Form 600-000-02 - Pay Item Request: New/expanded Structure - Fdot

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600-000-02
PROGRAM MANAGEMENT
12/04
Page 1 of 1
FLORIDA DEPARTMENT OF TRANSPORTATION
PAY ITEM REQUEST: NEW/EXPANDED STRUCTURE
Refer to the Basis of Estimates for instructions. Originator completes “* ” items.
Item Structure
Description*
Unit of Measure*
( )__ __ __-__ __ __-__ __ __
,
Requested Action*:
____ New Item
___ Permanent Block
___ Process with Item(s):
Structure*: (ATTACH ADDITIONAL SHEET IF NECESSARY)
Detail Information:
BOE Detail*: _______________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Unit Of Measure- Accuracy*: ____________________________________________________________________ Plan Quantity?*: YES NO (circle one)
Documentation:
Specification- Section/Article Number(s)*: _________________________________________________________ Tech Spec?*: YES NO (circle one)
Specifications Submitted: __________________________________________________________
Date:___________________________________
Plans Prep Manual (Vol, Chapter)*: _____________________________________________________________________________________________
Standards- Index No(s)*.: ___________________________________________________________________ Shop Drawings?*: YES NO (circle one)
CADD Form(s)*: ______________________________________ COMP Form Number(s)*: _______________________________________________
Plan Notes?*: YES NO (circle one) ____________________________________________________________________________________________
Other: _____________________________________________________________________________________________________________________
Responsible Office Approval: ________________________________________________________ Date:___________________________________
Cost Data:
Related Pay Item(s)*:_________________________________________________________________________________________________________
Unit Price*: ______________________________ Additional Cost(s): ________________________________________________________________
Manufacturer/Supplier(s)*: ___________________________________________________________________________________________________
Estimator’s Approval:______________________________________________________________ Date:___________________________________
*Originator
Name (PRINT)*: __________________________________________________________________
Date: __________________________________
Office: ______________________________________ Phone: (
) ______________ Suncom: __________________
District: _______________
District Estimates Office Approval: ___________________________________________________ Date:___________________________________
Central Office Approvals:
Design Coordinator Approval: ________________________________________________________ Date:___________________________________
Specifications Coordinator Approval: __________________________________________________ Date:___________________________________
BOE Coordinator Approval: __________________________________________________________ Date:___________________________________
TRNS*PORT Coordinator's Approval __________________________________________________ Date:___________________________________
Implementation:
Effective Letting Date: ________________________ Open/Block Date: ______________________________ C-Team Issue #: _________________
C-Team date, Details: ________________________________________________________________________________________________________
BOE Updated- Structure:________________________ Details: ______________________________________ Publish: _______________________
Master File- Item Number to open: ___________________ Project Number:___________________________ Proj. Let Date: __________________

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