Statement of Work - Attachment 9 - 01 33 00 - Attachment A - JB CHS Transmittal Form 4025.pdf

TRANSMITTAL OF SHOP DRAWINGS, EQUIPMENT DATA, MATERIAL SAMPLES, OR

MANUFACTURER'S CERTIFICATES OF COMPLIANCE

The proponent agency is 628CES/CEN.

DATE TRANSMITTAL NO.

SECTION I - REQUEST FOR APPROVAL OF THE FOLLOWING ITEMS (This section will be initiated by the contractor)

TO:

PROJECT TITLE AND LOCATIONSPECIFICATION SEC. NO. (Cover only one section with each transmittal)

FROM: CONTRACT NO. CHECK ONE:

THIS TRANSMITTAL IS FOR: (See Note 8)

THIS IS A NEW TRANSMITTAL

THIS IS A RESUBMITTAL OF

TRANSMITTAL

FIO GA DA CR DA/CR DA/GA

ITEM

NO.

(See

Note 3)

GOV

ACTION

CODE

(Note 10)

SUBMITTAL

TYPE CODE

(See Note 9)

TYPE

OF

COPIES

(See Note 1)

SPEC.

PARA. NO.

DRAWING

SHEET NO.

VARIATION

(See Note 6) g.

TIME/COST

IMPACT

(See Note 7)

DESCRIPTION OF SUBMITTAL ITEM

(Model Number, Catalog Number, Manufacturer, Nomenclature of Material, etc.)

a. i.c. d. e. f.b.

CONTRACT DOCUMENT

REFERENCE

REMARKS

SECTION II - APPROVAL ACTION

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.

NAME OF QC MANAGER SIGNATURE OF QC MANAGER

NAME AND TITLE OF APPROVING AUTHORITY

SIGNATURE OF APPROVING AUTHORITY DATE

REMARKS

REPLACES AF IMT 3000, WHICH IS OBSOLETE.JB CHS TRANSMITTAL FORM 4025, 20210421

h.

NOTES

9. When submittal items are transmitted, indicate the "Submittal Type" (SD-01 through SD-11) in column c of Section I.

Submittal types are the following:

SD-01 - Preconstruction SD-02 - Shop Drawings SD-03 - Product Data SD-04 - Samples SD-05 - Design Data SD-06 - Test Reports

SD-07 - Certificates SD-08 - Manufacturer's Instructions SD-09 - Manufacturer's Field Reports SD-10 - O&M Data SD-11 - Closeout

10. For each submittal item, the Contractor will assign Submittal Action Codes in column g. The approving authority will assign Submittal Action Codes in column i.

The Submittal Action Codes are:

A -- Approved as submitted.

B -- Approved, except as noted. Resubmission not required.

C -- Approved, except as noted Refer to attached comments.

Resubmission required.

D -- Will be returned by separate correspondence.

E -- Disapproved. Refer to attached comments.

11. Approval of items does not relieve the contractor from complying with all the requirements of the contract.

F -- Receipt acknowledged.

X -- Receipt acknowledged, does not comply with contract requirements, 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)

JB CHS TRANSMITTAL FORM 4025, MAR 2021

1. Indicate "E" For Electronically Submitted or "H-#” for hard copy (replacing “#” with the quantity)

2. Each Transmittal shall be numbered consecutively. If the Transmittal is a resubmittal, then add a decimal point to the end of the original Transmittal Number and begin numbering the resubmittal packages sequentially after the decimal.

3. The "Item No." for each entry on this form will be the same "Item No." as indicated on the submittal register.

4. Submittals requiring expeditious handling will be submitted on a separate Transmittal Form.

5. Items transmitted on each transmittal form will be from the same specification section. Do not combine submittal information from different specification sections in a single transmittal.

6. If the data submitted are intentionally in variance with the contract requirements, indicate a variation in column g, and enter a statement in the Remarks block describing he detailed reason for the variation.

7. If the variation causes an impact to time or cost indicate the type of impact in column h, and enter the associated RFI number in the remarks

8. Select one of the following depending on which approval source is required.

FIO – For Information Only GA – Government Approval DA - Designer of Record Approval CR - Government Conformance Review of Design DA/CR - Designer of Record Approval/Government Conformance Review DA/GA - Designer of Record Approval/Government Approval