Form CEM-1203 "Contractor Action Request - Assignment of Contract Performance" - California

What Is Form CEM-1203?

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 September 1, 2015;
  • 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-1203 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-1203 "Contractor Action Request - Assignment of Contract Performance" - California

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CONTRACTOR ACTION REQUEST - ASSIGNMENT OF CONTRACT PERFORMANCE
Page 1 of 3
CEM-1203 (REV 09/2015)
PERSONAL INFORMATION NOTICE
Pursuant to the Federal Privacy Act (P.L. 93-579) and the Information Practices Act of 1977 (IPA) (Civil Code Sections 1798, et seq.), notice is hereby given for the request of personal
information by this form. The requested personal information is voluntary. The principal purpose of the voluntary information is to facilitate the processing of this form. The failure to
provide all or any part of the requested information may delay processing of this form. No disclosure of personal information will be made unless permissible under Article 6, Section
1798.24 of the IPA of 1977. Each individual has the right upon request and proper identification, to inspect all personal information in any record maintained on the individual by an
identifying particular. Direct any inquiries on information maintenance to your IPA Officer.
ASSIGNMENT OF PERFORMANCE
ACCEPTANCE OF ASSIGNMENT OF PERFORMANCE
Assignor having contracted with the State of California, Department of
Assignee hereby accepts said assignment and agrees to perform and complete
Transportation for the performance of below contract hereby assigns said
said contract in accordance with the terms thereof. This assignment is not
contract performance to assignee indicated herewith. Assignor shall remain
effective until the director of the Department of Transportation has consented
responsible to the State of California, Department of Transportation to ensure
thereto in writing.
that its contractual obligations are satisfactorily completed.
Contract Number:
Assignee: (business name)
Contractor: (business name)
Mailing Address:
Contractor License #:
City:
State:
Zip Code:
Address:
City:
Phone Number:
State:
Zip Code:
Email Address:
Phone Number:
Assignee Representative's Name: (type or print)
Contractor Representative's Name: (type or print)
Title:
Contractor Principal's or CEO's Name: (type or print)
Date:
Signature:
Contractor Principal's or CEO's Signature:
Date:
By checking this box, I confirm that a completed
STD. 204 PAYEE DATA RECORD is attached.
CONSENT OF SURETY
Notary Public's signature and stamp here or as an attachment
As surety upon the performance bond and the payment bond (or labor and
materials bond) given on behalf of assignor and principal and in favor of the
State of California, obligee on said contract hereby consents to the foregoing
assignment and agrees that said bond shall continue in full force and effect and
that surety's obligations under said bonds shall be in no way impaired or
diminished by reason of said assignment.
Bond Number:
Surety Name:
Representative's Name: (type or print)
Title:
Notary Public's Name: (type or print)
Date:
Date:
Signature:
Signature:
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
CONTRACTOR ACTION REQUEST - ASSIGNMENT OF CONTRACT PERFORMANCE
Page 1 of 3
CEM-1203 (REV 09/2015)
PERSONAL INFORMATION NOTICE
Pursuant to the Federal Privacy Act (P.L. 93-579) and the Information Practices Act of 1977 (IPA) (Civil Code Sections 1798, et seq.), notice is hereby given for the request of personal
information by this form. The requested personal information is voluntary. The principal purpose of the voluntary information is to facilitate the processing of this form. The failure to
provide all or any part of the requested information may delay processing of this form. No disclosure of personal information will be made unless permissible under Article 6, Section
1798.24 of the IPA of 1977. Each individual has the right upon request and proper identification, to inspect all personal information in any record maintained on the individual by an
identifying particular. Direct any inquiries on information maintenance to your IPA Officer.
ASSIGNMENT OF PERFORMANCE
ACCEPTANCE OF ASSIGNMENT OF PERFORMANCE
Assignor having contracted with the State of California, Department of
Assignee hereby accepts said assignment and agrees to perform and complete
Transportation for the performance of below contract hereby assigns said
said contract in accordance with the terms thereof. This assignment is not
contract performance to assignee indicated herewith. Assignor shall remain
effective until the director of the Department of Transportation has consented
responsible to the State of California, Department of Transportation to ensure
thereto in writing.
that its contractual obligations are satisfactorily completed.
Contract Number:
Assignee: (business name)
Contractor: (business name)
Mailing Address:
Contractor License #:
City:
State:
Zip Code:
Address:
City:
Phone Number:
State:
Zip Code:
Email Address:
Phone Number:
Assignee Representative's Name: (type or print)
Contractor Representative's Name: (type or print)
Title:
Contractor Principal's or CEO's Name: (type or print)
Date:
Signature:
Contractor Principal's or CEO's Signature:
Date:
By checking this box, I confirm that a completed
STD. 204 PAYEE DATA RECORD is attached.
CONSENT OF SURETY
Notary Public's signature and stamp here or as an attachment
As surety upon the performance bond and the payment bond (or labor and
