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Deliverable Number
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Commodity/Service Type
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Major Deliverable
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Method of Payment
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Professional engineering services
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Task 4: Bridge Construction Engineering Inspections - Field inspection report, punch list and "as-bu...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 4: Bridge Construction Engineering Inspections - Field inspection report, punch list and "as-built" drawings shall be submitted as one original copy and a disk with electronic files in PDF format.
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| Deliverable Price: $5,974.84 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: The deliverables shall be reviewed by the project manager to verify that it is complete and includes all the deliverables and recommendations per the scope of services agreed to.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: TA4 |
| Deliverable Number: |
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Professional engineering services
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Task 2: The 100% design development plans shall be provided for construction purposes. Final signed ...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 2: The 100% design development plans shall be provided for construction purposes. Final signed and sealed submittals shall consist of four (4) full-sized 22- inches x 34-inches. In addition, electronic files (PDF & AutoCAD) that includes items listed above will be submitted to FDEP.
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| Deliverable Price: $18,152.60 |
| Non Price Justification: |
| Performance Metrics: Submit the above noted specifications, final opinion of probable cost and design sheets (Survey, Geotechnical, Civil, Electrical, Mechanical, Plumbing and associated Details) paper copies and the PDF/AutoCAD files for the Construction Document phase (100% Construction Documents).
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: TA2 |
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Professional engineering services
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Task 2: Stantec will provide a copy of the permit application submittal and NWFWMD response to the s...
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Cost Reimbursement Plus Fixed Fee(s), including Fixed Price Components
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| Major Deliverable: Task 2: Stantec will provide a copy of the permit application submittal and NWFWMD response to the submittal. Fixed $2,453.85, Reimbursables $100.00. $2,553.85
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Stantec will provide a copy (paper and pdf) of the permit application submittal and NWFWMD response to the submittal.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: TA2 |
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Professional engineering services
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Task 5, Del. 2: A copy of the final application packages shall be sent electronically to FDEP for th...
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Cost Reimbursement Plus Fixed Fee(s), including Fixed Price Components
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| Major Deliverable: Task 5, Del. 2: A copy of the final application packages shall be sent electronically to FDEP for their records. Fixed Price $4,157.04; reimbursables - DERM Env. Impact Review Fee $9,720, Miami Dade Co. Bldg. Rev. Fee $130, Miami Dade Co. Fire Review Fee $160. Cost not to exceed $14,167.04
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: 9 |
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Professional engineering services
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Task 5, Del. 4B: RFI responses in PDF format (assume up to 6)
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5, Del. 4B: RFI responses in PDF format (assume up to 6)
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| Deliverable Price: $1,708.05 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: 11 |
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Professional engineering services
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Task 5, Del. 4C: Inspections Reports in PDF format (up to 8 as directed by FDEP)
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5, Del. 4C: Inspections Reports in PDF format (up to 8 as directed by FDEP)
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| Deliverable Price: $1,708.05 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: 11 |
| Deliverable Number: |
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Professional engineering services
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Task 5, Del. 4D: Response to RFI's (assume up to 2) and Site Visits - RFI responses and inspections ...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5, Del. 4D: Response to RFI's (assume up to 2) and Site Visits - RFI responses and inspections Reports in PDF format. |
| Deliverable Price: $1,542.00 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely. |
| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform. |
| Source Documentation Page Reference: |
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Professional engineering services
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Task 2, CO1, Del. 14 - Deliverables will consist of substantial project review documentation/punch l...
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Cost Reimbursement Plus Fixed Fee(s), including Fixed Price Components
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| Major Deliverable: Task 2, CO1, Del. 14 - Deliverables will consist of substantial project review documentation/punch list/field report issued in pdf format. Punch list/field report to be published within one ( 1) week of site visit. Fixed price $3,669.28; reimbursable mileage $139.73. Cost not to exceed $3,809.01
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: 7 |
| Deliverable Number: |
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Professional engineering services
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Task 4: Bridge Maintenance Repairs - A draft site visit report that includes photographs of existing...
