance with Section 01 33 00 SUBMITTAL PROCEDURES

SD-01 Preconstruction Submittals

Investigation Package

Foreign Nationals

Submittal requirements for the investigation package and foreign nationals are detailed under Paragraph 1.8 FACILITY ACCESS SECURITY REQUIREMENT of this specification section.

Project Schedule, G

Submittal requirements for the Project Schedule are detailed under Paragraph 3.1 of this specification section.

SECTION 01 00 00 Page 3

1.7 PARTNERING

In order to most effectively accomplish this contract, the Government urges the contractor to join the Government in establishing a cohesive and professional project management team. Through this "partnering" relationship both entities would strive to draw on the strengths of each organization for the ultimate goal of assuring that the project's intended results are achieved, within budget and on schedule. This endeavor seeks an environment that nurtures team building, cooperation and trust between the Government and the Contractor. The partnering relationship would be bilateral in make-up, and participation will be totally voluntary.

At the discretion of each entity, a joint project management team "partnering" conference will be scheduled. The conference will be attended by multiple officers from each organization representing management and the key jobsite staff of each entity. An appointed individual would chair the conference and the Contractor will be responsible to establish its agenda and distribute minutes of the meeting. A professional facilitator acceptable to both parties would lead the participants of the session, through the steps of team building and the formation of a problem solving mechanism within the group. The conference duration would be no more than one day. Location and accommodations for the conference would be agreed upon by both entities. All costs in connection with rented facilities and the facilitator would be shared equally by the Government and the Contractor. Each organization would pay other costs of its respective employees attending the conference.

Additional partnering sessions would be held intermittently.

Implementation of the partnering concept and philosophy would be an on-going process.

1.8 FACILITY ACCESS SECURITY REQUIREMENT

1.8.1 General

All Contractor employees (U.S. citizens and Non-U.S. citizens) working under this contract or applicable task orders who require unescorted access in or around hydropower plants, navigation locks, or other facilities deemed necessary by the Nashville District Security Officer, must have or obtain a favorable background investigation. The investigation must be completed by a Department of Defense (DOD) approved investigation agency, such as Office of Personnel Management or the Defense Security Service.

The investigative requirements are a favorable National Agency Check with Inquiries (NACI) utilizing a Standard Form 85-P (SF85-P) Questionnaire for Public Trust Positions. Each applicable contractor/subcontractor shall complete an Investigation Package which must be submitted to the Nashville District Security Office within three (3) working days after award of any contract or task order OR prior to the individual being permitted unescorted access in or around all district facilities considered restricted by the Nashville District Security Office. Contractors which have a Facility Security Clearance through the Defense Security Service shall process the NACIs and forward results to the Nashville District Security Officer. For those contractors which do not have a Facility Security Clearance, the Nashville District Security Management Office can process the investigation in coordination with the Contractor and contract employees.

SECTION 01 00 00 Page 4

1.8.2 Investigation Package

The investigation package which needs to be submitted to the Nashville District Security Management Office consists of:

(1) SF-85P, Questionnaire for Public Trust Positions

(2) OF-306, Declaration for Federal Employment (Questions 1, 2, 8-13, 16 and 17a)

(3) I-9, Employment Eligibility Verification (completed by contract employee and employer)

(4) FD-258, Contractor Fingerprint Card (1 card for digital prints, 2 for ink prints) (Note: ORI block on FD-258 must be USOPM000Z)

The SF-85P and OF-306 can be printed from the following website:

http://www.opm.gov/forms/

The I-9 can be printed from the following website:

http://www.uscis.gov/files/form/i-9.pdf

The Contractor Fingerprint Cards (FD-258) can be obtained by contacting the Nashville District Security Manager at (615) 736-5567.

Copies of all investigation package forms are attached at the back of Section 01 00 50 FORMS AND ATTACHMENTS.

1.8.3 Foreign Nationals

In accordance with Engineering Regulation, ER 380-1-18, Section 4, all foreign nationals who work on Corps of Engineers' contracts or task orders shall be approved by the HQUSACE Foreign Disclosure Officer or higher before beginning work on the contract/task order. This regulation includes subcontractor employees. The contractor shall submit to the Nashville District Security Manager, the names of all foreign nationals proposed for performance under this contract/task order, along with documentation to verify that he/she was legally admitted into the United States and has authority to work and/or go to school in the U.S. Such documentation may include a U.S. passport, Certificate of U.S. Citizenship (INS Form N-560 or N-561), Certificate of Naturalization (INS Form N-550 or N-570), Alien Registration Card with photograph (INS Form I-151 or I-551), Employment Authorization Card (INS Form I-688A), etc. All foreign nationals shall be escorted at all times by a cleared federal employee unless approved by the Nashville District Security Manager on a case-by-case basis.

1.9 EVALUATION OF CONTRACTOR PERFORMANCE

The Contractor's performance will be evaluated in accordance with FAR Part 36 and ER 415-1-17 (MAR 1993). Evaluation will be based on quality of work, timely performance, effectiveness of management, and compliance with safety and labor standards. The format for the evaluation will be DD FORM 2626 and the Contractor will be rated either outstanding, above average, satisfactory, marginal, or unsatisfactory. A copy of DD FORM 2626 is attached at the end of Section 01 00 50 FORMS AND ATTACHMENTS.

Following initial completion by the Government, the Contractor will have thirty (30) calendar days to review, comment, and return the evaluation.

