00 43 25 Substitution Request Form (During Procurement).pdf
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- Attached to
- Granville Health System Imaging Renovation - MRI, CT, Nuc Med - General Construction/Renovation
- Solicitation number
- 373GHS00004
- Issued by
- Gates County, North Carolina
About this file
The document is a Substitution Request Form (Section 00 43 25) for the MRI, CT, and Nuclear Imaging Renovations project at Granville Medical Center in Oxford, North Carolina, associated with Haskell Project 1785003 and dated May 9, 2025. The form is designed to allow contractors to propose alternative products or materials during the procurement phase of the project, with a comprehensive set of questions and fields to evaluate the proposed substitution's compatibility, performance, and potential impacts on the project.
The form requires detailed information about the proposed substitution, including technical specifications, manufacturer details, warranties, maintenance services, replacement parts, and potential effects on construction schedule, dimensions, and other trades. Contractors must fully investigate and certify that the proposed substitution is equivalent or superior to the originally specified item(s). The form provides space for the architect's review and approval, with options to approve, approve with notes, or reject the substitution request, ensuring a thorough vetting process for any proposed product changes during the procurement stage of the medical imaging renovation project.
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Text version
MRI, CT, and Nuclear Imaging Renovations
Granville Medical Center
Oxford, North Carolina
00 43 25 - Substitution Request Form (During Procurement) - Page 1
Addendum 2
Haskell Project 1785003
May 9, 2025
SECTION 00 43 25
SUBSTITUTION REQUEST FORM (DURING PROCUREMENT)
Project: MRI, CT, and Nuclear Imaging Renovations Date:
We hereby submit for your consideration the following product instead of the specified item(s).
Drawing Sheet No. or Detail No. or
Section No. and Page: _________________ Article/Paragraph
Proposed Specified
Substitution: _________________________ Item(s)
Proposed Proposed
Trade Name: ________________________ Model No. _____________________________
Manufacturer: _______________________ Phone No. _____________________________
Manufacturer Address: _______________________________________________________
Attach complete technical data including product description, specifications, drawings, photographs, and performance and test data adequate for evaluation of the request; clearly identify applicable portions of the data. Include a complete description of changes to the Drawings and Specifications that the proposed substitution will require for its proper installation.
Fill in blanks below (use additional sheets if necessary):
1. Describe differences between proposed substitution and specified item(s): __________
2. Manufacturer warranties for specified item(s) and proposed substitution are:
_____ Same _____ Different (explain on attachment)
3. Maintenance service for specified item(s) and proposed substitution is:
4. Source of replacement parts for specified item(s) and proposed substitution is:
5. How will substitution affect other trades? _____________________________________
MRI, CT, and Nuclear Imaging Renovations
Granville Medical Center
Oxford, North Carolina
00 43 25 - Substitution Request Form (During Procurement) - Page 2
Addendum 2
Haskell Project 1785003
May 9, 2025
6. Will substitution affect Construction Progress Schedule or Contract Time? Yes No
If yes, how? ___________________________________________________________
7. How will substitution affect dimensions shown on Drawings? _____________________
8. How does weight of substitution compare to specified item(s)? Greater Lesser Same
If greater or lesser, by how much? __________________________________________
9. Will the Undersigned pay for architectural or engineering changes to building design, including detailing, and construction costs caused by substitution, if any? Yes No
In addition to the above statements, the Undersigned certifies that the substitution has been fully investigated and that the function, appearance, and quality of the substitution is equivalent or superior in all respects to the specified item(s).
Signature: _________________________________________________________________
Printed Name: ______________________________________________________________
Firm: _______________________________ Phone No. _____________________________
Address: __________________________________________________________________
E-Mail Address: ____________________________________________________________
ARCHITECT'S SIGNATURE
_____ Substitution approved -- Make submittals in accordance with Division 01.
_____ Substitution approved as noted -- Make submittals in accordance with Division 01.
_____ Substitution rejected -- Use specified materials.
_____ Substitution Request received too late -- Use specified materials.
Project Manager: _____________________ Date: _________________________________
Specifier: ___________________________ Date: _________________________________
Remarks: _________________________________________________________________
END OF SECTION
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