Attachment H (For AMDT 0002).pdf

ATTACHMENT H

Exhibit J

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U.S. Army Corps of Engineers (USACE)

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

MANUFACTURER'S CERTIFICATES OF COMPLIANCE

For use of this form, see ER 415-1-10; the proponent agency is CECW-CE.

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 TRANSMITTAL

THIS IS A RESUBMITTAL OF

TRANSMITTAL

SPECIFICATION SEC. NO. (Cover only one section with each transmittal) PROJECT TITLE AND LOCATION THIS TRANSMITTAL IS FOR: (Check one)

FIO GA DA CR

DA/CR DA/GA

ITEM

NO.

(See

Note 3)

DESCRIPTION OF SUBMITTAL ITEM

(Type size, model number/etc.)

SUBMITTAL

TYPE CODE

(See Note 8)

NO.

OF

COPIES

CONTRACT DOCUMENT

REFERENCE CONTRACTOR

REVIEW

CODE

VARIATION

Enter "Y" if requesting a variation

(See Note 6)

USACE

ACTION

CODE

(Note 9)

SPEC.

PARA. NO.

DRAWING

SHEET NO.

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

REMARKS 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 CONTRACTOR SIGNATURE OF CONTRACTOR

SECTION II - APPROVAL ACTION

ENCLOSURES RETURNED (List by item No.) NAME AND TITLE OF APPROVING AUTHORITY SIGNATURE OF APPROVING AUTHORITY DATE

ENG FORM 4025, MAY 2017 PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 2

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INSTRUCTIONS

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

2. Each Transmittal shall be numbered consecutively. The Transmittal Number typically includes two parts separated by a dash (-). The first part is the specification section number. The second part is a sequential number for the submittals under that spec section. 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 ENG FORM 4288-R.

4. Submittals requiring expeditious handling will be submitted on a separate ENG Form 4025-R.

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 h, and enter a statement in the Remarks block describing he detailed reason for the variation.

7. ENG Form 4025-R is self-transmitting - a letter of transmittal is not required.

8. 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

9. For each submittal item, the Contractor will assign Submittal Action Codes in column g of Section I. The U.S. Army Corps of Engineers approving authority will assign Submittal

Action Codes in column i of Section I. The Submittal Action Codes are:

A -- Approved as submitted. F -- Receipt acknowledged.

B -- Approved, except as noted on drawings. Resubmission not required. X -- Receipt acknowledged, does not comply with contract requirements, as noted.

C -- Approved, except as noted on drawings. Refer to attached comments. G -- Other action required (Specify)

Resubmission required. K -- Government concurs with intermediate design. (For D-B contracts)

D -- Will be returned by separate correspondence. R -- Design submittal is acceptable for release for construction. (For D-B contracts)

E -- Disapproved. Refer to attached comments.

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

ENG FORM 4025, MAY 2017 Page 2 of 2

SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 1 OF 3 PAGES

SUBMITTAL REGISTER

CONTRACT NO.

W912P622B0014

TITLE AND LOCATION

Indiana Shoreline Erosion Protection

CONTRACTOR

A C T I V I T Y

N O

T R A N S M I T T A L

N O

S E C

TI

O N

DESCRIPTION

ITEM

SUBMITTED

P A R A G # R A P H

G O V

C T L A O S R S I A F / I E C A R T E I V O W N R

CONTRACTOR:

SCHEDULE DATES

CONTRACTOR

ACTION

APPROVING AUTHORITY

MAILED

TO

CONTR/

DATE RCD

FRM APPR

AUTH REMARKS SUBMIT

APPROVAL

NEEDED

BY

MATERIAL

NEEDED

BY

A C T I O N

C O D E

DATE

OF

ACTION

DATE FWD

TO APPR

AUTH/

DATE RCD

FROM

CONTR

DATE FWD

TO OTHER

REVIEWER

DATE RCD

FROM OTH

REVIEWER

A C T I O N

C O D E

DATE

OF

ACTION

(a) (b) (c) ( d

(e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r)

4 SD-01 Preplacement Submittals

Sand Placement Schedule G, ECC-S

Condition of Existing Structures

Coordination with Others G, ECC-S

Drug Free Workplace

List of E-Verified/Eligible G GSE

Candidates

SD-06 Test Reports

Sand Placement Progress G, ECC-S

Photographs

Progress Meeting Minutes G, ECC-S

SD-11 Closeout Submittals

Sand Placement Complete G, ECC-S

Photographs

5 SD-01 Preplacement Submittals

Submittal Register G, ECC-S

6 SD-01 Preplacement Submittals

APP - Sand Placement G, ECC-S

Dive Operations Plan G, ECC-S

Accident Prevention Plan (APP) G, ECC-S

SD-06 Test Reports

SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 2 OF 3 PAGES

CONTRACT NO.

