Attachment_3_-_ENG_FORM_4025_MAY_92_R.pdf

TRANSMITTAL OF SHOPDRAWINGS, EQUIPMENT DATA, MATERIAL SAMPLES,

OR MANUFACTURER’S CERTIFICATES OF COMPLIANCE

(Read instructions on page two prior to initiating this form)

DATE:

TRANSMITTAL NO

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

TO:

FROM:

CONTRACT NO.

CHECK ONE:

THIS IS A NEW

SUBMITTAL

THIS IS A

RESUBMITTAL OF

TRANSMITTAL

SPECIFICATION SEC NO.(Cover only one section with each transmittal)

PROJECT TITLE AND LOCATION

ITEM

NO.

a.

DESCRIPTION OF ITEM SUBMITTED

(Type size, model number/etc.)

b.

MFG OR CONTR.

CAT., CURVE

DRAWING OR

BROCHURE NO.

(See instruction no. 8) c.

NO.

OF

COPIES

d.

CONTRACT

DOCU

SPEC.

PARA NO.

e.

REFERENCE

MENT .

DRAWING

SHEET NO.

f.

FOR

CONTR-

ACTOR

USE

CODE

g.

VARIATION

(See instruction No. 6) h.

FOR

CE

USE

CODE

i.

REMARKS

I certify that the above submitted items have been reviewed in detail and are correct and in strict compliance with the contract drawings and specifications except as other wise stated.

NAME AND SIGNATURE OF THE CONTRACTOR

SECTION II - APPROVAL ACTION

ENCLOSURES RETURNED (List by Item No.)

NAME, TITLE OF APPROVING AUTHORITY

DATE

ENG FORM 4025, MAY 91 (ER 415-1-10) EDITION OF AUG 89 IS OBSOLETE. SHEET OF . (Proponent: CEMP-CE):

INSTRUCTIONS

1. Section I will be initiated by the Contractor in the required numbers of copies.

2. Each transmittal shall be numbered consecutively in the space provided for “Transmittal No.”. This number in addition to the contract number, will form a serial number for identifying each submittal. For new submittals or resubmittals mark the appropriate box; on resubmittals, insert transmittal number of last submission as well as the new submittal number.

3. The “Item No.” will be the same “Item No.” as indicated on ENG FORM 4288 for each entry on this form.

4. Submittals requiring expeditious handling will be submitted under a separate form.

5. Separate transmittal form will be used for submittals under separate sections of the specifications.

6. A check shall be placed in the “Variation” column when a submittal is not in accordance with the plans and specifications --also a written statement to that effect shall be included in the space provided for “Remarks”.

7. Form is self transmitting, letter of transmittal is not required.

8. When a sample of a material or Manufacturer’s Certificate of Compliance is transmitted, indicate “Sample” or “Certificate” in column c, Section I

9. U.S. Army Corps of Engineers approving authority will assign action codes as indicated below in space provided in Section I, column I to each item submitted. In addition they will ensure enclosures are indicated and attached to the form prior to return to the contractor. The Contractor will assign action codes as indicated in Section I, Column g, to each item submitted.

THE FOLLOWING ACTION CODES ARE GIVEN TO ITEMS SUBMITTED

A -- Approved as submitted E -- Disapproved (See Attached) B -- Approved, except as noted on drawings. F -- Receipt acknowledged C -- Approved except as noted on drawings. FX -- Receipt acknowledged, does not comply Refer to attached sheet resubmission required. as noted with contract requirements D -- Will be returned by separate correspondence. G -- Other (Specify)

10. Approval of items does not relieve the contractor from complying with all the requirements of the contract plans and specifications.

Reverse of ENG Form 4025