Contractor

GSI Pacific, Inc.

Contract Number Task Order
N62478-16-D-4015 N6247818F4183
Project Name
Dry Dock No. 1 Caisson Overhaul and Dock Repair
Project Location
PHNSY & IMF, JBPHH, Hawaii

Specification Section Schedule Activity ID Definable Feature of Work

Page 1 of 34
Organization
Managing Member Zachary Payne
CQCM Jose Dar
ACQCM Brian Toepper
SSHO Dean Nutt
Health & Safety Mike Coyle
 Contract No. N62478-16-D-4015
Dry Dock #1 Overhaul Caisson Overhaul and Dock Repair,
PHNSY & IMF, JBPHH, Hawaii
CONSTRUCTION QUALITY CONTROL PLAN

Figure 1: Quality Control Organization Chart

PROJECT MANAGER
Joe Light

CORPORATE HEALTH & SAFETY

OFFICER
Martine Bissonnette
CQC MANAGER
Roy Iizaki
PROJECT
CONSTRUCTION HEALTH & SUPERINTENDENT Alternate CQC Manager
SAFETY OFFICER Shern Hacoba Heather Hammers
Christopher E. Skoog
Assistant CQC Manager
Josh Kaaialii

SSHO
Kenney Gomes, CSP

Alternate SSHO
James Pritchett,

SUB-CONTRACTORS
Pacific Shipyards CONSULTANTS/
QC SPECIALISTS
International TESTING LABS/
Anawati & Associates
Triton Marine Construction VENDORS
Corp.
 Contract No. N62478-16-D-4015
Dry Dock #1 Overhaul Caisson Overhaul and Dock Repair,
PHNSY & IMF, JBPHH, Hawaii
CONSTRUCTION QUALITY CONTROL PLAN

A-3
 Contract No. N62478-16-D-4015
GSI-ASI JV LLC
Dry Dock #1 Overhaul Caisson Overhaul and Dock Repair,
PHNSY & IMF, JBPHH, Hawaii
Greenwave Solutions, Inc.  Alan Shintani, Inc. CONSTRUCTION QUALITY CONTROL PLAN

Figure 1: Quality Control Organization Chart

MANAGING MEMBER
Dennet M. Azuma

CORPORATE HEALTH & CONTRACT MANAGEMENT/

SAFETY OFFICER ADMINISTRATION
Christopher E. Skoog, CHST Jennifer Smythe

ALTERNATE
SSHO/SUPERINTENDENT CQC MANAGER ALTERNATE CQCM's
SSHO/SUPERINTENDENT
Christopher E. Skoog Bruce Hansen Jason Lee
Albert Kam
Edilberto L. Odoya
Christy Bryant
Carlos A. Chavez
Ken Dias
Max Solmssen

CONSULTANTS
FIELD
SUBCONTRACTORS TESTING LABS QC SPECIALISTS
PERSONNEL
VENDORS
A-3
 Contract No. N62478-16-D-4015
GSI-ASI JV LLC
Dry Dock #1 Overhaul Caisson Overhaul and Dock Repair,
PHNSY & IMF, JBPHH, Hawaii
Greenwave Solutions, Inc.  Alan Shintani, Inc. CONSTRUCTION QUALITY CONTROL PLAN

Figure 4-1: Lines of Authority

MANAGING MEMBER
Dennet M. Azuma

CORPORATE HEALTH & CONTRACT MANAGEMENT/

SAFETY OFFICER ADMINISTRATION
Christopher E. Skoog, CHST Jennifer Smythe

ALTERNATE
SSHO/SUPERINTENDENT CQC MANAGER ALTERNATE CQCM's
SSHO/SUPERINTENDENT
Christy Bryant Carlos A. Chavez Jason Lee
Albert Kam Bruce Hansen
Christopher E. Skoog Dennet M. Azuma
Max Solmssen
Ken Dias

CONSULTANTS
FIELD
SUBCONTRACTORS TESTING LABS QC SPECIALISTS
PERSONNEL
VENDORS
4-7
 SUBMITTAL REGISTER
CONTRACT NO

N62478-16-D-4015
TITLE AND LOCATION CONTRACTOR

Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii GSI Pacific, Inc.
CONTRACTOR CONTRACTOR
GOVERNMENT ACTION
SCHEDULE DATES ACTION
DATE FWD
SPECIFICATION

N GOVT OR AIE
CLASSIFICATIO

ACTION CODE

ACTION CODE
TO APPR
ACTIVITY NO

PARAGRAPH
MITTAL NO.

AUTH/ MAILED TO

REVIEWER
DATE RCD CONTR/
SECTION

NUMBER
TRANS-

DATE RED DATE FWD FROM DATE RED

DESCRIPTION OF APPROVAL MATERIAL DATE OF FROM TO OTHER OTHER DATE OF FRM APPR
ITEM SUBMITTED SUBMIT NEEDED BY NEEDED BY ACTION CONTR REVIEWER REVIEWER ACTION AUTH REMARKS
(a) (b) (c) (d) (e) (f) (g) (h) (I) (j) (k) (l) (m) (n) (o) (p) (q) (r)
01 11 00.05 20 SUMMARY OF WORK FOR DESIGN-BUILD
SD-01 Preconstruction Submittals
Utility Outage Requests 1.5.2
Utility Connection Requests 1.5.2
Borrow Permits 1.5.3
Excavation Permits 1.5.3
Welding Permits 1.5.3
Burning Permits 1.5.3

