Attachment 27 Submittal Form ENG 4025 Example.pdf

TRANSMITTAL OF SHOP DRAWINGS, EQUIPMENT DATA, MATERIAL SAMPLES, OR

MANUFACTURER'S CERTIFICATES OF COMPLIANCE

For use of this form, see ER 415-1-10; the proponent agency is CECW-CE.

DATE TRANSMITTAL NO.

SECTION I - REQUEST FOR APPROVAL OF THE FOLLOWING ITEMS (This section will be initiated by the contractor)

TO:

PROJECT TITLE AND LOCATIONSPECIFICATION SEC. NO. (Cover only one section with each transmittal)

FROM: CONTRACT NO. CHECK ONE:

THIS TRANSMITTAL IS FOR: (Check one)

THIS IS A NEW TRANSMITTAL

THIS IS A RESUBMITTAL OF

TRANSMITTAL

FIO GA DA CR DA/CR DA/GA

ITEM

NO.

(See

Note 3)

USACE

ACTION

CODE

(Note 9)

SUBMITTAL

TYPE CODE

(See Note 8)

NO.

OF

COPIES

SPEC.

PARA. NO.

DRAWING

SHEET NO.

CONTRACTOR

REVIEW

CODE

VARIATION

Enter "Y" if requesting a variation

(See Note 6)

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.)

a. i.c. d. e. f. g. h.b.

CONTRACT DOCUMENT

REFERENCE

REMARKS

SECTION II - APPROVAL ACTION

I certify that the above submitted items had been reviewed in detail and are correct and in strict conformance with the contract drawings and specifications except as otherwise stated.

NAME OF CONTRACTOR SIGNATURE OF CONTRACTOR

NAME AND TITLE OF APPROVING AUTHORITY SIGNATURE OF APPROVING AUTHORITY DATEENCLOSURES RETURNED (List by item No.)

REPLACES EDITION OF MAR 95, WHICH IS OBSOLETE.ENG FORM 4025-R, MAR 2012

INSTRUCTIONS

1. Section I will be initiated by the Contractor in the required number of copies.

2. Each Transmittal shall be numbered consecutively. The Transmittal Number typically includes two parts separated by a dash (-). The first part is the specification section number. The second part is a sequential number for the submittals under that spec section. If the Transmittal is a resubmittal, then add a decimal point to the end of the original Transmittal Number and begin numbering the resubmittal packages sequentially after the decimal.

3. The "Item No." for each entry on this form will be the same "Item No." as indicated on ENG FORM 4288-R.

4. Submittals requiring expeditious handling will be submitted on a separate ENG Form 4025-R.

5. Items transmitted on each transmittal form will be from the same specification section. Do not combine submittal information from different specification sections in a single transmittal.

6. If the data submitted are intentionally in variance with the contract requirements, indicate a variation in column h, and enter a statement in the Remarks block describing he detailed reason for the variation.

7. ENG Form 4025-R is self-transmitting - a letter of transmittal is not required.

8. When submittal items are transmitted, indicate the "Submittal Type" (SD-01 through SD-11) in column c of Section I.

Submittal types are the following:

SD-01 - Preconstruction SD-02 - Shop Drawings SD-03 - Product Data SD-04 - Samples SD-05 - Design Data SD-06 - Test Reports

SD-07 - Certificates SD-08 - Manufacturer's Instructions SD-09 - Manufacturer's Field Reports SD-10 - O&M Data SD-11 - Closeout

9. For each submittal item, the Contractor will assign Submittal Action Codes in column g of Section I. The U.S. Army Corps of Engineers approving authority will assign Submittal

Action Codes in column i of Section I. The Submittal Action Codes are:

A -- Approved as submitted.

B -- Approved, except as noted on drawings. Resubmission not required.

C -- Approved, except as noted on drawings. Refer to attached comments.

Resubmission required.

D -- Will be returned by separate correspondence.

E -- Disapproved. Refer to attached comments.

10. Approval of items does not relieve the contractor from complying with all the requirements of the contract.

F -- Receipt acknowledged.

X -- Receipt acknowledged, does not comply with contract requirements, as noted.

G -- Other action required (Specify)

K -- Government concurs with intermediate design. (For D-B contracts)

R -- Design submittal is acceptable for release for construction. (For D-B contracts)

ENG FORM 4025-R, MAR 2012

Page of

TRANSMITTAL OF SHOP DRAWINGS, EQUIPMENT DATA, MATERIAL SAMPLES, OR

MANUFACTURER'S CERTIFICATES OF COMPLIANCE

For use of this form, see ER 415-1-10; the proponent agency is CECW-CE.

