Cantera Work Authorization Form

• Job Name

• Job Number

• Report Date (YYYYMMDD)

• Superintendent

• Project Manager

• Location
  Address

• Customer's Name

• Customer's Phone

• Address
  Address

• You do hereby authorize Cantera Concrete Company to perform the work described herein:

Customer

• Above additional work to be performed under same conditions as specified in original contract unless otherwise stipulated. Pricing to be completed by Cantera Concrete Company Corporate office for the below listed man hours, materials, and equipment. T&M will be based on the man hours, materials, and equipment listed below.

• Please select one

  Select Proceed on T&M Proceed after LS pricing Proceed with no cost

  • Proceed on T&M
  • Proceed after LS pricing
  • Proceed with no cost

• Proceed on T&M (Authorized Signature)

  Sign

• Proceed after LS pricing (Authorized Signature)

  Sign

• Proceed with no cost (Authorized Signature)

  Sign

Contractor

• We hereby agree to furnish labor, materials, and equipment in accordance with the contract documents and the above work description.

• Authorized Signature

  Sign

Resources Used

Man Hours

• Employee classification (choose one)

  Select Laborer Carpenter Rod Buster Equipment Operator Finisher Other

  • Laborer
  • Carpenter
  • Rod Buster
  • Equipment Operator
  • Finisher
  • Other

• Classification

• Number of men

• Hours (for each man)

• Overtime Hours (for each man)

• Total hours:

Equipment

• Equipment used

• Hours that equipment was used

Material

• Material used

• Date work completed

  Date

• Contractor signature and date

  Sign

• I hereby agree that the man hours, materials, and equipment were used to complete the above work.

• Add media

  Media