2-26-025 00 43 10 Substitution Reqeust Form.pdf

PDF 217 KB Posted

Attached to
Kitchen Worktable Replacement for Lakeland Health Care Center & Sheriff's Office
Solicitation number
26-025
Issued by
Winnebago County, Wisconsin

About this file

This is a Substitution Request Form for Walworth County, Wisconsin, related to the Kitchen Worktable Replacement project for Lakeland Health Care Center and the Sheriff's Office. The form serves as a template and submission document for contractors and bidders to request approval of substitute products or materials in place of those specified in the project specifications. The project involves furnishing and installing up to five stainless steel kitchen worktables of varying dimensions, which may include built-in sinks, spray and fill assemblies, electric heaters, and disposals.

The substitution request form requires submitters to identify the specification section affected, provide drawings and details, and explain the proposed substitution including manufacturer and product details. Submissions must indicate whether the request is a pre-bid substitution (requiring prior approval before the bid date) or submitted for other reasons such as product unavailability or cost savings. The form requires submitters to analyze the effects of the substitution on project dimensions, other work sections, and design requirements. All contractors and bidders must accept responsibility for coordination of the proposed substitution and any additional costs resulting from its incorporation. The form is submitted to Carolyn Holt, Senior Buyer, and requires review and approval with documented comments before acceptance or rejection.

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File Type Posted
3-26-025 - RFB - Final.pdf PDF
1-26-025 00 43 10 Substitution Reqeust Form.pdf PDF

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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: #26-025 Kitchen Worktable Replacements for Lakeland Health Care Center and Sheriff's Office

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 .