Form CEM-4902A "Extra Work Bill - Title Page" - California

What Is Form CEM-4902A?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 1994;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-4902A by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-4902A "Extra Work Bill - Title Page" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CASEWB
EXTRA WORK BILL-TITLE PAGE
CONTRACT NO.
CCO NO. REPORT NO. PAGE
CEM-4902A (NEW 7/1994)
OF
E.W.
A. C.
* 50%
SUB
R/W
PARTNERING
FLAG
WORK
DELAY
SWITCH
+/-
FA
LS
UP
FA
LS
UP
BR
DATE PERFORMED
DATE OF REPORT
CON. JOB. NO.
CONT. RPT. NO
0 1
WORK PERFORMED BY
0 2
DESCRIPTION OF WORK
0 3
FOR RESIDENT ENGINEERS USE ONLY
ATTACHED TO THIS BILL ARE:
DATE RECEIVED
Labor Charges CEM-4902B
New Bill
Approved for Payment
Equipment Charges CEM-4902C
DATE OF ACTION
Resubmittal
Returned for Correction
Material Charges CEM-4902D
TOTAL COST SUMMARY, STANDARD MARK-UPS & SUBCONTRACTOR MARK-UP
Total Equipment (A)
Total Other Expense (F)
Total Material (B)
Subtotal (C) + (D) + Regular Surcharge + Premium Surcharge + (E) + (F)
Subtotal Equipment & Materials (A) + (B)
% Standard Mark-up
% Standard Mark-up
Total Labor (C) + (D) + Surcharge + (E) + (F) + Mark-up
Total Equipment & Materials (A) + (B) + Standard Mark-up
Total Equipment & Materials
Total Regular Labor (C)
Total Equipment & Materials + Total Labor
% Regular Labor Surcharge
% of Mark-up on Subcontracted Work (Only)
Total Premium Labor (D)
GRAND TOTAL
% Premium Labor Surcharge
Subtotal Regular & Premium (C+D)
Subtotal (C) + (D) + Regular Surcharge + Premium Surcharge
Total Subsistence (E)
SIGNATURE (Resident Engineer)
IN CASE OF QUESTION:
(Resident Engineer Use Only)
SIGNATURE (Prime Contractor's Representative)
NAME
BUSINESS PHONE
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street,
ADA Notice
MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CASEWB
EXTRA WORK BILL-TITLE PAGE
CONTRACT NO.
CCO NO. REPORT NO. PAGE
CEM-4902A (NEW 7/1994)
OF
E.W.
A. C.
* 50%
SUB
R/W
PARTNERING
FLAG
WORK
DELAY
SWITCH
+/-
FA
LS
UP
FA
LS
UP
BR
DATE PERFORMED
DATE OF REPORT
CON. JOB. NO.
CONT. RPT. NO
0 1
WORK PERFORMED BY
0 2
DESCRIPTION OF WORK
0 3
FOR RESIDENT ENGINEERS USE ONLY
ATTACHED TO THIS BILL ARE:
DATE RECEIVED
Labor Charges CEM-4902B
New Bill
Approved for Payment
Equipment Charges CEM-4902C
DATE OF ACTION
Resubmittal
Returned for Correction
Material Charges CEM-4902D
TOTAL COST SUMMARY, STANDARD MARK-UPS & SUBCONTRACTOR MARK-UP
Total Equipment (A)
Total Other Expense (F)
Total Material (B)
Subtotal (C) + (D) + Regular Surcharge + Premium Surcharge + (E) + (F)
Subtotal Equipment & Materials (A) + (B)
% Standard Mark-up
% Standard Mark-up
Total Labor (C) + (D) + Surcharge + (E) + (F) + Mark-up
Total Equipment & Materials (A) + (B) + Standard Mark-up
Total Equipment & Materials
Total Regular Labor (C)
Total Equipment & Materials + Total Labor
% Regular Labor Surcharge
% of Mark-up on Subcontracted Work (Only)
Total Premium Labor (D)
GRAND TOTAL
% Premium Labor Surcharge
Subtotal Regular & Premium (C+D)
Subtotal (C) + (D) + Regular Surcharge + Premium Surcharge
Total Subsistence (E)
SIGNATURE (Resident Engineer)
IN CASE OF QUESTION:
(Resident Engineer Use Only)
SIGNATURE (Prime Contractor's Representative)
NAME
BUSINESS PHONE
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street,
ADA Notice
MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL-TITLE PAGE
CEM-4902A (NEW 7/1994)
Preparing Form CEM 4902A
Form CEM 4902A is provided for entry of basic information related to extra work performed on a Contract Change Order. It is the first of four input forms
used to file the Extra Work Bill and are required for each billing. Entries in the shaded areas will not become part of the electronic copy of the bill and are
for the user's information only.
The top of this form includes fields that are used to record basic information required on all Extra Work Bills. Following is a list of these fields: All switch
fields, Bridge, flagging, sub work, R/W Delay and Partnering are set by entering an "Y" in the appropriate box. To remove a switch from an existing bill,
place an "N" in the appropriate box.
FIELD
REMARKS
Contract Number
Required entry
CCO Number
Required entry
Report Number
Required entry. This number is assigned by the submitter (R.E.), in sequential order beginning with 0001 for each CCO.
Date performed
This is required entry. "VAR" may be entered in this field if the pay method is lump-sum or unitprice and forms for
equipment and labor bill are not used.
Date of Report
Required entry.
Cont. Job No.
Optional entry.
Cont. Rpt. No.
Optional entry.
Payment Method
Required entry. Indicate + or -, and place an "X" in the appropriate box. A blank is considered a +
BR Switch
Place a "Y" in this box if bridge work is involved. Use an "N" to remove BR Switch.
50% Flag
Place a "Y" in this box if pay is for 50% flagging. Use an "N" to remove 50% flagging.
Sub Work
Place a "Y" in this box if 5% Sub contractor markup is involved. Use "N" to remove Sub contractor markup.
R/W Delay
Place a "Y" in this box to indicate R/W delay. Use an "N" to remove R/W Delay.
Partnering Switch
Place a "Y" in this box to indicate this bill is for Partnering cost billing.
Work Performed By
Optional
Description of Work
Optional
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