4-26-005 Substitution Request Form - Fillable.pdf

PDF 218 KB Posted

Attached to
Lakeland Health Care Center Furniture Replacement - 2026
Solicitation number
26-005
Issued by
Winnebago County, Wisconsin

About this file

This is a Substitution Request Form used by Walworth County for the Lakeland Health Care Center Furniture Replacement project (26-005). The form provides a standardized process for contractors and bidders to request approval of substitute materials or products that differ from those specified in the project documents. Submitters must identify the specification section affected, provide manufacturer and product details, explain the reason for substitution (such as product unavailability or cost savings), and demonstrate how the substitution impacts project dimensions, other work sections, and design requirements. The form requires documentation of at least three comparable projects where the proposed substitution has been successfully used within the past twelve months, including owner and architect contact information. Contractors and subcontractors must sign the form accepting responsibility for coordination and any additional costs associated with the substitution. The completed form is submitted to Carolyn Holt, Senior Buyer, for architectural review and approval.

The Architect reviews submissions and indicates acceptance, rejection, or no action required status. Incomplete submissions or those received after specified deadlines are subject to rejection. All costs resulting from incorporation of an approved substitution remain the responsibility of the contractor per Section 01 25 13 of the contract specifications. This substitution process ensures quality control and design integrity while allowing flexibility for material sourcing during the procurement and construction phases of the furniture replacement project.

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Other files

File Type Posted
5-26-005 - Addendum No. 1.pdf PDF
1-26-005 Subcontractor List - Fillable.pdf PDF
2-26-005 Project Manual - Final.pdf PDF
3-26-005 Drawings.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)

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 per Section 01 25 13.

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

76380

Project: 26-005 Lakeland Health Care Center Furniture Replacement - 2026

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 .