HomeMy WebLinkAbout00 Request For Equivalent Review Form (Pre-Bid)Park Grove – Cayuga Medical Center
MEDICAL OFFICE BUILDING
Cayuga Park, Ithaca, NY 14850
HOLT Project No. 2018089
REQUEST FOR EQUIVALENT REVIEW FORM (PRE-BID) 00 63 19 - 1
SECTION 00 63 19 - REQUEST FOR EQUIVALENT REVIEW FORM (PRE-BID)
Use separate form for each material, product or equipment item submitted for review.
Submit this form as a RFI for review and approval. Without Project Architect’s approval,
do not include cost for equivalent scope of work, material, product or equipment in the
bid. If not approved, furnish and install specified per Project documents.
Date:_______________________________Request No.: _____________________________
Project: _____________________________________________________________________
Location:____________________________________________________________________
Name of material, product or equipment item submitted as an
equivalent:___________________________________________________________________
Name of material, product or equipment item
specified:____________________________________________________________________
Specification Section______________, Article____________, Paragraph_______________
Qualities that differ from specified product or system, if
any_________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Name of Manufacturer /
Fabricator___________________________________________________________________
Address_____________________________________________________________________
City: ________________________State: _______________ Zip Code: __________________
Phone:_________________________________ E-mail: _____________________________
Name of Vendor / Supplier_____________________________________________________
Address_____________________________________________________________________
City: ________________________State: _______________ Zip Code: __________________
Phone:_________________________________ E-mail: _____________________________
Received by DiMarco 02/25/2021
Park Grove – Cayuga Medical Center
MEDICAL OFFICE BUILDING
Cayuga Park, Ithaca, NY 14850
HOLT Project No. 2018089
REQUEST FOR EQUIVALENT REVIEW FORM (PRE-BID) 00 63 19 - 2
Reason for requesting consideration of proposed equivalent:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Proposed equivalent will affect other materials or systems, such as dimensional
revisions, redesign of structure, or modifications to other work:
__________No
__________Yes, describe requirements:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Savings or credit to Contract Sum for accepting proposed equivalent, if any:
($_________________________) Dollars Amount in words
Amount in Figures:
The attached data is furnished herewith for evaluation of the proposed equivalent:
Product Data _______, Drawings ______, Samples ________, Tests _______,
Reports_______Other Information:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Received by DiMarco 02/25/2021
Park Grove – Cayuga Medical Center
MEDICAL OFFICE BUILDING
Cayuga Park, Ithaca, NY 14850
HOLT Project No. 2018089
REQUEST FOR EQUIVALENT REVIEW FORM (PRE-BID) 00 63 19 - 3
The undersigned hereby certifies: The proposed equivalent has been fully investigated
and is considered equal or superior to specified brand, material, product or equipment
item. The same or better warranty will be furnished for proposed equivalent as for
specified brand, material, product or equipment. All changes in the work resulting from
the use of this equivalent, if approved, will be coordinated and completed in all respects
and all costs, including, but not limited to, those for additional services rendered by the
Architect are the responsibility of this Contractor at no additional compensation under
the Contract.
__________________________________Contractor
Signed by:
____________________________________________________________________________
Address_____________________________________________________________________
City State Zip Code
Phone:_______________________________ E-mail: ________________________________
END OF SECTION 00 63 19
Received by DiMarco 02/25/2021