Attachment-5-ServiceDeliveryRequestForm--GAOA_Funded.pdf

Service Delivery Request Blanket BPA Call No:

Service Delivery Request

SDR No:________ To be filled in by Regional COR

Project COR complete the following section

Name of Project/Contract to be Inspected:

Project COR Name:

Email:

Date Submitted:

Phone No:

Type of Project:

Overall Period Needed:

Project Location:

Responsible Forest Office:

Brief Project Description:

BPA Contract Inspection Services Requested

Line item Description Period Start Period End Number of Days

X001* Building Inspector

X002* Bridge Inspector

X003* Concrete Inspector

X004* Environmental Inspector

X005* Roads Inspector

X006* Trails Inspector

X007*

Enter the type of inspector if not listed above

*- The “X” represents the associated schedule number based on year

Project COR Electronic Signature

Email this form and associated project documents (specifications, drawings, etc) to the Regional Blanket BPA Call

COR

to

Service Delivery Request Blanket BPA Call No:

Blanket BPA Call COR complete the following section

Complete the Blanket Call – SDR TEMPLATE spreadsheet.

Ensure the remaining balance is available for the requested service.

Add the Blanket BPA Call No. to the header of this form.

Email the completed form and project attachments (plans, specifications etc..) to the Contractor.

Contractor Designated Representative complete the following section

Line item Description Inspector Name Phone Email Address

X001* Building Inspector

X002* Bridge Inspector

X003* Concrete Inspector

X004* Environmental Inspector

X005* Roads Inspector

X006* Trails Inspector

X007*

Contractor (Designated Representative) Name:

Date:

Signature:

Email this form to the Regional Blanket BPA Call COR, along with any information showing how the proposed inspector/s is qualified.

Blanket BPA Call COR completes the following and forwards to the Project COR with a copy of the signed Blanket Call SDR TEMPLATE.

I have reviewed the information submitted by the Contractor and I find the proposed Contract Inspector/s meets or exceeds qualifications needed to inspect the project. Please request the Project CO designate them as Government Technical Monitor (GTM) on the project contract.

Blanket BPA Call COR Name:

Signature:

Distribution:

Contractor, or Designated Representative Blanket BPA Call CO Project COR COR File

Note: Work may begin once the project CO completes GTM/s designations.