NAVFAC 9-11014/20 REV. 2-68) S/N 0105-LF-002-7510 Instructions in NAVFAC MO-321)
Supersedes NAVDOCKS 2351
PART I - REQUEST (Filled out by Requestor) |
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1. FROM |
2. REQUEST NO. |
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3. TO |
4. DATE OF REQUEST |
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5. REQUEST FOR ☐ COST ESTIMATE ☐ PERFORMANCE OF WORK |
5a. REQUEST WORK START |
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6. FOR FURTHER INFORMATION CALL |
7. SKETCH/PLAN ATTACHED ☐ YES ☐ NO |
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8. DESCRIPTION OF WORK AND JUSTIFICATION (Including location, type, size, quantity, etc.) |
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9. FUNDS CHARGEABLE |
10. SIGNATURE (Requesting Official) |
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PART II - COST ESTIMATE (Filled out by Maintenance Control Division if estimate requested) |
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11. TO: |
12. ESTIMATE NO. |
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13. COST ESTIMATE |
14. SKETCH/PLAN ATTACHED |
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☐ YES ☐ NO |
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a. Labor |
15. |
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b. Material |
☐ APPROVED: PROGRAMMING TO START IN . |
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| c. Overhead and/or Surcharge | ☐ APPROVED: BASED ON PRESENT WORKLOAD, THIS JOB CAN BE |
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| d. Equipment Rental/ Usage | PROGRAMMED TO START IN , IF |
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e. Contingency |
AUTHORIZED BY 25TH OF AND FUNDS ARE MADE AVAILABLE. ☐ DISAPPROVED. (See Reverse Side) |
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f. TOTAL |
16. SIGNATURE |
17. DATE |
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PART III - ACTION (Filled out by Requestor) |
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18. TO: |
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19. AUTHORIZATION TO PROCEED IS ATTACHED (Check one if other than PW funds are involved) ☐ NAVCOMPT 140 ☐ OTHER |
20. WORK REQUESTED HAS BEEN HAS BEEN WILL BE PERFORMED ☐ CANCELLED ☐ DEFERRED ☐ BY OTHERS |
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21. SIGNATURE |
22. DATE |
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