FIELD EVALUATION REPORT - Connecticut
Instructions:1.The DAS Project Manager (PM) or Assistant Project Manager (APM) must complete this form, obtain signatures from the Construction Administrator (CA) and DAS Assistant Director of Project Management (ADPM) for the Project, and submit the form with Final Payment to the ADPM for the Project.2.The DAS ADPM for the Project must check the Change Order (CO) summaries noted below with the data in PMWeb to insure that all CO Totals are calculated correctly, and verify these totals when making Final Payment.1.0DAS Project Number:2.0Project Name & Location:3.0General Contractor or CMR:4.0Consultant:4.1Consulting Engineers:5.0Original Completion Date (mm/dd/yyyy):Substantial Completion Date (mm/dd/yyyy):Acceptance Date (mm/dd/yyyy):6.0Number of Days in Original Contract:Additional Days Granted:Days Per Change Order:Days Per Delays:TOTAL ADDITIONAL DAYS:7.0Original Contract Dollar Amount: $7.1Percentage of Change Orders Processed against Original Contract:%Change Order TypeNumber of Each TypeDollar Amount of Change OrderPercent of Contract ValueDocument Deficiency:$%Job Condition:$%Agency Request:$%Other:$%TOTALS:$%8.0Contractor Performance Evaluation Score (DAS Form 7450):%9.0Consultant Performance Evaluation Score (DAS Form 7910):%Signatures(CA Name)(Signature)(Date)(PM Name)(Signature)(Date)(ADPM Name – PMWeb)(Signature)(Date)Copies: FORMCHECKBOX Project ADPM FORMCHECKBOX Project File - YH7END ................
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