01 14 00.05 20 WORK RESTRICTIONS FOR DESIGN-BUILD

SD-01 Preconstruction Submittals
List of Contact Personnel 1.4.2 G
Visit Request for Pearl Harbor Naval Shipyard Form (PHNSY 14ND-SYD-
1.4.2.3 G
5512/28)
Completed Special Access Determination (NAVSEA 5510/15); G
Pier Parking Authorization 1.5.3 G
Government Guard Services 1.5.7 G
Contractor Regulations 1.5.11 G
Transportation of Personnel, Materials, and Equipment G
Purchase Orders G
Personnel List 1.4.2 G
Vehicle List 1.4.3 G
Statement of Acknowledgement Form SF 1413 1.4.4 G

01 20 00.05 20 PRICE & PAYMENT PROCEDURES FOR DESIGN-BUILD

SD-01 Preconstruction Submittals
Suretrak Cost Loaded Schedule 1.3 G

01 30 00.05 20 ADMINISTRATIVE REQUIREMENTS FOR DESIGN-BUILD

SD-01 Preconstruction Submittals
Insurance 1.3 G

01 31 19.05 20 POST AWARD MEETINGS FOR DESIGN-BUILD

SD-01 Preconstruction Submittals G
Design Submittal Packaging Proposal 1.3.2 G
Project Schedule 1.3.8 G
Performance Assessment Plan (PAP) 1.3.7.1 G
Design Presentation Concept Site and Floor Plans 1.3.5 G
CDW Facilitator Experience Resume 1.3.6 G
CDW Preliminary Concept Design 1.3.6 G
CDW Basis of Design with Cost Estimate 1.3.6 G
CDW Concept Design Report 1.3.6 G

01 32 17.05 20 NETWORK ANALYSIS SCHEDULES (NAS) FOR DESIGN-BUILD

SD-01 Preconstruction Submittals
Qualifications 1.5 G
Design Baseline Network Analysis Schedule Package 1.3
Construction Baseline Network Analysis Schedule Package 1.3 G
SD-07 Certificates
Monthly Network Analysis Schedule Updates 1.7.1 G
SD-11 Closeout Submittals
As-Built Schedule 1.7.2 G

01 33 00.05 20 CONSTRUCTION SUBMITTAL PROCEDURES FOR DESIGN-BUILD

SD-01 Preconstruction Submittals
Submittal Register Format 1.3.1 G

01 33 10.05 20 DESIGN SUBMITTAL PROCEDURES FOR DESIGN-BUILD

SD-01 Preconstruction Submittals
Consolidated RFP Documents 2.1 G
Submittal Register 1.7.4 G
SD-04 Samples
Final Framed Rendering and Copies G
SD-05 Design Data
Design Drawings 1.6 G
Specifications 1.7 G
Design Analysis 1.8 G
Design Submittals 2.2 G
Sustainable Design 1.8.3 G
Project Rendering G
Historic Preservation and Planning Commission Submission 1.8.4 G
SD-07 Certificates
LEED Green Building Rating System (GBRS) 1.8.3.1 G
LEED Certification Registration Application 1.8.3.1 G
LEED Certification 1.8.3.1 G
SD-11 Closeout Submittals
Record Documents 1.9 G

01 33 29.05 20 LEED (TM) DOCUMENTATION FOR DESIGN-BUILD

SD-01 Preconstruction Submittals
LEED Implementation Plan 1.4 G
SD-11 Closeout Submittals
LEED Documentation Notebook 1.5 G

01 35 13.05 20 SPECIAL PROJECT PROCEDURES FOR DESIGN-BUILD

SD-01 Preconstruction Submittals
Watercraft List 3.2 G
SD-04 Samples
Model Unit 3.8 G

01 35 26.05 20 GOVERNMENTAL SAFETY REQUIREMENTS FOR DESIGN-BUILD

SD-01 Preconstruction Submittals
Accident Prevention Plan (APP) 1.7 G
Activity Hazard Analysis (AHA) 1.8 G
Crane Critical Lift Plan 1.7.1.d G
Proof of Qualification for Crane Operators G
SD-06 Test Reports
Reports 1.14
Accident Reports 1.14.1
Crane Reports 1.14.3
SD-07 Certificates
Confined Space Entry Permit 1.10.a
Hot Work Permit 1.10.b
License Certificates
Contractor Safety Self-Evaluation Checklist 1.4 G
Third Party Certification of Barge-Mounted Mobile Cranes 1.14.5
 SUBMITTAL REGISTER
CONTRACT NO

N62478-16-D-4015
TITLE AND LOCATION CONTRACTOR

Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii GSI Pacific, Inc.
CONTRACTOR CONTRACTOR
GOVERNMENT ACTION
SCHEDULE DATES ACTION
DATE FWD
SPECIFICATION

N GOVT OR AIE
CLASSIFICATIO

ACTION CODE

ACTION CODE
TO APPR
ACTIVITY NO

PARAGRAPH
MITTAL NO.

