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Sample Power of Attorney Forms - Excel - Excel

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Sample Power of Attorney Forms - Excel - Excel Powered By Docstoc
					Western C-11 Basin, Phase II, Spillway 381,Broward County FL - DACW17
RED = Not Approved                                  YELLOW = Transmitted Awaiting Approval
               Transmittal
               Number
              (Transmittal        Submittal                         Paragraph
              Form ENG 4025       Item Number                       Number
 Activity     Number used to      (Eng Form 4025                    (Section
Number        Transmit            Column 'a", use                   Subpart
(CPM          Submittal Item to   unique number
                                                    Specification   Number
Schedule      Contracting         for each          Section         Requiring
Event Number) Officer)            submittal item)   Number          Submittal Item)


                                  01000-1           01000           1.11
                                  01000-2           01000           1.26.1

                                  01000-3           01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1

                                                    01000           1.26.1

                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.26.1
                                                    01000           1.7.5
                                                    01000           1.7.6
                                                    01000           1.7.7
                                                    01000           1.7.1
                                                    01000                       1.8

                                                    01000                      1.1
                                                    01000                     1.25
                                                    01410
                                                    01410                       1.8
                                                    01410
                                                    01410
                                                    01410                       3.1
                                                    01410
                                                    01410
01410
01411
01411
02164
02164
02164   2.1.1
02164
02164
02164
02164
02164
02164
02300   3.4.1
02300
02300   1.6.1
02300   1.7.1
02300
02300
02300
02300
02300             3.12
02300             3.12


02300
02300
02316   3.4.2
02316   3.4.1
02378   2.1.1.1
02378   2.1.1.1
02395
02395
02395
02457              3.1
02457   3.1.2
02457              3.2
02464              2.1
02464   3.1.2.2
02464   3.1.1
02464   3.1.5

02464   2.3.2
02464   2.3.1
02741
02741
02821   2.1.1
02897              2.1
02897              2.2
02897   2.2.1
02921
02921
02921              2.8
02921   1.4.3
02921   3.1.2
02921   3.1.3
02921   1.4.1
02921   3.2.1
02921             2.2
02921             2.2
02921             2.1
02921   2.3.1
02921   2.3.2
02921   2.3.4
02921   2.3.5
02921             2.4
02921             2.5
02921             2.7
02921   1.4.1.1
02921             2.3
02921             2.4
02921             3.5
02921             3.9
02921   3.9.3.5
02921             3.6
03101             1.4
03101             2.1
03101             3.3
03151   2.2.2
03151   2.1.2.1
03151   2.1.3
03151   2.1.1
03151   2.1.2.2
03201             3.1
03201             2.1
03201             2.2
03201             2.2
03301             2.2
03301   3.1.1
03301   3.1.2
03301   3.1.2
03301   3.1.3
03301
03301             3.7
03301   3.7.1

03301   3.7.1
03301   3.2.3
03301             3.5
03301   3.3.4
03301   3.3.5
03301             3.4
03301   1.3.1.1

03301
03301   3.7.2.3
03301   3.7.2.13
03301              3.7
03301   2.1.1
03301   2.1.4.1
03301   2.1.3.1
03301   2.1.3.4
03301   2.1.4.2
03301   2.1.8
03301   2.1.7
03301   2.1.6
05055              1.3
05055   2.2.2.1
05055   2.2.2.3
05055   2.3.4
05055   2.1.1
05055   2.1.2
05055   2.1.3
05055              2.3

05055              1.4
05055   2.2.2.4
05055   2.2.2.3
05502              2.2

05502              2.1
05502              2.2

05502              2.1
05502              2.2

05502              2.1
05502              2.2
07600              2.1
08120              2.1
08120   3.1.2
08120   3.1.3
08120   2.1.1
08120              2.3
08700              2.5
08700              2.5
08700
09965
09965              1.4
09965              1.6
09965   1.6.6.1
09965   1.6.7.1
09965
09965   1.6.6
09965              1.7

09965
09965            2.1
09965            1.8
09965
13200
13300
13300
13300
13300
13854            2.1
13854            3.1

13854            1.3
14611   2.1.9
14611
14611            2.1
14611   2.2.6
14611
14611
14611            2.1
14611            2.2
14611            2.5
14611           2.15

