ENG Form 4025-R– Fill Out and Use This PDF

DATE TRANSMITTAL NO. TO: FROM: CONTRACT NO. CHECK ONE: THIS IS A NEW TRANSMITTAL, THIS IS A RESUBMITTAL OF.

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.

Enter the PROJECT TITLE AND LOCATION and the SPECIFICATION SEC. NO. (Cover only one section with each transmittal).

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.

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

THIS TRANSMITTAL IS FOR: (Check one) FIO, GA, DA, CR, DA/CR, DA/GA.

a. ITEM NO. (See Note 3) c. SUBMITTAL TYPE CODE (See Note 8) g. CONTRACTOR REVIEW CODE i. USACE ACTION CODE (Note 9)

The "Item No." for each entry on this form will be the same "Item No." as indicated on ENG FORM 4288-R.

b. DESCRIPTION OF SUBMITTAL ITEM (Type size, model number/etc.)

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

d. NO. OF COPIES e. SPEC. PARA. NO. f. DRAWING SHEET NO. under CONTRACT DOCUMENT REFERENCE

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. B -- Approved, except as noted on drawings. Resubmission not required. C -- Approved, except as noted on drawings. Refer to attached comments. Resubmission required. D -- Will be returned by separate correspondence. E -- Disapproved. Refer to attached comments.

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

G -- Other action required (Specify) K -- Government concurs with intermediate design. (For D-B contracts) R -- Design submittal is acceptable for release for construction. (For D-B contracts)

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

h. VARIATION Enter "Y" if requesting a variation (See Note 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.

The NAME OF CONTRACTOR and the SIGNATURE OF CONTRACTOR go with this certification: I certify that the submitted items had been reviewed in detail and are correct and in strict conformance with the contract drawings and specifications except as otherwise stated.

SECTION II - APPROVAL ACTION has NAME AND TITLE OF APPROVING AUTHORITY, SIGNATURE OF APPROVING AUTHORITY, DATE and ENCLOSURES RETURNED (List by item No.).