(D) SUBMITTAL REGISTER.pdf
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- Attached to
- Repair Water Main Valves/Lines, Southeast Zone
- Solicitation number
- 6062471
About this file
This document is a Submittal Register that lists the contract requirements and submittal items for a federal contract opportunity titled "Repair Water Main Valve/Lines SE Zone". The scope includes removing and replacing 38 water valves and associated piping on the underground fire and potable water distribution system at Naval Submarine Base New London in Groton, CT.
The contract is limited to 7 contractors under MACC ML-C00068, listed in a separate attachment. Key submittal items include a Salvage Plan, Schedule of Prices, Preliminary and Initial Project Schedules, Submittal Register, Accident Prevention Plan, Quality Control Plan, Construction Site Plan, Traffic Control Plan, Environmental Protection Plan, and various test reports and closeout documents. The contract requires compliance with federal procurement, environmental, safety, and construction requirements.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment 00001.pdf | ||
| (M) FAR 52.204-24.pdf | ||
| (K) RFI Form.pdf | ||
| (O) Sales Tax Exemption Form 2016-R-0149.pdf | ||
| (J) Map to B135.pdf | ||
| (H) General Requirements.pdf | ||
| (B) Specifications.pdf | ||
| (C) Drawings.pdf | ||
| (F) PRICE PROPOSAL FORM.docx | DOCX document | |
| (E) NEPA.pdf | ||
| (N) Guide to Taxes.pdf | ||
| (A) MACC RFP.pdf | ||
| (G) Wage Determination.pdf | ||
| (P) CERT-141.pdf | ||
| (I) Base Map.pdf | ||
| (L) ECMS.pdf |
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SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 1 OF 12 PAGES
1705774
Repair Water Main Valve/Lines SE Zone
01 11 00 SD-01 Preconstruction Submittals
1.6 GSalvage Plan
01 14 00 SD-01 Preconstruction Submittals
1.2.1.1List of Contact Personnel
01 20 00 SD-01 Preconstruction Submittals
1.3 GSchedule of Prices
01 30 00 SD-01 Preconstruction Submittals
1.3View Location Map
1.4Progress and Completion
Pictures
01 32 01.00 10 SD-01 Preconstruction Submittals
1.3 GProject Scheduler Qualifications
3.4.1 GPreliminary Project Schedule
3.4.2 GInitial Project Schedule
3.6.2 GPeriodic Schedule Update
01 32 16.00 20 SD-01 Preconstruction Submittals
1.2 GBaseline Construction Schedule
SD-07 Certificates
1.4Monthly Updates
01 33 00 SD-01 Preconstruction Submittals
1.8 GSubmittal Register
01 35 26 SD-01 Preconstruction Submittals
1.8.1 GAPP - Construction
1.8 GAccident Prevention Plan (APP)
SD-06 Test Reports
1.4Monthly Exposure Reports
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P H
C L A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
AUTH REMARKS
(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r)
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 2 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
01 35 26 1.13Notifications and Reports
1.13.2 GAccident Reports
SD-07 Certificates
1.5Contractor Safety Self-Evaluation
Checklist
1.7.1.4Crane Operators/Riggers
1.8.3.2 GStandard Lift Plan
1.8.3.3 GCritical Lift Plan
1.9Activity Hazard Analysis (AHA)
1.10.1Confined Space Entry Permit
1.10.1Hot Work Permit
1.13.4 GCertificate of Compliance
01 45 00.10 20 SD-01 Preconstruction Submittals
1.6 GQC Plan
01 50 00 SD-01 Preconstruction Submittals
1.3 GConstruction Site Plan
3.4.1 GTraffic Control Plan
2.2.1 GHaul Road Plan
1.6.1.4 GContractor Computer
Cybersecurity Compliance
Statements
1.6.6 GContractor Temporary Network
Cybersecurity Compliance
Statements
01 57 19 SD-01 Preconstruction Submittals
1.6.1Preconstruction Survey
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 3 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
