36C25818B0332-059.pdf
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- Attached to
- 36C25818B0332 / 691-18-2-5155-0005 -RETROFIT SEWER SYSTEM BLDG500 (VA-18-00042765) LOS ANGELES, CA.
- Solicitation number
- 36C25818B0332
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36C25818B0332 S02 ATTACHMENT 30-- Material Approval Submittal FILLABLE.pdf
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(YYYYMMDD)
(YYYYMMDD)
(YYYYMMDD)
(YYYYMMDD)
(YYYYMMDD)
MATERIAL APPROVAL SUBMITTAL
(See Instructions on Reverse)
TO: (Contracting Officer) FROM: (Contractor) DATE
CONTRACT NUMBER SUBMISSION NUMBER SUBMITTAL
NEW RESUBMITTAL
PREVIOUS SUBMISSION NUMBER PROJECT NUMBER
TO BE COMPLETED BY CONTRACTOR FOR GOVERNMENT USE ONLY
ITEM SPECIFICATION SECTION/ DESCRIPTION OF MATERIAL AP-
PROVED
DISAP-
PROVED
SEE
REVERSE INITIAL
BY COMPLETING THIS FORM, THE UNDERSIGNED CONTRACTOR CERTIFIES THAT
THE MATERIAL COMPLIES WITH ALL SPECIFICATIONS OF SUBJECT CONTRACT.
DATE CONTRACT SPECIALIST SIGNATURE
TO: (SENT TO COR AND DATE RECEIVED BY COR
DATE TYPE OR PRINT NAME AND GRADE SIGNATURE
RECOMMEND APPROVAL DISAPPROVAL AS INDICATED ABOVE AND SUBJECT TO ANY APPLICABLE COMMENTS ON THE REVERSE
DATE TYPE OR PRINT NAME AND GRADE SIGNATURE
(CONTRACT SPECIALIST
DISAPROVED AS INDICATED ABOVE AND SUBJECT TO ANY APPLICABLE COMMENTS ON THE REVERSE SIDE. REQUESTAPPROVED
RESUBMITTAL ON DISAPPROVED ITEMS WITHIN DAYS OF DATE SHOWN BELOW.
DATE TYPE OR PRINT NAME AND GRADE
SIGNATURE
PREVIOUS EDITION IS OBSOLETE.
NO. PARA NO./DRAWING NO. (Include Type, Model Number, Catalog Number, Mfg., etc.)
COMMENTS
(Number to correspond with applicable Item Number on reverse)
INSTRUCTIONS TO CONTRACTORS
1. The term "material" is defined as articles, supplies, raw materials, equipment, parts, components, and end items that are to be incorporated into the work required by the contract.
2. This form is to be used by contractors for submitting Shop Drawings, Equipment Data, Manufacturer's Literature and Certificates and samples of Materials to the Government for approval in accordance with the provisions of this contract. Unless otherwise specified, it is to be prepared in 4 copies, signed, and provided to the contracting officer with appropriate attachments.
3. Item(s) to be approved will be clearly tabbed or identified. Data pertaining to item(s) to be approved will be clearly identified or tabbed, particularly where documents are voluminous, in order to properly evaluate the materials or articles to be incorporated in the work. Each attachment will be numbered to correspond with the item number shown on the face of this form.
4. Requests submitted shall be numbered consecutively, by contract, in the space entitled "Submission No.". This number, in addition to the Contract No., will be used to identify each Material Approval Submittal. Resubmissions will be indicated in the appropriate block and the insertion of previous submission number and data in addition to a new submission number. A single submission should be used for all work of a section of the specifications, but in NO instance should the submission include work for more than one (1) contract. Submittals requiring priority handling will be submitted by separate submittal using the form and so marked across the face of the form.
5. This Material Approval Submittal is not valid unless it is signed by the contracting officer. This approval is required as called for by the contracting officer under the terms of this contract.
(REVERSE)
| CONTRACT NUMBER: |
| SUBMISSION NUMBER: |
| NEW: Off |
| RESUBMITTAL: Off |
| PREVIOUS SUBMISSION NUMBER: |
| ITEM NORow1: |
| SPECIFICATION SECTION PARA NODRAWING NORow1: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow1: |
| ITEM NORow2: |
| SPECIFICATION SECTION PARA NODRAWING NORow2: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow2: |
| ITEM NORow3: |
| SPECIFICATION SECTION PARA NODRAWING NORow3: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow3: |
| ITEM NORow4: |
| SPECIFICATION SECTION PARA NODRAWING NORow4: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow4: |
| ITEM NORow5: |
| SPECIFICATION SECTION PARA NODRAWING NORow5: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow5: |
| ITEM NORow6: |
| SPECIFICATION SECTION PARA NODRAWING NORow6: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow6: |
| ITEM NORow7: |
| SPECIFICATION SECTION PARA NODRAWING NORow7: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow7: |
| ITEM NORow8: |
| SPECIFICATION SECTION PARA NODRAWING NORow8: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow8: |
| ITEM NORow9: |
| SPECIFICATION SECTION PARA NODRAWING NORow9: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow9: |
| ITEM NORow10: |
| SPECIFICATION SECTION PARA NODRAWING NORow10: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow10: |
| ITEM NORow11: |
| SPECIFICATION SECTION PARA NODRAWING NORow11: |
| DESCRIPTION OF MATERIAL Include Type Model Number Catalog Number Mfg etcRow11: |
| YYYYMMDD DATE_2: |
| TYPE OR PRINT NAME AND TITLE: |
| TO Base Civil Engineering Officer: |
| YYYYMMDD DATE_3: |
| TO AF Contracting Office: |
| YYYYMMDD DATE_4: |
| TO Contractor: |
| APPROVED: Off |
| DAYS OF DATE SHOWN BELOW: |
| YYYYMMDD DATE_5: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow1: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow2: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow3: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow4: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow5: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow6: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow7: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow8: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow9: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow10: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow11: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow12: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow13: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow14: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow15: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow16: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow17: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow18: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow19: |
| COMMENTS Number to correspond with applicable Item Number on reverseRow20: |
| SUBMITTAL DATE: |
| CONTRACTOR COMPANY NAME: |
| CONTRACTING OFFICER NAME: |
| PROJECT NUMBER AND TITLE: |
| APPROVED 1: |
| 0: Off |
| 1: Off |
| 2: Off |
| 3: Off |
| 4: Off |
| 5: Off |
| 6: Off |
| 7: Off |
| 8: Off |
| 9: Off |
| 10: Off |
| DISAPPROVED 1: |
| 0: Off |
| 1: Off |
| 2: Off |
| 3: Off |
| 4: Off |
| 5: Off |
| 6: Off |
| 7: Off |
| 8: Off |
| 9: Off |
| 10: Off |
| SEE REVERSE 1: |
| 0: Off |
| 1: Off |
| 2: Off |
| 3: Off |
| 4: Off |
| 5: Off |
| 6: Off |
| 7: Off |
| 8: Off |
| 9: Off |
| 10: Off |
| APPROVE: Off |
| DISAPPROVE: Off |
| DISAPPROVED: Off |
| CONTRACTING NAME: |
| CENM NAME: |
| CO NAME: |
| Suspense Date: |
| Text2: |
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