AUTH/ MAILED TO

REVIEWER
DATE RCD CONTR/
SECTION

NUMBER
TRANS-

DATE RED DATE FWD FROM DATE RED

DESCRIPTION OF APPROVAL MATERIAL DATE OF FROM TO OTHER OTHER DATE OF FRM APPR
ITEM SUBMITTED SUBMIT NEEDED BY NEEDED BY ACTION CONTR REVIEWER REVIEWER ACTION AUTH REMARKS
(a) (b) (c) (d) (e) (f) (g) (h) (I) (j) (k) (l) (m) (n) (o) (p) (q) (r)

01 45 00.05 20 CONSTRUCTION QUALITY CONTROL

SD-01 Preconstruction Submittals
Design Quality Control (DQC) Plan 1.4.2 G
Construction Quality Control (CQC) Plan 1.4.2 G
Indoor Air Quality (IAQ) Management Plan 1.14 G
Basis of Design and Design Intent 1.5.3.d G
SD-07 Certificates
Preliminary Inspections and Final Acceptance Testing 1.5.4.1.c G
Final Life Safety/Fire Protection Certification 1.5.4.1.c G
IBC Special Inspections Certification 1.5.4.3 G
SD-11 Closeout Submittals
Summary Commissioning Report 1.4.4 G
Training Course Outline 1.11 G
Training Video Recording 1.11 G
Equipment Inventory 1.5.3.l G

01 50 00.05 20 TEMPORARY FACILITIES AND CONTROLS

SD-01 Preconstruction Submittals
Traffic Control Plan 1.9.2.1 G
Construction Site Plan 1.4 G
SD-03 Product Data
Backflow Preventers 2.1
SD-06 Test Reports
Backflow Preventer Tests 3.3 G
SD-07 Certificates
Backflow Tester Certification 1.7 G
Backflow Preventers Certificate of Full Approval 1.5

01 57 19.05 20 TEMPORARY ENVIRONMENTAL CONTROLS

SD-01 Preconstruction Submittals
Preconstruction Survey 1.5.1 G
Environmental Management Plan 3.1 G
Solid Waste Management Plan and Permit 3.4 G
Regulatory Notification 1.5.2 G
Storm Water Pollution Prevention Plan 3.2.2 G
Notice of Intent /Application for NPDES Permit Coverage 3.2.2.1 G
Contractor Hazardous Material Inventory Log 3.6 G
ECATTS Certificate of Completion 1.4.1 G
SD-06 Test Reports
Laboratory Analysis 3.13.2.2
Disposal Requirements 3.15.2
Erosion and Sediment Control Inspection Reports 3.2.2
Inspection and Testing Reports for NPDES Permit Coverage 3.2.2.1
Contractor 40 CFR Employee Training Records 1.5.5
Solid Waste Management Report 3.4.1 G
SD-11 Closeout Submittals
NPDES Permit Compliance Notebook 3.2.2.1 G
Waste Management Documents 3.5
Disposal Documentation for Hazardous and Regulated Waste 3.6.1
Contractor 40 CFR Employee Training Records 1.5.5
Solid Waste Management Report 3.4.1
Contractor Hazardous Material Inventory Log 3.6 G
Hazardous Waste/Debris Management 3.9
Regulatory Notifications 1.5.2

01 58 00.05 20 PROJECT IDENTIFICATION

SD-02 Shop Drawings
Preliminary One Line Drawings of Project Rendering 1.3.1 G
Preliminary Drawing Indicating Layout and Text Content 1.4.1 G
Sign Legend Orders 1.4.2 G
SD-04 Samples
Final Rendering Sample 1.3.1 G
Final Framed Rendering and Copies 1.3.1 G
Facility Recognition Plaque 1.3.2 G

01 78 00.05 20 CLOSEOUT SUBMITTALS

SD-03 Product Data
As-Built Record of Equipment and Materials 1.3.2
Warranty Management Plan 1.7.1
Warranty Tags 1.7.5
Final Cleaning 1.1
Spare Parts Data 1.4
SD-08 Manufacturer’s Instructions
Preventative Maintenance 1.5
Condition Monitoring (Predictive Testing) 1.5
Inspection 1.5
Posted Instructions 1.7.1.f
SD-10 Operation and Maintenance Data
Operation and Maintenance Manuals 1.9
SD-11 Closeout Submittals
Record Drawings 1.3.1
Certification of EPA Designated Items 1.6 G
Interim Form DD1354 1.11 G
Checklist for Form DD1354 1.11 G

01 78 24.05 20 FACILITY OPERATION AND MAINTENANCE SUPPORT INFORMATION FOR DESIGN-BUILD

SD-06 Test Reports
Validation Site Visit and Presentation 3.1 G
SD-11 Closeout Submittals
OMSI, Preliminary Submittal 1.4.1 G
OMSI, 100% - Prefinal Submittal 1.4.2 G
OMSI, Final Submittal 1.4.3 G
 SUBMITTAL REGISTER
CONTRACT NO

N62478-16-D-4015
TITLE AND LOCATION CONTRACTOR

Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii GSI Pacific, Inc.
CONTRACTOR CONTRACTOR
GOVERNMENT ACTION
SCHEDULE DATES ACTION
DATE FWD
SPECIFICATION

N GOVT OR AIE
CLASSIFICATIO

ACTION CODE

ACTION CODE
TO APPR
ACTIVITY NO

PARAGRAPH
MITTAL NO.

