03 - Annex 0200000 F Deliverables Annex 2 (POSCIIIRFPAmd6 - 04may16)

N62742-16-R-3580
RFP Amd 0006

05 May 2016
PERFORMANCE WORK STATEMENT (PWS)
SECTION F
ANNEX 0200000 MANAGEMENT AND ADMINISTRATION
DELIVERABLES FOR ANNEX 0200000
DELIVERABLES FORM PREPARATION INSTRUCTION
DELIVERABLE TITLE: 0200000/2.2.1.2 Request to Work Outside Governments Regular Working Hours
FORM ATTACHMENT NO.: N/A
GOVERNMENT APPROVAL REQUIRED:
MEDIA:
___ HARD COPY
YES
ELECTRONIC
NO
____ DIRECT SYSTEM INPUT
INSTRUCTIONS:
1.
The request shall be prepared using Microsoft Office Word software.
2.
Submit for Government review and comment.

a. If the KO accepts the request, the Government shall notify the Contractor of Government acceptance.
b. If the KO responds to the request with review comments, then incorporate the Governments
comments and resubmit the request via email to recipients on the distribution list. Continue this cycle
until the Government notifies the Contractor of Government acceptance.
Page 1 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F
DELIVERABLES FORM PREPARATION INSTRUCTIONS

DELIVERABLE TITLE: 0200000/2.3.4 Permits and Licenses
MEDIA:
X HARD COPY
___YES
X ELECTRONIC
X NO
_____ DIRECT SYSTEM INPUT
DESCRIPTION/PURPOSE OF REPORT:
To provide evidence that all permits, licenses and authorizations have been obtained prior to commencement
of work under this contract and complies with all the applicable GOS localRepublic of the Philippines laws
and regulations and DoD requirements.
INSTRUCTIONS:
1.
Use industry accepted format.
2.
Provide hard copy to the COR.
Page 2 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.3.5 Certificate of Insurance
MEDIA:
X HARD COPY
_____ YES
X ELECTRONIC
X NO
______ DIRECT SYSTEM INPUT
To ensure insurance exists and coverage amounts are in accordance with the FAR.
INSTRUCTIONS:
1.
Certificates of Insurance shall include but not limited to Republic of the Philippines GOS equivalents
of Comprehensive General Liability, Automobile Liability, Employees Liability coverage and
Workmens Compensation.
2.
Provide Certificate of Insurance to KO within 15 days of award with copy to COR.
Page 3 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.4.3.1 - Start Up Material and Critical Spares Inventory Listing
MEDIA:
HARD COPY
X YES
X ELECTRONIC
NO
To identify long-lead critical spares, equipment, material needed to sustain Government operations..
INSTRUCTIONS:
The Government requires no special format for submission. Industry standard is acceptable.
Page 4 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.4.4.1 - GFE Replacement Schedule
MEDIA:
HARD COPY
X YES
X ELECTRONIC
NO
Identifies GFE replacement schedule.
INSTRUCTIONS:
Page 5 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.4.6 - Property Control Plan
MEDIA:
HARD COPY
YES
X ELECTRONIC
X NO
Identifies Contractor Property Control Plan/SOPs.
INSTRUCTIONS:
Page 6 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.4.6 Inventory Report
MEDIA:
X HARD COPY
X YES
X ELECTRONIC
_____ NO
INSTRUCTIONS:
1.
Provide the Government an up-to-date inventory of:

