Statement of Work - Attachment 10 - 01 33 00 - Attachment B - JB CHS Request for Information Form

ACTIVITY ID

REQUEST FOR INFORMATION

CONTRACT NO

CONTRACT TITLE

RFI NO

RFI SUBJECT

RFI PRIORITY?

HIGH

NORMAL

POTENTIAL TIME/COST IMPACT?

YES

NO

SCHEDULE IMPACT?

YES

NO

CRITICAL PATH IMPACT?

YES

NO

DATE

EST DAYS UNTIL CP IMPACT:

SPEC SECTION

DWG NO

SPEC PARAGRAPH

DWG DETAIL

SPEC PAGE NO

DWG SHEET NO

SECTION I - CONTRACTOR INFORMATION

CONTRACTOR QUESTION/ISSUE: (Reference All Attachments)

CONTRACTOR PROPOSED SOLUTION: (Reference All Attachments)

NAME OF CONTRACTOR

NAME OF QC MANAGER

SIGNATURE OF QC MANAGER

DATE

SIGNATURE OF REVIEWER

DATE

SECTION II - RFI REVIEWER

REVIEWER RECOMMENDED RFI RESPONSE:

TITLE OF REVIEWER

NAME OF REVIEWER

SECTION III - RFI RESPONSE

NOTE: THE RFI SYSTEM IS INTENDED TO PROVIDE AN EFFICIENT MECHANISM FOR RESPONDING TO CONTRACTOR'S REQUESTS FOR INFORMATION. IT DOES NOT PROVIDE AUTHORITY TO PROCEED WITH ADDITIONAL WORK. IF THE CONTRACTOR CONSIDERS THE RFI RESPONSE A CHANGED CONDITION, PROVIDE WRITTEN NOTICE TO THE CONTRACTING OFFICER'S REPRESENTATIVE IN ACCORDANCE WITH CONTRACT PROVISIONS.

TITLE OF GOVERNMENT OFFICIAL

JB CHS REQUEST FOR INFORMATION, 20210824

NAME OF GOVERNMENT OFFICIAL

SIGNATURE OF GOVERNMENT OFFICIAL DATE