SECTION I - REQUEST FOR APPROVAL OF THE FOLLOWING ITEMS (This section will be initiated by the contractor)

CHECK ONE:

THIS TRANSMITTAL IS FOR: (Check one)

ITEM

NO.

(See Note 3)

USACE

ACTION

CODE

(Note 9)

SUBMITTAL

TYPE CODE

(See Note 8)

NO.

OF

COPIES

SPEC.

PARA. NO.

DRAWING

SHEET NO.

CONTRACTOR

REVIEW

CODE

VARIATION

Enter "Y" if requesting a variation (See Note 6)

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.)

a.

i.

c.

d.

e.

f.

g.

h.

b.

CONTRACT DOCUMENT

REFERENCE

SECTION II - APPROVAL ACTION

I certify that the above submitted items had been reviewed in detail and are correct and in strict conformance with the contract drawings and specifications except as otherwise stated.

REPLACES EDITION OF MAR 95, WHICH IS OBSOLETE.

ENG FORM 4025-R, MAR 2012

INSTRUCTIONS

1. Section I will be initiated by the Contractor in the required number of copies.

2. Each Transmittal shall be numbered consecutively. The Transmittal Number typically includes two parts separated by a dash (-). The first part is the specification section number. The second part is a sequential number for the submittals under that spec section. If the Transmittal is a resubmittal, then add a decimal point to the end of the original Transmittal Number and begin numbering the resubmittal packages sequentially after the decimal.

3. The "Item No." for each entry on this form will be the same "Item No." as indicated on ENG FORM 4288-R.

4. Submittals requiring expeditious handling will be submitted on a separate ENG Form 4025-R.

5. Items transmitted on each transmittal form will be from the same specification section. Do not combine submittal information from different specification sections in a single transmittal.

6. If the data submitted are intentionally in variance with the contract requirements, indicate a variation in column h, and enter a statement in the Remarks block describing he detailed reason for the variation.

7. ENG Form 4025-R is self-transmitting - a letter of transmittal is not required.

8. When submittal items are transmitted, indicate the "Submittal Type" (SD-01 through SD-11) in column c of Section I.

Submittal types are the following:

SD-01 - Preconstruction SD-02 - Shop Drawings SD-03 - Product Data SD-04 - Samples SD-05 - Design Data SD-06 - Test Reports

SD-07 - Certificates SD-08 - Manufacturer's Instructions SD-09 - Manufacturer's Field Reports SD-10 - O&M Data SD-11 - Closeout

9. For each submittal item, the Contractor will assign Submittal Action Codes in column g of Section I. The U.S. Army Corps of Engineers approving authority will assign Submittal Action Codes in column i of Section I. The Submittal Action Codes are:

A -- Approved as submitted. B -- Approved, except as noted on drawings. Resubmission not required. C -- Approved, except as noted on drawings. Refer to attached comments. Resubmission required. D -- Will be returned by separate correspondence. E -- Disapproved. Refer to attached comments.

10. Approval of items does not relieve the contractor from complying with all the requirements of the contract.

F -- Receipt acknowledged.

X -- Receipt acknowledged, does not comply with contract requirements, as noted.

G -- Other action required (Specify) K -- Government concurs with intermediate design. (For D-B contracts) R -- Design submittal is acceptable for release for construction. (For D-B contracts)

ENG FORM 4025-R, MAR 2012

1.0 darwin.chen@usace.army.mil 2012-03-27 Forms Design Team Darwin Chen

TRANSMITTAL OF SHOP DRAWINGS, EQUIPMENT DATA, MATERIAL SAMPLES, OR

MANUFACTURER'S CERTIFICATES OF COMPLIANCE

2012-03-29

(Type size, model number/etc.): Project Schedule

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.): As Requested by Gov't

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.): Copies of Permits (Dig, Hot Work,any others)

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.): Hazardous material and HJB form

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.): Shop dwg of wall Outrigger and attachment plate

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.): Closeout Documents

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.): Item Samples

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.): Outriggers and item information and cerifications

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.): Filled in submittal Log ENG 4025-R

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.): QC designation by Contractor

: REQ'd

CONTRACTOR REVIEW CODE

: REQ'd

CONTRACTOR REVIEW CODE

: REQ'd

CONTRACTOR REVIEW CODE

: REQ'd

CONTRACTOR REVIEW CODE

: REQ'd

CONTRACTOR REVIEW CODE

: REQ'd

CONTRACTOR REVIEW CODE

: REQ'd

CONTRACTOR REVIEW CODE

: REQ'd

CONTRACTOR REVIEW CODE

: REQ'd

See sheet 2 for further information

ATTACHMENT #27 Example Submittal Form Filled in