14611
15895            2.1
15895

15895
16264

16264
16264
16264

16264
16264
16264
16264
16264   1.3.7
16264            1.6
16264   1.3.8
16264   1.3.8
16264            2.5
16264
16264   1.3.6
16264
16264
16264
16264
16264            2.9
16264            2.6
16264
16264
16264
16264             2.23
16264
16264
16264              3.7
16410
16410   1.3.1
16410              3.1
16410   1.3.1
16410   1.3.1
16410   2.3.1
16410
16410   1.3.1
16410   1.3.1
16410

16410

16410              3.2
16415
16415
16415
16415
16415
16415
16415
16905   2.6.1
16905
16905   2.2.7.2

16905
16905   2.2.14
16905              2.2
16905
16905              2.4
16905              2.3
16905
16905   2.2.9.2
16905              2.2
16905              2.3
16905   2.2.7.1
16905
16905              2.8
way 381,Broward County FL - DACW17-01-C-0026
Transmitted Awaiting Approval                     GREEN = Approved                                Contractor Schedule Dates




                                                                                     "G" or
                                                                                     "FIO"
                                                                                     (note when
                                                                                                                Approval
        Description of Item Submitted (Eng Form   Type of Submittal (using Section   req'd A/E                  Needed
        4025 Column "b")                          01330 Submittal Descriptions)      Reviewer)    Submit        By

        Contractor-Furnished Equipment            Preconstruction Submittal          FIO            21-Oct-01
        Letter Appointing Superintendent          Preconstruction Submittal          FIO            21-Oct-01
        Power of Attorney and Certified Copy of
        Resolution for local representatives      Preconstruction Submittal          FIO            21-Oct-01
        Certificate of Insurance                  Preconstruction Submittal          FIO            21-Oct-01
        Affirmative Action Plan                   Preconstruction Submittal          FIO            21-Oct-01
        Drug-Free Workplace                       Preconstruction Submittal          FIO            21-Oct-01
        List of Subcontractors                    Preconstruction Submittal          FIO            21-Oct-01
        Accident Prevention Plan                  Preconstruction Submittal          FIO            21-Oct-01
        Critical Lift Plan Operation              Preconstruction Submittal          FIO            21-Oct-01
        Hazard Communication Program              Preconstruction Submittal          FIO            21-Oct-01
        Confined Space Entry Plan                 Preconstruction Submittal          FIO            21-Oct-01
        Hurricane and Severe Storm Plan           Preconstruction Submittal          FIO            21-Oct-01
        Hurricane and Severe Storm Plan           Preconstruction Submittal          FIO            21-Oct-01
        Diving Plan                               Preconstruction Submittal          FIO            21-Oct-01
        Quality Control Plan (See 01451)          Preconstruction Submittal          FIO            21-Oct-01
        Manufacturer's Literature for Equipped
        Boat, Trailer, and Hand-Held Radios       Preconstruction Submittal          FIO            21-Oct-01


