Sow part 4- ref-attach-JCI controls- HVAC-NPSLC - Submittal 029.pdf

MATERIAL APPROVAL SUBMITTAL

(See instructions on Reverse)

Form Approved OMB No 9000‐0062 Expires Apr 30, 1993

Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Department of Defense, Washington Headquarters Services. Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202‐4302, and to the Office of Management and Budget , Paperwork Reduction Project OMB No. 9000‐0062, Washington, DC 20503.

Please DO NOT RETURN your form to either of these addresses. Send your completed form to: SAF/AQCO, Pentagon, Washington, DC 20330‐1000

TO: (Contracting Officer)

Scott Vigil Department of Veterans Affairs 3801 Miranda Ave Palo Alto, CA

FROM: (Contractor)

Noel H. Campos Glen/Mar Construction 15800 SE 135th Ave Clackamas, OR 97015

DATE:

04/06/15

Project Number:

640‐385

SUBMISSION NUMBER:

SUBMITTAL

NEW RESUMBITTAL

PREVIOUS SUBMISSION NUMBER:

TO BE COMPLETED BY CONTRACTOR

ITEM

NO.

SPECIFICATION SECTION/

PARA NO. /DRAWING NO.

DESCRIPTION OF MATERIAL

(Include Type, Model Number, Catalog No, Mfg., etc.)

APPROVED DISAPPROVED

SEE

REVERSE

INITIAL

1 23 09 23 – 1.7 Direct Digital Control Shop Drawings X NHC

2 23 09 23 – 1.7 Manufacturer’s Literature and Data X NHC

BY COMPLETING THIS FORM, THE UNDERSIGNED CONTRACTOR CERTIFIES THAT

THE MATERIAL COMPLIES WITH ALL SPECIFICATIONS OF SUBJECT CONTRACT.

TYPE OR PRINT NAME AND TITLE

Noel H. Campos, Project Engineer

SIGNATURE

Noel H. Campos

FOR GOVERNMENT USE ONLY

Comments:

For Evaluation and Action

TYPE OR PRINT NAME AND GRADE

Scott Vigil, COR

SIGNATURE

TO: (AF Contracting Office)

RECOMMEND APPROVAL DISAPPROVAL AS INDICATED ABOVE AN0D SUBJECT TO ANY APPLICABLE COMMENTS ON THE RESERVE

TO: (Contractor)

Glen/Mar Construction, 15800 SE 135th Ave., Clackamas, OR 97015

APPROVED DISAPPROVED AS INDICATED ABOVE AND SUBJECT TO APPLICABLE COMMENTS ON RESERVE. REQUEST

RESUBMITTAL WITHIN __________ DAYS OF DATE SHOWN BELOW.

AF FORM 3000, SEP 91(EF) PREVIOUS EDITION IS OBSOLETE

VHAPALSubhaN Text Box For reference only

A Service-Disabled Veteran-Owned Small Business

SUBMITTAL

15790 SE 135th Avenue, Clackamas, OR 97015 Phone: 503-650-1720

Fax: 503-650-1902

Project:

Contract No: VA261-14-C-0191

Submittal Title: Direct Digital Controls

Spec Section No: 23 09 23 – 1.7

Submittal No.: 029

Revision No:

Sent Date: 04/06/2015

Contractor Stamp:

Architect / Owner Stamp:

REMARKS:

Glen/Mar Construction, Inc.

Copy to: File Signed___________________________

, PE

VA Palo Alto New Patient Simulation Learning Center

Noel Submittal Review Stamp