a. All GFP appropriately categorized according to GFF, GFE, or GFM status. GFP shall be considered
as Government Furnished, Government Replaced, and Government Title; and Contractor Operated
and Maintained.
b. GOP used by the Government and requiring maintenance and repair services from the Contractor.
Such GOP shall be considered as Government Furnished Property of the Government, Government
Operated, Government Replaced, and Government Title; and Contractor Maintained.
2.
The report shall include but is not limited to listing quantity, type of equipment, identifying serial
number, make, model, capacity, location, and condition.
3.
Each monthly report (subsequent to the initial document) shall clearly enumerate any addition or deletion
of GFP/GOP from the previous report. This report shall be prepared using Microsoft Excel, sortable by
location and property designation (i.e., GFF, GFE, GFM, or GOP).
4.
GOP used by the Government and requiring maintenance and repair services from the Contractor. Such
GOP shall be considered as Government Furnished Property of the Government, Government Operated,
Government Replaced, and Government Title; and Contractor Maintained.
5.
Contractor shall determine format. Contractor shall use DD Form 200 Financial Liability Investigation
of Property Loss to record Contractor investigations of loss, damaged, deteriorated, declared valueless or
misplaced GFP and as necessary and appropriate in other situations. Identify items that have been
disposed of through DRMS.
c. Initial Report: Include all required information in accordance with FAR Part 45. Provide a revised
report within 30 calendar days from acceptance of additional GFP received after start of full
performance.
d. Annual Report: In accordance with DFARS 252.245-7001. Originate survey for equipment
damaged, deteriorated or declared valueless.
e. Final Report: Include all required information in accordance with FAR Part 45. Final inventory shall
include, but not limited to list of all GFP including property condition, use and location; written
statement indicating balances have been transferred; excess property is reported on inventory
schedules; disposition of GFP has been properly accomplished and documented; all questions
regarding title to property fabricated or acquired under contract has been resolved and properly
documented. Final Report shall highlight GFP the Contractor shall replace per contract requirements.
6.
Provide hard copy of report to COR.
Page 7 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.6.3 - General Schedule of Work
MEDIA:
HARD COPY
YES
X ELECTRONIC
X NO
Identifies Contractor work plan and schedule.
INSTRUCTIONS:
Page 8 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F
DEL IVERABLES FORM PREPARATION INSTRUCTIONS

DELIVERABLE TITLE: 0200000/2.6.7.1 - Quality Management Plan (QM)
MEDIA:
HARD COPY
YES
X ELECTRONIC
X NO
Identifies Contractor Quality Management Plan/SOPs, and to describe the QMS methodology and approach
incorporating both Quality Control (QC) and Quality Assurance (QA) elements.
INSTRUCTIONS:
1. The Government requires no special format for submission. Industry standard is acceptable.
2. The QC component will include, but not limited to:
a. Contractors production procedures and work processes
b. Quality checks conducted during production
c. Methodology to adjust processes as indicated by the quality checks
3. The QA component will include the evaluation approach and techniques to be used to determine whether the
service or product meets the performance objectives, standards, and requirements in the Performance Work
Statement.
4. The plan shall be prepared using the latest Microsoft Office Word or Excel software.
Page 9 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.6.7.3 Contractor Quality Inspection Surveillance Report
MEDIA:
_____ HARD COPY
_____YES
X ELECTRONIC
X NO
To ensure contractor is monitoring its processes through routine/ scheduled inspections and documenting the
outcome.
INSTRUCTIONS:
1.
The inspection and surveillance report shall be prepared using Microsoft Office software.
2.
The information shall include, but not be limited to:

