Substitution Request Form

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SUBSTITUTION REQUEST

Project:	Substitution Request Number:
	From:
To:	Date:
	A/E Project Number:
Re:	Contract For:
Specification Title:	Description:
Section:Page:	Article/Paragraph:
Proposed Substitution:
Manufacturer: ABH Manufacturing Address: 1222 Ardmore Ave Itasca, IL 60143_Phone: (630) 875-9900
_	Model No.:
Attached data includes product description, specifications, drawings, photographs and performance and test data adequate for evaluation of the request; applicable potions of the data are clearly identified. Attached data also includes a description of changes to the Contract Documents that the proposed substitution will require for its' proper installation.
Same maintenance service and source of replacement parts, as applicable, is available. Proposed substitution will have no adverse effect on the other trades and will not affect or delay progress schedule. Proposed substitution does not affect dimensions and functional clearances. Payment will be made for changes to building design, including A/E design, detailing and constructions costs caused by the substitution.
Submitted by:
Signed by:
Firm:
Address:
Telephone:
A/E's REVIEW AND ACTION
□ Substitution approved – Make submittals in accordance with Specification Section 01 25 00 Substitution Procedures.
□ Substitution approved as noted – Make submittals in accordance with Specification Section 01 25 00 Substitution Procedures.
☐ Substitution rejected – Use specified materials.
☐ Substitution Request received too late – Use specified
Signed by:	Date:
Supporting Data Attached: Drawings Product Date Samples Tests Reports
©Copyright 2004, Construction Specifications Institute	June 2004