Office Of Space And Building Management (Osbm) Work Request printable pdf download

Office Of Space And Building Management (Osbm) Work Request

Form CD-410

U.S. DEPARTMENT OF COMMERCE

(REV 12 -12)

OFFICE OF SPACE AND BUILDING MANAGEMENT (OSBM) WORK REQUEST

HERBERT C. HOOVER BUILDING

To be completed by OSBM

RECEIPT DATE:

CONTROL NO:

SECTION I: REQUEST FOR SERVICES (To be completed by Ordering Agency) Agency CONTROL NO:______________

1. Requesting Office/Bureau:

2. Agency Point of Contact:

(Room No.)

(Phone)

(Typed Name)

3. Location of Work Requested

(Room/Location)

4. Description of Work:

Attachments:

5. Charge To:

(Agency Accounting Data)

6. Ordering Agency Official:

(Phone)

(Signature)

(Date)

(Position/Title)

(Name)

SECTION II: COST ESTIMATE (To be completed by OSBM)

Item/Activity

7. Estimated Cost

8. Final Cost

Construction

Carpet

Draperies

Furniture

Electric

HVAC

Paint

Plumber

Carpenter

TOTAL:

Detailed Estimate Attached:

9. Project Coordinator:

(Phone)

(Signature)

(Date Estimated)

(Name)

(Position/Title)

SECTION III: WORK PERFORMANCE AUTHORIZATION/FUNDS AVAILABLE (To be completed by Ordering Agency)

10. Authorized Agency Official:

OEB Authorization for OS

Projects over $25,000

(Phone)

(Signature)

(Date)

(Name)

(Position/Title)

SECTION IV: COMPLETION CERTIFICATION

To be completed by OSBM/Ordering

To be completed by OSBM

Agency

11. Project Physically Complete:

13. Partial Billing:

(Date)

12. Authorized Agency Official:

(Signature)

(Date )

(Phone)

(Signature)

(Date)

14. Final Billing:

(Name)

(Position/Title)

(Date )

(Signature)

Office Of Space And Building Management (Osbm) Work Request

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