Attachment 7, Contractor Work Performance Notification Form.pdf

157 KB Posted

Attached to
7840601ADEM, Roos Blvd Mow
Solicitation number
6100048358
Issued by
Montgomery County, Koppel Borough, Pennsylvania

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This document is a Contractor Work Performance Notification Form for a state Department of Transportation (DOT) District 6-0 Roadside project. The form is used to notify the contractor of any work performance issues related to the contract, including deficiencies in work tasks and compliance with the Scope of Work (SOW). The form includes details such as the contract number, date and time of inspection, and a checklist of potential issues across various work categories. The contractor is required to provide a proposed remedy within 24 hours of receiving the notification.

The form does not provide additional details about the overall project or contract opportunity. It is focused solely on the process for documenting and addressing contractor work performance concerns during the execution of the contract.

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District 6-0 Roadside (12/18) CWP Form

Page: __________ of __________

Stage:____________________________

Contract No: ______________________

Date Sent Time Sent recipient of Notification

� AM

� PM

MONTh DAY YEAr

Inspection Time reviewed Inspector

� AM

� PM

MONTh DAY YEAr

Emailed Copy to Contractor?

� Yes � No

Check Box if Meeting will be scheduled

Work Performance Issue(s) and SOW Section

AM Deficiency PM Deficiency Comments Date/Time Corrected

YES NO YES NO

CONTRACTOR WORK

PERFORMANCE

COMPLIANCE AND

NOTIFICATION

This Section is To Be Completed by Contractor* Proposed Remedy:

* Contractor must provide a Proposed Remedy within 24 hours of receiving this Form

Print Button:
Page Number:
Page Number 2:
Stage:
Contract Number:
Month:
Day:
Year:
AM Time:
PM Time:
AM Check Box: Off
PM Check Box: Off
Inspector:
Yes: Off
No: Off
Month2:
Day2:
Year2:
AM Time2:
AM Check Box2: Off
PM Time2:
PM Check Box2: Off
WZLD: Off
Recipient Notification:
Traffic Control Devices:
0:
1:
2:
3:
4:
5:
6:
AM Yes:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
AM No:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
PM Yes:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
PM No:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
Comments:
1:
2:
3:
0:
4:
5:
6:
Date/Time Corrected:
0:
1:
2:
3:
4:
5:
6:
Remedy:
0:

File details come from the government source that posted it. Updated .