If the Contractor desires a meeting to discuss the evaluation, it must be requested in writing to the Contracting Officer no later than seven calendar days following receipt of the evaluation. This meeting will be held during the 30 day review period.

SECTION 01 00 00 Page 5

The Contractor's review of the evaluation shall be completed electronically at the CPARS / CCASS website, http://www.cpars.navy.mil. Upon contract award, the Contractor shall provide the Contracting Officer with the name and e-mail address of the Contractor's Reviewing Representative to be registered into the system. Due to security provisions, the Contractor shall be required to purchase and utilize a valid DoD PKI (Public Key Infrastructure) certificate to access the CPARS / CCASS website. This requirement applies to DoD contractors who operate computer equipment that is not the property of the Government. The DoD PKI certificate shall be purchased from an External Certificate Authority (ECA). Contractors accessing CPARS / CCASS will need an Identity Certificate only; an Encryption Certificate is not required. Contractors will need to purchase a separate certificate for each computer used to access the system.

It shall be the Contractor's responsibility to monitor up-to-date information on obtaining PKI certificate(s) including price, application procedures, and renewal processes. A list of ECAs is provided below.

Updates on the list of ECAs along with additional, useful information is available at http://www.cpars.csd.disa.mil/pki_info.htm.

Approved ECA vendors:

Operational Research Consultants, Inc. (ORC) http://www.eca.orc.com

VeriSign, Inc. http://www.verisign.com/authentication/ government-authentication/index.html

IdenTrust, Inc. http://www.identrust.com/certificates/eca/index.html

PART 2 PRODUCTS (Not Used)

PART 3 EXECUTION

3.1 PROJECT SCHEDULE

The Contractor shall provide a project schedule in accordance with Contract Clause 52.236-15 SCHEDULES FOR CONSTRUCTION CONTRACTS.

Project Schedule shall be capable of providing all requirements of this specification. Failure of the Contractor to meet the requirements of this specification shall result in the disapproval of the schedule. Manual methods used to produce scheduling information shall require approval by the Contracting Officer.

3.2 AVAILABILITY AND USE OF UTILITY SERVICES

3.2.1 Contractor Responsibilities

a. The Contractor shall be responsible for the availability of utilities for use on the project. Unless otherwise provided in the contract, the amount of each utility service consumed shall be charged to and paid for by the Contractor. The Contractor shall carefully conserve any utilities furnished without charge.

b. The Contractor, at its expense and in a workmanlike manner satisfactory to the Contracting Officer, shall install and maintain all necessary temporary connections and distribution lines, and all meters

SECTION 01 00 00 Page 6 required to measure the amount of each utility used for the purpose of determining charges. Before final acceptance of the work by the Government, the Contractor shall remove all the temporary connections, distribution lines, meters, and associated paraphernalia.

c. The Contractor is responsible for providing restroom and drinking water facilities for all personnel associated with this contract.

3.2.2 Alterations to Utilities

a. Where changes and relocations of utility lines are noted to be performed by others, the Contractor shall give the Contracting Officer at least thirty (30) days written notice in advance of the time that the change or relocation is required. In the event that, after the expiration of thirty (30) days after the receipt of such notice by the Contracting Officer, such utility lines have not been changed or relocated and delay is occasioned to the completion of the work under contract, the Contractor will be entitled to a time extension equal to the period of time lost by the Contractor after the expiration of said thirty (30) day period. Any modification to existing or relocated lines required as a result of the Contractor's method of operation shall be made wholly at the Contractor's expense and no additional time will be allowed for delays incurred by such modifications.

b. Separate payment will not be made for alterations or relocations of utilities.

3.2.3 Interruptions of Utilities

a. No utility services shall be interrupted by the Contractor to make connections, to relocate, or for any purpose without approval of the Contracting Officer.

b. Request for Permission to shut down services shall be submitted in writing to the Contracting Officer not less than seventeen (17) days prior to date of proposed interruption. The request shall give the following information:

(1) Nature of Utility (Gas, L.P. or H.P., Water, etc.)

(2) Size of line and location of shutoff.

(3) Buildings and services affected.

(4) Hours and date of shutoff.

(5) Estimated length of time services will be interrupted.

c. Services shall not be shutoff until receipt of approval of the proposed hours and date from the Contracting Officer.

d. Shutoffs which will cause interruption of Government work operations as determined by the Contracting Officer shall be accomplished during regular non-work hours or on non-work days of the Using Agency.

e. Operation of valves on water mains will be by Government personnel.

Where shutoff of water lines interrupts service to fire hydrants or fire sprinkler systems, the Contractor shall arrange his operations and have sufficient material and personnel available to complete the work without undue delay or to restore service without delay in event of emergency.

SECTION 01 00 00 Page 7

-- End of Section --

SECTION 01 00 00 Page 8

SECTION TABLE OF CONTENTS

DIVISION 01 - GENERAL REQUIREMENTS

SECTION 01 00 50

FORMS AND ATTACHMENTS

PART 1 GENERAL

1.1 PROJECT IDENTIFICATION SIGN

1.2 SAFETY PERFORMANCE SIGN

1.3 SF-85P QUESTIONNAIRE FOR PUBLIC TRUST POSITIONS

1.4 OF-306 DECLARATION FOR FEDERAL EMPLOYMENT

1.5 I-9 EMPLOYMENT ELIGIBILITY VERIFICATION

1.6 FD-258 CONTRACTOR FINGERPRINT CARD

1.7 DD FORM 2626 PERFORMANCE EVALUATION

1.8 ENG FORM 4025 TRANSMITTAL FORM

1.9 SUBMITTAL REGISTER

1.10 LRNP 385-1-2 CONTRACTOR GUIDELINES

1.11 CONTRACTOR QUALITY CONTROL REPORT FORM

1.12 DEFICIENCY LIST FORM

PART 2 PRODUCTS (Not Used)

PART 3 EXECUTION (Not Used)

-- End of Section Table of Contents --

SECTION 01 00 50 Page 1

SECTION 01 00 50

FORMS AND ATTACHMENTS

PART 1 GENERAL

Listed below, and attached at the end of this section, are forms and attachments referred to in other parts of the set of technical specifications.