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Cost Reimbursement Plus Fixed Fee(s), including Fixed Price Components
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| Major Deliverable: Task 4: Bridge Maintenance Repairs - A draft site visit report that includes photographs of existing conditions, a summary of observations, and sketches to document field measurements. The draft report shall be submitted in electronic format as a PDF document via e-mail. Cost not to exceed $3,121.77
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: The deliverables shall be reviewed by the project manager to verify that it is complete and includes a summary of observations, condition descriptions and list of deficiencies, sketches and measurements, and photographs.
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| Financial Consequences: "No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of
a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a
satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform."
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| Source Documentation Page Reference: TA4 |
| Deliverable Number: |
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Professional engineering services
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Task 4: Bridge Repair Documents - Bridge design repair plans and specifications. One set of signed a...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 4: Bridge Repair Documents - Bridge design repair plans and specifications. One set of signed and sealed original plans and specifications in 11 x 17 format, and a disk with electronic files in PDF format.
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| Deliverable Price: $6,531.66 |
| Non Price Justification: |
| Performance Metrics: The deliverables shall be reviewed by the project manager to verify that it is complete and includes all the deliverables and recommendations per the scope of services agreed to.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a
satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: TA4 |
| Deliverable Number: |
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Professional engineering services
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Task 2: Stantec will provide a copy of the permit application submittal. $2,406.01
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Cost Reimbursement Plus Fixed Fee(s), including Fixed Price Components
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| Major Deliverable: Task 2: Stantec will provide a copy of the permit application submittal. $2,406.01
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| Deliverable Price: $0.00 |
| Non Price Justification: Price cannot be determined until the work has been completed |
| Performance Metrics: Stantec will provide a copy (paper and pdf) of the permit application submittal and FDEP response to the submittal.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: TA2 |
| Deliverable Number: |
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Professional engineering services
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Task 3: Stantec will provide a copy of the response package to Collier County SDP Permit Response. T...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 3: Stantec will provide a copy of the response package to Collier County SDP Permit Response. This response package will include a copy of the Gopher Tortoise Survey and reduced scope of work plans recently requested by FDEP.
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| Deliverable Price: $3,173.90 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to verify the permitting submittals were timely, complete and meet or the Task/Deliverable requirement.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: TA3 |
| Deliverable Number: |
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Professional engineering services
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Task 3: Provide a copy of the checks submitted to satisfy the above permit submittal and review fees...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 3: Provide a copy of the checks submitted to satisfy the above permit submittal and review fees as outlined in the attached email.
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| Deliverable Price: $8,886.41 |
| Non Price Justification: |
| Performance Metrics: Check submitted and a copy of the check provided as documentation along with a receipt from Collier County.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: TA3 |
| Deliverable Number: |
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Professional engineering services
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Task 3: Provide shop drawing responses and punch list to FDEP identifying corrective actions require...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 3: Provide shop drawing responses and punch list to FDEP identifying corrective actions required. Provide copies of certification doc augmentation submittals for completion of Beach Area Number 1 & 5 (partial) to FDEP Beaches & Coastal System and Collier County. A PDF of each deliverable (responses, punch list and permit close out).
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| Deliverable Price: $2,159.96 |
| Non Price Justification: |
| Performance Metrics: The deliverables will be reviewed to verify the submittal was timely, complete and meets or exceeds the Task/Deliverable requirement.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: TA3 |
| Deliverable Number: |
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Professional engineering services
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Task 3: Letter report submitted to the Florida Department of Environmental Protection (FDEP) and to ...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 3: Letter report submitted to the Florida Department of Environmental Protection (FDEP) and to Collier County Growth Management Division (only if requested by Collier County).
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| Deliverable Price: $1,503.69 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: TA3 |
| Deliverable Number: |
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Professional engineering services
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Task 5, Del. 1: The original Construction documents, as revised, shall be prepared in 11" x 17" page...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5, Del. 1: The original Construction documents, as revised, shall be prepared in 11" x 17" page format. As with the original plan set, the revised plans shall include the following: Cover Sheet; Site Plan; Seawall Damage Observations; Seawall Profiles; Sections and Details; Notes and Specifications; Environmental Plan; The Construction Documents package will include plan level specifications as applicable for the materials to be incorporated into the work. In addition, An Opinion of Probable Costs organized by pay item and based on the Construction Documents will be provided at the completion of this task.
