2-25-124 Substitution Request Form - Fillable.pdf
PDF 143 KB Posted
- Attached to
- Sheriff's Office Exterior Building Remediation
- Solicitation number
- 25-124
- Issued by
- Winnebago County, Wisconsin
About this file
This document is a Substitution Request Form from Walworth County for the 25-124 Sheriff's Office Exterior Building Remediation project, with an A/E Project Number of 250035.00. The form is designed to allow contractors or bidders to propose a substitution for a specified product, with options to request substitution due to product unavailability, potential cost savings, or other reasons. The form requires detailed documentation about the proposed substitution, including its potential impacts on project dimensions, other work sections, and design requirements.
The form requires the submitting party to provide comprehensive information about the proposed substitution, including the manufacturer, product details, and rationale for the change. The contractor must accept responsibility for coordination and additional costs resulting from the substitution. The form includes sections for the architect's review, with options to accept, reject, or require additional information about the proposed substitution. Supporting documentation, such as a list of three recent projects using the proposed substitution, must be attached to substantiate the request.
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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)
Attach list of at least three projects where proposed substitution has been used within past twelve months include name, address, and telephone number of Owner and Architect.
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, Buyer Project: 25-124 Sheriff's Office Exterior Building Remediation
250035.00
| 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 .