1.1 PROJECT IDENTIFICATION SIGN

See Section 01 00 00 GENERAL REQUIREMENTS.

1.2 SAFETY PERFORMANCE SIGN

See Section 01 00 00 GENERAL REQUIREMENTS.

1.3 SF-85P QUESTIONNAIRE FOR PUBLIC TRUST POSITIONS

See Section 01 00 00 GENERAL REQUIREMENTS.

1.4 OF-306 DECLARATION FOR FEDERAL EMPLOYMENT

See Section 01 00 00 GENERAL REQUIREMENTS.

1.5 I-9 EMPLOYMENT ELIGIBILITY VERIFICATION

See Section 01 00 00 GENERAL REQUIREMENTS.

1.6 FD-258 CONTRACTOR FINGERPRINT CARD

See Section 01 00 00 GENERAL REQUIREMENTS.

1.7 DD FORM 2626 PERFORMANCE EVALUATION

See Section 01 00 00 GENERAL REQUIREMENTS.

1.8 ENG FORM 4025 TRANSMITTAL FORM

See Section 01 33 00 SUBMITTAL PROCEDURES.

1.9 SUBMITTAL REGISTER

See Section 01 33 00 SUBMITTAL PROCEDURES.

1.10 LRNP 385-1-2 CONTRACTOR GUIDELINES

See Section 01 35 26 GOVERNMENTAL SAFETY REQUIREMENTS.

1.11 CONTRACTOR QUALITY CONTROL REPORT FORM

See Section 01 45 01 USACE QUALITY CONTROL.

SECTION 01 00 50 Page 2

1.12 DEFICIENCY LIST FORM

See Section 01 45 01 USACE QUALITY CONTROL.

PART 2 PRODUCTS (Not Used)

PART 3 EXECUTION (Not Used)

-- End of Section --

SECTION 01 00 50 Page 3

PROJECT IDENTIFICATION SIGN

PROJECTS OR TASK ORDERS FUNDED BY THE AMERICAN

RECOVERY AND REINVESTMENT ACT (ARRA) SHALL DISPLAY

THE PRIMARY ARRA EMBLEM ON THE PROJECT SIGN. THE

ARRA EMBLEM SHALL BE PLACED UNDER THE US ARMY CORPS

OF ENGINEER’S LETTERING. THE ARRA EMBLEM SHALL NOT BE

DISPLAYED AT A SIZE LESS THAN 6 INCHES IN DIAMETER,

LEGEND GROUP 1: ONE- TO TWO-LINE DESCRIPTION OF CORPS RELATIONSHIP TO PROJECT,

COLOR: WHITE, TYPEFACE: 1.25" HEL VETICA REGULAR MAXIMUM LINE LENGTH: 19".

LEGEND GROUP 2: DISTRICT NAME PLACED BELOW 10.5" REVERSE SIGNATURE (6" CASTLE).

COLOR: WHITE. TYPEFACE: 1.25" HELVETICA REGULAR.

LEGEND GROUP 3: ONE- TO THREE-LINE PROJECT TITLE LEGEND DESCRIBES THE WORK BEING

DONE UNDER THIS CONTRACT. COLOR: BLACK. TYPEFACE: 3" HELVETICA BOLD MAX IMUM LINE

LENGTH: 42'".

LEGEND GROUP 4: ONE- TO TWO-LINE IDENTIFICATION OF PROJECT OR FACILITY (CIVIL WORKS), TYPEFACE: 1.5" HELVETICA REGULAR MAXIMUM LINE LENGTH: 42".

CROSS-ALIGN THE FIRST LINE OF LECEND GROUP 4 WITH THE FIRST LINE OF THE CORPS

SIGNATURE (US ARMY CORPS) AS SHOWN.

LEGEND GROUPS 5: ONE- TO FIVE-LINE IDENTIFICATION OF PRIME CONTRACTORS INCLUDING: TYPE

(GENERAL CONTRACTOR, ETC,), CORPORATE OR FIRM NAME, CITY, STATE.

COLOR: BLACK. TYPEFACE: 1.25" HEl VET ICA REGULAR MAXIMUM LINE LENGTH, 21 ".

ALL TYPOGRAPHY IS FLUSH LEFT AND RAG RIGHT, UPPER AND LOWER CASE WITH INITIAL

CAPITALS ONLY AS SHOWN.

PANEL SIZE 4' X 6', POST SIZE 4" X 4", MOUNTING HEIGHT 48", COLOR BKG/LGD WH-RD/BK.

SAFETY PERFORMANCE SIGN

LEGEND GROUP 1: STANDARD TWO-LINE TITLE “SAFETY IS A JOB REQUIREMENT” WITH (8” OD.)

SAFETY GREEN FIRST AID LOGO. 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. TYPE FACE: 1.5”

HELVETICA REGULAR MAXIMUM LINE LENGTH: 42”.

LEGEND GROUP 3: ONE- TO TWO-LINE IDENTIFICATION: 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 5.0”.

ALL TYPOGRAPHY IS FLUSH LEFT AND RAG RIGHT, UPPER AND LOWER CASE WITH INITIAL

CAPITALS ONLY AS SHOWN.

PANEL SIZE 4' X 4', POST SIZE 4" X 4". MOUNTING HEIGHT 48". COLOR BKG/LGD WH/BK-GR.

DATE WORK

ACCEPTED

d.REVISED CONTRACT

COMPLETION DATE

c.ORIGINAL CONTRACT

COMPLETION DATE

b.

NET AMOUNT PAID

CONTRACTOR

d.

LIQUIDATED

DAMAGES ASSESSED

c.

TOTAL AMOUNT OF

MODIFICATIONS

b.

AMOUNT OF BASIC

CONTRACT

a.

PART II - PERFORMANCE EVALUATION OF CONTRACTOR

TELEPHONE NUMBER (Include Area Code)

TELEPHONE NUMBER (Include Area Code) b.

14. AGENCY USE (Distribution, etc.)

PERFORMANCE EVALUATION

(CONSTRUCTION)

1. CONTRACT NUMBER

2. CEC NUMBER

IMPORTANT: Be sure to complete Part III - Evaluation of Performance Elements on reverse.

PART I - GENERAL CONTRACT DATA

3. TYPE OF EVALUATION (X one)

5. CONTRACTOR (Name, Address, and ZIP Code)

7. DESCRIPTION AND LOCATION OF WORK

8. TYPE AND PERCENT OF SUBCONTRACTING

9. FISCAL DATA

SIGNIFICANT

DATES

a. DATE OF AWARD

11. OVERALL RATING (X appropriate block)

12. EVALUATED BY

a. ORGANIZATION (Name and Address (Include ZIP Code))

c. NAME AND TITLE

13. EVALUATION REVIEWED BY

FOR OFFICIAL USE ONLY (WHEN COMPLETED)

DD FORM 2626, JUN 94 EXCEPTION TO SF 1421

APPROVED BY GSA-IRSM 6/94

a. PROCUREMENT METHOD (X one)

%) FINAL AMENDED

4. TERMINATED FOR DEFAULT

6.

b. TYPE OF CONTRACT (X one)

SEALED BID NEGOTIATED

FIRM FIXED PRICE

OTHER (Specify)

COST REIMBURSEMENT

10.

INTERIM (List percentage

OUTSTANDING UNSATISFACTORY (Explain in Item 20 on reverse)

ABOVE AVERAGE

SATISFACTORY

MARGINAL

d. SIGNATURE e. DATE

a. ORGANIZATION (Name and Address (Include ZIP Code)

c. NAME AND TITLE b.

d. SIGNATURE e. DATE

USAPPC V1.01

20.

PART III - EVALUATION OF PERFORMANCE ELEMENTS

N/A=NOT APPLICABLE

FOR OFFICIAL USE ONLY (WHEN COMPLETED)

DD FORM 2626, JUN 94 (BACK) USAPPC V1.01

15. QUALITY CONTROL N/A O A S M U

O=OUTSTANDING A=ABOVE AVERAGE S=SATISFACTORY M=MARGINAL

QUALITY OF WORKMANSHIP

ADEQUACY OF THE CQC PLAN

IMPLEMENTATION OF THE CQC

PLAN

c.

QUALITY OF QC

DOCUMENTATION

d.

STORAGE OF MATERIALS

ADEQUACY OF MATERIALS

ADEQUACY OF SUBMITTALS

ADEQUACY OF QC TESTING

ADEQUACY OF AS-BUILTS

USE OF SPECIFIED MATERIALS

IDENTIFICATION / CORRECTION

OF DEFICIENT WORK IN A TIMELY

MANNER

k.

U=UNSATISFACTORY

N/A O A S M U16. EFFECTIVENESS OF MANAGEMENT

COOPERATION AND RESPONSIVENESS

MANAGEMENT OF RESOURCES/

PERSONNEL

COORDINATION AND CONTROL OF

SUBCONTRACTOR(S)

c.

d. ADEQUACY OF SITE CLEAN-UP b.

EFFECTIVENESS OF JOB-SITE

SUPERVISION

COMPLIANCE WITH LAWS AND

REGULATIONS

g. PROFESSIONAL CONDUCT

REVIEW / RESOLUTION OF

SUBCONTRACTOR'S ISSUES

IMPLEMENTATION OF

SUBCONTRACTING PLAN

e.

f.

h.

i.

17. TIMELY PERFORMANCE

ADEQUACY OF INITIAL PROGRESS

SCHEDULE

ADHERENCE TO APPROVED

SCHEDULE

c. RESOLUTION OF DELAYS

SUBMISSION OF REQUIRED

DOCUMENTATION

d.

COMPLETION OF PUNCHLIST

ITEMS

SUBMISSION OF UPDATED AND

REVISED PROGRESS SCHEDULES

g. WARRANTY RESPONSE

COMPLIANCE WITH LABOR

STANDARDS

a. CORRECTION OF NOTED DEFICIENCIES

COMPLIANCE WITH LABOR LAWS

AND REGULATIONS WITH SPECIFIC

ATTENTION TO THE DAVIS-BACON

ACT AND EEO REQUIREMENTS

c.

