W912PM-15-R-0001-0007.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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

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

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

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

FAR (48 CFR) 53.243

Solicitation hereby amended as follow s:

1. See Technical Summary of Changes

2. The hour and date specified for receipt of offer has NOT been extended as a result of this amendment.

3. All other terms and conditions remain unchanged.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 2

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

16C. DATE SIGNED

BY 23-Jan-2015

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

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

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W912PM-15-R-0001

X 9B. DATED (SEE ITEM 11)

04-Dec-2014

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

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

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

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

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

12. ACCOUNTING AND APPROPRIATION DATA (If required)

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

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

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

CONTRACT ORDER NO. IN ITEM 10A.

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

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

D. OTHER (Specify type of modification and authority)

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

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

10A. MOD. OF CONTRACT/ORDER NO.

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

6. ISSUED BY

3. EFFECTIVE DATE

23-Jan-2015

CODE

U S ARMY CORPS OF ENGINEERS

WILMINGTON DISTRICT

ATTN: CONTRACTING DIVISION

69 DARLINGTON AVE

WILMINGTON NC 28403-1343

W912PM 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W912PM-15-R-0001

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

W912PM-15-R-0001

Amendment 0007

Technical Summary of Changes

01 35 26 – GOVERNMENT SAFETY REQUIREMENTS

ADD Attachments 1, 2, and 3 Covers and Enclosures in their entirety.

NOTE:

Text that is added or revised by this amendment is identified with and/or printed in bold AND identified with ***Amendment 0007***(beginning and ending of revision OR addition).

-- End of Summary of Changes --

Encls As Stated

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Attachment 1

Minimum Basic Outline for Accident Prevention Plan

(Added by Amendment 0007)

EM 385-1-1

15 Sep 08

APPENDIX A

MINIMUM BASIC OUTLINE FOR ACCIDENT

PREVENTION PLANS

An Accident Prevention Plan (APP) is a safety and health policy and program document. The following areas are typically addressed in an APP, but an APP shall be job-specific and shall also address any unusual or unique aspects of the project or activity for which it is written.

The APP shall interface with the employer’s overall safety and health program, and a copy shall be available on the work site. Any portions of the overall safety and health program that are referenced in the APP shall be included as appropriate.

ANSI/ASSE A10.38 should be referenced for Programmatic Issues.

1. SIGNATURE SHEET. Title, signature, and phone number of the following:

a. Plan preparer (Qualified Person, Competent Person, such as corporate safety staff person, QC);

b. Plan must be approved, by company/corporate officers authorized to obligate the company;

c. Plan concurrence (e.g., Chief of Operations, Corporate Chief of Safety, Corporate Industrial Hygienist, project manager or superintendent, project safety professional, project QC).

Provide concurrence of other applicable corporate and project personnel (Contractor).

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(Added by Amendment 0007)

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2. BACKGROUND INFORMATION. List the following:

a. Contractor;

b. Contract number;

c. Project name;

d. Brief project description, description of work to be performed, and location; phases of work anticipated (these will require an

AHA).

3. STATEMENT OF SAFETY AND HEALTH POLICY. Provide a copy of current corporate/company Safety and Health Policy Statement, detailing commitment to providing a safe and healthful workplace for all employees. The Contractor’s written safety program goals, objectives, and accident experience goals for this contract should be provided.

4. RESPONSIBILITIES AND LINES OF AUTHORITIES. Provide the following:

a. A statement of the employer’s ultimate responsibility for the implementation of his SOH program;

b. Identification and accountability of personnel responsible for safety at both corporate and project level. Contracts specifically requiring safety or industrial hygiene personnel shall include a copy of their resumes. Qualifications shall include the OSHA 30-hour course or equivalent course areas as listed here:

(1) OSH Act/General Duty Clause;

(2) 29 CFR 1904, Recordkeeping;

(3) Subpart C: General Safety and Health Provisions, Competent Person;

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(4) Subpart D: Occupational Health and Environmental Controls, Citations and Safety Programs;

(5) Subpart E: PPE, types and requirements for use;

(6) Subpart F: understanding fire protection in the workplace;

(7) Subpart K: Electrical;

(8 Subpart M: Fall Protection;

(9) Rigging, welding and cutting, scaffolding, excavations, concrete and masonry, demolition; health hazards in construction, materials handling, storage and disposal, hand and power tools, motor vehicles, mechanized equipment, marine operations, steel erection, stairways and ladders, confined spaces or any others that are applicable to the work being performed.

c. The names of Competent and/or Qualified Person(s) and proof of competency/qualification to meet specific OSHA Competent/Qualified Person(s) requirements must be attached.

