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Appendix A Blank Forms

Contractor’s Statement of Responsibility

Each contractor responsible for the construction or fabrication of a system or component designated in the Quality Assurance Plan must submit a Statement of Responsibility.

Project:

Contractor’s Name:

Address:

License No.:

Description of designated building systems and components included in the Statement of Responsibility:

Contractor s Acknowledgment of Special Requirements

I hereby acknowledge that I have received, read, and understand the Quality Assurance Plan and Special Inspection program.

I hereby acknowledge that control will be exercised to obtain conformance with the construction documents approved by the Building Official.

________________________________ Signature

_______________ Date

Contractor s Provisions for Quality Control

Procedures for exercising control within the contractor’s organization, the method and frequency of reporting and the distribution of reports is attached to this Statement.

Identification and qualifications of the person(s) exercising such control and their position(s) in the organization are attached to this Statement.

  • Contractor’s Statement of Responsibility

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