J.7._Material_Request.pdf
PDF 39 KB Posted
- Solicitation number
- 70Z082-18-B-PMV-050-00
About this file
MATERIAL REQUEST
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Text version
SHOP DRAWING/MATERIAL APPROVAL REQUEST
NOTE: ALL ENTRIES WILL BE FILLED IN BY TYPEWRITER OR PEN INK PROJECT NO: __________
FROM: CONTRACTOR _________________________________________________
CONTRACT NUMBER:
70Z082-_____________________
TASK ORDER:
70Z082-_____________________
SUBMISSION NUMBER
DATE
MORE FORMS REQUIRED
NO YES
TYPE OF SUBMITTAL
NEW RESUBMITTAL OF #
GOVERNMENT USE ONLY
ITEM
NO
SPECIFICATION
SECTION AND
PARAGRAPH NO
DESCRIPTION OF MATERIAL
APPROVED
AS
NOTED
DIS
INT
CONTRACTOR’S SIGNATURE CERTIFIES THAT SUBMITTAL HAS BEEN REVIEWED AND APPROVED IAW FAR 52.236- 21, SPECIFICATIONS AND DRAWINGS FOR CONSTRUCTION AND/OR 52.236-5 MATERIAL AND WORKMANSHIP, AND THAT MATERIALS COMPLY WITH THE FAR 52.255, BUY AMERICAN ACT CONSTRUCTION MATERIALS
NO OF COPIES TO
(CEU) _____________
BY (NAME AND TITLE)
SIGNATURE
COMMENTS
FOR GOVERNMENT USE ONLY
ENGINEER/COR COMMENTS
TO: COR/CONSTRUCTION MANAGER
RECOMMEND APPROVAL, APPROVAL AS NOTED. OR DISAPPROVAL AS INDICATED AND SUBJECT TO APPLICABLE
COMMENTS ABOVE.
TYPED NAME AND GRADE
DATE
CONTRACTING OFFICERS REPRESENTATIVE (COR)
TO: CONTRACTOR
1. APPROVED, APPROVED AS NOTED OR DISAPPROVED AS INDICATED AND SUJECT TO ANY APPLICABLE
COMMENTS ABOVE.
2. REQUEST PROMPT RESUBMITTAL OF DISAPPROVED ITEMS WITHIN 7-BUSINESS DAYS.
TYPED NAME AND GRADE
DATE
Revised 10/4/2017 RRH
| COMMENTS |
| FOR GOVERNMENT USE ONLY |
| PROJECT NO: |
| undefined: |
| DATE: |
| CONTRACT NUMBER: |
| undefined_2: |
| TASK ORDER: |
| SUBMISSION NUMBER: |
| MORE FORMS REQUIRED: Off |
| TYPE OF SUBMITTAL: |
| NEW: |
| RESUBMITTAL OF: |
| GOVERNMENT USE ONLY: |
| ITEM NORow1: |
| SPECIFICATION SECTION AND PARAGRAPH NORow1: |
| DESCRIPTION OF MATERIALRow1: |
| APPROVEDRow1: |
| APPROVED AS NOTEDRow1: |
| DIS APPROVEDRow1: |
| INTRow1: |
| ITEM NORow2: |
| SPECIFICATION SECTION AND PARAGRAPH NORow2: |
| DESCRIPTION OF MATERIALRow2: |
| APPROVEDRow2: |
| APPROVED AS NOTEDRow2: |
| DIS APPROVEDRow2: |
| INTRow2: |
| ITEM NORow3: |
| SPECIFICATION SECTION AND PARAGRAPH NORow3: |
| DESCRIPTION OF MATERIALRow3: |
| APPROVEDRow3: |
| APPROVED AS NOTEDRow3: |
| DIS APPROVEDRow3: |
| INTRow3: |
| ITEM NORow4: |
| SPECIFICATION SECTION AND PARAGRAPH NORow4: |
| DESCRIPTION OF MATERIALRow4: |
| APPROVEDRow4: |
| APPROVED AS NOTEDRow4: |
| DIS APPROVEDRow4: |
| INTRow4: |
| NO OF COPIES TO: |
| BY NAME AND TITLE: |
| COMMENTS: |
| APPROVAL: Off |
| APPROVAL AS NOTED OR: Off |
| DISAPPROVAL AS INDICATED AND SUBJECT TO APPLICABLE: Off |
| TYPED NAME AND GRADE: |
| DATE_2: |
| APPROVED: Off |
| APPROVED AS NOTED OR: Off |
| DISAPPROVED AS INDICATED AND SUJECT TO ANY APPLICABLE: Off |
| TYPED NAME AND GRADE_2: |
| SIGNATURE_3: |
| DATE_3: |
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