1-26-054-R- Substitution Request Form.pdf

PDF 195 KB Posted

Attached to
Department of Public Works Garage Door Replacement - Rebid
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

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