SOW - Doc A4 - Submittal - Transmittal Form - 2015 R2.pdf

CATALOG CUT / SUBMITTAL TRANSMITTAL NAVFAC NW STD FORM

NAVFAC NW (REV. 5-15)

SUBMITTAL NO.

CHECK ONE:

RECORD APPROVAL ACCEPTANCE (APP PLAN, CQC PLAN, NAS BASELINE & UPDATES)

PART I – FOR CONTRACTOR USE

FROM (Contractor) TO:

CONTRACT NO.: CONTRACT TITLE:

SECTION NO.: PARAGRAPH NO.: SUBMITTAL DESCRIPTION NO.:

DESCRIPTION of ITEM BEING SUBMITTED:

CERTIFICATION (This form shall not be used to forward proposed substitutions)

IT IS HEREBY CERTIFIED THAT THE EQUIPMENT MATERIAL DOCUMENTATION SHOWN AND

MARKED IN THIS SUBMITTAL IS THAT PROPOSED TO BE INCORPORATED INTO THE SUBJECT CONTRACT, AND IS IN COMPLIANCE WITH THE CONTRACT DRAWINGS AND SPECIFICATIONS AND CAN BE INSTALLED IN THE ALLOCATED

SPACES.

CERTIFIED BY: (CQC)

DATE:

PART II – FOR REVIEWER USE

FROM: (DESIGNER) TO: (GOVERNMENT)

THIS SUBMITTAL HAS BEEN REVIEWED BY DESIGNER. COMMENT/CORRECTION PROVIDED:

SIGNATURE: DATE:

PART III – FOR GOVERNMENT USE

FROM: (GOVERNMENT) TO:

ENCLOSURES ARE RETURNED WITH THE FOLLOWING COMMENT/CORRECTION PROVIDED:

APPROVED ACCEPTED RECORD RECEIVED

WITH COMMENTS OR CORRECTIONS Response NOT Required Response Required

Refer to comments noted on attached document.

REVISE AND RESUBMIT: DISAPPROVED UNACCEPTABLE

Refer to comments noted on attached document.

THIS SUBMITTAL HAS BEEN REVIEWED BY GOVERNMENT. THE FOLLOWING RECOMMENDATION IS MADE:

Response is subject to contract requirements with no change in contract price or time.

SIGNATURE: DATE: