1-26-039 - 00 43 10 Substitution Reqeust Form.pdf

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Attached to
Webster House Restoration - Phase 2
Solicitation number
26-039
Issued by
Winnebago County, Wisconsin

About this file

This is a Substitution Request Form from Walworth County, Wisconsin, used for the Webster House Restoration - Phase 2 project (Project #26-039). The form is designed to allow contractors and bidders to request approval for substituting specified materials or products with alternative options prior to or during the bidding process. The form requires submitters to identify the specification section and drawings affected, provide details about the proposed substitution including manufacturer and product information, and explain the reason for the substitution request, whether due to product unavailability, cost savings, or other factors. Contractors and bidders must complete detailed sections addressing whether the substitution affects dimensions shown on drawings, impacts work in other specification sections, or requires modifications to the project design or specifications. The form designates Carolyn Holt, Senior Buyer, as the submission recipient and requires sign-off from subcontractors and contractors as well as architect review.

The substitution request process includes architect evaluation with options to accept, not accept, or take no action on submissions, with notation of whether submissions are complete or late. The form appears to be a blank template with multiple unchecked boxes for various response options, indicating it serves as a standardized document for managing material and product substitutions throughout the Webster House Restoration project. No specific pricing information, contract terms, award dates, or response deadlines are detailed within the form itself, as it functions as an administrative tool for the substitution approval process rather than as a procurement document containing substantive project parameters.

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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: #26-039 Webster House Restoration - Phase 2

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 .