J.5 6010-5 CAI Form.pdf

FAA Form 6010-5 (10/16) Page 1 of 3

Contractor Acceptance Inspection (CAI) Cover Sheet

INSTRUCTIONS FOR COMPLETING FAA FORM 6010-5

Form Block

Description

1 CAI number. Electronically assigned by national database: The first character represents the Service Area, the next two characters represent the calendar year that the CAI was performed; then a dash followed by the letter ‘C’, which designates CAI; and the last five characters are sequentially assigned.

2 Date of Inspection. The date the JAI checklist was completed.

3 Job Control Number (JCN). Service Area unique number assigned to specific projects.

4 Related Job Order Number(s) (JONs). Budgetary Control Number.

5 Project Implementer. The entity implementing the project.

6 District. The affected District identifier.

7 SSC. The affected Systems Service Center identifier.

8 Cost Center Code. The cost center of the affected facility, system, or equipment.

9 Location Identifier. Alpha Numeric location identifier (LOCID) where the facility, system, or equipment is physically located (can be found in FSEP).

10 FSEP Facility Type. The Facility Type published in the FSEP.

11 City. Full name of the location where the facility, system, or equipment is actually located.

12 State. The two-letter abbreviation of the State where facility, system, or equipment is actually located.

13 Facility Ident Code. From the FSEP, lists the facility, system, or equipment features and capabilities in a six-digit code. The digits are broken out below:

S = System C = Category F = Facility T = Type M = Model C = Class

14 Runway number. If applicable, list of the runway impacted by this JAI. Typically, if the Facility Ident Code System Code (S) is a ‘3’, then a runway must be listed here.

15 Project Title. Short title of project.

16 Contractor. The business name of the contractor performing the work.

17 Contract Number. The number of the contract that authorized the expenditure of funds required to complete this work.

18 Contract Date. The date that the contract was awarded.

19 Description of Project. Describes the work accomplished by the project.

20 Description of Real Property Assets. Describes each real property asset that was accepted from the contractor.

pxantus Typewritten Text Electronic Version (PDF) pxantus Typewritten Text

FAA Form 6010-5 (10/16) Page 2 of 3

21 PI Representative Performing the Inspection or Acceptance. The PI Representative or COTR that performed the inspection must be an FAA employee. The PI Representative or COTR signs and dates the CAI Cover Sheet.

22 Remarks. Any comments or discrepancies necessary to clarify the CAI.

23 Punch List. The appropriate box is checked to indicate if a punch list was completed. Also lists the date that any punch list items will be completed.

Electronic Version (PDF)

FAA Form 6010-5 (10/16) Page 3 of 3

CONTRACTOR ACCEPTANCE

INSPECTION REPORT

CAI COVER

SHEET

CAI Number Date of Inspection

Job Control Number (JCN) Related Job Order Number(s) (JONs) Project Implementer District SSC

Cost Center Code

Location Identifier

Facility Type

(FSEP)

Physical Location Facility Ident. Code Runway City State S C F T M C

Project Title:

Contractor: Contract Number: Contract Date:

Description of Project:

Description of Real Property Assets (List each asset separately):

Name and Title of Person Performing the Inspection or Acceptance:

Print Name and Title Signature Date

Remarks:

Punch List Attached. Recommended Date of Completion for Punch List Items:

No Punch List. All Contract Deliverables Received by the FAA.

FAA Form 6010-5 (07/08)

Electronic Version (PDF)

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