COMPLIANCE WITH SAFETY

STANDARDS

19.

a. ADEQUACY OF SAFETY PLAN

b. IMPLEMENTATION OF SAFETY PLAN

c. CORRECTION OF NOTED DEFICIENCIES a.

b.

e.

f.

18.

PAYROLLS PROPERLY COMPLETED

AND SUBMITTED

b.

REMARKS (Explanation of unsatisfactory evaluation is required. Other comments are optional. Provide facts concerning specific events or actions to justify the evaluation . These data must be in sufficient detail to assist contracting officers in determining the contractor's responsibility. Continue on separate sheet(s), if needed.)

a.

b.

e.

f.

g.

h.

i.

j.

a.

CONTRACTOR GUIDANCE FOR COMPLETING AN SF 85P, QUESTIONNAIRE FOR

PUBLIC TRUST POSITIONS (As of 11/21/08)

To Print a Copy of the SF-85P Form:

http://www.opm.gov/forms/pdf_fill/SF85P.pdf

FOLLOW THESE INSTRUCTIONS CAREFULLY

Do Not Use White-Out to Make Corrections. Draw a line thru the answer, write correct answer & initial. All changes must be initialed by the employee.

Information must be typed or printed legibly.

Do not leave any question blank. Put N/A if not applicable.

Explain any “Yes” answers thoroughly in the remarks. Use an extra sheet of paper if required.

Most questions go back seven (7) years. Your response must cover the period of time requested.

If you are not sure of an exact date, put “est” for estimate

Do not list the same reference twice (provide different people for each response). Always provide the full address and phone number (including area code).

Question 5 – Other Names Used: Be sure and list any other names used, including nicknames, maiden name, etc., and dates the other name(s) were used. If the other name is your maiden name, put “nee” in front of it. (Include all former names for spouse, such as maiden name and from previous marriages and include dates used.)

Question 14 – Marital Status: Include all information on current spouse (even if separated), to include maiden name (if appli-cable), name(s) by other marriages, and dates other name(s) were used.

Question 15 – Relatives: List COUNTRY of birth (such as US), not county. Include all children, even if they are adults.

Question 17 – Selective Service Record: If applicable and registration number is unknown, call 1-888-655-1825

CONTRACTOR GUIDANCE FOR COMPLETING AN SF 85P, QUESTIONNAIRE FOR

PUBLIC TRUST POSITIONS (As of 11/21/08) CONTINUED

FOLLOW THESE INSTRUCTIONS CAREFULLY

There is an “Authorization for Release of Information” (Page 8) and an “Authorization for Release of Medical Information”. You must complete the “Authorization for Release of Information,” but you are not required to submit the Release of Medical Information form unless the investigation develops the need for this document. Be sure and include “Other Names Used” which you listed for Question 5.

Ensure your social security number is at the bottom of each page where required.

Be sure and make a copy of the completed form for your records.

Ensure you have answered every question to the best of your ability. Contact the Security Manager at (615) 736-5567 if you have any questions. Return the forms to the Security Management Office as soon as possible, but before the suspense date.

If you will not be able to complete the requirements by the suspense date, please contact the Security Manager at (615) 736- 5567 as soon as possible to set a new completion date.

Standard Form 85P Form approved:

Revised September 1995 OMS No. 3206-0191

U.S. Office of Personnel Management NSN 7540-01-317-7372 5 CFR Parts 731, 732, and 736 85-1602

Questionnaire for Public Trust Positions

Follow instructions fully or we cannot process your form. Be sure to sign and date the certification statement on Page 7 and the release on Page 8. Jfyou have any questions, call the office that gave you the form.

Purpose ofthis Form

The U.S. Government conducts background investigations and reinvestigations to establish that applicants or incumbents either employed by the Government or working for the Government under contract, are suitable for the job and/or eligible for a public trust or sensitive position. Information from this form is used primarily as the basis for this investigation. Complete this form only after a conditional offer of employment has been made.

Giving us the information we ask for is voluntary. However, we may not be able to complete your investigation, or complete it in a timely manner, if you don't give us each item of information we request. This may affect your placement or employment prospects.

Authority to Request this Information

The U.S. Government is authorized to ask for this information under Executive Orders 10450 and 10577, sections 330 I and 3302 of title 5, U.S. Code; and parts 5, 731, 732, and 736 of Title 5, Code of Federal Regulations.

Your Social Security number is needed to keep records accurate, because other people may have the same name and birth date. Executive Order 9397 also asks Federal agencies to use this number to help identify individuals in agency records.

The Investigative Process

Background investigations are conducted using your responses on this form and on your Declaration for Federal Employment (OF 306) to develop information to show whether you are reliable, trustworthy, of good conduct and character, and loyal to the United States. The information that you provide on this form is confirmed during the investigation. Your current employer must be contacted as part of the investigation, even if you have previously indicated on applications or other forms that you do not want this.

In addition to the questions on this form, inquiry also is made about a person's adherence to security requirements, honesty and integrity, vulnerability to exploitation or coercion, falsification, mis representation, and any other behavior, activities, or associations that tend to show the person is not reliable, trustworthy, or loyal.

Your Personal Interview

Some investigations will include an interview with you as a normal part of the investigative process. This provides you the opportunity to update, clarifY, and explain information on your form more completely, which often helps to complete your investigation faster. It is important that the interview be conducted as soon as possible after you are contacted. Postponements will delay the processing of your investigation, and declining to be interviewed may result in your investigation being delayed or canceled.

