North Carolina Department Of Transportation Active Claim Resolution Form Page 2
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4Claim Resolution Form
Requests for Extensions in Contract Time:
(Applicable section(s) to be filled out by Resident Engineer)
108-10(B)3
Delays To The Contractor’s Controlling Operation(s)
1.
Has the Contractor submitted all information as required by the Subarticle?
Yes
No
2.
According to the Contractor:
What is the alleged controlling operation delayed? ___________________________________________________________
What are the circumstances resulting in the alleged delay? ____________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
What calendar dates/times was the controlling operation allegedly delayed? ________________through________________
3.
Resident Engineer's Determination:
What was the controlling operation? ______________________________________________________________________
Was the controlling operation delayed?
Yes
No
What are the calendar dates/times the controlling operation was delayed? __________________through_________________
Was the delay due to circumstances originating from the work required under the contract?
Yes
No
What were the circumstances resulting in delay? ____________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
4.
Did the Contractor pursue the work in accordance with Article 108-1?
Yes
No
(This applies to the period prior to the delay or alleged delay.)
5.
Were the delays caused by circumstances beyond the contractor’s control and without his fault or negligence?
Yes
No
6.
Number of days/hours recommended _________________________ Please explain: ___________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
108-10(B)4
Changes In The Work Ordered By The Engineer (Additional Work, Etc.)
1.
Has the Contractor submitted all information as required by the Subarticle?
Yes
No
2.
What is the category of the request?
Reduction in Quantities
Elimination of Items
Additional Work
Extra Work
3.
According to the Contractor:
What is the affected operation? __________________________________________________________________________
What are the calendar dates/times affected? ______________________________through____________________________
What time extension is being requested by the Contractor? ____________________________________________________
4.
Resident Engineer’s Determination:
What is the affected operation? __________________________________________________________________________
What are the calendar dates/times affected? ______________________________through____________________________
5.
Did the Contractor pursue the work in accordance with Article 108-1?
Yes
No
6.
Number of days/hours recommended _________________________ Please explain: ___________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Form ACRF-2 (5-28-15)
Page 2 of 4
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