AUTH/ MAILED TO

REVIEWER
DATE RCD CONTR/
SECTION

NUMBER
TRANS-

DATE RED DATE FWD FROM DATE RED

DESCRIPTION OF APPROVAL MATERIAL DATE OF FROM TO OTHER OTHER DATE OF FRM APPR
ITEM SUBMITTED SUBMIT NEEDED BY NEEDED BY ACTION CONTR REVIEWER REVIEWER ACTION AUTH REMARKS
(a) (b) (c) (d) (e) (f) (g) (h) (I) (j) (k) (l) (m) (n) (o) (p) (q) (r)
 SUBMITTAL REGISTER
CONTRACT NO

N62478-16-D-4015
TITLE AND LOCATION CONTRACTOR

Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii GSI Pacific, Inc.
CONTRACTOR CONTRACTOR
ACTION
GOVERNMENT ACTION
SCHEDULE DATES

CLASSIFICATION GOVT OR
SPECIFICATION SECTION

PARAGRAPH NUMBER
DATE FWD

AIE REVIEWER

ACTION CODE

ACTION CODE
TO APPR
ACTIVITY NO

MITTAL NO.

AUTH/ MAILED TO
DATE RCD CONTR/
TRANS-

DATE RED DATE FWD FROM DATE RED

DESCRIPTION OF APPROVAL MATERIAL DATE OF FROM TO OTHER OTHER DATE OF FRM APPR
ITEM SUBMITTED SUBMIT NEEDED BY NEEDED BY ACTION CONTR REVIEWER REVIEWER ACTION AUTH REMARKS
(a) (b) (c) (d) (e) (f) (g) (h) (I) (j) (k) (l) (m) (n) (o) (p) (q) (r)
01 20 00.05 20 PRICE AND PAYMENT PROCEDURES FOR DESIGN-BUILD

SD-01 Preconstruction Submittals

Earned Value Report 1.3 G

01 32 17.05 20 NETWORK ANALYSIS SCHEDULES FOR DESIGN-BUILD

SD-01 Preconstruction Submittals

Qualifications 1.5 G

Design Baseline Network Wrok Analysis Schedule Package 1.3 G

Construction Baseline Network Wrok Analysis Schedule Package 1.3 G

SD-07 Certificates

Monthly Network Analysis Schedule Package 1.7.1 G

SD-11 Closeout Submittals 1.4.2 G

As-Built Schedule 1.7.2 G

01 33 00.05 20 CONSTRUCTION SUBMITTAL PROCEDURES

SD-01 Preconstruction Submittals

Submittal Register 1.3.1 G

01 33 10.05 20 DESIGN SUBMITTAL PROCEDURES

SD-05 Design Data

Design Drawings 1.9 G

Specifications 1.1 G

Design Analysis 1.11 G

SD-11 Closeout Submittals

Record Documents 1.14 G

01 35 26.05 20 GOVERNMENT SAFETY REQUIREMENTS FOR DESIGN-BUILD

SD-01 Presonstruction Submittals

 SUBMITTAL REGISTER
CONTRACT NO

N62478-16-D-4015
TITLE AND LOCATION CONTRACTOR

Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii GSI Pacific, Inc.
CONTRACTOR CONTRACTOR
ACTION
GOVERNMENT ACTION
SCHEDULE DATES

CLASSIFICATION GOVT OR
SPECIFICATION SECTION

PARAGRAPH NUMBER
DATE FWD

AIE REVIEWER

ACTION CODE

ACTION CODE
TO APPR
ACTIVITY NO

MITTAL NO.

AUTH/ MAILED TO
DATE RCD CONTR/
TRANS-

DATE RED DATE FWD FROM DATE RED

DESCRIPTION OF APPROVAL MATERIAL DATE OF FROM TO OTHER OTHER DATE OF FRM APPR
ITEM SUBMITTED SUBMIT NEEDED BY NEEDED BY ACTION CONTR REVIEWER REVIEWER ACTION AUTH REMARKS
(a) (b) (c) (d) (e) (f) (g) (h) (I) (j) (k) (l) (m) (n) (o) (p) (q) (r)
Accident Prevention Plan 1.6.3.2 G

01 35 26.05 20 Activity Hazard Analysis (AHA) 1.6.3.3 G

SD-06 Test Reports

Accident Notifications 1.7.1 G

Accident Reports 1.7.2 G

SD-07 Certificates

Confined Space Entry Permit 1.11 G

Hot Work Permit 1.8 G

01 45 00.05 20 DESIGN AND CONSTRUCTION QUALITY CONTROL

SD-01 Presonstruction Submittals

Design Quality Control Plan 1.3.3 G

Construction Quality Control Plan 1.3.3 G

01 57 19.00 20 TEMPORARY ENVIRONMENTAL CONTROLS

SD-01 Preconstruction Submittals

Preconstruction Survey 1.5.1 G

Solid Waste Management Plan and Permit 3.4 G

Regulatory Notifications 1.5.2 G

Environmental Management Plan 3.1 G

Storm Water Pollution Prevention Plan 3.1.B G

Contractor Hazardous Material Inventory Log 3.6 G

SD-06 Test Reports

Solid Waste Management Report 3.4.1 G

33 11 00 WATER DISTRIBUTION MAIN

SD-03 Product Data

 SUBMITTAL REGISTER
CONTRACT NO

N62478-16-D-4015
TITLE AND LOCATION CONTRACTOR

Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii GSI Pacific, Inc.
CONTRACTOR CONTRACTOR
ACTION
GOVERNMENT ACTION
SCHEDULE DATES

CLASSIFICATION GOVT OR
SPECIFICATION SECTION

PARAGRAPH NUMBER
DATE FWD

AIE REVIEWER

ACTION CODE

ACTION CODE
TO APPR
ACTIVITY NO

MITTAL NO.

