Attachment_5.pdf

Attachment 5 – ENG Form 4025, Submittal Transmittal Form

SHEET OF

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

CHECK ONE:

THIS IS A NEW TRANSMITTAL

THIS IS A RESUBMITTAL OF

TRANSMITTAL

DATE

REMARKS

CONTRACT REFERENCE

DOCUMENT

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

TO: FROM:

PROJECT TITLE AND LOCATION

CONTRACT NO.

ENCLOSURES RETURNED (List by Item No.)

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

MANUFACTURER'S CERTIFICATES OF COMPLIANCE

(Read instructions on the reverse side prior to initiating this form)

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

TRANSMITTAL NO.

NAME, TITLE AND SIGNATURE OF APPROVING AUTHORITY DATE

SECTION II - APPROVAL ACTION

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.

SPEC.

PARA. NO.

e.

DRAWING

SHEET NO.

f.

FOR

CONTRACTOR

USE CODE

g.

VARIATION

(See instruction No. 6) h.

FOR

CE

USE

CODE

i.

NAME AND SIGNATURE OF CONTRACTOR

ENG FORM 4025-R, MAR 95 (Proponent: CEMP-CE)EDITION OF SEP 93 IS OBSOLETE.(ER 415-1-10)

CHECK ONE: THIS TRANSMITTAL IS

FOR FIO GOV'T. APPROVAL

INSTRUCTIONS

1. Section I will be initiated by the Contractor in the required number 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-R for each entry on this form.

4. Submittals requiring expeditious handling will be submitted on 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-transmittal, letter of transmittal is not required.

8. When a sample of 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 below in Section I, column g, to each item submitted.

THE FOLLOWING ACTION CODES ARE GIVEN TO ITEMS SUBMITTED

A -- Approved as submitted.

B -- Approved, except as noted on drawings.

C -- Approved, except as noted on drawings.

Refer to attached sheet resubmission required.

D -- Will be returned by separate correspondence.

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-R)

E -- Disapproved (See attached).

F -- Receipt acknowledged.

FX -- Receipt acknowledged, does not comply as noted with contract requirements.

G -- Other (Specify)

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