Facilities Construction Minor Project Request Form

Important Notice to All Users

Intent:
The purpose of this form is to provide a systematic process for documenting, requesting and procuring design and construction services for the University. Please note it is not intended to address routine maintenance Work Orders.

THIS FORM IS TO BE USED FOR ALL MINOR PROJECT REQUESTS WITHOUT EXCEPTION Protocols:
1. User will initiate process by completing the Minor Project Request Form, or MPRF. 2. Forms may be downloaded from the Facilities Construction web site: http://facilities.fiu.edu. Go to the "Excel Forms" Menu to download form. 3. Submit completed form via email to Facilities Construction Director for Minor Projects to the attention of Sylvia.Berenguer@fiu.edu. 4. Print and endorse all required original signatures. Research related and/or funded projects require OSRA approval. 5. Submit via inter-office mail executed MPRF Form to UP/CSC, attention Sylvia Berenguer, or FAX executed MPRF to 305.348.4010 . 6. No work will proceed unless a completed executed form is completed & submitted via email accompanied by a faxed copy of signed original. 7. Remodeling is defined as the change of existing facilities by rearrangement of space and/or change of use. The installation of new equipment in a space may alter the physical attributes and change the use of a space (from a Classroom to Research for instance). Any such change requires approval by Space Committee prior to any action by Facilities Construction staff. 8. It is the users' responsibility to initiate submission to Space Committee on all applicable projects . 9. Note: Pursuant to Florida Building Code Section 3401.7.2, the portion of the building being remodeled is subject to the University's Permitting and Code Compliance Process may need to be brought into compliance with current building and life safety codes if certain thresholds are exceeded. 10. All work is to be completed by insured & licensed state general contractor. Construction Permits will be required where mandated by Florida Statutes and the Florida Building Code.

General Instructions:

1. Complete all fields with a light green background in MPRF. 2. If your MFRF includes equipment installation, please complete Section 2.2 and submit the Supplemental Data Form. 3. If the Scope of the Work includes, contains, or impacts any of the hazards listed in Section 2.3, check off appropriate box(es) and submit the Supplemental Data Form. Approval from EH&S shall be obtained prior to commencement of the Work. It is the user's responsibility to contact the University Lab Safety Team at EH&S, CSC 162, phone 305.348.2621, fax 305.348.3574 or via e-mail at eh&slabs@fiu.edu. 4. Based on information provided and estimates obtained, the FIU Project Manager will complete the Project Budget Worksheet and review the Estimate of Probable Construction Cost with you prior to project initiation.

Funding E&G FUNDED PROJECTS: E&G Minor 1. A budget transfer shall be processed through PeopleSoft by the User for the amount of the proposal plus a 5% Construction Services Reimbursement (CSR). Projects: 2. Funds are to be transferred to Dept. ID 110940100.
3. User shall requests Anneyra Espinosa Ext.7-1138 to Post the budget transfer journal. 4. E&G funded projects follow University rules - Projects initiated before June 30th, MUST BE COMPLETED AND PAID to the contractor/architect by August 29th of the same year. If the project cannot be completed and paid by this deadline, the project should not be funded until July 1st. 5. Projects funded July 1st will have a 13 month life span until August 29th of the following year.

E&G CARRY FORWARD FUNDED PROJECTS:

1. A budget transfer shall be processed through PeopleSoft by the User for the amount of the proposal plus a 5% Construction Services Reimbursement (CSR). 2. Funds are to be transferred to Dept. ID 110940199. 3. User shall requests Anneyra Espinosa Ext.7-1138 to Post the budget transfer journal. 4. E&G Carry Forward funded projects follow University rules and MUST BE COMPLETED AND PAID before June 30th.

MPRF Read Me First

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Facilities Construction Minor Project Request Form

Funding AUXILIARY FUNDED PROJECTS: Auxiliary 1. An ID Transfer shall be completed by the User for the amount of the proposal plus a 5% Construction Services Reimbursement (CSR). Minor 2. ID Transfer shall be made to Dept. ID 110900605.. Projects: 3. Original ID Transfer and a copy of the signed proposal shall be sent to the PM or issued to Cary Monteagudo at
CSC 217 (Ext 7-4048 / cmontea@fiu.edu). NOTE: User must procure budget authority from Claudia Paz at Ext. 7-0055.

