Form DC-161 "Contractual Notice Form" - New Jersey

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Download this version of Form DC-161 for the current year.

What Is Form DC-161?

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

Form Details:

  • Released on November 9, 2016;
  • The latest edition provided by the New Jersey Department of Transportation;
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Download Form DC-161 "Contractual Notice Form" - New Jersey

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Form DC-161 for 2007 Specifications- 11/09/2016
Project Claim Reference #
NEW JERSEY DEPARTMENT OF TRANSPORTATION
CONTRACTUAL NOTICE FORM
THE CONTRACTOR IS ADVISED THAT THERE ARE SPECIFIC TIME LIMITS FOR FILING NOTICES UNDER BOTH THE
CONTRACT SPECIFICATIONS AND THE NEW JERSEY CONTRACTUAL LIABILITY ACT, N.J.S.A. 59:13-1, ET SEQ. (THE
CONTRACTUAL LIABILITY ACT.). THE CONTRACTOR MUST COMPLY WITH THE TIME REQUIREMENTS OF BOTH THE
SPECIFICATIONS AND THE CONTRACTUAL LIABILITY ACT IN ORDER TO FULLY RESERVE THIS CLAIM.
THE
CONTRACTOR UNDERSTANDS THAT IF IT FAILS TO GIVE NOTICE AS REQUIRED BY THE SPECIFICATIONS WITHIN THE
TIME PROVIDED, ANY CLAIM MAY BE FOREVER BARRED OR LIMITED AS PROVIDED BY THE SPECIFICATIONS. THE
CONTRACTOR ALSO UNDERSTANDS THAT IT MAY BE BARRED FROM RECOVERING AGAINST THE STATE IF IT FAILS TO
GIVE NOTICE OF ANY ACT OR FAILURE TO ACT BY THE NEW JERSEY DEPARTMENT OF TRANSPORTATION, OR THE
HAPPENING OF ANY EVENT, THING OR OCCURRENCE WITHIN 90 DAYS OF SUCH ACT, FAILURE TO ACT, OR HAPPENING
OF SUCH EVENT, THING OR OCCURRENCE IN ACCORDANCE WITH THE CONTRACTUAL LIABILITY ACT, EXCEPT IF
PERMISSION TO FILE A LATE NOTICE OF CLAIM IS OBTAINED FROM THE SUPERIOR COURT WITHIN ONE YEAR OF THE
ACCRUAL OF THE CLAIM.
Name of Contractor
Street Address
Business Phone Number
Fax Number
City
State
Zip Code
Project Name, Section, Location and
Description
1.
Is this the first written notice made to the Department regarding this claim?
Yes; please reference as Contractor’s Project Claim #
or
No; this supplements the previous written notice submitted
, referenced as Contractor’s Project Claim #
2.
State (in a narrative) the nature of and circumstances/reasons of the act, failure to act, event, thing, occurrence, condition, cause of delay, or
alleged suspension, which gives rise to this claim (include the name, function, and activity of each individual involved in or knowledgeable
about the claim and the identification of documents and the substance of communications relating to the claim):
3.
State the specific beginning date of such act, failure to act, event, thing, occurrence, condition, cause of delay, or alleged suspension which
gives rise to this claim:
(date)
4.
State (in a narrative) the detailed actions taken by the Contractor to mitigate the claim:
5.
Will/could the change affect Contract Time?
No; or
Yes, but the extent of the impacts on Contract Time are not known but affects the following activity(ies):
(list); or
Yes, the change impacts Contract Time by
days and affects the following activity(ies):
(list);
(select one) A Time Impact Evaluation (TIE) Form DC-186:
is attached; or
was submitted on:
(date)
(A TIE, CPM fragnet, and an approved progress schedule is required as per Subsection 108.11.01.C of the 2007 Specifications)
6.
Will/could the change affect costs to the Department?
No; or
Yes, but the amount is unknown at this time; a non-binding estimate is (check applicable box):
less than $20,000;
between
$20,000 - $250,000;
$250,000 - $500,000;
$500,000 - $1,000,000;
more than $1,000,000; or
Yes; the amount of this claim is $
(Provide the basis for the calculation, including all types of all costs incurred)
7.
State the Pay Item(s) that will/could be affected by this claim: (list)
Form DC-161 for 2007 Specifications- 11/09/2016
Project Claim Reference #
NEW JERSEY DEPARTMENT OF TRANSPORTATION
CONTRACTUAL NOTICE FORM
THE CONTRACTOR IS ADVISED THAT THERE ARE SPECIFIC TIME LIMITS FOR FILING NOTICES UNDER BOTH THE
CONTRACT SPECIFICATIONS AND THE NEW JERSEY CONTRACTUAL LIABILITY ACT, N.J.S.A. 59:13-1, ET SEQ. (THE
CONTRACTUAL LIABILITY ACT.). THE CONTRACTOR MUST COMPLY WITH THE TIME REQUIREMENTS OF BOTH THE
SPECIFICATIONS AND THE CONTRACTUAL LIABILITY ACT IN ORDER TO FULLY RESERVE THIS CLAIM.
THE
CONTRACTOR UNDERSTANDS THAT IF IT FAILS TO GIVE NOTICE AS REQUIRED BY THE SPECIFICATIONS WITHIN THE
