Attachment E.pdf
PDF 296 KB Posted
- Attached to
- D6 Depth Patch Services 3-Year
- Solicitation number
- 5400030135
- Issued by
- Richland County, South Carolina
About this file
This is a Notification of Damage to SCDOT Property form issued by the South Carolina Department of Transportation. The document serves as an official record for reporting and documenting damage incidents to SCDOT property. The form requires contractors to provide detailed information about damage occurrences, including the date of occurrence, specific location details (route, direction, and mile marker), photographic evidence, and a comprehensive cost assessment. The notification must be completed and submitted to SCDOT with contractor contact information, including name, address, and fax number, as well as the relevant contract number for reference and tracking purposes.
The form itemizes damage-related costs in two categories: repair costs and liquidated damages, with a total cost calculation required. The document includes signature lines for SCDOT employees responsible for documenting the incident, along with spaces for employee name, title, and authorization. This standardized form appears to be part of the contractual framework for the D6 Depth Patch Services 3-Year contract, establishing a formal mechanism for contractors to report and substantiate claims related to property damage that may occur during service delivery in South Carolina.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment D.pdf | ||
| Solicitation 5400030135.pdf |
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Text version
Attachment E
DATE:
TO:
CONTRACTOR
CONTRACT NO.:
NAME: __________________________________________
ADDRESS:________________________________________
FAX NO.: ________________________________________
FROM:
SOUTH CAROLINA
DEPARTMENT OF
TRANSPORTATION
OFFICE: __________________________________________
ADDRESS:________________________________________
PHONE NO.: ______________________________________
RE: NOTIFICATION OF DAMAGE TO SCDOT PROPERTY
DESCRIPTION OF DAMAGE:
(PHOTOGRAPH OF THE DAMAGED PROPERTY IS ATTACHED).
DATE OF OCCURENCE: ROUTE: DIRECTION: MILE MARKER:
COSTS:
REPAIR COST =
LIQUIDATED DAMAGES =
TOTAL COST =
SCDOT EMPLOYEE (NAME / SIGNATURE / TITLE):
File details come from the government source that posted it. Updated .