materials bond) given on behalf of assignor and principal and in favor of the
State of California, obligee on said contract hereby consents to the foregoing
assignment and agrees that said bond shall continue in full force and effect and
that surety's obligations under said bonds shall be in no way impaired or
diminished by reason of said assignment.
Bond Number:
Surety Name:
Representative's Name: (type or print)
Title:
Notary Public's Name: (type or print)
Date:
Date:
Signature:
Signature:
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
CONTRACTOR ACTION REQUEST - ASSIGNMENT OF CONTRACT PERFORMANCE
Page 2 of 3
CEM-1203 (REV 09/2015)
CURRENT CONTRACT PAYEE
Payee: (business name)
Phone Number:
Mailing Address:
Fax Number:
City:
Zip Code:
Email Address:
State:
For this request, will the current Contract Payee be the same?
Yes
No
If no, the Requestor must attach with this submission a completed form CEM-1202B.
- For Department Use Only -
Advantage CT Document Vendor Information Update
PRIOR to Advantage update (data entered
AFTER Advantage update (data entered by
by District Payments Coordinator)
District Payments Coordinator)
CT Document Identification Number
Vendor/Customer Identification Number
Vendor/Customer Address Identification Number
Resident Engineer's Verification
Director, Department of Transportation Consent
I certify that the above information has been reviewed and determined
Director, Department of Transportation, acting by his undersigned
to be complete and accurate. Both assignor and assignee have
authorized agent, consents to the foregoing assignment of
confirmed validity of the requested action.
performance of said contract upon the express condition that assignor
and the surety on the contract bonds remain responsible to ensure that
its contractual obligations are satisfactorily completed.
Resident Engineer's Name: (type or print)
Signature:
Date:
Date:
Division of Construction Chief's Signature:
Division of Construction Field Coordinator's Concurrence
Advantage CT Document and Vendor Information Updated By
Field Coordinator's Name: (type or print)
District Payments Coordinator's Name: (type or print)
Signature:
Date:
Signature:
Date:
CAS Updated By
HQ Payments Coordinator's Name: (type or print)
Signature:
Date:
CONTRACTOR ACTION REQUEST - ASSIGNMENT OF CONTRACT PERFORMANCE
Page 3 of 3
CEM-1203 (REV 09/2015)
GENERAL INSTRUCTIONS
1. This form and form STD. 204 Payee Data Record are required when requesting assignment of contract performance to another contractor or
entity (i.e. surety, bonding companies).
Attach form CEM-1202B if also requesting assignment of contract monies to another
contractor or entity.
Instructions to the REQUESTOR (ie. contractor, surety, bonding company)
2. Make a separate request per contract.
3. If the request involves a new surety, submit original bonding documentation to the resident engineer as an attachment to this request.
4. Signatures in Sections 1, 2, and 3 must be acknowledged before a Notary Public.
5. Submit completed form CEM-1203, form STD. 204 (do not complete Section 6 of form STD. 204), and if applicable, form CEM-1202B to the
resident engineer. Prompt and correct requests will prevent delay in processing payments.
Instructions to the RESIDENT ENGINEER
6. VERIFY form STD. 204 is attached to submitted form CEM-1203.
7. REVIEW supplemental attachments (form CEM-1202B or bonding documentation), if applicable.
8. REVIEW submittal for completeness and accuracy.
9. VERIFY that the business name and mailing address in form STD. 204 matches the information in form CEM-1203.
10. Print or type name, sign, and date in appropriate section.
11. Forward reviewed submittal to District Payments Coordinator.
Instructions to the DISTRICT PAYMENTS COORDINATOR
12. Enter existing Advantage CT document and vendor information.
13. Forward submittal to Division of Construction Field Coordinator for concurrence.
Instructions to the DIVISION OF CONSTRUCTION FIELD COORDINATOR
14. Upon receipt of the submittal, conduct a quality assurance review in coordination with the resident engineer.
15. Print or type name, sign, and date in appropriate section.
16. Obtain the Division of Construction Chief's consent.
17. Forward submittal, with concurrence, to the District Payments Coordinator to create CT document with the new vendor information.
Instructions to the DISTRICT PAYMENTS COORDINATOR
18. Upon receipt of the approved submittal, forward a copy of form STD. 204 to HQ Accounting (Payee.Data.Records@dot.ca.gov).
19. Create a new CT document with the new vendor information in Advantage.
20. Enter new Advantage CT document and vendor information.
21. Print or type name, sign and date in the appropriate section.
22. Forward the submittal to the HQ Payments Coordinator.
Instructions to the HQ PAYMENTS COORDINATOR
23. Upon receipt of approved submittal, update Contract Administration System (CAS).
24. If the submittal includes form CEM-1202B, then process form CEM-1203 before processing form CEM-1202B.
25. Print or type name, sign, and date in appropriate section.
26. Send a copy of the processed submittal to the resident engineer, District Payments Coordinator and Division of Accounting, Office of
Commodity and Contract Payables (OCCP).
Instructions to the DISTRICT PAYMENTS COORDINATOR
27. Upon receipt of processed submittal, verify requested change was made in Advantage.
Instructions to the RESIDENT ENGINEER
28. Provide a copy of the processed submittal to the REQUESTOR.
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