a. All scheduled and performed QC inspections,
b. Dates of inspections,
c. Inspection results, and
d. Corrective and preventive actions taken.
Page 10 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.7.1 List of Key Personnel & Organizational Chart
MEDIA:
____ HARD COPY
____ YES
X ELECTRONIC
X NO
To review the qualifications of key personnel and authority within the organization.
INSTRUCTIONS:
1. Personnel list shall include, but not be limited to, information on all key personnel, including:
a. Names
b. Position titles
c. Qualifications
2.
Organizational Chart shall list all key personnel and employees performing under this task order.
3.
Report may be prepared using Microsoft Office software. The Government requires no special
format for submission; industry standard is acceptable.
Page 11 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.7.3 Contractor Labor Hours (eCMRA) Report
MEDIA:
____ HARD COPY
____ YES
____ ELECTRONIC
X NO
X DIRECT SYSTEM INPUT
INSTRUCTIONS:
1.
The purpose of this requirement is to report total number of contractor hours worked on this task
order during the performance period.
2.
Information should include sub-contractor labor hours if applicable.
3.
See https://doncmra.nmci.navy.mil for instructions for data entry. Call the help desk at the web site
for additional help if necessary.
4.
Reporting inputs will be for the labor executed during the period of performance during each
Government fiscal year (FY), which runs October 1 through September 30.
5.
Entry for each calendar month can be made throughout the year but must be completed by 31 Oct
annually.
Page 12 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.8.1 - Synchronized Predeployment and Operational Tracker (SPOT)
Report
1
GOVERNMENT APPROVAL REQUIRED: ____ YES
X NO
MEDIA:
____ HARD COPY
__ X ELECTRONIC
DIRECT SYSTEM INPUT
To provide an up-to-date listing of all Contractor personnel who are entered in the SPOT database and
possess a KO-issued Letter of Authorization.
INSTRUCTIONS:
1. For each individual, information shall include:
-
Last name, fist name, middle initial
Citizenship (specify country)
Company
For US citizens and TCNs: Common Access Card (CAC) issuance and expiration dates
A sub-total of Contractor personnel (by company) and the grand total number of Contractor personnel shall
be annotated.
This report shall be prepared using Microsoft Excel, sortable by last name, citizenship and company.
Information should include sub-contractor labor hours if applicable.
Page 13 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.8.8 Personnel Security Investigation (PSI), Fingerprint Card (FD87),
and OF-306 Declaration for Federal Employment
MEDIA:
____ HARD COPY
X YES
X ELECTRONIC
_____ NO
INSTRUCTIONS:
1.
Upon a favorable NACI, the Contractor personnel shall provide the completed Personnel Security
Investigation (PSI) to the Security Manager along with the original signed release statements, applicant
fingerprint card (FD87), and an OF-306 Declaration for Federal Employment.
2.
The Contractor shall be responsible for providing the fingerprint card.
Page 14 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.8.10 - Anti-Terrorism Force Protection (ATFP) Plan
MEDIA:
____ HARD COPY
X YES
X ELECTRONIC
_____ NO
Identifies the Contractors ATFP Plan for reducing the vulnerability of individuals and property to terrorist acts.
INSTRUCTIONS:
Plan shall include but is not limited to measures for reducing the vulnerability of individuals and property to
terrorist acts; deterring, detecting, defending, and responding to terrorist incidents; and other proactive measures
required for a robust ATFP Plan.
Page 15 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.8.11 - Physical Security Plan
MEDIA:
____ HARD COPY
X YES
X ELECTRONIC
_____ NO
The Contractor shall identify all Sensitive and/or Controlled GFP and CFP and the required Physical Security
requirements in their Standard Operating Procedures, 530 days after contract award.
INSTRUCTIONS:
Page 16 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.9.1 - Accident Prevention Plan (APP)
MEDIA:
____ HARD COPY
YES
X ELECTRONIC
___ X NO
To identify and document Contractor Safety Program via the APP and SOPs for each site of operations.
INSTRUCTIONS:
Contractor shall follow the format and cover all topics as delineated in Appendix A of EM-385-1-1. The APP shall
include Hazard Specific Safety Plans for areas such as but not limited to Abrasive Blasting, Access and Haul Road,
Asbestos Abatement, Confined Space Access, Contingency Plan for Severe Weather, Critical Lift Procedures,
Demolition, Drug Abuse Prevention, Emergency Response, Emergency Rescue, Fall Protection, Fire Prevention,
Hazard Communication, Hazardous Energy Control, Health Hazard Control, Layout, Lead Abatement Compliance
and Respiratory Protection. The Contractor should note in the APP which areas are not covered and the reasons
such as no demolition, abrasive blasting, confined space access shall not be done by the Contractor since the
Contractor does not expect to engage in such activities and so on. The Contractor shall also cross reference in the
APP any current specific Safety Plans already developed for an Annex such as but not limited to Logistics Flights
and Casualty Evacuation (0501080).
As part of the APP, the Contractor shall develop the appropriate Accident Hazard Analyses (AHA). AHAs shall
follow the format in EM-385-1-1 and shall explain the following:
The steps of the service process.
Identify potential hazards that exist as a result of the Contractors service process within the environment.
Measures or plans of actions to safely remove potential hazards away from people in and around the
service process and environment.
Specific materials and equipment necessary to safely remove potential hazards away from people in and
around the service process and environment.
Inspection requirements to assure service activity is safe.
Training of service personnel to be aware of potential hazards and measures or plans of actions to be used
to remove hazards from service environment.
When plans of actions or measures are selected to manage hazards away from service site, the Contractor Safety
Officer will coordinate such plans with competent person.
Page 17 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.9.2 Activity Hazard Analysis (AHA)
MEDIA:
_____ HARD COPY
X YES
X ELECTRONIC
_____ NO
To identify common recurring work activities performed in this task order and any potential hazards that
may exist.
INSTRUCTIONS:
1.
Submit with Accident Prevention Plan (APP).
2.
AHA shall follow format of Figure 1-2 of EM-385-1-1 and shall explain the following:
a. the steps of the service process;
b. identify potential hazards that exist as a result of the Contractors service process within the
environment;
c. measures or plans of actions to safely remove potential hazards away from people in and around
the service process and environment;
d. specific materials and equipment necessary to safely remove potential hazards away from people in
and around the service process and environment;
e. inspection requirements to assure service activity is safe; and
f. training of service personnel to be aware of potential hazards and measures or plans of actions to be
used to remove hazards from service environment.
3.
The report shall be prepared using the latest Microsoft Office software.
Page 18 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.9.3 Occupational Risk & Compliance Plans
MEDIA:
_____ HARD COPY
X YES
X ELECTRONIC
_____ NO
To identify risks and requirements associated with various types of work and how these plans will be
implemented and complied with.
INSTRUCTIONS:
1.
2.
These plans shall be submitted with the APP and shall be updated as situations change.
3.
Follow instructions in the Performance Work Statement specification items and relevant subspecification items listed in the Deliverable Title of this page.
4.
Additional plans as referenced in Appendix A of EM 385-1-1 shall be developed as applicable when

