Form CEM-6201D "Initial Potential Claim Record" - California

What Is Form CEM-6201D?

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, 2014;
  • 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-6201D 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-6201D "Initial Potential Claim Record" - California

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FOR STATE USE ONLY
INITIAL POTENTIAL CLAIM RECORD
Received by
Date
CEM-6201D (REV 9/2014)
(For resident engineer)
TO
(RESIDENT ENGINEER)
CONTRACT NUMBER
DATE
IDENTIFICATION NUMBER
This is an Initial Potential Claim Record for additional compensation and/or days submitted as required under the provisions of Section
5-1.43, "Potential Claims and Dispute Resolution," of the Standard Specifications. The engineer's response to the Request for Information
was received on:
DATE
The particular nature and circumstances of this potential claim are described as follows:
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.
FOR STATE USE ONLY
INITIAL POTENTIAL CLAIM RECORD
Received by
Date
CEM-6201D (REV 9/2014)
(For resident engineer)
TO
(RESIDENT ENGINEER)
CONTRACT NUMBER
DATE
IDENTIFICATION NUMBER
This is an Initial Potential Claim Record for additional compensation and/or days submitted as required under the provisions of Section
5-1.43, "Potential Claims and Dispute Resolution," of the Standard Specifications. The engineer's response to the Request for Information
was received on:
DATE
The particular nature and circumstances of this potential claim are described as follows:
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.