You will be asked to bring identification with your picture on it, such as a valid State driver's license, to the interview. There are other documents you may be asked to bring to verifY your identity as well.

These include documentation of any legal name change, Social Security card, and/or birth certificate.

You may also be asked to bring documents about information you provided on the form or other matters requiring specific attention.

These matters include alien registration, delinquent loans or taxes, bankruptcy, judgments, liens, or other financial obligations, agreements involving child custody or support, alimony or property settlements, arrests, convictions, probation, and/or parole.

Instructions for Completing this Form

I. Follow the instructions given to you by the person who gave you the form and any other clarifying instructions furnished by that person to assist you in completion of the form. Find out how many copies of the form you are to tum in. You must sign and date, in black ink, the original and each copy you submit.

2. Type or legibly print your answers in black ink (if your form is not legible, it will not be accepted). You may also be asked to submit your form in an approved electronic format.

3. All questions on this form must be answered. If no response is necessary or applicable, indicate this on the form (for example, enter "None" or "N/A"). If you find that you cannot report an exact date, approximate or estimate the date to the best of your ability and indicate this by marking "APPROX." or "EST."

4. Any changes that you make to this form after you sign it must be initialed and dated by you. Under certain limited circumstances, agencies may modify the form consistent with your intent.

5. You must use the State codes (abbreviations) listed on the back of this page when you fill out this form. Do not abbreviate the names of cities or foreign countries.

6. The 5-digit postal ZIP codes are needed to speed the processing of your investigation. The office that provided the form will assist you in completing the ZIP codes.

7. All telephone numbers must include area codes.

8. All dates provided on this form must be in Month/DayNear or Month/Year format. Use numbers (1-12) to indicate months. For example, June 10, 1978, should be shown as 6/10/78.

9. Whenever "City (Country)" is shown in an address block, also provide in that block the name of the country when the address is outside the United States.

10. If you need additional space to list your residences or employments/self-employments/unemployments or education, you should use a continuation sheet, SF 86A. If additional space is needed to answer other items, use a blank piece of paper. Each blank piece of paper you use must contain your name and Social Security Number at the top of the page.

Final Determination on Your Eligibility

Final determination on your eligibility for a public trust or sensItive position and your being granted a security clearance is the responsibility of the Office of Personnel Management or the Federal agency that requested your investigation. You may be provided the opportunity personally to explain, refute, or clarify any information before a final decision is made.

Penalties for Inaccurate or False Statements

The U.S. Criminal Code (title 18, section 100 I) provides that knowingly falsifying or concealing a material fact is a felony which may result in fines of up to $10,000, and/or 5 years imprisonment, or both. In addition, Federal agencies generally fire, do not grant a security clearance, or disqualify individuals who have materially and deliberately falsified these forms, and this remains a part of the permanent record for future placements. Because the position for which you are being considered is one of public trust or is sensitive, your trustworthiness is a very important consideration in deciding your suitability for placement or retention in the position.

Your prospects of placement are better if you answer all questions truthfully and completely. You will have adequate opportunity to explain any information you give us on the form and to make your comments part of the record.

Disclosure of Information

The information you give us is for the purpose of investigating you for a position; we will protect it from unauthorized disclosure. The collection, maintenance, and disclosure of background investigative information is governed by the Privacy Act. The agency which requested the investigation and the agency which conducted the investigation have published notices in the Federal Register describing the system of records in which your records will be maintained. You may obtain copies of the relevant notices from the person who gave you this form. The information on this form, and information we collect during an investigation may be disclosed without your consent as permitted by the Privacy Act (5 USC 552a(b)) and as follows:

PRIVACY ACT ROUTINE USES

1. To the Department of Justice when: (a) the agency or any component thereof: or

(b) any employee of the agency in his or her official capacity; or (c) any employee of the agency in his or her individual capacity where the Department of Justice has agreed to represent the employee; or (d) the United States Government. is a party to litigation or has interest in such litigation, and by careful review, the agency determines that the records are both relevant and necessary to the litigation and the use of such records by the Department of Justice is therefore deemed by the agency to be for a purpose that is compatible with the purpose for which the agency collected the records.

2. To a court or adjudicative body in a proceeding when: (a) the agency or any component thereof; or (b) any employee of the agency in his or her official capacity;

or (c) any employee of the agency in his or her individual capacity where the Department of Justice has agreed to represent the employee; or (d) the United States Government is a party to litigation or has interest in such litigation, and by careful review, the agency determines that the records are both relevant and necessary to the litigation and the use of such records is therefore deemed by the agency to be for a purpose that is compatible with the purpose for which the agency collected the records.

3. Except as noted in Question 21, when a record on its face, or in conjunction with other records, indicates a violation or potential violation of law, whether civil, criminal, or regulatory in nature, and whether arising by general statute, particular program statute, regulation, rule, or order issued pursuant thereto, the relevant records may be disclosed to the appropriate Federal, foreign, State, local. tribal, or other public authority responsible for enforcing, investigating or prosecuting such violation or charged with enforcing or implementing the statute, rule, regulation, or order.

4. To any source or potential source from which information is requested in the course of an investigation concerning the hiring or retention of an employee or other personnel action, or the issuing or retention of a security clearance, contract, grant, license, or other benefit, to the extent necessary to identify the individual, inform the source of the nature and purpose of the investigation, and to identify the type of information requested.