new types of work are required under this contract.
Page 19 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.9.5 NAVFAC Contractor Incident Reporting System (CIRS)
FORM ATTACHMENT NO.: J-0200000-04
MEDIA:
____ HARD COPY
____ YES
X ELECTRONIC
X NO
X DIRECT SYSTEM INPUT
To document significant incidents such as damages, accidents, mishaps, and near misses.
INSTRUCTIONS:
1.
At a minimum, the report shall include the following:

a. General information (e.g., accident classification, accident involving)
b. Personal information (e.g., Name of person involved, etc.)
c. Witness information (e.g., Name of witness involved, etc.)
d. Contract information (e.g., Name of contract, etc.))
e. Accident description (e.g., Date/Time/Location of accident, details of accident, action taken
to prevent re-occurrence, etc.)
f. Injury/Illness/Fatality information (e.g., Severity of injury/illness, etc.)
g. Estimated damage cost (for property, material or supply damage)
2.
See J- 0200000-04, Contractor Incident Reporting System (CIRS) for form. Additional
information provided on the internet at:
https://www.navfac.navy.mil/content/dam/navfac/NAVFAC%20Atlantic/NAVFAC%20Southeast
/PDFs/Safety/se_sf_cirs_trn_symposium.pdf
Page 20 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.9.7 Monthly On-Site Labor Report
MEDIA:
____ HARD COPY
____ YES
X ELECTRONIC
X NO
To document the hours performed by contractor employees (prime and sub-contract) as required by
NAVFAC Safety Office.
INSTRUCTIONS:
1.
2.
Include subcontractor and contractor man-hours.
Page 21 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.9.8 Safety Citations and Violations Correction Action Report
MEDIA:
____ HARD COPY
____ YES
X ELECTRONIC
X NO
To notify the Government of safety citations and corrective actions taken.
INSTRUCTIONS:
1.
2.
Submit a copy via email to recipients on the distribution list for Government review and comment.
Page 22 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.9.10 Safety Certifications
MEDIA:
____ HARD COPY
____ YES
X ELECTRONIC
To validate Contractors safety certificate.
INSTRUCTIONS:
Use industry accepted format.
Page 23 of 26
X NO
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.11 - Contingency and Disaster Recovery Plan
MEDIA:
____ HARD COPY
____ YES
X ELECTRONIC
X NO
Identifies Contractor Contingency and Disaster Recovery Plan/SOPs.
INSTRUCTIONS:
Page 24 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.12 - Mobilization Plan
MEDIA:
_____ HARD COPY
X YES
X ELECTRONIC
NO
To address how the Contractor will phase in its services at the start of the task order to achieve full operational
capability.
INSTRUCTIONS:
1.
2.
The plan shall be prepared using the latest Microsoft Office Word or Excel software.
3.
Submit Mobilization Plan to KO for review, feedback, clarification and approval. Send a copy of
Approved Mobilization Plan to COR.
Page 25 of 26
N62742-16-R-3580
RFP Amd 0006
05 May 2016
SECTION F

