STATE ARBITRATION BOARD
THIS FORM IS REQUIRED ONLY WHEN THE CLAIM INVOLVES A REQUEST FOR EXTENSION OF THE ALLOWABLE CONTRACT TIME
STATE JOB NO.: ________________________
PRIME CONTRACTOR: ________________________
Original Contract Time Allowed: __________ C. D.
Contract Time Extensions Granted By The DOT: + __________ C. D.
Final Contract Time Allowed: __________ C. D.
Total Contract Days Charged: __________ C. D.
Amount Of Liquidated Damages Assessed By DOT:
___________ C.D. @ $ _____________________ Per C. D. = $___________________
Contract Day On Which The Contractor Began Work: _________ C.D.
Date On Which Work Began: ______________________
Date On Which DOT Accepted The Project:______________________
4/25/00