Appendix A - Project Data Form.pdf

APPENDIX A - PROJECT DATA FORM

For: USNH Event #212027989 CM Services - KSC Student Center, Mabel Brown Room Theatrical and House Lighting Upgrades

KEENE STATE COLLEGE

KEENE, NEW HAMPSHIRE

CONTRACTOR: ___________________________________________________________________

DELIVERY METHOD: design/bid/build; design/build; CM at risk

Project Name: ______________________________________________________________________________

Project Address: ______________________________________________________________________________

Owner’s Name: _______________________________________________________________________________

Owner’s Address: ______________________________________________________________________________

Owner’s Contact: _________________________________ Phone Number: _________________________

Owner’s Contact E-mail Address: _________________________________________________________________

Architect of Record: __________________________________________________________________________

Architect’s Address: __________________________________________________________________________

Architect’s Contact: ________________________________ Phone Number: _________________________

Architect’s Contact E-mail Address: _______________________________________________________________

Engineer of Record: __________________________________________________________________________

Engineer’s Address: __________________________________________________________________________

Engineer’s Contact: ________________________________ Phone Number: _________________________

Engineer’s Contact E-mail Address: ________________________________________________________________

Contractor’s Employees who worked on this Project

(Note if these individuals will be working on the proposed project and in what capacity)

Employee Name Position Held on Project Will work on proposed project as (fill in the blank)

1. Project Description: (please emphasize similarities to proposed project):

2. Construction Costs:

Original Contract Amount: $____________________

Change Order Total: $____________________

Final Contract Amount: $____________________

If change order total exceeds 5% of the original contract amount, please explain:

3. Project Complexity: Attach additional page(s) if needed.

4. Project Schedule: Required/Contracted Construction Duration: _________________________________

Notice to Proceed Date: __________________________________________________

Date of Substantial Completion: ___________________________________________

Date of Final Completion (final payment): ___________________________________

5. Coordination: If applicable, describe specific circumstances surrounding the requirement that the general contractor coordinate work with other contractors hired separately by the Owner working in adjacent buildings or roads.

6. Additional Comments/Information: In addition to filling out this form completely, please feel free to attach other project information hereto.

7. Project Photograph(s): Please include one or more photographs of the subject project that emphasize project complexities, site constraints, architectural details and the like.