W912P622B0014

TITLE AND LOCATION

Indiana Shoreline Erosion Protection FY22

CONTRACTOR

A C T I V I T Y

N O

T R A N S M I T T A L

N O

S E C T I O N

DESCRIPTION

ITEM SUBMITTED

P A R A G # R A P H

G O V

C T L A O S R S I A F / I E C A R T E I V O W N R

CONTRACTOR:

SCHEDULE DATES

CONTRACTOR

ACTION

APPROVING AUTHORITY

MAILED

TO

CONTR/

DATE RCD

FRM APPR

AUTH REMARKS SUBMIT

APPROVAL

NEEDED

BY

MATERIAL

NEEDED

BY

A C T I O N

C O D E

DATE

OF

ACTION

DATE FWD

TO APPR

AUTH/

DATE RCD

FROM

CONTR

DATE FWD

TO OTHER

REVIEWER

DATE RCD

FROM OTH

REVIEWER

A C T I O N

C O D E

DATE

OF

ACTION

(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r)

5 Notifications and Reports

Accident Reports G, ECC-S

LHE Inspection Reports

SD-07 Certificates

Crane Operators/Riggers

Standard Lift Plan G, ECC-S

Critical Lift Plan G, ECC-S

Activity Hazard Analysis (AHA)

Certificate of Compliance

License Certificates

Work Sheet

Portable Gauge Operations G, ECC-S

Planning Worksheet

8 SD-01 Preplacement Submittals

Contractor Quality Control (CQC) G,ECC-S

Plan

SD-06 Test Reports

Verification Statement

10 SD-01 Preplacement Submittals

Environmental Protection Plan G,ECE-H

11 SD-02 Shop Drawings

Sign Legend Orders G, ECC-S

SD-01 Preplacement Submittals

SUBMITTAL FORM,Jan 96 PREVIOUS EDITION IS OBSOLETE PAGE 3 OF 3 PAGES

CONTRACT NO.

W912P622B0014

TITLE AND LOCATION

Indiana Shoreline Erosion Protection FY22

CONTRACTOR

A C T I V I T Y

N O

T R A N S M I T T A L

N O

S E C

TI

O N

DESCRIPTION

ITEM SUBMITTED

P A R A G # R A P H

G O V

C T L A O S R S I A F / I E C A R T E I V O W N R

CONTRACTOR:

SCHEDULE DATES

CONTRACTOR

ACTION

APPROVING AUTHORITY

MAILED

TO

CONTR/

DATE RCD

FRM APPR

AUTH REMARKS SUBMIT

APPROVAL

NEEDED

BY

MATERIAL

NEEDED

BY

A C T I O N

C O D E

DATE

OF

ACTION

DATE FWD

TO APPR

AUTH/

DATE RCD

FROM

CONTR

DATE FWD

TO OTHER

REVIEWER

DATE RCD

FROM OTH

REVIEWER

A C T I O N

C O D E

DATE

OF

ACTION

(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) (r)

3 SD-01 Preplacement Submittals

Work Plan G, ECE-C

Sand Source G,ECE-G

Sand Placement Equipment Lists

Pedestrian/Sand Placement G, ECE-C

Traffic Control Plan

Sampling Plan for G,ECE-

H,ECE-G

Contractor-Furnished Borrow

Source

Analytical Test Report for G,ECE-

H,ECE-G

Contractor-Furnished Borrow

Source

SD-03 Product Data

Displacement Gauge Installation G, ECE-C

Data

SD-05 Design Data

Gauging Table Data G, ECE-C

SD-06 Test Reports

Independent Testing Laboratory G, ECE-G

Qualifications

Moisture Sample Test Results G, ECE-G

Gradation Sample Test Results G, ECE-G

Daily Log Sheets of Shipments G, ECE-C

Weigh Bills G, ECE-C

SD-07 Certificates

Weigh Scale Certification G, ECE-C