The chairman of ICE-SA may be called upon to nominate an Adjudicator where an Adjudicator resigns or becomes unable to act and the Parties cannot agree on a replacement. Requests for nominations must be made on-line by completing the following form: Request for Chairman to nominate an Adjudicator Contract Number and Title * 1. Name of the person requesting the Nomination Name * Email Address * Cellphone* Telephone Fax 2.1 Party 1: Names of the parties to the Contract * Responsible person: * Telephone Number Fax Number Cell Number * E-mail address * Physical Address: Postal Address: 2.2 Party 2: Names of the parties to the Contract * Responsible person: * Telephone Number Fax Number Cell Number E-mail address * Physical Address Postal Address: 3.1. Brief description of the works, services or supplies * 3.2 Which of the NEC3 forms of contract have been used * Engineering and Construction Contract Engineering and Construction Short Contract Engineering and Construction Subcontract Engineering and Construction Short Subcontract Professional Services Contract Professional Services Short Contract Term Services Contract Term Services Short Contract Supply Contract Supply Short Contract CIDB Supply Contract CIDB Short Supply Contract Other If Other, please state which form of contract is required 3.3 Location of the site (if applicable) 4. Briefly outline what the Adjudicator will be required to rule on (no more than 200 words) * 5. Indicate if there are any persons who might be restricted from participating as an Adjudicator. State the reason why 6. Any specific comments, requests, or special requirements? Upload all relevant files that are pertinent to the dispute.Please upload / attach the following documents to this form, in order that the Adjudicator can be Nominated correctly, and with a minimum of delay: Required:Copy of the Contract Data * Files must be less than 10 MB.Allowed file types: txt rtf html odf pdf doc docx ppt pptx xls xlsx xml. Declaration * I hereby declare that: I am authorised by at least one of the parties to the contract to request a Nomination of an Adjudicator. I also confirm that a dispute has been declared. The parties have attempted to find an Adjudicator using the means identified in the attached Contract Data, and failed to come to agreement. As a result, we request that you nominate a suitable person from the ICE-SA Panel of NEC Adjudicators who will act as Adjudicator for this dispute. The Chairman will base his selection of an Adjudicator on factors which include: 1) Avoidance of conflicts of interest 2) Availability 3) Experience of Adjudicator in relation to the dispute 4) Residency of Adjudicator The chairman will email the name of the selected Adjudicator to the person requesting the dispute. Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 18 + 2 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.