        Completed Electronic Submittal Register   Preconstruction Submittal          FIO            21-Oct-01
        Progress Charts                           Preconstruction Submittal          FIO            21-Oct-01
        Environmental Protection Plan             Preconstruction Submittal          FIO            21-Oct-01
        Traffic Control Plan                      Preconstruction Submittal          FIO            21-Oct-01
        As-Built Shop Drawings                    Shop Drawings                      FIO            21-Oct-01
        As-Built Contract Drawings                Shop Drawings                      FIO            21-Oct-01
        Electronic As-Built Files                 Closeout Submittals                FIO            21-Oct-01
        Working As-Built Drawings,                Shop Drawings                      G              21-Oct-01
        Construction Drawings                     Shop Drawings                      G              21-Oct-01
        Equipment Operating Instructions and
        Parts Identification                      Manufacturer's Instructions        G              21-Oct-01
        Hurricane and Severe Storm Plan           Preconstruction Submittal          G              21-Oct-01
        Bird Nesting Monitoring Qualifications    Preconstruction Submittal          G              21-Oct-01
        Environmental Protection Plan             Preconstruction Submittal          G              21-Oct-01
        Eastern Indigo Snake Observer             Certificates                       G (PD)         21-Oct-01
        Eastern Indigo Snake Monitoring Report    Closeout Submittals                FIO            21-Oct-01
        Project Environmental Summary Sheet       Closeout Submittals                FIO            21-Oct-01
        Logs/Final Summary Report                 Closeout Submittals                FIO            21-Oct-01
        Logs/Summary of Monitoring                Closeout Submittals                FIO            21-Oct-01
Final Comprehensive Report                   Closeout Submittals           FIO   21-Oct-01
Test Reports                                 Test Reports                  FIO   21-Oct-01
Calibration Standard,                        Manufacturer's Instructions   FIO   21-Oct-01
Load Test Set-Up                             Shop Drawings                 FIO   21-Oct-01
Employee Experience                          Certificates                  FIO   21-Oct-01
Threadbars                                   Certificates                  G     21-Oct-01
Grout Ingredients                            Certificates                  G     21-Oct-01
Test Jacks and Gages                         Certificates                  G     21-Oct-01
Grouting Records                             Test Reports                  FIO   21-Oct-01
Anchor Test Results                          Test Reports                  G     21-Oct-01
Core Log of Each Hole                        Test Reports                  FIO   21-Oct-01
Grout Compression Tests                      Test Reports                  G     21-Oct-01
Materials Other Than Salable Timber          Preconstruction Submittal     G     21-Oct-01
Earthwork                                    Product Data                  G     21-Oct-01
Operational Blasting Plan                    Product Data                  FIO   21-Oct-01
Vibration Control Plan                       Product Data                  G     21-Oct-01
Monitoring Report                            Test Reports                  FIO   21-Oct-01
Monitoring Location Set-Up                   Test Reports                  FIO   21-Oct-01
Daily Instrument Logs                        Test Reports                  FIO   21-Oct-01
Post-Construction Structural Survey          Test Reports                  FIO   21-Oct-01
Testing                                      Test Reports                  G     21-Oct-01
Testing,,                                    Certificates                  G     21-Oct-01
Qualifications for Structural
Inspection/Evaluation and Vibration
Monitoring Personnel                         Certificates                  G     21-Oct-01
Earthwork                                    Certificates                  G     21-Oct-01
Field Density Tests                          Test Reports                  FIO   21-Oct-01
Testing of Backfill Materials                Test Reports                  FIO   21-Oct-01
Geotextile                                   Samples                       FIO   21-Oct-01
Geotextile                                   Certificates                  FIO   21-Oct-01
Stone Samples                                Samples                       G     21-Oct-01
Stone                                        Certificates                  G     21-Oct-01
Stone Placement Plan                         Certificates                  G     21-Oct-01
Installation                                 Shop Drawings                 FIO   21-Oct-01
Pile Driving                                 Shop Drawings                 FIO   21-Oct-01
Pile Driving Equipment                       Product Data                  FIO   21-Oct-01
Metal Sheet Piling                           Shop Drawings                 G     21-Oct-01
Driving                                      Shop Drawings                 FIO   21-Oct-01
Pile Driving Equipment                       Product Data                  G     21-Oct-01
Pulling and Redriving                        Product Data                  G     21-Oct-01


