C05_Attachment 12 - Material Submittal Form.pdf
PDF 218 KB Posted
- Attached to
- Roof Replacement Federal contract opportunity
- Solicitation number
- 1232SA26Q0942
About this file
This is a Material Approval Submittal Cover Sheet form used by the USDA/ARS to document and track contractor submissions of materials for federal construction projects. The form is specifically designed for the "Roof Repair by Replacement (North and South Wings)" project at USDA-ARS-NCAUR in Peoria, Illinois.
The form serves as a multi-level approval document requiring sequential review and authorization from four parties: the Contractor, RRC/A&E (Architect/Engineer), COR/EPM (Contracting Officer Representative/Engineering Project Manager), and the Contracting Officer. For each material line item submitted (up to 10 items per submittal), the form captures the specification section, paragraph number, drawing reference, material description including type, model, and manufacturer, and approval status. Each reviewing party indicates approval (APP) or disapproval (DISAP) with space for comments on the reverse side. The template includes fields for tracking submittal numbers, previous submittal references, receipt dates from various parties, and a mandatory timeframe for resubmittal if items are disapproved. By signing the form, the contractor certifies that all submitted materials comply with contract specifications. The form is dated November 2016 and designed for use as a standard federal construction project document management tool.
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Text version
MATERIAL APPROVAL SUBMITTAL
TO: USDA/ARS
CO CC: RRC/A&E,
COR
FROM: (Contractor) PROJECT TITLE: CONTRACT NUMBER:
(To be completed by the Contractor) Government Use Only
SUBMITTAL
NUMBER:
PREVIOUS SUBMITTAL NUMBER
(only if items listed were submitted previously):
RRC/A&E
Recommendation
COR/EPM
Recommendation
Contracting Officer Approval/Disapproval
Line
No.
Specification Sect.
Para No., Draw No.
Description of Material
(Include type, model, mfg) APP
See
Comments on Reverse APP DISAP
See
Comments on Reverse APP DISAP
See
Comments on
Reverse
If an item is disapproved, a resubmittal is due within ________ calendar days of the Contracting Officer’s signature below.
Contractor RRC/A&E COR/EPM Contracting Officer TYPE or PRINT NAME & TITLE TYPE or PRINT NAME & TITLE TYPE or PRINT NAME & TITLE TYPE or PRINT NAME & TITLE
SIGNATURE: SIGNATURE: SIGNATURE: SIGNATURE:
DATE: DATE: DATE: DATE:
By completing this form, the above signed contractor certifies that the material complies with all specifications of the subject contract.
DATE RECEIVED FROM KTR: DATE RECEIVED FROM KTR: DATE RECEIVED FROM COR:
Material Approval Submittal Cover Sheet (11/2016)
Roof Repair by Replacement (North and South Wings) USDA-ARS-NCAUR, Peoria, IL
Wayne.Myers Cross-Out
CONTRACT #: SUBMITTAL #:
COMMENTS
Instructions: Enter the initials of the individual making the comment, the Line Number of the item for which the comment is being made, and the comment.
Material Approval Submittal Cover Sheet (11/2016) (Reverse)
File details come from the government source that posted it. Updated .