Custodial_Services_TE_-_E2_Special_or_Emergency_Clean_Form_(1).pdf

Technical Exhibit E2 - SPECIAL/EMERGENCY PROJECT FORM (Custodial Service Request)

Request Made By:

Date:

Location Of Services Required:

Date/Time Service Required:

Brief Description Of Services Required:

Signature of Requestor: Phone Number:

Received at Contract Management Division by: (with date) approved disapproved

Received at Contractor Office by (with date): will perform cannot perform

Contractor Concerns/Issues: (state reason service cannot be performed if applicable)

Information below this line to be filled out by Contract Management Personnel only!

Estimated Cost of Service:

Actual cost of service (as invoiced by provider):

Contract Management Division Form Custodial 1 March 2010