EXHIBIT C
Print Form
PLANNING, DESIGN AND CONSTRUCTION
Request for Building System Coverage
PD&C Project No.
Date of Request:
(Five (5) working days prior to the required date)
Note - If an emergency, check here:
To:
Check Box
Mike Smith, Director, Department of Facilities Management, 111 General Services Building
Fax: 215-768-1433
Requested By:
(Contractor)
Indicate building name, building #, floors, areas or rooms requiring clearance; include room numbers by campus
plans and, if possible, the actual room numbers.
Enter
Type of Work Shutdown:
Please select
Reason for coverage:
Enter
Start Date:
Approximate starting time:
Anticipated completion date:
Duration of shutdown:
Coverage requested for:
(Subcontractor)
Foreman:
Signature of Superintendent:
Comments:
(GC/CM)
Enter here
cc: Project Manager - Planning, Design & Construction
Project Manager - UNICCO (for Creese, MacAlister, Phys Ed Ctr. & all Dormitories)
Property Manager - API (for 3001-101 Market)
Property Manager - API (for other API properties)
Director - Safety & Health Programs (for any sprinkler, standpipe, fire alarm work)
Director - Telecommunications (telephones & computers)
Fax: 215 895-6733
Fax: 215 895-6701
Fax: 215 222-0620
Fax: 215 662-5924
Fax: 215 762-7899
Fax: 215 895-6677