RE-BID *D6 DEPTH PATCH SERVICES 3-YEAR

Attachment E
DATE:
TO:
CONTRACTOR
NAME: __________________________________________
CONTRACT NO.:
__________________ ADDRESS:________________________________________
FAX NO.: ________________________________________
FROM:
SOUTH CAROLINA
OFFICE: __________________________________________
DEPARTMENT OF
TRANSPORTATION
ADDRESS:________________________________________
PHONE NO.: ______________________________________
RE: NOTIFICATION OF DAMAGE TO SCDOT PROPERTY
DESCRIPTION OF DAMAGE:
(PHOTOGRAPH OF THE DAMAGED PROPERTY IS ATTACHED).
DATE OF OCCURENCE: ROUTE: DIRECTION: MILE MARKER:
COSTS:
REPAIR COST =
LIQUIDATED DAMAGES =
============================
TOTAL COST =

SCDOT EMPLOYEE (NAME / SIGNATURE / TITLE):