AUTH/ MAILED TO
DATE RCD CONTR/
TRANS-

DATE RED DATE FWD FROM DATE RED

DESCRIPTION OF APPROVAL MATERIAL DATE OF FROM TO OTHER OTHER DATE OF FRM APPR
ITEM SUBMITTED SUBMIT NEEDED BY NEEDED BY ACTION CONTR REVIEWER REVIEWER ACTION AUTH REMARKS
(a) (b) (c) (d) (e) (f) (g) (h) (I) (j) (k) (l) (m) (n) (o) (p) (q) (r)
Piping Materials 2.1.1

Water distribution main 2.1

2.2
33 11 00 Water service line

SD-05 Design Data

Design calculations of water

piping

SD-06 Test Reports

Disinfection 2.2.2.2 G

SD-07 Certificates

Water distribution main 2.1

Water service line 2.2

SD-08 Manufacturer's Instructions

Delivery, storage, and handling 1.4

3.1.1
Installation
 SUBMITTAL REGISTER
CONTRACT NO

N62478-16-D-4015
TITLE AND LOCATION CONTRACTOR

Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii GSI Pacific, Inc.
CONTRACTOR CONTRACTOR
ACTION
GOVERNMENT ACTION
SCHEDULE DATES

CLASSIFICATION GOVT OR
SPECIFICATION SECTION

PARAGRAPH NUMBER
DATE FWD

AIE REVIEWER

ACTION CODE

ACTION CODE
TO APPR
ACTIVITY NO

MITTAL NO.

AUTH/ MAILED TO
DATE RCD CONTR/
TRANS-

DATE RED DATE FWD FROM DATE RED

DESCRIPTION OF APPROVAL MATERIAL DATE OF FROM TO OTHER OTHER DATE OF FRM APPR
ITEM SUBMITTED SUBMIT NEEDED BY NEEDED BY ACTION CONTR REVIEWER REVIEWER ACTION AUTH REMARKS
(a) (b) (c) (d) (e) (f) (g) (h) (I) (j) (k) (l) (m) (n) (o) (p) (q) (r)
 SUBMITTAL REGISTER
CONTRACT NO

N62478-16-D-4015
TITLE AND LOCATION CONTRACTOR

Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii GSI Pacific, Inc.
CONTRACTOR CONTRACTOR
ACTION
GOVERNMENT ACTION
SCHEDULE DATES

CLASSIFICATION GOVT OR
SPECIFICATION SECTION

PARAGRAPH NUMBER
DATE FWD

AIE REVIEWER

ACTION CODE

ACTION CODE
TO APPR
ACTIVITY NO

MITTAL NO.

AUTH/ MAILED TO
DATE RCD CONTR/
TRANS-

DATE RED DATE FWD FROM DATE RED

DESCRIPTION OF APPROVAL MATERIAL DATE OF FROM TO OTHER OTHER DATE OF FRM APPR
ITEM SUBMITTED SUBMIT NEEDED BY NEEDED BY ACTION CONTR REVIEWER REVIEWER ACTION AUTH REMARKS
(a) (b) (c) (d) (e) (f) (g) (h) (I) (j) (k) (l) (m) (n) (o) (p) (q) (r)
 TESTING PLAN AND LOG

CONTRACT NUMBER PROJECT TITLE AND LOCATION CONTRACTOR

Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF,
N62478-16-D-4015 GSI Pacific, Inc.
JBPHH, Hawaii

SPECIFICATION ACCREDITED/

SECTION APPROVED LOCATION DATE

AND SCHEDULE LAB OF TEST FORWARDED
PARAGRAPH ACTIVITY ON OFF DATE TO
NUMBER ID TEST REQUIRED YES NO SAMPLED BY TESTED BY SITE SITE COMPLETED CONTR. OFF. REMARKS
02 83 13.00 - 1.5.2.3 Sampling Results X GSI Pacific Inc. X
05 12 01 - 3.4.2 Ultrasonic Testing X PSI PSI X
05 12 01 - 3.6 Air Test X PSI PSI X
05 12 01 - 3.7 Form 9997/1 X PSI PSI X
05 12 01 - 3.9 Torque Test X PSI PSI X
09 97 13.26 - 2.1 Coating Systems X PSI PSI X
Naval Shipyard QA
09 97 13.26 - 3.5.2 X PSI PSI X
Checklist
23 05 93 - 1.5.7.1 TAB X PSI PSI X
26 20 00 - 3.5.2 600V Wiring Test X PSI PSI X
26 20 00 - 3.5.3 Transformer Tests X PSI PSI X
Ground-Fault
26 20 00 - 3.5.4 X PSI PSI X
Receptacle Test
40 05 13 - 3.6.3 Pipe Leakage Tests X PSI PSI X
41 05 13 - 3.6.1 Hydrostatic Tests X PSI PSI X
42 05 13 - 3.6.2 Pneumatic Tests X PSI PSI X
43 05 13 - 3.6.5 Valve Testing X PSI PSI X

4296/4 (9/98) SHEET 1

 REWORK ITEMS LIST
CONTRACT NO. N62478-16-D-4015
CONTRACT TITLE: Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii

CONTRACTOR: GSI Pacific, Inc.

CONTRACT REQUIREMENT (Spec. Section

NUMBER DATE IDENTIFIED DESCRIPTION and Par. No., Drawing No. and Detail No., ACTION TAKEN BY QC MANAGER RESOLUTION DATE COMPLETED
etc.)

