Form CEM-6204 "Dispute Resolution Board (Drb) - Dispute Meeting Report" - California

What Is Form CEM-6204?

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 February 1, 2019;
  • 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-6204 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISPUTE RESOLUTION BOARD (DRB) — DISPUTE MEETING REPORT
Page 1 of 1
CEM-6204 (REV 02/2019)
The Dispute Resolution Board (DRB) chair shall complete Sections 1 through 5 of this form within 35 days of the dispute meeting and email it to
to the resident engineer and the alternative dispute resolution (ADR) engineer at ADR.Engineer@dot.ca.gov. The resident engineer shall
complete Section 6 of this form and email to ADR.Engineer@dot.ca.gov. Section 7 is for DRB chair and resident engineer's comments.
1. PROJECT INFORMATION (DRB chair to complete this section)
Contract Number
Date
Resident Engineer
Phone Number
Contractor
2. MEETING DETAILS (DRB chair to complete this section)
DRB Chair
Meeting Called by:
Caltrans
Contractor
Meeting Date
DRB Member
Meeting Location
DRB Member
Caltrans' Representative
Attendee 1
Contractor's Representative
Attendee 2
3. DISPUTE INFORMATION (DRB chair to complete this section)
Brief Description of Dispute
Potential Claim Identification Number
Traditional DRB
Informal DRB
Date of Supplemental Potential Claim Record
Date of Dispute Meeting
Date of Engineer's Response to Supplemental Potential Claim Record Dollar Value of Potential Claim (per contractor)
Date of Referral to the DRB
Delay Days on Controlling Items of Work (per contractor)
4. DRB REQUEST FOR ADDITIONAL INFORMATION AND RECOMMENDATION (DRB chair to complete this section)
Did the DRB Request Additional Information?
Yes
No
Date Additional Information Requested From
CALTRANS
CONTRACTOR
Date Additional Information was Provided to DRB
DRB Recommendation Date
DRB Recommendation in Favor of Which Party
CALTRANS
CONTRACTOR
BOTH
5. SIGNATURE OF THE DRB CHAIR
Signature
Name
Date
6. CALTRANS' AND CONTRACTOR'S RESPONSE TO DRB RECOMMENDATION (Resident engineer to complete this section)
Date of Caltrans' Response
ACCEPTED
Caltrans' Response to DRB Recommendation
(see note)
REJECTED
Date of Contractor's Response
ACCEPTED
Contractor's Response to DRB Recommendation
REJECTED
Note: Rejection of the DRB's decision requires approval of the Division of Construction's field coordinator. Acceptance of an unfavorable DRB
recommendation requires approval in conformance with the change order approval authority table.
7. COMMENTS (DRB chair and resident engineer's to use this section)
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISPUTE RESOLUTION BOARD (DRB) — DISPUTE MEETING REPORT
Page 1 of 1
CEM-6204 (REV 02/2019)
The Dispute Resolution Board (DRB) chair shall complete Sections 1 through 5 of this form within 35 days of the dispute meeting and email it to
to the resident engineer and the alternative dispute resolution (ADR) engineer at ADR.Engineer@dot.ca.gov. The resident engineer shall
complete Section 6 of this form and email to ADR.Engineer@dot.ca.gov. Section 7 is for DRB chair and resident engineer's comments.
1. PROJECT INFORMATION (DRB chair to complete this section)
Contract Number
Date
Resident Engineer
Phone Number
Contractor
2. MEETING DETAILS (DRB chair to complete this section)
DRB Chair
Meeting Called by:
Caltrans
Contractor
Meeting Date
DRB Member
Meeting Location
DRB Member
Caltrans' Representative
Attendee 1
Contractor's Representative
Attendee 2
3. DISPUTE INFORMATION (DRB chair to complete this section)
Brief Description of Dispute
Potential Claim Identification Number
Traditional DRB
Informal DRB
Date of Supplemental Potential Claim Record
Date of Dispute Meeting
Date of Engineer's Response to Supplemental Potential Claim Record Dollar Value of Potential Claim (per contractor)
Date of Referral to the DRB
Delay Days on Controlling Items of Work (per contractor)
4. DRB REQUEST FOR ADDITIONAL INFORMATION AND RECOMMENDATION (DRB chair to complete this section)
Did the DRB Request Additional Information?
Yes
No
Date Additional Information Requested From
CALTRANS
CONTRACTOR
Date Additional Information was Provided to DRB
DRB Recommendation Date
DRB Recommendation in Favor of Which Party
CALTRANS
CONTRACTOR
BOTH
5. SIGNATURE OF THE DRB CHAIR
Signature
Name
Date
6. CALTRANS' AND CONTRACTOR'S RESPONSE TO DRB RECOMMENDATION (Resident engineer to complete this section)
Date of Caltrans' Response
ACCEPTED
Caltrans' Response to DRB Recommendation
(see note)
REJECTED
Date of Contractor's Response
ACCEPTED
Contractor's Response to DRB Recommendation
REJECTED
Note: Rejection of the DRB's decision requires approval of the Division of Construction's field coordinator. Acceptance of an unfavorable DRB
recommendation requires approval in conformance with the change order approval authority table.
7. COMMENTS (DRB chair and resident engineer's to use this section)
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.