TE-10-2_Work Request Estimate and Completion Form.pdf

Region: Order Date:

Contract: Order Value:

CSS W/O: Estimate Date:

FACID: Priority:

Building: Funding Source:

D

Sections A, B C, and D required for ALL estimates

** Repair Requests under $2,500.00 require labor hours, material description and all costs involved.

** Repair Requests over $2,500.00 require RS Means lines that relate to the description/SOW and associated costs.

** Contractor required to provide manufacturer, model and serial number for all components being serviced, repaired and/or replaced.

A

CSS Description:

Work Request, Estimate and Completion Form

Diagnosis:

B

C

Scope of Work/Repair Requirement:

CSS W/O: Estimate Date:

FACID: Priority:

Building: Funding Source:

** Repair Requests under $2,500.00 require labor hours, material description and all costs involved.

** Repair Requests over $2,500.00 require RS Means lines that relate to the description/SOW and associated costs.

** Contractor required to provide manufacturer, model and serial number for all components being serviced, repaired and/or replaced.

A

Work Request, Estimate and Completion Form

Hours

Total Hours Labor Rate

Cost

Total Labor Grand Total

New Total:

This section required for all estimates less than $2,500.00

Repair over $2,500.00 new WO Required

Repair Less than $2,500.00

E

F

Material:

Labor:

Total Material

This section required to be submitted when additional funding is required.

G

Additional Funding Description:

Original Total:

Additional funds required:

CSS W/O: Estimate Date:

FACID: Priority:

Building: Funding Source:

** Repair Requests under $2,500.00 require labor hours, material description and all costs involved.

** Repair Requests over $2,500.00 require RS Means lines that relate to the description/SOW and associated costs.

** Contractor required to provide manufacturer, model and serial number for all components being serviced, repaired and/or replaced.

A

Work Request, Estimate and Completion Form

1 Repair Order Date:

2 Repair Control Number:

3 Additional Funding Request (Yes/No):

4 Additional Funding Authorized (Date):

Repair Completion Date:

H

This section required to be submitted when repair is complete.

Repair Completion

Prime Contractor Signature Government Signature

Data Release: Year_______ Quarter ______

A B C D E F G H I J K

Quantity Line Number Description Unit Total O&P

Ext. Mat.

O&P

Ext. Labor O&P

Ext. Equip.

O&P

Data Release

CCI

Location Notes

Work Request, Estimate and Completion Form ** Repair Requests under $2,500.00 require labor hours, material description and all costs involved.

** Repair Requests over $2,500.00 require RS Means lines that relate to the description/SOW and associated costs.

** Contractor required to provide manufacturer, model and serial number for all components being serviced, repaired and/or replaced.

This page required on all repairs estimated over $2,500.00.

RS Means - No Cost Estimate

Estimate Date:

Priority:

Funding Source:

Contractor Logo

Building:

Region:

CSS W/O:

FACID:

Contract:

II

Section G is required when additional funds are requested Section H is completed as follows:

Work Request, Estimate and Completion Form ** Repair Requests under $2,500.00 require labor hours, material description and all costs involved.

** Repair Requests over $2,500.00 require RS Means lines that relate to the description/SOW and associated costs.

** Contractor required to provide manufacturer, model and serial number for all components being serviced, repaired and/or replaced.

Document Instructions Sections A, B, C, and D required on ALL estimate submissions Sections E and F required on ALL estimates less than $2,500.00

Section I required on ALL estimates over $2,500.00 (DO NOT INCLUDE ANY COST DATA)

H1 - Upon submission H2 - When estimate submitted H3 - If additional funds are required above original order amount H4 - If additional funds are requried above original order amount H5 - When repair has been completed and proper operation has been verified.