TIME PROVIDED, ANY CLAIM MAY BE FOREVER BARRED OR LIMITED AS PROVIDED BY THE SPECIFICATIONS. THE
CONTRACTOR ALSO UNDERSTANDS THAT IT MAY BE BARRED FROM RECOVERING AGAINST THE STATE IF IT FAILS TO
GIVE NOTICE OF ANY ACT OR FAILURE TO ACT BY THE NEW JERSEY DEPARTMENT OF TRANSPORTATION, OR THE
HAPPENING OF ANY EVENT, THING OR OCCURRENCE WITHIN 90 DAYS OF SUCH ACT, FAILURE TO ACT, OR HAPPENING
OF SUCH EVENT, THING OR OCCURRENCE IN ACCORDANCE WITH THE CONTRACTUAL LIABILITY ACT, EXCEPT IF
PERMISSION TO FILE A LATE NOTICE OF CLAIM IS OBTAINED FROM THE SUPERIOR COURT WITHIN ONE YEAR OF THE
ACCRUAL OF THE CLAIM.
Name of Contractor
Street Address
Business Phone Number
Fax Number
City
State
Zip Code
Project Name, Section, Location and
Description
1.
Is this the first written notice made to the Department regarding this claim?
Yes; please reference as Contractor’s Project Claim #
or
No; this supplements the previous written notice submitted
, referenced as Contractor’s Project Claim #
2.
State (in a narrative) the nature of and circumstances/reasons of the act, failure to act, event, thing, occurrence, condition, cause of delay, or
alleged suspension, which gives rise to this claim (include the name, function, and activity of each individual involved in or knowledgeable
about the claim and the identification of documents and the substance of communications relating to the claim):
3.
State the specific beginning date of such act, failure to act, event, thing, occurrence, condition, cause of delay, or alleged suspension which
gives rise to this claim:
(date)
4.
State (in a narrative) the detailed actions taken by the Contractor to mitigate the claim:
5.
Will/could the change affect Contract Time?
No; or
Yes, but the extent of the impacts on Contract Time are not known but affects the following activity(ies):
(list); or
Yes, the change impacts Contract Time by
days and affects the following activity(ies):
(list);
(select one) A Time Impact Evaluation (TIE) Form DC-186:
is attached; or
was submitted on:
(date)
(A TIE, CPM fragnet, and an approved progress schedule is required as per Subsection 108.11.01.C of the 2007 Specifications)
6.
Will/could the change affect costs to the Department?
No; or
Yes, but the amount is unknown at this time; a non-binding estimate is (check applicable box):
less than $20,000;
between
$20,000 - $250,000;
$250,000 - $500,000;
$500,000 - $1,000,000;
more than $1,000,000; or
Yes; the amount of this claim is $
(Provide the basis for the calculation, including all types of all costs incurred)
7.
State the Pay Item(s) that will/could be affected by this claim: (list)
Form DC-161 for 2007 Specifications- 11/09/2016
Project Claim Reference #
8.
Identify the section(s) of the specifications on which the Contractor is basing this claim (check the applicable boxes):
104.03.03.1- Increase/Decreased Quantities;
104.03.03.2- New Work;
104.03.03.3- Character of Work;
108.11.01- Extensions to Contract Time;
109.01- Measurement of Quantities;
Other (Specify)
9.
Is the Contractor notifying the Department that the Form is complete as per Specification Subsection 104.03.04 or 107.12.01?
This Form is complete to provide written notice, or supplements a previous written notice, under N.J.S.A.59:13-1, et seq. and
Specification Subsection 104.03.04. The final impacts to Contract time and/or costs are unknown/partially unknown at this time;
or
This Form is complete as per 107.12.01; it is requested to begin the Contractual Claims Resolution Process. All supporting
documentation, including all costs and proof(s) thereof, and for all requests for Extensions of Contract Time, including a Time
Impact Evaluation, with a CPM fragnet diagram, as per Subsection 108.11.01.C, of the 2007 Specification are herein submitted.
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are
knowingly or willfully false, I am subject to such punishment as may be provided by all applicable laws, including but not limited to the
New Jersey False Claims Act, N.J.S.A. 2A:32C-1, et seq.
DATED:
Signature-Prime Contractor’s Authorized Representative
(Type - Name and Title)
If correspondence relative to this form should be sent to someone other than the Contractor, please state Name and Address:
THE ORIGINAL OF THIS NOTICE MUST BE SIGNED AND DELIVERED TO THE RE
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