Page 18 of 34
 CONTRACTOR PRODUCTION REPORT DATE
(ATTACH ADDITIONAL SHEETS IF NECESSARY)
CONTRACT NO TITLE AND LOCATION T.O. N6247818F4183 REPORT NO
N62478-16-D-4015 Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii
CONTRACTOR: SUPERINTENDENT
GSI Pacific, Inc.
AM WEATHER PM WEATHER MAX TEMP F MIN TEMP F

WORK PERFORMED TODAY

Schedule
DEFINABLE FEATURE OF WORK, WORK LOCATION AND DESCRIPTION EMPLOYER NUMBER TRADE HRS
Activity No.:

WAS A JOB SAFETY MEETING HELD THIS DATE? TOTAL WORK HOURS ON JOB
YES NO SITE,
JOB (If YES attach copy of the meeting minutes) THIS DATE INCL CON'T SHEETS

SAFETY WERE THERE ANY LOST TIME ACCIDENTS THIS DATE? YES NO CUMULATIVE TOTAL OF WORK
(If YES attach copy of completed OSHA report)
HOURS FROM PREVIOUS REPORT
WAS CRANE/MANLIFT/TRENCHING/SCAFFOLD/HV ELEC/HIGH WORK/ HAZMAT WORK DONE? YES NO
(If YES attach statement or checklist showing inspection performed.)
TOTAL HOURS FROM START
WAS HAZARDOUS MATERIAL/WASTE RELEASED INTO THE ENVIRONMENT? YES NO OF CONSTRUCTION
(If YES attach description of incident and proposed action.)
Schedule
Activity No.
DEFINABLE FEATURE OF WORK AND LIST SAFETY ACTIONS TAKEN TODAY/SAFETY INSPECTIONS CONDUCTED SAFETY REQUIREMENTS HAVE BEEN MET

EQUIPMENT/MATERIAL RECEIVED TODAY TO BE INCORPORATED IN JOB (INDICATE SCHEDULE ACTIVITY NUMBER)

Schedule
Activity No.
Submittal # Definable Feature of Work and Description of Equipment/Materials Received

CONSTRUCTION AND PLANT EQUIPMENT ON JOB SITE TODAY. INDICATE HOURS USED AND SCHEDULE ACTIVITY NUMBER.
Schedule
Activity No.
Owner Definable Feature of Work and Description of Construction Equipment Used today (incl Make and Model) Hours Used

Schedule
Activity No.
DEFINABLE FEATURE OF WORK AND REMARKS

CONTRACTOR/SUPERINTENDENT DATE
SHEET OF
 CONTRACTOR PRODUCTION REPORT DATE
(CONTINUATION SHEET)
CONTRACT NO TITLE AND LOCATION T.O. N6247818F4183 REPORT NO
N62478-16-D-4015 Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii
WORK PERFORMED TODAY
Schedule
DEFINABLE FEATURE OF WORK, WORK LOCATION AND DESCRIPTION EMPLOYER NUMBER TRADE HRS
Activity No.:

Schedule
Activity No.
DEFINABLE FEATURE OF WORK AND LIST SAFETY ACTIONS TAKEN TODAY/SAFETY INSPECTIONS CONDUCTED

EQUIPMENT/MATERIAL RECEIVED TODAY TO BE INCORPORATED IN JOB (INDICATE SCHEDULE ACTIVITY NUMBER)

Schedule
Activity No.
Submittal # Definable Feature of Work and Description of Equipment/Materials Received

CONSTRUCTION AND PLANT EQUIPMENT ON JOB SITE TODAY. INDICATE HOURS USED AND SCHEDULE ACTIVITY NUMBER.
Schedule
Activity No.
Owner Definable Feature of Work and Description of Construction Equipment Used today (incl Make and Model) Hours Used

Schedule
Activity No.
DEFINABLE FEATURE OF WORK AND REMARKS

INCLUDE ALL PERSONNEL WORK HOURS IN THE WORK PERFORMED SECTION ON THIS SHEET
INTO THE FRONT CONTRACTOR PRODUCTION REPORT

SHEET OF
 CONTRACTOR QUALITY CONTROL REPORT DATE
(ATTACH ADDITIONAL SHEETS IF NECESSARY) REPORT NO
Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY &
PHASE CONTRACT NO: N62478-16-D-4015 CONTRACT TITLE: TO N624 IMF, JBPHH, Hawaii
WAS PREPARATORY PHASE WORK PREFORMED TODAY? YES NO
PREPARATORY

IF YES, FILL OUT AND ATTACH SUPPLEMENTAL PREPARATORY PHASE CHECKLIST.

Schedule
Activity No.:
Definable Feature of Work Index #

WAS INITIAL PHASE WORK PREFORMED TODAY? YES NO

IF YES, FILL OUT AND ATTACH SUPPLEMENTAL INITIAL PHASE CHECKLIST.
Schedule
INITIAL

Activity No.:
Definable Feature of Work Index #

WORK COMPLIES WITH CONTRACT AS APPROVED DURING INITIAL PHASE? YES NO

WORK COMPLIES WITH SAFETY REQUIREMENTS? YES NO
Schedule Description of Work, Testing Performed & By Whom, Definable Feature of Work, Specification
Activity No.: Secton, Location and List of Personnel Present
FOLLOW-UP

REWORK ITEMS IDENTIFIED TODAY (NOT CORRECTED BY CLOSE OF BUSINESS) REWORK ITEMS CORRECTED TODAY (FROM REWORK ITEMS LIST)

