STATE OF HAWAII
STATE OF HAWAII
DEPARTMENT OF ACCOUNTING AND GENERAL SERVICES
DIVISION OF PUBLIC WORKS
P.O. BOX 119
HONOLULU, HAWAII 96810-0119
TRANSMITTAL FORM
|PROJECT: | LOCATION |
| | WHERE & WHAT IS BEING DONE |
|D.A.G.S. JOB NO: | |
| |
|PROJECT ENGINEER: | |INSPECTOR: | |
| |
|CONTRACTOR |CONTRACTOR | |CONSULTANT |LEAD CONSULTANT NAME |
| |NAME | | | |
|PHONE: | | |PHONE: | |
|FAX: | | |FAX: | |
|EMAIL: | | |EMAIL: | |
| |
|TRANSMITTAL TYPE: |
| |
|SUBMITTAL |X |REQUEST FOR CHANGE (RFC) | |MONTHLY ESTIMATE | |
| |
|PAYROLL AFFADAVIT | |REPORT | |
| |
| |INFORMATION | |
| |
| | |NO. SENT |SECTION NO. / REF. | | | |*NO. RTN’D |** CODE |
|NO. |DATE SENT | | |SECTION NAME |ITEM SENT |TYPE | | |
| | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
| |
|* |COPIES RETURNED TO THE CONTRACTOR AFTER 2 OR 3 COPIES TO THE STATE |** |SUBMITTAL COMPLETION CODE - BELOW: |
| |
|A01 |Approved, Subject to Contract Requirements |D01 |Disapproved, Not pre-qualified |
|A02 |Approved as Noted, Subject to Contract Requirements |D02 |Resubmitted and Disapproved |
|A03 |Resubmitted and Approved |R01 |Disapproved, Revise and Resubmit |
| |I01 |For your reference |
| |
| | X | ................
................
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