2017 Awards Program - Data Sheet 1
Official Project Name: ______
Location: ______
______
Individual to Contact for this Submission:
Name: ______
Firm: ______
Address: ______
______
Tel: ______
Cell: ______
Fax: ______
E-mail: ______
The Concrete Industry Board recognizes all companies that contribute to the concrete work for award-winning projects. Please help us to acknowledge the members of your team by providing complete information on the following Data Sheets. Insert “NONE” when there is no consultant, contractor or supplier for a category.
Please coordinate with other team members to ensure only one submission is made per project.
Insert “NONE” where not applicable
2017 Awards Program - Data Sheet 2
Owner/Client
Contact Name: Tel:
Firm: Fax:
Address: ______
E-mail:
Architect of Record
Contact Name: Tel:
Firm: Fax:
Address: ______
E-mail:
Structural Engineer of Record
Contact Name: Tel:
Firm: Fax:
Address: ______
E-mail:
Construction Manager
Contact Name: Tel:
Firm: Fax:
Address: ______
E-mail:
General Contractor
Contact Name: Tel:
Firm: Fax:
Address: ______
E-mail:
Concrete Subcontractor (Foundation)
Contact Name: Tel:
Firm: Fax:
Address: ______
E-mail:
Insert “NONE” where not applicable
2017 Awards Program - Data Sheet 3
Concrete Subcontractor (Superstructure)
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Concrete Subcontractor (Precast)
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Ready Mix Concrete Supplier
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Concrete Mix Designer
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Field Testing Lab
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Concrete Consultant
Contact Name: Tel:
Firm: Fax:
Address:
E-mail:
Insert “NONE” where not applicable
2017 Awards Program - Data Sheet 4
Cement Manufacturers
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Pozzolan Manufacturer (Fly Ash or Blast Furnace Slag)
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Coarse Aggregate
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Fine Aggregate
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Concrete Admixture Manufacturer # 1
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Concrete Admixture Manufacturer # 2
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Insert “NONE” where not applicable
2017 Awards Program - Data Sheet 5
Formwork System Supplier
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Formwork Accessory Supplier
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Formwork Shoring Supplier
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Reinforcing Steel Supplier
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Reinforcing Accessories Manufacturer
Contact Name: Tel:
Company: Fax:
Address:
E-mail:
Insert “NONE” where not applicable
2017 Awards Program - Data Sheet 6
Please add below any additional suppliers who contributed to the concrete work for this project.
______
Contact Name: Tel:
Firm: Fax:
Address:
E-mail:
______
Contact Name: Tel:
Firm: Fax:
Address:
E-mail:
______
Contact Name: Tel:
Firm: Fax:
Address:
E-mail:
Project Title:
Category-
Owner/Client-
Architect of Record-
Structural Engineer of Record-
Construction Manager-
General Contractor-
Concrete Subcontractor (Foundation)-
Concrete Subcontractor (Superstructure)-
Concrete Subcontractor (Precast)-
Ready Mix Concrete Supplier-
Concrete Mix Designer-
Field Testing Laboratories -
Concrete Consultant-
Cement Manufacturers-
Pozzolan Manufacturer (Fly Ash or Blast Furnace Slag)
Coarse Aggregate-
Fine Aggregate-
Concrete Admixture Manufacturer #1-
Concrete Admixture Manufacturer #2-
Formwork System Supplier-
Formwork Accessory Supplier-
Formwork Shoring Supplier-
Reinforcing Steel Supplier-
Reinforcing Accessories Manufacturer-
ADDITIONAL: