Attachment G - DPW SUBMITTAL FORM V.1.pdf

MATERIAL APPROVAL SUBMITTAL

(TRADOC Reg 715-3)

TRADOC FORM 928-R-E, Jan 02 8½ x 11

TO: (Contracting Officer) FROM: (Contractor)

CONTRACT NUMBER SUBMISSION NUMBER SUBMITTAL

NEW RESUBMITTAL

ITEM

NO.

SPECIFICATION SECTION/

PARA NO./DRAWING NO.

AP-

PROVED

DATE

BY COMPLETING THIS FORM, THE UNDERSIGNED CONTRACTOR CERTIFIES THAT

THE MATERIAL COMPLIES WITH ALL SPECIFICATIONS OF SUBJECT CONTRACT.

DATE

PREVIOUS SUBMISSION NUMBER PROJECT NUMBER

TO BE COMPLETED BY CONTRACTOR FOR GOVERNMENT USE ONLY

DISAP-

PROVED

SEE

REVERSE

INITIAL

DESCRIPTION OF MATERIAL

(Include Type, Model Number, Catalog Number, Mfg., etc.)

TYPE OR PRINT NAME AND TITLE SIGNATURE

FOR GOVERNMENT USE ONLY

DATE TYPE OR PRINT NAME AND GRADE SIGNATURE

DATE TYPE OR PRINT NAME AND GRADE SIGNATURE

DATE TYPE OR PRINT NAME AND GRADE SIGNATURE

TO:

For Evaluation and Action.

TO:

TO: (Contractor)

Recommend Approval Disapproval as Indicated Above and Subject to Any Applicable Comments on the Reverse

Approved Disapproved as Indicated Above and Subject to Any Applicable Comments on the Reverse Side. Request Resubmittal on Disapproved

Items Within ________________ Days of Date Shown Below.

1056428964.CIV

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Adrian

COMMENTS

(Number to correspond with applicable Item Number on reverse)

INSTRUCTIONS TO CONTRACTORS

1. The term "material" is defined as articles, supplies, raw materials, equipment, parts, components, and end items that are to be incorporated into the work required by the contract.

2. This form is to be used by contractors for submitting Shop Drawings, Equipment Data, Manufacturer's Literature and Certificates and Sample of Materials to the Government for approval in accordance with the provisions of this contract. Unless otherwise specified, it is to be prepared in 4 copies, signed, and provided to the contracting officer with appropriate attachments.

3. Item(s) to be approved will be clearly tabbed or identified. Data pertaining to item(s) to be approved will be clearly identified or tabbed, particularly where documents are voluminous, in order to properly evaluate the materials or articles to be incorporated in the work. Each attachment will be numbered to correspond with the item number shown on the face of this form.

4. Requests submitted shall be numbered consecutively, by contract, in the space entitled "Submission No." This number, in addition to the Contract No., will be used to identify each Material Approval Submittal. Resubmissions will be indicated in the appropriate block and the insertion of previous submission number and date in addition to a new submission number. A single submission should be used for all work of a section of the specifications, but in NO instance should the submission include work for more than one (1) contract. Submittals requiring priority handling will be submitted by separate submittal using the form and so marked across the face of the form.

5. This material Approval Submittal is not valid unless it is signed by the contracting officer. This approval is required as called for by the contracting officer under the terms of this contract.

TRADOC FORM 928-R-E, Nov 91 8½ x 11