Funding CONTRACTS AND GRANTS FUNDED PROJECTS: C&G Minor 1. An ID Transfer shall be completed by the User for the amount of the proposal plus a 5% Construction Services Reimbursement (CSR). Projects: 2. Benefitting Dept ID will be determined upon receipt by Facilities Management.
3. Original ID Transfer and a copy of the signed proposal shall be sent to the PM or issued to Cary Monteagudo at CSC 217 (Ext 7-4048 / cmontea@fiu.edu).

Useful definitions in planning your project:

MAINTENANCE AND REPAIR. The upkeep of educational and ancillary plants including, but not limited to, roof or roofing replacement, short of complete replacement of membrane or structure; repainting of interior or exterior surfaces; resurfacing of floors; repair or replacement of glass and hardware; repair or replacement of electrical and plumbing fixtures; repair of furniture and equipment; replacement of system equipment with equivalent items meeting current code requirements providing that the equipment does not place a greater demand on utilities, structural requirements are not increased, and the equipment does not adversely affect the function of lifesafety systems; traffic control devices and signage; and repair or resurfacing of parking lots, roads, and walkways. Does not include new construction, remodeling, or renovation, except as noted above. NEW CONSTRUCTION. Any construction of a building or unit of a building in which the entire work is new. An addition connected to an existing building is considered new construction. REMODELING. Changing existing facilities by rearrangement of space and/or change of use. Only that portion of the building being remodeled must be brought into compliance with the building and life safety codes unless the remodeling adversely impacts existing life safety systems of building or as otherwise mandated by current codes and/or State Fire Marshall rules (Florida Fire Code). RENOVATION. Upgrading existing facilities by installation or replacement of materials and equipment. The use and occupancy of the spaces remain the same. Only that portion of the building being renovated must be brought into compliance with the building and life safety codes unless the renovation adversely impacts the existing life safety systems of the building.

A. Rodrguez, RA For questions Jos Director, Facilities Operations Anal ysis on form Facilities Management SW 17th Street, CSC 142 contact: 11555 Mia mi, FL 33199
O: 305.348.4410 F: 305.348.0579 E: jrodrigu@fiu.edu W: http://facilities.fiu.edu

FIU MPRF 2009.1028 jar

MPRF Read Me First

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MPRF
Instructions: Complete all cells in light green. All cells with a yellow background for use by Facilities Construction ONLY

Facilities Construction Minor Project Request Form

BT:

REQUESTED BY: REQUESTOR'S EMAIL: PHONE #: DEPARTMENT NAME: PROJECT NAME: CAMPUS: 1.0 SERVICES REQUESTED:
Please check all applicable boxes.
Feasibility Study/Preliminary Cost Estimate Programming Assistance Continuing Contract Design/Construction Services

Minor Project/Permit Number: PW Number (FEMA only): Purchase Order (PO): FIU Project Manager: e-mail address: PM Phone Number: FACILITY:
Other

Remodeling of Existing Space (See 2.1) Renovation of Existing Spaces New Equipment Installation OR Relocation of Exist. (See 2.2 & 2.3) Minor Mechanical or Electrical Alterations or Renovations

(Please describe service request):

Building Number: Building Name: Rooms/Area Affected:

2.0 Description of Proposed Scope of Work:

Check and attach supplemental data if provided

Provide a narrative and/or diagrammatic drawings to clarify your proposal. 2.1 Description of Proposed Use (or change of use):
Check and attach supplemental data if provided

Describe intended use 2.2 Description of Proposed Equipment (New and/or Relocated):
Check and complete Supplemental Data Form SDF on listed items in 2.2 or 2.3

Current Use: T Proposed Use: T 2.3 Check Special Hazard Materials: included in the scope of work:
NOT APPLICABLE Laser Devices Controlled Substances Hazardous Chemicals

Describe equipment, hazard and/or services required for installation. Provide catalogue cuts for any specialized equipment, including power requirements, and environmental control requirements.

