Form CEM-4902C "Extra Work Bill - Equipment Charges" - California

What Is Form CEM-4902C?

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-4902C by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

ADVERTISEMENT
ADVERTISEMENT

Download Form CEM-4902C "Extra Work Bill - Equipment Charges" - California

Download PDF

Fill PDF online

Rate (4.8 / 5) 45 votes
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - EQUIPMENT CHARGES
CASEWB
CEM-4902C (NEW 7/1994)
CONTACT NO.
CCO NO.
REPORT NO.
PAGE
of
EQUIPMENT DESCRIPTION
REGULAR
OVERTIME
REG
OT
EXTENDED
EQUIP ID NUMBER
HOURS
HOURS
RATE
RATE
AMOUNT
CLASS
MAKE
CODE
ATTACH
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
SIGNATURE OF RESIDENT ENGINEER
TOTAL
IN CASE OF QUESTION CONTACT:
$0.00
(RESIDENT ENGINEERS USE ONLY)
(A)
SIGNATURE OF PRIME CONTRACTORS REPRESENTATIVE
NAME
BUSINESS PHONE
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
EXTRA WORK BILL - EQUIPMENT CHARGES
CASEWB
CEM-4902C (NEW 7/1994)
CONTACT NO.
CCO NO.
REPORT NO.
PAGE
of
EQUIPMENT DESCRIPTION
REGULAR
OVERTIME
REG
OT
EXTENDED
EQUIP ID NUMBER
HOURS
HOURS
RATE
RATE
AMOUNT
CLASS
MAKE
CODE
ATTACH
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
SIGNATURE OF RESIDENT ENGINEER
TOTAL
IN CASE OF QUESTION CONTACT:
$0.00
(RESIDENT ENGINEERS USE ONLY)
(A)
SIGNATURE OF PRIME CONTRACTORS REPRESENTATIVE
NAME
BUSINESS PHONE
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
ADA Notice
For individuals with sensory disabilities, this document is available in alternate
EXTRA WORK BILL - EQUIPMENT CHARGES
formats.
For information call (916) 654-6410 or TDD (916) 654-3880 or write
Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
CEM-4902C (NEW 7/1994)
Preparing Form CEM-4902C
Form CEM-4902C is provided for entry of the contractor equipment costs used to perform work on a contract change order.
Information in the shaded area will not become part of the electronic copy of the bill. Following is a list of these fields:
FIELD
REMARKS
Contract No.
Required entry, same as on the Title Page
CCO No.
Required entry, same as on the Title Page
Report No.
Required entry, same as on the Title Page
Equipment ID
Required entry. Enter the equipment's I.D. number.
Equipment Description
Each piece of equipment is identified by code. This code is either in the Equipment Rental Rate Book or is
included in the Miscellaneous Equipment Listing.
Equipment Class
Required entry. In the Equipment Rental Rate book, this code is included in the heading for the class of
equipment and is set off by brackets [ ].
Equipment Make
Required entry. In the Equipment Rental Rate book, this code is included in the subheading adjacent to the
Manufacturer's name and is set off by brackets [ ].
Equipment Code
Required entry. In the Equipment Rental Rate book, this code is included in the line of the equipment being
identified under the subheading "CODE".
Attach
Optional entry. In the equipment Rental Rate Book, the attachment codes are in the class "ATTACHMENTS"
and are identified under the subheading "CODE."
Regular Hours
Enter the number of Regular hours worked.
Premium Hours
Enter the number of Premium hours worked.
NOTE: If the equipment was on R/W delay, place a "Y" in the R/W Delay box on the Title Page Form.
Page of 2