The District SOHO will review the qualifications for acceptance;

d. Requirements that no work shall be performed unless a designated competent person is present on the job site;

e. Requirements for pre-task safety and health analysis;

f. Lines of authority;

g. Policies and procedures regarding noncompliance with safety requirements (to include disciplinary actions for violation of safety requirements) should be identified;

h. Provide written company procedures for holding managers and supervisors accountable for safety.

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5. SUBCONTRACTORS AND SUPPLIERS. If applicable, provide procedures for coordinating SOH activities with other employers on the job site:

a. Identification of subcontractors and suppliers (if known);

b. Safety responsibilities of subcontractors and suppliers.

6. TRAINING.

a. Requirements for new hire SOH orientation training at the time of initial hire of each new employee.

b. 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.

c. Procedures for periodic safety and health training for supervisors and employees.

d. Requirements for emergency response training.

> See paragraph 9.b. below for a list of requirements that may require emergency response training.

7. SAFETY AND HEALTH INSPECTIONS.

a. Specific assignment of responsibilities for a minimum daily job site safety and health inspection during periods of work activity: Who will conduct (e.g., SSHO, PM, safety professional, QC, supervisors, employees – depends on level of technical proficiency needed to perform said inspections), proof of inspector’s training/qualifications, when inspections will be conducted, procedures for documentation, deficiency tracking system, and follow-up procedures;

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b. Any external inspections/certifications that may be required (e.g., USCG).

8. ACCIDENT REPORTING. The Contractor shall identify person(s) responsible to provide the following:

a. Exposure data (man-hours worked);

b. Accident investigations, reports, and logs: Report all accidents as soon as possible but not more than 24 hours afterwards to the Contracting Officer/Representative (CO/COR).

The contractor shall thoroughly investigate the accident and submit the findings of the investigation along with appropriate corrective actions to the CO/COR in the prescribed format as soon as possible but no later than five (5) working days following the accident. Implement corrective actions as soon as reasonably possible;

c. The following require immediate accident notification:

(1) A fatal injury;

(2) A permanent total disability;

(3) A permanent partial disability;

(4) The hospitalization of three or more people resulting from a single occurrence;

(5) Property damage of $200,000 or more.

9. PLANS (PROGRAMS, PROCEDURES) REQUIRED BY THE

SAFETY MANUAL. 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 may include but not be limited to:

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a. Layout plans (04.A.01);

b. Emergency response plans:

(1) Procedures and tests (01.E.01);

(2) Spill plans (01.E.01, 06.A.02);

(3) Firefighting plan (01.E.01, Section 19);

(4) Posting of emergency telephone numbers (01.E.05);

(5) Man overboard/abandon ship (Section19.A.04);

(6) Medical Support. 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 (Section 03.A.02; 03.D);

c. Plan for prevention of alcohol and drug abuse (01.C.02);

d. Site sanitation plan (Section 02);

e. Access and haul road plan (4.B);

f. Respiratory protection plan (05.G);

g. Health hazard control program (06.A);

h. Hazard communication program (06.B.01);

i. Process Safety Management Plan (06.B.04);

j. Lead abatement plan (06.B.05 & specifications);

k. Asbestos abatement plan (06.B.05 & specifications);

