A6_DesignationofReps.doc

Designation of Representative, CLRD Poudre Steps II Project

DESIGNATION OF REPRESENTATIVE

CONTRACT NO.

To Be Determined at time of contract award

PROJECT

Pine Lodge Brill Allotment Fence Reconstruction

UNIT

Lincoln National Forest

TO

Chris Jordan, Contract Specialist

CONTRACTOR NAME, ADDRESS & POC EMAIL

Contractor Name

Street Address

City, State + Zipcode

POC Name, Email

Key Personnel

In accordance with the above specified contract number, the following personnel are assigned to this contract:

Contractor Representative

Name

Phone(s))

Email

Project Manager

Project Forman/Woman

Inspector

Designated Representative

The individual named below is designated as my representative for this contract and, in my absence, is authorized to act in my behalf.

(Name)

(Title)

This delegation extends authority to take any action necessary with respect to the execution of work, including acknowledging receipt of Notice to Proceed, Suspend and Resume Work Orders, and Notices of Noncompliance. The items check below indicates additional authority authorized by this delegation:

FORMCHECKBOX

Sign progress payment estimates and invoices.

FORMCHECKBOX

Sign contract modifications.

FORMCHECKBOX

Sign final payment estimate and invoice and contract release.

FORMCHECKBOX

Execute contract termination settlement agreement.

FORMCHECKBOX

Full authority in all contractual matters.

(Date)

(Signature)

(Title)

Fname Lname

(000) 000-0000

EMAIL@address.com

Type Title