North Carolina Department Of Transportation Active Claim Resolution Form
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4North Carolina Department of Transportation
Active Claim Resolution Form
Use this form for Contractor Claims over $50,000 and/or over 30 days.
Contract No.:
Division:
Claim ID No.:
Issue:
County:
TIP No.:
Contractor:
Project No.:
Resident Engineer:
The Contractor's Request is for:
Extension in Contract Time: Amount: __________
Days
Hours
Additional Compensation:
Amount: $______________
Date of Written Request: _______________
Department Initiated
Brief Description of Claim Issue (Utility, weather, etc.):
_______________________________________________________________________________________
The RESIDENT ENGINEER’S Recommendation is:
Extension in Contract Time:
Recommend
Recommend Granting: Extend Completion Date: _________
Days
Hours
Denial
Extend ICT No. ______ for _________
Days
Hours
Additional Compensation:
Recommend
Recommend Granting: Amount: $____________________
Denial
Signature:_______________________________ Name:_________________________ Date:____________
(Resident Engineer)
The CONSTRUCTION UNIT’S Review:
___________________________________________________________________
Comments:
___________________________________________________________________________
___________________________________________________________________________
Signature:_______________________________ Name:_________________________ Date:____________
(Roadway/Bridge Construction Engineer)
The DIVISION ENGINEER’S Decision is:
Extension in Contract Time:
Denied
Granted:
Extend Completion Date: _________
Days
Hours
Extend ICT No. ______ for _________
Days
Hours
Additional Compensation:
Denied
Granted:
Amount: $_____________________
__________________________________________________________________
Comments:
__________________________________________________________________________
__________________________________________________________________________
Signature:_______________________________ Name:_________________________ Date:____________
(Division Engineer)
Form ACRF-2 (5-28-15)
Page 1 of 4
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