Interlocked Joint Strength in Tension Test   Product Data                  G     21-Oct-01
Materials Tests                                                            FIO   21-Oct-01
Job Mix Formula                              Product Data                  FIO   21-Oct-01
Results of Asphalt Testing                   Product Data                  FIO   21-Oct-01
Chain Link Fence"                            Certificates                  FIO   21-Oct-01
Gage Strips and Figure Plates                Product Data                  G     21-Oct-01
Lumber                                       Certificates                  G     21-Oct-01
Preservatives                                Certificates                  G     21-Oct-01
Equipment                                    Preconstruction Submittal     FIO   21-Oct-01
Equipment                                    Product Data                  FIO   21-Oct-01
Surface Erosion Control Material             Product Data                  FIO   21-Oct-01
Chemical Treatment Material               Product Data    FIO   21-Oct-01
Equipment Calibration                     Test Reports    FIO   21-Oct-01
Soil Test                                 Test Reports    FIO   21-Oct-01
Delivery                                                  FIO   21-Oct-01
Finished Grade and Topsoil                Certificates    FIO   21-Oct-01
Topsoil                                   Certificates    FIO   21-Oct-01
Topsoil                                   Certificates    FIO   21-Oct-01
Seed                                      Certificates    FIO   21-Oct-01
pH Adjuster                               Certificates    FIO   21-Oct-01
Fertilizer                                Certificates    FIO   21-Oct-01
Organic Material                          Certificates    FIO   21-Oct-01
Soil Conditioner                          Certificates    FIO   21-Oct-01
Mulch                                     Certificates    FIO   21-Oct-01
Asphalt Adhesive                          Certificates    FIO   21-Oct-01
Pesticide                                 Certificates    FIO   21-Oct-01
Delivered Topsoil                         Samples         FIO   21-Oct-01
Soil Amendments                           Samples         FIO   21-Oct-01
Mulch                                     Samples         FIO   21-Oct-01
Quantity Check                                            FIO   21-Oct-01
Seed Establishment Period                                 FIO   21-Oct-01
Maintenance Record                                        FIO   21-Oct-01
Application of Pesticide                                  FIO   21-Oct-01
Shop Drawings                             Shop Drawings   FIO   21-Oct-01
Materials                                 Product Data    FIO   21-Oct-01
Inspection                                Test Reports    FIO   21-Oct-01
Splicing Waterstops                       Product Data    G     21-Oct-01
Field Molded Sealants and Primer          Samples         G     21-Oct-01
Waterstops                                Samples         G     21-Oct-01
Premolded Expansion Joint Filler Strips   Test Reports    G     21-Oct-01
Compression Seals and Lubricant           Test Reports    G     21-Oct-01
Fabrication and Placement                 Shop Drawings   G     21-Oct-01
Materials                                 Shop Drawings   G     21-Oct-01
Material                                  Test Reports    G     21-Oct-01
Tests, Inspections, and Verifications     Test Reports    G     21-Oct-01
Concrete Mixture Proportioning            Product Data    G     21-Oct-01
Batch Plant                               Product Data    FIO   21-Oct-01
Concrete Mixers                           Product Data    FIO   21-Oct-01
Capacity                                  Product Data    FIO   21-Oct-01
Conveying Equipment                       Product Data    FIO   21-Oct-01
Placing Equipment                         Product Data          21-Oct-01
Tests and Inspections                     Product Data    G     21-Oct-01
Testing Technicians                       Product Data    G     21-Oct-01
Concrete Transportation Construction
Inspector (CTCI)                          Product Data    G     21-Oct-01
Construction Joint Treatment              Product Data    G     21-Oct-01
Curing and Protection                     Product Data    G     21-Oct-01
Cold-Weather Placing                      Product Data    G     21-Oct-01
Hot-Weather Placing                       Product Data    G     21-Oct-01
Finishing                                 Product Data    G     21-Oct-01
Aggregates                                Samples         G     21-Oct-01
Cementitious Materials, Admixtures, and
Curing Compound                           Samples         G     21-Oct-01
Quality of Aggregates                       Test Reports    G   21-Oct-01
Mixer Uniformity                            Test Reports    G   21-Oct-01
Tests and Inspections                       Test Reports    G   21-Oct-01
Cementitious Materials                      Certificates    G   21-Oct-01
Impervious-Sheet Curing Materials           Certificates    G   21-Oct-01
Air-Entraining Admixture                    Certificates    G   21-Oct-01
Other Chemical Admixtures                   Certificates    G   21-Oct-01
Membrane-Forming Curing Compound            Certificates    G   21-Oct-01
Epoxy Resin                                 Certificates    G   21-Oct-01
Latex Bonding Compound                      Certificates    G   21-Oct-01
Nonshrink Grout                             Certificates    G   21-Oct-01
Detail Drawings                             Shop Drawings   G   21-Oct-01
Welding of Structural Steel                 Product Data    G   21-Oct-01
Welding of Aluminum                         Product Data    G   21-Oct-01
Structural Steel Welding Repairs            Product Data    G   21-Oct-01
Materials Orders                            Product Data    G   21-Oct-01
Materials List                              Product Data    G   21-Oct-01
Shipping Bill                               Product Data    G   21-Oct-01
Tests, Inspections, and Verifications       Test Reports    G   21-Oct-01
Qualification of Welders and Welding
Operators                                   Certificates    G   21-Oct-01
Application Qualification for Steel Studs   Certificates    G   21-Oct-01
Welding of Aluminum                         Certificates    G   21-Oct-01
Shop Fabricated Metal Items                 Shop Drawings   G   21-Oct-01
Miscellaneous Metals and Standard Metal
Articles                                    Product Data    G   21-Oct-01
Shop Fabricated Metal Items                 Product Data    G   21-Oct-01
Miscellaneous Metals and Standard Metal
Articles                                    Samples         G   21-Oct-01
Shop Fabricated Metal Items                 Samples         G   21-Oct-01
Miscellaneous Metals and Standard Metal
Articles                                    Test Reports    G   21-Oct-01
Shop Fabricated Metal Items                 Test Reports    G   21-Oct-01
Materials                                   Shop Drawings   G   21-Oct-01
Aluminum Doors and Frames                   Product Data    G   21-Oct-01
Installation                                Product Data    G   21-Oct-01
Cleaning                                    Product Data    G   21-Oct-01
Finishes                                    Samples         G   21-Oct-01
Aluminum Doors                              Test Reports    G   21-Oct-01
Exit Devices                                Shop Drawings   G   21-Oct-01
Exit Device Accessories                     Product Data    G   21-Oct-01
Hardware Schedule                           Product Data    G   21-Oct-01
Inspections and Operations                  Product Data    G   21-Oct-01
Qualifications                              Product Data    G   21-Oct-01
Safety and Health Provisions                Product Data    G   21-Oct-01
Ventilation                                 Product Data    G   21-Oct-01
Respirators                                 Product Data    G   21-Oct-01
Airborne Sampling Plan                      Product Data    G   21-Oct-01
Paint Application                           Product Data    G   21-Oct-01
Medical Status                              Product Data    G   21-Oct-01
Waste Classification, Handling, and
Disposal Plan                               Product Data    G   21-Oct-01
Special Paint Formulas                    Samples                           G     21-Oct-01
Thinners                                  Samples                           G     21-Oct-01
Specification and Proprietary Paints      Test Reports                      G     21-Oct-01
Shop drawings and catalog data            Product Data                      G     21-Oct-01
Shop and erection drawings                Shop Drawings                     G     21-Oct-01
Manufacturer's standard design data       Product Data                      G     21-Oct-01
Warranty                                  Certificates                      G     21-Oct-01
Written documentation                     Certificates                      G     21-Oct-01
Manufacturer's Catalog Data               Product Data                      FIO   21-Oct-01
Listing of Product Installations          Certificates                      FIO   21-Oct-01