5. To a Federal, State, local, foreign, tribal, or other public authority the fact that this system of records contains information relevant to the retention of an employee, or the retention of a security clearance, contract, license, grant, or other benefit. The other agency or licensing organization may then make a request supported by written consent of the individual for the entire record if it so chooses. No disclosure will be made unless the information has been determined to be sufficiently reliable to support a referral to another office within the agency or to another Federal agency for criminal, civil, administrative, personnel, or regulatory action.

6. To contractors, grantees, experts, consultants, or volunteers when necessary to perform a function or service related to this record for which they have been engaged. Such recipients shall be required to comply with the Privacy Act of 1974, as amended.

7. To the news media or the general public, factual information the disclosure of which would be in the public interest and which would not constitute an unwarranted invasion of personal privacy.

8. To a Federal, State. or local agency, or other appropriate entities or individuals, or through established liaison channels to selected foreign governments, in order to enable an intelligence agency to carry out its responsibilities under the National Security Act of 1947 as amended, the CIA Act of 1949 as amended, Executive Order 12333 or any successor order, applicable national security directives, or classified implementing procedures approved by the Attorney General and promulgated pursuant to such statutes, orders or directives.

9. To a Member of Congress or to a Congressional staff member in response to an inquiry of the Congressional office made at the written request of the constituent about whom the record is maintained.

10. To the National Archives and Records Administration for records management inspections conducted under 44 USC 2904 and 2906.

11. To the Office of Management and Budget when necessary to the review of private relief legislation.

STATE CODES (ABBREVIATIONS)

Alabama AL Hawaii HI Massachusetts MA New Mexico Alaska AK Idaho 10 Michigan MI New York Arizona AZ. Illinois IL Minnesota MN North Carolina Arkansas AR Indiana IN Mississippi MS North Dakota California CA Iowa IA Missouri MO Ohio Colorado CO Kansas KS Montana MT Oklahoma Connecticut CT Kentucky KY Nebraska NE Oregon Delaware DE Louisiana LA Nevada NV Pennsylvania Florida FL Maine ME New Hampshire NH Rhode Island Georgia GA Maryland MD New Jersey NJ South Carolina

American Samoa AS District of Columbia DC Guam GU Northern Marianas Trust Territory IT Virgin Islands VI

PUBLIC BURDEN INFORMATION

NM South Dakota SO NY Tennessee TN NC Texas TX NO Utah UT OH Vermont VT OK Virginia VA OR Washington WA PA West Virginia WV RI Wisconsin WI SC Wyoming WY

CM Puerto Rico PR

Public burden reporting for this collection of information is estimated to average 60 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 Reports and Forms Management Officer, U.S. Office of Personnel Management, 1900 E Street, N.W., Room CHP-500, Washington, D.C. 20415. Do not send your completed form to this address.

Standard Form 85P (EG) Form approved:

Revised September 1995 QUESTIONNAIRE FOR OMB No. 3206-0191 U.S. Office of Personnel Management NSN 7540-01-317-7372 PUBLIC TRUST POSITIONS 5 CFR Parts 731, 732, and 736 85-1602 OPM Codes Case Number

USE

ONLY

J

SON

L SOl

ZIP Code

ZIP Code

OFULL -If you have only initials in your name. use them and state (10).

NAME -If you have no middle name, enter "NMN".

- If you are a "Jr.," "Sr.," "II," etc., enter this in the o DATE OF box after your middle name. BIRTH

Last Name First Name Middle Name

PLACE OF BIRTH - Use the two leller code for the State.

City County State Country (if not in the United States)

Day Year

• OTHER NAMES USED

Name MonthNear MonthNear Name MonthNear MonthNear

#1 #3To To

Name MonthNear MonthNear Name MonthNear MonthNear

#2 #4To To

OOTHER

IDENTIFYING

INFORMATION

.TELEPHONE

NUMBERS

Height (feet ad'Inches) We'ght (pounds) Ha'r Color n I I Eye Color Sex (Maric one box

Day Day

NiQht ( ) Night ( )

G) Your Mother's Maiden Name OCITIZENSHIP e Mark the box at the right that

I am a U.S. citizen or national by birth in the U.S. or U.S. territory/possession. Answer items band d.

I am a US. citizen. but I was NOT born in the U.S. Answer items b, c and d.reflects your current citizenship status. and follow its instructions.

I am not a U.S. citizen. Answer items band e.

..e UNITED STATES CITIZENSHIP If you are a U.S. Citizen. but were not born In the U.S.. provide Information about one or more of the following proofs of your citizenship.

Naturalization Certificate (Where were you naturalized?)

_C_o_urt I_C_i_ty ....JU Certificate Number I Month/DayNear Issued

Citizenship Certificate (Where was the certificate issued?)

_C_ity --JLI Certificate Number IMonth/DayNear Issued

State Department Form 240 - Report of Birth Abroad of a Citizen of the United States

Give the date the form was Month/DayNear Explanation prepared and give an explanation if needed.

U.S. Passport

Month/DayNear Issued

This may be either a current or previous U.S. Passport

(D DUAL CITIZENSHIP If you are (or were) a dual citizen of the United States and another country.

provide the name of that country in the space to the right.

