Form CEM-6201 "Notice of Potential Claim" - California

What Is Form CEM-6201?

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, 2008;
  • 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-6201 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-6201 "Notice of Potential Claim" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
FOR STATE USE ONLY
NOTICE OF POTENTIAL CLAIM
Received by
Date
CEM-6201 (REV. 7/2008)
(For resident engineer)
TO
CONTRACT NUMBER
DATE
(resident engineer)
This is a Notice of Potential Claim for additional compensation under the provisions of Section 9-1.04 of the Standard Specifications.
The act of the engineer, or his/her failure to act, or the event, thing, occurrence, or other cause giving rise to the potential claim
occurred on:
DATE
The particular circumstances of this potential claim are described in detail as follows:
The reasons for which I believe additional compensation may be due are:
The nature of the costs involved and the amount of the potential claim are described as follows:
(If accurate cost figures are not available, provide an estimate, or describe the types of expenses involved.)
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or
ADA Notice
write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
FOR STATE USE ONLY
NOTICE OF POTENTIAL CLAIM
Received by
Date
CEM-6201 (REV. 7/2008)
(For resident engineer)
TO
CONTRACT NUMBER
DATE
(resident engineer)
This is a Notice of Potential Claim for additional compensation under the provisions of Section 9-1.04 of the Standard Specifications.
The act of the engineer, or his/her failure to act, or the event, thing, occurrence, or other cause giving rise to the potential claim
occurred on:
DATE
The particular circumstances of this potential claim are described in detail as follows:
The reasons for which I believe additional compensation may be due are:
The nature of the costs involved and the amount of the potential claim are described as follows:
(If accurate cost figures are not available, provide an estimate, or describe the types of expenses involved.)
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or
ADA Notice
write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.