Attach 2 Material Submittals.pdf

PDF 177 KB Posted

Attached to
Water Softener Replacement Federal contract opportunity
Solicitation number
12305B21R0033
Issued by
Department of Agriculture Agricultural Research Service Field Research Implementation and Information Delivery Northeast Area

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Text version

MATERIAL APPROVAL SUBMITTAL

TO: USDA/ARS CO

CC: A&E, COR

FROM: (Contractor) PROJECT TITLE: CONTRACT NUMBER:

(To be completed by the Contractor) Government Use Only

SUBMITTAL

NUMBER:

PREVIOUS SUBMITTAL NUMBER

(only if items listed were submitted previously):

A&E Recommendation

COR/EPM

Recommendation

Contracting Officer Approval/Disapproval

Line No.

Specification Sect.

Para No., Draw No.

Description of Material

(Include type, model, mfg)

APP

DISAP

See

Comments on Reverse

Comments on Reverse

Comments on Reverse

If an item is disapproved, a resubmittal is due within ________ calendar days of the Contracting Officer’s signature below.

Contractor (Ktr) A&E COR/EPM Contracting Officer TYPE or PRINT NAME & TITLE TYPE or PRINT NAME & TITLE TYPE or PRINT NAME & TITLE TYPE or PRINT NAME & TITLE

SIGNATURE: SIGNATURE: SIGNATURE: SIGNATURE:

DATE: DATE: DATE: DATE:

By completing this form, the above signed contractor certifies that the material complies with all specifications of the subject contract.

DATE RECEIVED FROM KTR: DATE RECEIVED FROM A&E: DATE RECEIVED FROM COR:

Material Approval Submittal Cover Sheet (11/2016)

CONTRACT #: SUBMITTAL #:

COMMENTS

Instructions: Enter the initials of the individual making the comment, the Line Number of the item for which the comment is being made, and the comment.

Material Approval Submittal Cover Sheet (11/2016) (Reverse)

Address City State WV Zip

P I C R N E O W O S S R & A D T S T T M R U D R C A I R C R U H T R F S R M A T A C E E E I A E A N

W T D M P C M C N T D I I U E O A P O U Y A N O L N R T L R A T G N E T T E E D L A S S S S S S S S S X X X X X X X X

X X X X X X X X X X X X X X X X X

PH Meter Turbidity Data Logger

Water Tower Isolation/Check Valve

Project Name NCCCWA WATER SOFTENER REPLACEMENT

11861 LEETOWN ROAD

Award Date

KEARNEYSVILLE

Type Of Submittal

Item Description

Water Softener PVC Pipe, Fittings and Valves

Submittal Number

Submittal Date

Specification Number Dwg

Number Specification Name Status

Contract Number Project Number

Insulation Liquid Chlorine Meter

Material Submittal Log.pdf
Sheet1

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