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| Deliverable Price: $2,491.56 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: 5 |
| Deliverable Number: |
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Professional engineering services
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Task 5, Del. 3: Consultant shall respond in writing to FDEP Project Manager as needed to insure all ...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5, Del. 3: Consultant shall respond in writing to FDEP Project Manager as needed to insure all questions from bidders are addressed in a timely manner.
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| Deliverable Price: $2,030.64 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: 9 |
| Deliverable Number: |
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Professional engineering services
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Task 5, Del. 4A: Shop Drawing Review transmitted via PDF
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5, Del. 4A: Shop Drawing Review transmitted via PDF
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| Deliverable Price: $1,366.44 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: 11 |
| Deliverable Number: |
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Professional engineering services
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Task 5, Del. 5: Consultant shall provide inspections with written observation reports for each site ...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5, Del. 5: Consultant shall provide inspections with written observation reports for each site visit. Reports shall be submitted to the agencies directly with copies provided to FDEP on a weekly basis. Photos shall be attached where warranted.
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| Deliverable Price: $7,572.48 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely.
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform.
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| Source Documentation Page Reference: 13 |
| Deliverable Number: |
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Professional engineering services
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Task 5 Subtask 4C: RFI responses and Inspections Reports in PDF format (Sta. 4+25 to Sta. 12+75)
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5 Subtask 4C: RFI responses and Inspections Reports in PDF format (Sta. 4+25 to Sta. 12+75)
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| Deliverable Price: $1,708.05 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform
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| Source Documentation Page Reference: TA5CO1 |
| Deliverable Number: |
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Professional engineering services
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Task 5 Subtask 4B: RFI responses and Inspections Reports in PDF format (Sta. 0+00 to Sta. 4+25)
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5 Subtask 4B: RFI responses and Inspections Reports in PDF format (Sta. 0+00 to Sta. 4+25)
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| Deliverable Price: $1,708.05 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform
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| Source Documentation Page Reference: TA5CO1 |
| Deliverable Number: |
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Professional engineering services
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Task 5 Subtask 4D: RFI responses and Inspections Reports in PDF format (Sta. 12+75 to Sta. 14+75)
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5 Subtask 4D: RFI responses and Inspections Reports in PDF format (Sta. 12+75 to Sta. 14+75)
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| Deliverable Price: $1,542.00 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform
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| Source Documentation Page Reference: TA5CO1 |
| Deliverable Number: |
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Professional engineering services
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Task 5 Subtask 5A: "Consultant shall provide inspections with written observation reports for each s...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5 Subtask 5A: "Consultant shall provide inspections with written observation reports for each site visit.
Reports shall be submitted to the agencies directly with copies provided to FDEP on a weekly basis.
Photos shall be attached where warranted."
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| Deliverable Price: $2,694.84 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform
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| Source Documentation Page Reference: TA5CO1 |
| Deliverable Number: |
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Professional engineering services
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Task 5 Subtask 5B: Consultant shall provide inspections with written observation reports for each si...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5 Subtask 5B: Consultant shall provide inspections with written observation reports for each site visit.
Reports shall be submitted to the agencies directly with copies provided to FDEP on a weekly basis.
Photos shall be attached where warranted.
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| Deliverable Price: $2,438.82 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform
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| Source Documentation Page Reference: TA5CO1 |
| Deliverable Number: |
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Professional engineering services
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Task 5 Subtask 5C: "Consultant shall provide inspections with written observation reports for each s...
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Fixed Price - Lump Sum
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| Major Deliverable: Task 5 Subtask 5C: "Consultant shall provide inspections with written observation reports for each site visit.
Reports shall be submitted to the agencies directly with copies provided to FDEP on a weekly basis.
Photos shall be attached where warranted.
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| Deliverable Price: $2,438.82 |
| Non Price Justification: |
| Performance Metrics: Deliverables will be reviewed by the Department to confirm they are complete, accurate and timely
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| Financial Consequences: No payment will be made for unsatisfactory deliverables. In the event that a deliverable is deemed unsatisfactory, the Consultant shall re-perform the services needed for submittal of a satisfactory deliverable, at no additional cost to the Department within 15 consecutive days. If a satisfactory deliverable is not submitted within the specified timeframe, the Department may, in its sole discretion, terminate the Contract for failure to perform
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| Source Documentation Page Reference: TA5CO1 |
| Deliverable Number: |
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