Exhibit C-FS_Form_4025.pdf
PDF 1 MB Posted
- Attached to
- Fort Sill MATOC - Solicitation Federal contract opportunity
- Solicitation number
- W9124L-23-B-0001
About this file
This document is a transmittal form used by contractors to submit shop drawings, equipment data, material samples, or manufacturer's certificates of compliance to the Directorate of Public Works at Fort Sill for approval. The form requires contractors to provide key details such as the transmittal and specification numbers, contract document references, descriptions of submittal items, quantities, and codes indicating whether the items comply with contract requirements or require a variation. Contractors must sign the form to certify details are correct and in conformance with contract drawings and specifications before the Directorate of Public Works takes approval action. The approving authority then signs and dates the form upon completion of review, returning any enclosures with comments as needed. This transmittal form facilitates the review and approval process between contractors and the Directorate of Public Works for submittals required under construction contracts at Fort Sill.
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david.dold1 10.0.2.20120224.1.869952
DATE:
TRANSMITTAL OF SHOP DRAWINGS, EQUIPMENT DATA, MATERIAL SAMPLES, OR MANUFACTURER'S CERTIFICATES OF COMPLIANCE
TRANSMITTAL NUMBER:
SECTION I - REQUEST FOR APPROVAL OF THE FOLLOWING ITEMS (This section will be initiated by the contractor)
TO: FROM: CONTRACT NUMBER: CHECK ONE:
THIS IS A NEW TRANSMITTAL
THIS IS A RE-SUBMITTAL OF
TRANSMITTAL:
SPECIFICATION DIVISION NUMBER (Cover only one Division with each submittal) PROJECT TITLE & LOCATION THIS TRANSMITTAL IS FOR: (Check one)
FIO
GA
DA
CR
DA/CR
DA/GA
DIRECTORATE OF PUBLIC WORKS
PREVIOUS EDITIONS ARE OBSOLETE
FS FORM 4025, OCT 2015
SECTION II - APPROVAL ACTION
REMARKS:
I certify that the above submitted items had been reviewed in detail and are correct and in strict conformance with the contract drawings and specifications except as otherwise stated.
ITEM
NO.
(See Note 3)
CONTRACT DOCUMENT REFERENCE
DESCRIPTION OF SUBMITTAL ITEM (Type, size, model number etc.)
SUBMITTAL TYPE
CODE (See Note 8)
NO. OF
COPIES
SPEC. NO.
SPEC. PARA.
NO.
DRAWING
SHEET NO.
CONTRACTOR
REVIEW CODE
VARIATION
Enter "Y" if requesting a variation (See Note 6)
FORT SILL DIRECTORATE
OF PUBLIC WORKS
ACTION CODE (Note 9)
a. b. c. d. e. f. g. h. i. j.
NAME OF CONTRACTOR SIGNATURE OF CONTRACTOR
ENCLOSURES RETURNED (List by item No.) NAME AND TITLE OF APPROVING AUTHORITY SIGNATURE OF APPROVING AUTHORITY DATE
PREVIOUS EDITIONS ARE OBSOLETE
DIRECTORATE OF PUBLIC WORKS
FS FORM 4025, OCT 2015
INSTRUCTIONS
1. Section 1 will be initiated by the Contractor in the required number of copies.
2. Each Transmittal shall be numbered consecutively. The Transmittal Number typically includes two parts separated by a dash (-). The first part is the specification section number. The second part is the sequential number for the submittals under that spec section. If the transmittal is a re-submittal, then add a decimal point to the end of the original Transmittal Number and begin numbering the re-submittal packages sequentially after the decimal.
3. The "item No." for each entry on this form will be the same "item No." as indicated on ENG FORM 4288-R.
4. Submittals requiring expeditious handling will be submitted on a separate FS Form 4025.
5. Items transmitted on each transmittal form will be from the same specification division. Do not combine submittal information from different specification division in a single transmittal.
6. If the data submitted are intentionally in variance with the contract requirements, indicate a variation in column i, and enter a statement in the Remarks block describing the detailed reason for the variation.
7. FS Form 4025 is self-transmitting - a - letter of transmittal is not required.
8. When submittal items are transmitted, indicate the "Submittal Type" (SD-01 through SD-11) in column c of Section 1.
9. For each submittal item, the Contractor will assign Submittal Action Codes in column h of Section 1. The Fort Sill Directorate of Public Works approving authority will assign Submittal Action Codes in column j of Section 1. The Submittal Action Codes are:
A-Approved as submitted B-Approved, except as noted. Re-submission not required C-Approved, except as noted. Refer the attached comments. Re-submission required D-Will be returned by separate correspondence E-Disapproved. Refer to attached comments F-Receipt acknowledged X-Receipt acknowledged, does not comply with contract requirement, as noted G-Other action required (Specify) K-Government concurs with intermediate design. (For D-B contracts) R-Design submittal is acceptable for release for construction. (For D-B contracts)
10. Approval of items does not relieve the contractor from complying with all the requirements of the contract.
SD-01 - Pre-construction SD-04 - Samples SD-07 - Certificate SD-10 - O&M Data SD-02 - Shop Drawings SD-05 - Design Data SD-08 - Manufacture's Instructions SD-03 - Product Data SD-06 - Test Report SD-09 - Manufacturer's Field Report SD-11 - Closeout
| TRANSMITTAL NO.: |
| TO:: |
| ENCLOSURES RETURNED (List by item No.): |
| NAME AND TITLE OF APPROVING AUTHORITY: |
| DateField1: |
| CheckBox1: |
| SignatureField1: |
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