DOCUMENT SUBMITTAL FORM (DSF)

Part A: Project & Record Information:

New Demerara River Bridge
Project Name/Contract No. DSF. Ref. No
NPTAB #: 2433/2020/31
Client/Employer Ministry of Public Works Rev. No
Engineer Politecnica Submission Date
Contractor 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)

List attached documents:

Document Title

Document Reference
Number

Related Contract
Clauses

Remarks by Contractor

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 QA/QC Manager Project Manager

Name
Signature

Date

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 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

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