Schedule Schedule
ActivityNo.:
Description ActivityNo.:
Description

REMARKS (Also Explain Any Follow-Up Phase Checklist Item From Above That Was Answered "NO"), Manuf. Rep On-Site, etc.
Schedule
ActivityNo.:
Description

On behalf of the contractor, I certify that this report is complete and

correct and equipment and material used and work performed during this
reporting period is in compliance with the contract drawings and
specifications to the best of my knowledge except as noted in this report.
AUTHORIZED QC MANAGER AT SITE DATE

GOVERNMENT QUALITY ASSURANCE REPORT DATE

QUALITY ASSURANCE REPRESENTATIVE'S REMARKS AND/OR EXCEPTIONS TO THE REPORT

GOVERNMENT QUALITY ASSURANCE MANAGER DATE

COMBINED FORM 01450-1 (9/98) (BACK) SHEET OF
 CONTRACTOR QUALITY CONTROL REPORT DATE
(CONTINUATION SHEET) REPORT NO
Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY &
PHASE CONTRACT NO: N62478-16-D-4015 CONTRACT TITLE: TO N624 IMF, JBPHH, Hawaii
WORK COMPLIES WITH CONTRACT AS APPROVED DURING INITIAL PHASE? YES NO
WORK COMPLIES WITH SAFETY REQUIREMENTS? YES NO
Schedule Description of Work, Testing Performed & By Whom, Definable Feature of Work, Specification
Activity No. Section, Location and List of Personnel Present
FOLLOW-UP

REMARKS (Also Explain Any Checklist Item From Above That Was Answered "NO"), Manuf. Rep. On-Site, etc.
Schedule
Activity No. Description
COMBINED FORM 01450-2 (9/98) SHEET OF
 PREPARATORY PHASE CHECKLIST SPEC SECTION DATE
(CONTINUED ON SECOND PAGE)
CONTRACT NO DEFINABLE FEATURE OF WORK SCHEDULE ACT NO. INDEX #
N62478-16-D-4015
GOVERNMENT REP NOTIFIED ( ) HOURS IN ADVANCE: YES NO
NAME POSITION COMPANY/GOVERNMENT
PERSONNEL
PRESENT

REVIEW SUBMITTALS AND/OR SUBMITTAL REGISTER. HAVE ALL SUBMITTALS BEEN APPROVED? YES NO
IF NO, WHAT ITEMS HAVE NOT BEEN SUBMITTED?
SUBMITTALS

ARE ALL MATERIALS ON HAND? YES NO

IF NO, WHAT ITEMS ARE MISSING?

CHECK APPROVED SUBMITTALS AGAINST DELIVERED MATERIAL. (THIS SHOULD BE DONE AS MATERIAL ARRIVES.)
COMMENTS:

ARE MATERIALS STORED PROPERLY? YES NO

IF NO, WHAT ACTION IS TAKEN?
MATERIAL
STORAGE

REVIEW EACH PARAGRAPH OF SPECIFICATIONS.

SPECIFICATIONS

DISCUSS PROCEDURE FOR ACCOMPLISHING THE WORK.

CLARIFY ANY DIFFERENCES.

ENSURE PRELIMINARY WORK IS CORRECT AND PERMITS ARE ON FILE.

PRELIMINARY

IF NOT, WHAT ACTION IS TAKEN?

PERMITS
WORK &

REV DATE: 9/98

SHEET OF
 PREPARATORY PHASE CHECKLIST SPEC SECTION DATE
(CONTINUED FROM FIRST PAGE)
CONTRACT NO DEFINABLE FEATURE OF WORK SCHEDULE ACT NO. INDEX #
N62478-16-D-4015
IDENTIFY TEST TO BE PERFORMED, FREQUENCY, AND BY WHOM.

WHEN REQUIRED?
TESTING

WHERE REQUIRED?

REVIEW TESTING PLAN.

HAS TEST FACILITIES BEEN APPROVED?

ACTIVITY HAZARD ANALYSIS APPROVED? YES NO

REVIEW APPLICABLE PORTION OF EM 385-1-1.
SAFETY MEETING COMMENTS

NAVY PWD/ROICC COMMENTS DURING MEETING.

OTHER ITEMS OR REMARKS:

OTHER ITEMS OR
REMARKS

QC MANAGER DATE
REV DATE: 9/98 SHEET OF
 SPEC SECTION DATE
INITIAL PHASE CHECKLIST
CONTRACT NO DEFINABLE FEATURE OF WORK SCHEDULE ACT NO. INDEX #
N62478-16-D-4015
GOVERNMENT REP NOTIFIED _____ HOURS IN ADVANCE: YES NO
NAME POSITION COMPANY/GOVERNMENT
PERSONNEL
PRESENT COMPLIANCE

IDENTIFIY FULL COMPLIANCE WITH PROCEDURES IDENTIFIED AT PREPARATORY. COORDINATE PLANS,

PRELIMINAR PROCEDURE

SPECIFICATIONS, AND SUBMITTALS.

COMMENTS:

ENSURE PRELIMINARY WORK IS COMPLETE AND CORRECT. IF NOT, WHAT ACTION IS TAKEN?
Y WORK

ESTABLISH LEVEL OF WORKMANSHIP.

WORKMANSHIP

WHERE IS WORK LOCATED?