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l. Radiation Safety Program (06.E.03.a);

m. Abrasive blasting (06.H.01);

n. Heat/Cold Stress Monitoring Plan (06.I.02)

o. Crystalline Silica Monitoring Plan (Assessment) (06.M) ;

p. Night operations lighting plan (07.A.08);

q. Fire Prevention Plan (09.A);

r. Wild Land Fire Management Plan (09.K);

s. Hazardous energy control plan (12.A.01);

t. Critical lift Plan (16.H);

u. Contingency plan for severe weather (19.A.03);

v. Float Plan (19.F.04);

w. Site-Specific Fall Protection & Prevention Plan (21.C);

x. Demolition plan (to include engineering survey) (23.A.01);

y. Excavation/trenching plan (25.A.01);

z. Emergency rescue (tunneling) (26.A.);

aa. Underground construction fire prevention and protection plan (26.D.01);

bb. Compressed air plan (26.I.01);

cc. Formwork and shoring erection and removal plans (27.C);

dd. PreCast Concrete Plan (27.D);

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ee. Lift slab plans (27.E);

ff. Steel erection plan (27.F.01);

gg. Site Safety and Health Plan for HTRW work (28.B);

hh. Blasting Safety Plan (29.A.01);

ii. Diving plan (30.A.13);

jj. Confined space Program (34.A).

10. RISK MANAGEMENT PROCESSES. Detailed project-specific hazards and controls shall be provided by an Activity Hazard Analysis (0I.A.13) for each major phase/activity of work.

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Attachment 2

Safety Performance Sign

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

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Fabrication and Mounting GuidelinesEP 310-1-6a 01 Jun 06

16-4

All Construction Project Identification signs and Safety Performance signs are to be fabricated and installed as de-scribed below. The signs are to be erected at a location designated by the contracting officer representative and shall conform to the size, format, and typographic standards shown on pages16-2 and 16-3. Detailed specifica-tions for HDO plywood panel preparation are provided in Appendix B.

Shown below the mounting diagram is a panel layout grid with spaces provided for project information. Photocopy this page and use as a worksheet when preparing sign legend orders.

For additional information on the proper method to prepare sign panel graphics, contact the district Sign Program Manager.

The sign panels are to be fabricated from .75" High Density Overlay Plywood. Panel preparation to follow HDO specifications provided in Appendix B.

Sign graphics to be prepared on a white nonreflective vinyl film with positionable adhesive backing.

All graphics except for the Communication Red background with Corps Signature on the project sign are to be die-cut or computer-cut nonreflective vinyl, prespaced legends prepared in the sizes and typefaces specified and applied to the background panel following the graphic formats shown on pages 16-2 and 16-3.

The 2’x 4’ Communication Red panel (to match Pantone system 032) with full Corps Signa-ture (reverse version) is to be screen-printed on the white background. Identification of the district or division may be applied under the signature with white cut vinyl letters prepared to Corps standards.

Drill and insert six (6) .375" T-nuts from the front face of the HDO sign panel. Position holes as shown. Flange of T-nut to be flush with sign face.

Apply graphic panel to prepared HDO plywood panel following manufacturers’ instructions.

Sign uprights to be structural grade 4" x 4" treated Douglas Fir or Southern Yellow Pine, No.1 or better. Post to be 12' long. Drill six (6) .375" mounting holes in uprights to align with T-nuts in sign panel. Countersink (.5") back of hole to accept socket head cap screw (4" x .375").

Assemble sign panel and uprights. Imbed assembled sign panel and uprights in 4' hole.

Local soil conditions and/or wind loading may require bolting additional 2" x 4" struts on inside face of uprights to reinforce installation as shown.

48”

48”

18”

Construction Project Identification Sign Legend Group 1: Corps Relationship 1.

2.

Legend Group 2: Division/District Name 1.

2.

Legend Group 3: Project Title 1.

2.

3.

Legend Group 4: Facility Name 1.

2.

Legend Group 5: Contractor/A&E 1.

2.

3.

4.

5.

Safety Performance Sign Legend Group 2: Project Title 1.

2.

Legend Group 3: Contractor/A&E 1.

2.

Legend Group 2a: Military/Civil Works Sponsor 1.

2.

Legend Group 5b: Contractor/A&E 1.

2.

3.

4.

5.

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Attachment 3

Work Sheet for Preliminary Accident Notification

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