1-26-054-R- Substitution Request Form.pdf
PDF 195 KB Posted
- Solicitation number
- 26-054-R
- Issued by
- Winnebago County, Wisconsin
About this file
This is a Substitution Request Form for Walworth County, Wisconsin's Department of Public Works, related to Project #26-054-R for Garage Door Replacement. The form serves as the official mechanism for contractors and bidders to request approval for substituting specified materials or products prior to bid submission or during project execution. The project involves the demolition of one oversized salt dome garage door system and the furnishing and installation of a replacement rolling door, operator, track, and associated components. Substitution requests must be submitted to Carolyn Holt, Senior Buyer, and include detailed information about the proposed alternative product, including manufacturer and model specifications.
The form requires submitters to indicate the reason for substitution, such as product unavailability or cost savings to the owner, and to provide comparative cost analysis when applicable. Submitters must address whether the proposed substitution affects drawing dimensions, other work sections, or requires design modifications or specification revisions. The form includes checkboxes for the Architect's review determination—acceptance, non-acceptance, or no action required—along with a notation of whether the submission is incomplete or submitted too late. All contractors and subcontractors must sign and date the form, accepting responsibility for coordination and any additional costs resulting from the substitution's incorporation into the project.
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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: #26-054-R Department of Public Works Garage Door Replacement
N/A
| 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 .