Biohazardous Materials
Live Animals
Check Fund Source from which you propose to pay for this project. The maximum construction contract value for Minor Projects is $1,000,000. Total Project Budget must include all soft costs (including but not limited to design and inspection fees) and F&E where applicable.

3.0 Funding:

Radioactive materials

radioactive components

Equipment with

If ANY of the listed materials or processes are checked off , approval from EH&S must be obtained prior to commencement of the Work. See Universtiy Compliance Office and the EH&S website http://www.fiu.edu/~ehs/ for details.

See Instructions in MPRF Read Me First tab Other:

AUXILIARY

E&G C&G CARRY FORWARD

PECO PO&M

Preliminary Construction Budget $ Space Committee Approval

4.0 Project Approval

check once all approval signatures are submitted

Requested by: (Manual Signature) Name:

Submittal Date:

Department Chair or Designee Department: Date:

Approved by: (Manual Signature) Name: Approval Date:

Action Required

Approved

Not Applicable

Notice:

Research Projects require OSRA approval

Approved by: (Manual Signature) Name:

Dean or AVP College/School Name:

Date: Date:
Required Not Applicable

Assoc. VP for Research Office of Sponsored Research Administration 6.0 Distribution

Originator: PM: Code Compliance: Facilities Management: Facilities Construction: Sponsored Research Admin: Environmental Health & Safety:

5.0 Permits Contractor-of-Record:

FIU MPRF 2009.1216 jar

0 0 Frank Quintana Ed Brozic Sylvia Berenguer 0 Lab Safety Team

0 Facilities Construction Facilities Management Facilities Management Facilities Construction OSRA

EH&S

FIU/Facilities Construction

0902 Edition

Facilities Construction
Minor Project Supplemental Data Form
Instructions: Complete all cells & attach specifications

Equipment List
Item
Room # where located Description

Date:
Cut sheets attached

January 0, 1900

Minor Project/Permit Number: 00 0000

Electrical
Voltage Amp Phase

Mechanical
Ventilation Rqmnts Special Safety Rqmnts

Other
Acoustic / Radiation or other Hazard

Y/N 1 1025 WSY - Sample Yes 110 20 II 100% FA make up Connect to independent chilled Equipment generates UV radiation water supply

FIU MPRF 2009.0202 jar

FIU/Facilities Construction

0706 Edition

Facilities Construction

Minor Project Request Form

Instructions: Project Manager:

Complete cells highlighted in green Minor Project/Permit Number: 00 0000

Analysis of Program Requirements

* Costs derived from survey recommendation CIP Report or other sources NASF/GSF

1 Facility Space Name 2 Classrooms 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Classroom Storage Comp Storage Offices Reception Conference Room Workroom Lounge Environmental Sciences Lab Preparation Room Technical Labs Related Instructional Environmental Sciences Storage Support Services

NASF 1 1 0 0 0 0 0 0 0 0 0 0 0

$/SF*

Base Cost Count Multiplier $0 0 1.4204 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 0 0 0 0 0 0 0 0 0 0 0 0 1.4204 1.4204 1.4204 1.4204 1.4204 1.4204 1.4204 1.4204 1.4204 1.4204 1.4204 1.4204

Total \GSF -

$ $

Total NASF Facility 21 Total GSF Facility (NASF X 1.4204) Project Contingency 22 (12-15% Remodeling/Renovation) 23 Estimate of Probable Construction Cost 24 25 26 27

0 #DIV/0! 15.0% #DIV/0! 20.0% 1.5% 5.0% $0 $0 $0 $0 $0 $0 $0 -

Softcosts AE Fees, Testing, Inspections (Budget Range) Fire Marshall Plan Review & Inspections Construction Services Reimbursement (CSR)

28 Estimate of Total Project Budget

REV 2009.1028 JR

FIU/Facilities Planning and Construction

2006 0818 Edition