Operation and Maintenance Manual          Operations and Maintenance Data   FIO   21-Oct-01
Motor nameplates                          Preconstruction Submittal         G     21-Oct-01
Vertical Lift Gate Operating System,      Shop Drawings                     G     21-Oct-01
Hoist Motor                               Shop Drawings                     FIO   21-Oct-01
Brake Enclosing Case                      Shop Drawings                     FIO   21-Oct-01
Calculations and Drawings                 Product Data                            21-Oct-01
Catalog Data                              Product Data                      FIO   21-Oct-01
Hoist Motor                               Product Data                            21-Oct-01
Brake                                     Product Data                      FIO   21-Oct-01
Limit Switch                              Product Data                      FIO   21-Oct-01
Tests                                     Test Reports                      FIO   21-Oct-01


Vertical Lift Gate Operating System       Operations and Maintenance Data G       21-Oct-01
Components and Equipment                  Product Data                    G       21-Oct-01
Similar Services                          Product Data                    G       21-Oct-01


Operating and Maintenance Instructions    Operations and Maintenance Data   FIO   21-Oct-01
Layout and Shop Drawings                  Shop Drawings                     G     21-Oct-01
As-Built Drawings                         Shop Drawings                     G     21-Oct-01
Equipment Performance                     Product Data                      FIO   21-Oct-01
Generator Data                            Product Data                      FIO   21-Oct-01
Power Factor Capability Curve             Product Data                      FIO   21-Oct-01