01 57 19 1.6.2 GRegulatory Notifications
1.6.4 GEnvironmental Manager
Qualifications
1.6.5 GEmployee Training Records
1.7 GEnvironmental Protection Plan
1.7.9.1 GDirt and Dust Control Plan
1.10 GSolid Waste Management Permit
3.2.1.1 GStormwater Pollution Prevention
Plan
3.10.2 GSpill Prevention Control And
Countermeasure (SPCC) Plan
SD-06 Test Reports
1.10.1 GMonthly Solid Waste Disposal
Report
3.7.1.1.2Laboratory Analysis
SD-07 Certificates
1.6.5 GEmployee Training Records
SD-11 Closeout Submittals
1.6.2 GRegulatory Notifications
1.6.5 GAssembled Employee Training
Records
1.10 GSolid Waste Management Permit
3.2.1.4 GStormwater Pollution Prevention
Plan Compliance Notebook
3.7.1 GWaste Determination
Documentation
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 4 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
01 57 19 3.7.2.1 GProject Solid Waste Disposal
Documentation Report
3.7.2.1 GSales Documentation
3.7.2.1Contractor Certification
3.7.3.1 GHazardous Waste/Debris
Management
3.7.3.6 GDisposal Documentation for
Hazardous and Regulated Waste
3.8.1 GContractor Hazardous Material
Inventory Log
01 74 19 SD-01 Preconstruction Submittals
1.6 GConstruction Waste Management
Plan
SD-11 Closeout Submittals
1.8 SFinal Construction Waste
Diversion Report
01 78 00 SD-03 Product Data
1.6.1Warranty Management Plan
1.6.4Warranty Tags
Final Cleaning
1.5Spare Parts Data
SD-08 Manufacturer’s Instructions
1.6.1Instructions
SD-10 Operation and Maintenance
Data
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 5 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
01 78 00 3.3 GOperation and Maintenance
Manuals
SD-11 Closeout Submittals
3.1 GAs-Built Drawings
3.2 GRecord Drawings
1.6.1As-Built Record of Equipment and Materials
2.1 GCertification of EPA Designated
Items
GCertification Of USDA Designated
Items
3.5.1 GInterim DD FORM 1354
3.5.2 GChecklist for DD FORM 1354
01 78 23 SD-10 Operation and Maintenance
Data
GFacility Data Workbook
3.1.1 GTraining Plan
3.1.2 GTraining Content
3.2.2 GOperation And Maintenance
Manual, Prefinal Submittal
3.2.3 GOperation And Maintenance
Manual, Final Submittal
SD-11 Closeout Submittals
3.1.1 GTraining Plan
1.6.6.7 GRecord Drawings And Utility
Systems
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 6 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
02 61 13 SD-01 Preconstruction Submittals
GWork Plan
SD-02 Shop Drawings
3.1Surveys
SD-06 Test Reports
3.8.2Compaction
3.10 GClosure Report
03 30 00 SD-01 Preconstruction Submittals
1.6.5 GQuality Control Plan
1.6.6 GQuality Control Personnel
Certifications
1.6.6Quality Control Organizational
Chart
1.6.8 GLaboratory Accreditation
3.3.10Maturity Method Data
SD-02 Shop Drawings
1.6.2.1 GReinforcing Steel
SD-03 Product Data
2.4.5Joint Sealants
2.4.4Joint Filler
2.1Formwork Materials
2.3.3.3Recycled Aggregate Materials
2.3.1Cementitious Materials
2.4.6Vapor Retarder
2.4.1Concrete Curing Materials
2.6Reinforcement
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 7 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
03 30 00 2.4.3.1Liquid Chemical Floor Hardeners and Sealers
2.3.4Admixtures
2.6.6Reinforcing Fibers
2.6.2Mechanical Reinforcing Bar
Connectors
Waterstops
1.8.1Local/Regional Materials
2.2.3Biodegradable Form Release
Agent
2.4.2Nonshrink Grout
SD-05 Design Data
1.6.1.1 GConcrete Mix Design
SD-06 Test Reports
1.6.1.1 GConcrete Mix Design
1.6.3.1Fly Ash
1.6.3.1Pozzolan
1.6.3.2Slag Cement
1.6.3.3Aggregates
3.14.3.3 GCompressive Strength Tests
3.14.3.1Slump Tests
2.3.2Water
SD-07 Certificates
2.6.1Reinforcing Bars
1.9Welder Qualifications
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 8 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
03 30 00 1.8.2Forest Stewardship Council
(FSC) Certification
1.6.6.2Field Testing Technician and
Testing Agency
SD-08 Manufacturer’s Instructions
2.4.3.1Liquid Chemical Floor Hardeners and Sealers
2.4.5Joint Sealants
22 00 00 SD-03 Product Data
1.5.1Welding
3.7Tests, Flushing and Disinfection
2.1.1Bolts
SD-10 Operation and Maintenance
Data
3.7.1 GPlumbing System
31 00 00 SD-01 Preconstruction Submittals
3.3 GShoring
1.6.3 GDewatering Work Plan
SD-03 Product Data
3.7 GUtilization of Excavated Materials
3.2Opening of any Excavation or
Borrow Pit
3.13Shoulder Construction
31 23 00.00 20 SD-01 Preconstruction Submittals
1.7.1Shoring and Sheeting Plan
GDewatering work plan
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 9 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
31 23 00.00 20 SD-06 Test Reports
3.13.1.1Fill and backfill
3.13.1.2Select material
3.13.1.4Density tests
32 11 26 SD-03 Product Data
1.4.4Sources of Aggregates
2.4.2 GJob Mix Formula
SD-06 Test Reports
1.4.4Sources of Aggregates
1.4.6Bituminous Materials
2.2Bituminous Materials
1.6.2 GTest Section
1.4.4 GService Record
SD-09 Manufacturer’s Field
Reports
1.4.3Batch Tickets
32 12 13 SD-03 Product Data
1.1.3Waybills and Delivery Tickets
2.2.4Local/Regional Materials
SD-06 Test Reports
3.7Sampling and Testing
32 12 16.16 SD-02 Shop Drawings
2.1 GPlacement Plan
SD-03 Product Data
2.1.5 GDiamond Grinding Plan
2.4 GMix Design
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 10 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
32 12 16.16 3.1 GContractor Quality Control
SD-04 Samples
2.2Aggregates
2.3Asphalt Cement Binder
SD-06 Test Reports
2.2 GAggregates
3.1.3.9QC Monitoring
SD-07 Certificates
2.3 GAsphalt Cement Binder
1.4.11Laboratory Accreditation and
Validation
32 92 19 SD-03 Product Data
2.4.2Wood Cellulose Fiber Mulch
SD-07 Certificates
2.1Seed
SD-08 Manufacturer’s Instructions
2.6Erosion Control Materials
33 11 00 SD-01 Preconstruction Submittals
3.1.1 GConnections
SD-03 Product Data
2.1.1 GPipe, Fittings, Joints and
Couplings
2.1.1.3.1.1GBall And Socket Joint
2.1.2 GValves
2.1.2.7 GValve Boxes
2.2.1 GPipe Restraint
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 11 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
33 11 00 GPrecast Concrete Thrust Blocks
3.2.2 GDisinfection Procedures
SD-06 Test Reports
3.3.1.4 GBacteriological Samples
3.2.1.5.1 GPost-Construction Fusion Report
3.2.1.1.6Hydrostatic Sewer Test
3.3.1.3Leakage Test
3.3.1.1Hydrostatic Test
SD-07 Certificates
2.1.1Pipe, Fittings, Joints and
Couplings
2.1.2Valves
33 52 23.15 SD-01 Preconstruction Submittals
1.6 GWelding Procedure Specifications
(WPS)
1.6 GWelder Performance Qualification
(WPQ)
1.6 GProcedure Qualification Record
(PQR)
3.1 GWelding Operations
SD-02 Shop Drawings
1.6.2 GPOL Service Piping
SD-06 Test Reports
3.2Examinations, Inspections and
Tests
SD-07 Certificates
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 12 OF 12 PAGES
Repair Water Main Valve/Lines SE Zone
33 52 23.15 1.6 GQualifications
SUBMITTAL REGISTER
CONTRACT NO.
TITLE AND LOCATION CONTRACTOR
CONTRACTOR:
SCHEDULE DATES
CONTRACTOR
ACTION
APPROVING AUTHORITY
A C T I V I T Y
N O
T R A N S M I T T A L
N O
S P E C
S E C T
DESCRIPTION
ITEM SUBMITTED
P A R A G R A P
A S S I F I C A T I O N
G O V T
O R
A E
R E V W
R SUBMIT
APPROVAL
NEEDED
BY
MATERIAL
NEEDED
BY
A C T I O N
C O D E
DATE
OF
ACTION
DATE FWD
TO APPR
AUTH/
DATE RCD
FROM
CONTR
DATE FWD
TO OTHER
REVIEWER
DATE RCD
FROM OTH
REVIEWER
A C T I O N
C O D E
DATE
OF
ACTION
MAILED
TO
CONTR/
DATE RCD
FRM APPR
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