DELIVERABLE TITLE: 0200000/2.13 - Demobilization Plan
MEDIA:
_____ HARD COPY
X YES
X ELECTRONIC
_____ NO
To address how the Contractor will transfer services to another entity or cease support services entirely.
INSTRUCTIONS:
1. The Government requires no special format for submission. Industry standard is acceptable.
2.
The plan shall be prepared using the latest Microsoft Office Word or Excel software.
3. Submit plan after receipt of all available and necessary de-mobilization requirements information, and
no later than 60 calendar days prior to the start of demobilization to KO for review, feedback,
clarification and approval. Plan should include but not limited to:
a.
b.
c.
Remaining/backlogged maintenance and repair

Inventories
Completion and turnover of records, logs, operating and maintenance manuals.
Page 26 of 26

03 - Annex 0200000 F Deliverables Annex 2 (POSCIIIRFPAmd6 - 04may16)

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N62742-16-R-3580

RFP Amd 0006

___ HARD COPY

The request shall be prepared using Microsoft Office Word software.

Submit for Government review and comment.

DELIVERABLES FORM PREPARATION INSTRUCTIONS

Use industry accepted format.

Provide hard copy to the COR.

DELIVERABLES FORM PREPARATION INSTRUCTIONS

Provide Certificate of Insurance to KO within 15 days of award with copy to COR.

DELIVERABLES FORM PREPARATION INSTRUCTIONS

DELIVERABLES FORM PREPARATION INSTRUCTIONS

DELIVERABLES FORM PREPARATION INSTRUCTIONS

DELIVERABLES FORM PREPARATION INSTRUCTIONS

Provide the Government an up-to-date inventory of:

Provide hard copy of report to COR.

DELIVERABLES FORM PREPARATION INSTRUCTIONS

DEL IVERABLES FORM PREPARATION INSTRUCTIONS

DELIVERABLES FORM PREPARATION INSTRUCTIONS

_____ HARD COPY

The information shall include, but not be limited to:

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

Information should include sub-contractor labor hours if applicable.

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

DIRECT SYSTEM INPUT

Last name, fist name, middle initial

Citizenship (specify country)

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

The Contractor shall be responsible for providing the fingerprint card.

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

The steps of the service process.

Inspection requirements to assure service activity is safe.

DELIVERABLES FORM PREPARATION INSTRUCTIONS

_____ HARD COPY

Submit with Accident Prevention Plan (APP).

DELIVERABLES FORM PREPARATION INSTRUCTIONS

_____ HARD COPY

Additional plans as referenced in Appendix A of EM 385-1-1 shall be developed as applicable when

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

At a minimum, the report shall include the following:

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

Include subcontractor and contractor man-hours.

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

DELIVERABLES FORM PREPARATION INSTRUCTIONS

____ HARD COPY

DELIVERABLES FORM PREPARATION INSTRUCTIONS

_____ HARD COPY

DELIVERABLES FORM PREPARATION INSTRUCTIONS