G_A_L1_E_N_I_f.:..yo_u_a_re.,a,n=a,..lie_n.......;.p_ro_V_id_e_th_e_f_o_lIo_w_i_ng=-in_fo_r_m_a_t_io_n_:_==---,=':"""'=-===-,-,-",...__....,,=====~== ----:====:--.=,,-----,=-- City Alien Registration Number Country(ies) of Citizenship

Place You

Entered the

United States:

Exception to SF85. SF85P. SF85P-S, SF86, and SF86A approved by GSA September, 1995. Page 1

Country

Desi9ned using Perform Pro, WHSIOIOR. Sep 95

OWHERE YOU HAVE LIVED

List the places where you have lived, beginning with the most recent (#1) and working back 7 years All periods must be accounted for in your list Be sure to indicate the actual physical location of your residence: do not use a post office box as an address, do not list a permanent address when you were actually living at a school address, etc. Be sure to specify your location as closely as possible: for example. do not list only your base or ship. list your barracks number or home port. You may omit temporary military duty locations under 90 days (list your permanent address instead), and you should use your APO/FPO address if you lived overseas.

For any address in the last 5 years, list a person who knew you at that address, and who preferably still lives in that area (do not list people for residences completely outside this 5-year period. and do not list your spouse, former spouses, or other relatives). Also for addresses in the last 5 years, if the address is "General Delivery," a Rural or Star Route. or may be difficult to locate, provide directions for locating the residence on an attached continuation sheet.

MonthlYear MonthlYear Street Address Apt. # ICity (Country) State IZIP Code

#1 To Present Name of Person Who Knows You Street Address Apt. # ICity (Country) IState IZIP Code Telephone Number

MonthlYear MonthlYear Street Address Apt. # ICity (Country)

State

IZIP Code

#2 To

Name of Person Who Knew You Street Address Apt. # ICity (Country) IState IZIP Code Telephone Number

MonthlYear MonthlYear Street Address Apt. # ICity (Country)

State

IZIP Code #3 To

Name of Person Who Knew You Street Address Apt. #.. ICity (Country) IState IZIP Code Telephone Number

MonthlYear MonthlYear Street Address Apt. # ICity (Country)

State

IZIP Code #4 To

Name of Person Who Knew You Street Address Apt. # ICity (Country) IState IZIP Code Telephone Number

MonthlYear MonthlYear Street Address Apt. # ICity (Country)

State

IZIP Code #5 To

Name of Person Who Knew You Street Address Apt. # ICity (Country) IState IZIP Code Telephone Number

_WHERE YOU WENT TO SCHOOL

List the schools you have attended. beyond Junior High School, beginning with the most recent (#1) and working back 7 years. List ell COllege or University degrees and the dates they were received. If all of your education occurred more than 7 years ago, list your most recent education beyond high school. no matter when that education occurred.

'Use one of the following codes in the "Code" block:

1 • High School 2 • College/University/Military College 3· VocationallTechnicallTrade School

'For schools you attended in the past 3 years, list a person who knew you at school (an instructor, student, etc.). Do not list people for education completely outside this 3-year period.

'l=or correspondence schools and extension classes, provide the address where the records are maintained.

MonthlYear MonthlYear MonthlYear Awarded Code IName of School IDegree/Diploma/Other

#1 To

Street Address and City (Country) of School ZIP Code IState

Name of Person Who Knew You Street Address Telephone Number

MonthlYear MonthlYear

Apt. # ICity (Country) IState IZIP Code

Code MonthlYear Awarded IName of School IDegree/Diploma/Other

#2 To

Street Address and City (Country) of School ZIP CodeIState

Name of Person Who Knew You Street Address Telephone Number

MonthlYear MonthlYear

Apt. # ICity (Country) IState IZIP Code

MonthlYear AwardedCode IName of School IDegree/Diploma/Other

#3 To

Street Address and City (Country) of School ZIP Code IState

Name of Person Who Knew You Street Address Telephone Number

Apt. # ICity (Country) IState IZIP Code

Enter your Social Security Number before going to the next page-------------

G YOUR EMPLOYMENT ACTIVITIES

List your employment activities, beginning with the present (#1) and working back 7 years. You should list all full-time work, part-time work, military service, temporary military duty locations over 90 days, self-employment, other paid work, and all periods of unemployment. The entire 7-year period must be accounted for without breaks, but you need not list employments before your 16th birthday.

• Code. Use one of the codes listed below to identify the type of employment:

1 - Active military duty stations 5 - State Government (Non-Federal 7 - Unemployment (Indude name of 9 - Other 2 - National Guard/Reserve employment) person who can verify) 3 - U.S.P.H.S. Commissioned Corps 6 - Self-employment (Indude business B - Federal Contractor (List Contractor, 4 - Other Federal employment and/or name of person who can verify) not Federal agency)

• EmployerNerlfier Name. List the business name of your employer or the name of the person who can verify your self-employment or unemployment in this block. If military service is being listed, include your duty location or home port here as well as your branch of service. You should provide separate listings to reflect changes in your military duty locations or home ports.

• Previous Periods of Activity, Complete these lines if you worked for an employer on more than one occasion at the same location. After entering the most recent period of employment in the initial numbered block, provide previous periods of employment at the same location on the additional lines provided. For example, if you worked at X'f Plumbing in Denver, CO, during 3 separate periods of time, you would enter dates and information concerning the most recent period of employment first, and provide dates, position titles, and supervisors for the two previous periods of employment on the lines below that information.

MonthlYear MonthlYear

#1 To Present

Employer'sNerifier's Street Address

EmployerNerifier Name/Military Duty Location Your Position Title/Military Rank ICode

City (Country) State ZIP Code

Street Address of Job Location (if different than Employer's Address) City (Cou~try) State ZIP Code ..

City (Country)…