Heat Rejected to Engine-Generator Space   Product Data                      FIO   21-Oct-01
Alarm Setpoints                           Product Data                      FIO   21-Oct-01
Cooling Equipment and Performance         Product Data                      FIO   21-Oct-01
Manufacturer's Catalog Data               Product Data                      FIO   21-Oct-01
Vibration-Isolation                       Product Data                      FIO   21-Oct-01
Onsite Test                               Test Reports                            21-Oct-01
Component Manufacturer                    Certificates                      FIO   21-Oct-01
Manufacturer/Assembler                    Certificates                      FIO   21-Oct-01
Cooling System,                           Certificates                      FIO   21-Oct-01
Field Engineer                            Certificates                      FIO   21-Oct-01
Welder Qualification                      Certificates                      FIO   21-Oct-01
Installation Procedures                   Certificates                      FIO   21-Oct-01
Torsional Vibration                       Certificates                      FIO   21-Oct-01
Prototype Tests                           Certificates                      FIO   21-Oct-01
Reliability and Durability                Certificates                      FIO   21-Oct-01
Emissions                                 Certificates                      FIO   21-Oct-01
Sound limitation                          Certificates                      FIO   21-Oct-01
Site Visit                                Certificates                      FIO   21-Oct-01
Flywheel Balance                             Certificates                      FIO   21-Oct-01
Standards Compliance                         Certificates                      FIO   21-Oct-01
Factory Tests                                Certificates                      FIO   21-Oct-01
Functional Facilities                        Certificates                      FIO   21-Oct-01
Posted Data                                  Manufacturer's Instructions       G     21-Oct-01
Instructions                                 Manufacturer's Instructions       G     21-Oct-01
Switches                                     Shop Drawings                     G     21-Oct-01
Equipment                                    Shop Drawings                     G     21-Oct-01
Installation                                 Shop Drawings                     G     21-Oct-01
Material                                     Product Data                      G     21-Oct-01
Equipment                                    Product Data                      G     21-Oct-01
Tests                                        Test Reports                      G     21-Oct-01
GE                                           Test Reports                      G     21-Oct-01
Equipment                                    Certificates                      G     21-Oct-01
Material                                     Certificates                      G     21-Oct-01
Switching Equipment                          Certificates                      G     21-Oct-01


Switching Equipment                          Operations and Maintenance Data G       21-Oct-01


Instructions                                 Operations and Maintenance Data   G     21-Oct-01
Interior Electrical Equipment                Shop Drawings                     G     21-Oct-01
As-Built Drawings                            Shop Drawings                     FIO   21-Oct-01
Manufacturer's Catalog                       Product Data                      G     21-Oct-01
Material, Equipment, and Fixture Lists       Product Data                      G     21-Oct-01
Installation Procedures                      Product Data                      FIO   21-Oct-01
Onsite Test                                  Certificates                      G     21-Oct-01
Materials and Equipment                      Certificates                      G     21-Oct-01
Conductors,                                  Preconstruction Submittal         FIO   21-Oct-01
Terminal Leads                               Preconstruction Submittal         FIO   21-Oct-01
Terminal Blocks                              Preconstruction Submittal         FIO   21-Oct-01
Method of identifying conductors, terminal
leads, and terminal blocks                   Preconstruction Submittal         G     21-Oct-01
Equipment and Door Nameplates                Preconstruction Submittal         G     21-Oct-01
Controller                                   Shop Drawings                     G     21-Oct-01
As-Built Drawings                            Shop Drawings                     FIO   21-Oct-01
Limit Switch                                 Shop Drawings                     FIO   21-Oct-01
Control Stations                             Shop Drawings                     FIO   21-Oct-01
Instruments and Controls                     Shop Drawings                     FIO   21-Oct-01
Overload Relays                              Product Data                      G     21-Oct-01
Controller                                   Product Data                      G     21-Oct-01
Control Stations                             Product Data                      G     21-Oct-01
Wiring                                       Product Data                      G     21-Oct-01
Instruments and Controls                     Product Data                      G     21-Oct-01
Tests                                        Test Reports                      FIO   21-Oct-01
or Schedule Dates   Contractor's Action              Approving Authority
                                            Date
                                            FWD to
                                            Appr
                                            Auth -                                          Mailed to
                    Action                  Date                Date                        Contr/
                    Code                    Received            Received                    Date Rcd
                    Contractor
           Item     QC Code See
                                            from     Date Fwd from                          from
           Needed   back of ENG   Date of   Contract to Other   Other    Action   Date of   Apprv
           By       4025          Action    or       Reviewer Reviewer Code       Action    Auth
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Description: Sample Power of Attorney Forms document sample