1-26-025 00 43 10 Substitution Reqeust Form.pdf

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Attached to
Kitchen Worktable Replacement for Lakeland Health Care Center & Sheriff's Office
Solicitation number
26-025
Issued by
Winnebago County, Wisconsin

About this file

This is a Substitution Request Form from Walworth County, Wisconsin, for Project #26-025, Kitchen Worktable Replacements for Lakeland Health Care Center and Sheriff's Office. The form serves as the official template and submission mechanism for contractors and bidders to request approval of substitute products or materials that deviate from the specifications outlined in the project documents. The substitution process requires requestors to identify the specification section and paragraph number affected, provide detailed information about the proposed substitute manufacturer and product model, explain the justification for the substitution, and document how the substitution impacts project dimensions, other work sections, and design requirements. Submissions are directed to Carolyn Holt, Senior Buyer, and must be reviewed and approved before incorporation into the project.

The form categorizes substitution requests as either pre-bid (prior approval) or post-bid submissions and requires requestors to provide comparative cost analysis when cost savings are the basis for the substitution. The contractor or bidder submitting the substitution accepts full responsibility for coordination and any additional costs resulting from the proposed change. The reviewing architect or project manager indicates approval status through checkboxes for accepted, not accepted, or no action required, and notes whether submissions are incomplete or submitted too late for consideration. All parties must sign and date the form, including the subcontractor and contractor representatives.

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File Type Posted
3-26-025 - RFB - Final.pdf PDF
2-26-025 00 43 10 Substitution Reqeust Form.pdf PDF

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Text version

Walworth County

SECTION 00 43 10

SUBSTITUTION REQUEST FORM

A/E Project No.:

Date Received:

Specification Section Number and Paragraph:

Drawings and details affected:

Proposed Substitution:

Manufacturer:

Product (model, pattern, etc.):

WHY IS SUBSTITUTION BEING SUBMITTED? (Select one of the following):

Pre-Bid Substitution (Prior Approval) Bid Date:

Specified product is not available. Explain Cost savings to Owner. Attach comparative cost analysis and proposed deduct.

Other. Explain.

EFFECTS OF PROPOSED SUBSTITUTION Answer the following questions and attach explanations.

Does substitution affect dimensions indicated on Drawings?

(NO) (YES, explain)

Does substitution affect Work of other Sections?

(NO) (YES, explain)

Does substitution require modifications to design, changes to Drawings, or revisions to Specifications to be incorporated into the Project?

(NO) (YES, explain)

CONTRACTOR’S/BIDDER’S REPRESENTATION

Undersigned accepts responsibility for coordination of proposed substitution and accepts all additional costs resulting from the incorporation of proposed substitution into the Project.

SUBMITTED BY: For Architect’s Use:

Accepted

Not Accepted

No Action Required Submission: Incomplete Too Late

Reviewed by/Date:

Comments:

Subcontractor’s signature and date:

Contractor’s signature and date:

To: Carolyn Holt, Senior Buyer Project: #26-025 Kitchen Worktable Replacements for Lakeland Health Care Center and Sheriff's Office

Date Received:
Specification Section Number and Paragraph:
Drawings and details affected:
Proposed Substitution:
Manufacturer:
Product model pattern etc:
SUBMITTED BY 1:
SUBMITTED BY 2:
Reviewed byDate:
Comments:
Check Box3: Off
Check Box4: Off
Check Box2: Off
Check Box5: Off
Check Box6: Off
Check Box7: Off
Check Box8: Off
Check Box9: Off
Check Box10: Off
Check Box11: Off

File details come from the government source that posted it. Updated .