Project Management forms

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Builder project completion adv... HBCF HOME BUILDING COMPENSATION FUND Builder Project Completion Advice (All fields are mandatory) This form is not to be used in the case of contract disputes or termination before practical completion.

Public works affidavit califor... PUBLIC WORKS AFFIDAVIT California Labor Code 1775 b 4 The undersigned Contractor/Subcontractor has complied with the provisions of the has paid all employees the specified general prevailing rate of per diem wages to its employees and any amounts due pursuant to 1813 on the public project Project Name C0404 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Idph project submission form h... Project Submission Form for Hospitals Project identifying information All sections of this form must be completed. Altered forms will not be accepted IDPH Number Facility name Street address City IL ZIP code Project name IF THIS PROJECT CHANGES THE FACILITY S LICENSED BED COUNT BY ADDING OR REDUCING BEDS IT WILL BE NECESSARY TO CONTACT THE HEALTH FACILITIES SERVICES AND REVIEW BOARD. Is this a phased occupancy project Yes No If yes attach an occupancy schedule describing the rooms to be occupied in each phase with a small scale graphic plan Type of project new/replace facility addition to existing facility PPS rehab unit Type of submission renovation/update to existing facility PPS psychiatric unit Safety Net/Community hospital grant design development drawings first stage construction/working drawings second stage Certificate of Need Submit a copy of the approved certificate of need CON. A review by the Department WILL NOT begin until a CON or appropriate documentation is received* Written documentation from the Health Services and Review Board may be requested indicating a CON is not required* CON project number Date approved Functional program narrative Provide a functional program narrative for the project that describes the purpose of the project departmental relationships space requirements and other basic information relating to fulfillment of the facility s objectives. The functional program shall include a description of those services necessary for the complete operation of the facility. Attach additional sheets if needed* Systems program narrative Provide a systems program narrative describing all special systems including but not limited to fire alarm nurses call special locking devices security packages electrical plumbing HVAC medical gas and fire protection* Form Number 443086-rev021914 Page 1 of 5 Estimated project cost 1. Site preparation costs 2. Demolition costs 3. Construction contracts including cost of materials 4. Change orders Subtotal - lines 1 thru 4 6. Fixed capital equipment Add lines 5 and 6 If the fixed capital equipment is not more than 51 percent of the total cost then use line 7 for the plan review fee calculation below. 8. If line 6 is 51 percent more than line 7 then multiply line 6 by. 20 Place the total adjusted estimated project cost in the appropriate estimated project cost category listed below. diagnostic equipment MRI scanners X-ray equipment etc. Equipment which is part of the building such as AHU boilers chillers lights fire alarm panels and all related components are to be included in the construction costs. Plan review fee calculation The plan review fee is due and payable upon submission of this form along with the drawings and required information* Using the figures in line 7 or line 9 whichever is applicable calculate the plan review fee. Fee as listed below Less than 500 000 No fee 500 000 - 999 999 Project cost x. 0096 or 6 000 whichever is greater x. 0022 x. 0011 Greater than 5 000 000 10. Plan review fee to be submitted 11. Is the facility a disproportionate share hospital 13.

Pmp certification application... PMP Certification Application PAGE 1 OF 6? ? YOUR INFORMATION Tips for completing this form: Hand-write your information clearly in blue or black ink onto a printed form and submit it by postal mail.

Texas kincare primer form Source: http://www.truckerguide.com/assets/texasi202.pdf ... Source: https://texasguardianship.files.wordpress.com/2011/09/texaskincareprimer1.pdf.

Psychiatric review technique p... Form Approved OMB No. 0960-0413 PSYCHIATRIC REVIEW TECHNIQUE Name SSN NH (If different from above) SSN I. MEDICAL SUMMARY A. Assessment is from: to B. Medical Disposition(s): 1. No Medically Determinable

Graphic design project request... PROJECT REQUEST form IOCI Job No.: ... Mail: IOCI Design and Publications, 401 S. Spring St., Stratton Office Building, Rm. 600, Springfield, ... poster / sign.

Exigent health form PROJECT OWNER S CERTIFICATION THAT ALL EXIGENT HEALTH AND SAFETY ITEMS HAVE BEEN CORRECTED SEND OR FAX SIGNED COPY TO LOCAL MF OFFICE Name of Project Owner the Project Owner the owner of Project Name City State Project Number the Project by and through its duly authorized representative identified below hereby certifies that 1. If repairs were not made the dangerous condition was eliminated. This certification is made by the Project Owner and is signed by a duly authorized representative of the Project Owner who is so authorized by reason of his/her position as the State Fully Relationship Between Signer of Certification and Project Owner All of the foregoing statements as well as the date signature and identifying information of the signer and the Project Owner that follows are HEREBY CERTIFIED as true and accurate this day of 20. All Exigent Health and Safety EH S items at the Project have been corrected* Such EHS items include those identified in the Notification of Exigent and Fire Safety Hazards Observed dated. 2. The attached Report accurately identifies the repairs that have been made to correct the EHS items the location of those repairs and the date or dates the repairs were made. All Exigent Health and Safety EH S items at the Project have been corrected* Such EHS items include those identified in the Notification of Exigent and Fire Safety Hazards Observed dated. 2. The attached Report accurately identifies the repairs that have been made to correct the EHS items the location of those repairs and the date or dates the repairs were made.

Kindergarten pwa rubric the wr... Kindergarten Rubric: Process Writing Assessment Score 1 Equivalent ELD Level: Beginning 2 ELD Level: Beginning Ideas & Content Illustration expresses an idea that may or may not be related to

Re evaluation request form cel... REEVALUATION REQUEST FORM You can apply for a reevaluation of some or all components of your CELPIP test within six weeks of the test date. You must pay a reevaluation fee at the time of your application

Globalization project follow t... Globalization project: Follow that product! The purpose of this project is to demonstrate the width of globalization in everyday products in our daily lives. This will include picking a product of

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