IS SAMPLE PANEL REQUIRED? YES NO

WILL THE INIITAL WORK BE CONSIDERED AS A SAMPLE? YES NO
(IF YES, MAINTAIN IN PRESENT CONDITION AS LONG AS POSSIBLE AND DESCRIBE LOCATION OF SAMPLE)
RESOLUTION

RESOLVE ANY DIFFERENCES.

COMMENTS:

REVIEW JOB CONDITIONS USING EM 385-1-1 AND JOB HAZARD ANALYSIS

COMMENTS:
SAFETY
CHECK

OTHER ITEMS OR REMARKS

OTHER

QC MANAGER DATE
REV DATE: 9/98 SHEET OF
 Conversation/Meeting Record Form
Record of:
Meeting Date: Project:
Tele Conversation Time: WR No.:

Subject:

Present: Distribution:

Discussion:

Action Taken:

Prepared by: Notice:

Failure to notify the writer of any necessary corrections
Date: to this record constitutes acceptance of all information
as it is represented.
 PUNCH LIST ITEM(S) LOG
CONTRACT NO.: N62478-16-D-4015
PROJECT: Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii

CONTRACTOR: GSI Pacific, Inc. NOTE: CORRECTIVE ACTION TAKEN TO ADDRESS EACH PUNCH
CONTRACT ADMIN.: LIST ITEM IS SUBJECT TO VERIFICATION BY CQCM & QA CON REP.
QA CONSTRUCTION REP:
QC Manager NOTE: SCHEDULING OF FINAL INSPECTION IS SUBJECT TO COMPLETION
OF PUNCH ITEMS OR BY CONSENT CONTRACT ADMINISTRATOR / QA CON REP.

ITEM NUMBER DATE IDENTIFIED PUNCH ITEM DESCRIPTION AND LOCATION CORRECTIVE ACTION TAKEN BY QC MANAGER DATE COMPLETED

Page 29 of 34
 Training Procedures and Training Log
CONTRACT NO.: N62478-16-D-4015
PROJECT: Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii

CONTRACTOR: GSI Pacific, Inc.

CONTRACT ADMIN.:
QA CONSTRUCTION REP:
QC Manager

Date Systems Included in the Training Training Provider Training Location and Time Attendees

Page 30 of 34
TRANSMITTAL/REVIEW/APPROVAL DATE
Submit 1 Original and 5 Copies Minimum 28-Mar-20
CONTRACT NO. TITLE Delivery Order No. Work Request No.

N62478-16-D-4015 Dry Dock No. 1 Caisson Overhaul and Dock Repair, N6247818F4183
PHNSY & IMF, JBPHH, Hawaii
FROM(CONTRACTOR) TO SUBMITTAL NO. FOR SPEC SECTION
GSI Pacific, Inc. 1 01 45 00.00 20
ENCL. NO. NO. OF COPIES DESCRIPTION SPEC. PARA. NO. CQC CODE
1 pdf Quality Control Plan 1.6.1 G

Transmitted for: APPROVAL CLARIFIC SELECTI RECORD OTHER

It is hereby certified that the material submitted herein conforms to Contractors Signature
contract requirements and can be installed in the allocated spaces. Carlos Antonio Chavez
FROM SIGNATURE DATE

TO For review/comment. RETURN WITHIN 5 WORKING DAYS, unless submittal

is for record/info purposes only and there are no adverse comments.
FROM TO DATE

RECOMMEND:
APPROVED/ ACCEPT (subject to contract requirements) RETURN for correction and resubmission
APPROVED/ ACCEPT (as noted, subject to contract requirements) DISAPPR NOT ACCEPT
REVIEWED AND PROCEED OTHER
REMARKS:

SIGNATURE
( ) copies of encls retained REVIEWER
FROM TO (CONTRACTOR) DATE

ENCLOSURE(s) IS (are):
APPROVED/ ACCEPT (subject to contract requirements) DISAPPR NOT ACCEPT
APPROVED/ ACCEPT (as noted, subject to contract requirements) RECEIVED FOR RECORD
REVIEWED AND PROCEED OTHER
RETURNED (for correction and resubmission)
REMARKS:

( )copies of encls returned

Copy to : Contract File (w/encls)
QAE (w/encls) SIGNATURE
Engineer/Engineering Tech (w/encls) BY DIRECTION OF THE CONTRACTING OFFICER
Submittal File
X: INDICATES THAT THE INDIVIDUAL IS CAPABLE
AND AUTHORIZED TO PERFORM THE TASK LISTED. PERSONNEL MATRIX OF QUALITY CONTROL STAFF & RESPONSIBILITIES

N62478-16-D-4015 PROJECT TITLE AND LOCATION: ALL JOB ORDER CONTRACTS (JOC), VARIOUS LOCATIONS
SDVOSB Dry Dock No. 1 Caisson Overhaul and Dock Repair, PHNSY & IMF, JBPHH, Hawaii

REVIEW & APPROVE PERFORM

SPECIFICATION SECTION PERFORM FOLLOW-UP CONDUCT PREFINAL WITNESS AND CONDUCT
KEY PERSONNEL SUBMITTALS (AS REQUIRED PREPARATORY PERFORM INITIAL PHASE CONDUCT FINAL INSPECTION
RESPONSIBILITY PHASE INSPECTION TESTING
PER SPECIFICATIONS) PHASE

Roy Iizaki ALL SECTIONS X X X X X X X

Heather Hammers ALL SECTIONS X X X X X X X

Jack Laws FIELD WELDING X X X X X X