Att 1(e) - Utility Outage Request.doc

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Indefinite Delivery Indefinite Quantity Roofing
Solicitation number
N62473-14-R-2201
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Attachment 1(e) - Utility Outage Request.doc

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REQUEST FOR ROUTINE UTILITY SERVICE

INTERRUPTION

*** A MINIMUM OF TEN (10) WORKING DAYS IS REQUIRED TO PROVIDE UTILITY SERVICE INTERUPTION ***

Today’s Date: _________________

Name of Contractor/Company: ___________________________________

Contract Number: _____ -___- ______________DO#_________________

Purpose/Description of Outage: ____________________________________________

Location of Outage: _____________________________________________________

Utilities Affected: _______________________________________________________

Requested Date/Time: From: _______________ Hour: _________________________

To: _________________ Hour: __________________________

Contractor’s Remarks: ____________________________________________________

Contractor’s Signature: X __________________________ Date: _________________

Forward to ROICC/FSC Representative for Approval:

Signature: __________________Date:__________

Utility Outage Coordinator’s Comments:_____________________________________

Disapproval/Approval X __________________________ Date: ___________________

Utility Outage Coordinator

Phone @ 760-3638/FAX 760-763-1319

File details come from the government source that posted it. Updated .