Design and Construction

AN ISO 9001:2008 CERTIFIED ORGANIZATION

Division of Construction, 34th Floor, Corning Tower
The Governor Nelson A. Rockefeller Empire State Plaza
Albany, New York 12242
Phone: (518) 474-0331

DAILY MATERIAL AND EQUIPMENT REPORT

Contractor Subcontractor
Project No.

NOTE: Three copies are required (see Distribution below). Submit original and two copies to the Engineer-in-Charge.
Contractor/Subcontractor Name: Change Order Control No.: Work Date:
(if applicable)

Work Accomplished:

Quantity /
License No. or EIC
Detailed Description of Material or Equipment Operating Unit
Serial No. Comments
Hours

On-Site Certification EIC Certification

I certify that the equipment described was used on this work for the hours I certify that the comments I have entered on each line are based on
indicated and that the material was used or turned over to the state on this my observation of the work. The comments indicate my agreement or
date. observed differences with the contractor’s submittal.

For Subcontractor, if applicable Date

For Contractor Date For Design and Construction Date

Distribution: Labor and Materials Submission Copy (White)

Engineer-In-Charge (Yellow) Page of
Contractor’s File Copy (Pink)

BDC 269 Rev02 E-FILE: V:\DesignAndConstr\PEAxxx\EAxxx\Construction\Payments