
IDENTIFICATION NUMBER (resident engineer) This is a Supplemental Notice of Potential Claim for additional compensation submitted as required under the provisions of Section 9-1.04, "Notice of Potential Claim," of the Standard Specifications. The act of the engineer, or his/her failure to act, or the event, thing, occurrence, DATE or other cause giving rise to the potential claim occurred on: The particular nature and circumstances of this potential claim are described in detail as follows (at.
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How to fill out the CA CEM-6201B online
The CA CEM-6201B, also known as the Supplemental Notice of Potential Claim, is a crucial document used within the State of California for submitting potential claims for additional compensation. This guide provides clear, user-friendly instructions to assist you in completing the form accurately and efficiently.
Follow the steps to successfully complete the CA CEM-6201B online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the date at the top of the form on the specified line.
- Provide the contract number in the designated section to link your submission to the appropriate contract.
- In the field labeled 'To,' indicate the name or title of the individual the notice is being submitted to.
- Re-enter the date again in the specified field below the 'To' section.
- Fill in the identification number associated with the resident engineer overseeing the contract.
- Detail the date, event, or cause that has given rise to the potential claim in the respective section.
- Elaborate on the circumstances surrounding your claim in the available space, and attach additional sheets if necessary.
- Enumerate the basis for your claim, referencing all relevant contract provisions and attaching additional sheets as required.
- Present an estimated dollar cost of the claim, including a description of how the estimate was derived and an itemized breakdown of costs.
- If applicable, attach a time impact analysis that discusses the effect on the project's completion date.
- Sign the form in the section for the originator, making sure to circle whether you are a subcontractor or contractor.
- Include the authorized representative's name, and have the prime contractor acknowledge and certify the notice by signing where indicated.
- Once all fields are completed, review your entries for accuracy. Then, you may choose to save changes, download, print, or share the form as required.
Complete your CA CEM-6201B online easily and accurately to ensure your potential claims are properly submitted.
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