DSF 111 Rev

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DOCUMENT SUBMITTAL FORM (DSF)

Part A: Project & Record Information:


New Demerara River Bridge
Project Name/Contract No. DSF. Ref. No NDRB/JV/DSF 111
NPTAB #: 2433/2020/31
Client/Employer Ministry of Public Works Rev. No 01
Engineer Politecnica Submission Date
Contractor CRCCI-CRCCCL-CRBG JV Received Date

Part B: Document Submittal Discipline:


☒ Civil ☐ Architectural ☐ Electrical
Related Discipline ☐ Mechanical ☐ QA/QC ☐ HSE
☐ Others (xxxx)

Part C: Document Details:


List of Attachments
Item Description Details (Tick all provided
attachments)
Method Of Statement For Construction Of The New
(Hard Copy and Soft
Document Title Demerara River Bridge Substructure- Approach Bridge
Pile Cap Copy)

Document Reference
NDRB-CON-SUB-APC-001,Rev01
Number

Plant And Design- Build Contract (Fidic 2017 Yellow


Related Contract Book)
Clauses Sub-Clause 4.1 Of The Contractor’s General Obligations
Sub-Clause 5.2 Of Contractor’s Documents

Remarks by Contractor Submission for approval

Contractor’s:
We do certify that the submitted information herewith has been reviewed in details and in accordance with the Contract Documents except as
otherwise stated here above.

Discipline Engineer Design Manager Project Manager


Name Xu Bing Dr. Manuel Aguilar Balbuena Zhiliang Wang
Signature

Date

Page 1 DOCUMENT SUBMITTAL FORM: 5181/QLT/CSS/F03 Rev.00


Part D: Employer/ Engineer Review and Approval2:

Employer/
Engineer’s
Comments

Employer/ ☐ A: Approved ☐ B: Approved with Comments


Engineer
Approval ☐ C: Revise & Resubmit ☐ D: Rejected

Note(2): Employer’s/ Engineer’s approval is for conformance with information given and design concept expressed in Contract Documents. Approval
does not authorize changes to Contract Documents. Employer’s/ Engineer’s approval does not relieve the Contractor from his contractual obligation to
ensure conformance to all Contract Documents. Any deviations, to the Contract Documents found subsequent to Employer’s/ Engineer’s approval are to
be corrected by the Contractor at no extra Cost/Time.

Employer/ Engineer Approval:


For Politecnica
Name Mr. Abdul Hameed
Designation Resident Engineer/Team Leader
Signature
Date

Page 2 DOCUMENT SUBMITTAL FORM: 5181/QLT/CSS/F03 Rev.00

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