FORMS
(Revised January 16, 2015)
Subpart 5153.2 – Prescription of Forms
5153.201 Federal acquisition system.
5153.201-90 Sample contracting officer’s representative designation letter.
In accordance with 5101.602-2-91, the Army will use the Virtual Contracting Enterprise Contracting Officer’s Representative (COR) module to nominate, appoint, track, and revoke COR appointments. When the Virtual Contracting Enterprise COR module is unavailable, contracting officers shall use the sample COR designation letter format in 5153.303-1 to designate a COR. Designate CORs using official letterhead and follow standard procedures for correspondence. Address the designation to the individual by name, including rank or grade, and full mailing address.
5153.201-91 Sample ordering officer appointment letter.
Use the sample ordering officer appointment letter format in 5153.303-2 to appoint an ordering officer in accordance with 5101.602-2-92. Use official letterhead and follow standard procedures for correspondence. Address the appointment to the individual by name, including rank or grade, and full mailing address.
5153.206 Competition requirements.
5153.206-90 Format for justification review document.
Use the justification review document format at 5153.303-4 to document the requesting activity’s internal review of a proposed justification when using other than full and open competition. Contracting officers will tailor the justification review document format to accommodate the justification’s approval threshold. For example, justifications approved by a contracting officer may not require special competition advocate, principal assistant responsible for contracting or head of the contracting activity review. The completed format becomes the cover page(s) of the justification. Do not use letterhead for this document.
5153.206-91 Format for justification and approval for other than full and open competition.
Use the justification and approval format at 5153.303-5 to support justifications for other than full and open competition in accordance with the Competition in Contracting Act as implemented in the FAR. Contracting officers shall tailor the justification and approval format to accommodate other type justifications in accordance with the FAR approval thresholds and required content. Do not use letterhead for this document. The approval page is separate from the certifications.
5153.213 Simplified acquisition procedures.
5153.213-70 Completion of DD Form 1155, order for supplies or services.
(a) Instructions for DD Form 1155 entries. (See DFARS PGI 253.213-70.)
Block 19, Schedule of Supplies or Services, for task orders under job order contracts, see 5117.9004-3(g)(1).
5153.233 Protests, disputes, and appeals.
5153.233-90 Format for bid protest action report.
Use the format for a bid protest action report at 5153.303-6 to provide notification of a Government Accountability Office protest resolution. Contracting officers will email the report to the addressees provided at 5133.190-1 within 15 calendar days of its resolution.
5153.233-91 Format for quarterly bid protest analysis report.
Use the sample format for the quarterly bid protest analysis report at 5153.303-7 to submit quarterly bid protest reports in accordance with 5133.190-2. The quarterly bid protest analysis report for Government Accountability Office protests is emailed with copies of the bid protest action reports to the addressee in 5101.290(b)(5), not later than 30 calendar days following the end of the quarter.
5153.242 Contract administration and audit services.
5153.242-90 Contractor Performance Assessment Reporting System initial registration consolidated format.
Use the sample Contractor Performance Assessment Reporting System (CPARS) initial registration consolidated format at 5153.303-9 to submit contract registration information to the CPARS contracting activity focal point upon award of a contract eligible for a past performance assessment report. Retain the completed document in the official contract file.
5153.242-91 CPARS access request format.
Use the sample CPARS access request format at 5153.303-10 to submit contract access information to the CPARS contracting activity focal point upon award of a contract eligible for a past performance assessment report. Retain the completed document in the official contract file.
5153.245-90 Sample withdrawal of approval of property control system letter.
Use the sample withdrawal of approval of property control system letter at 5153.303-8 in accordance with FAR subpart 45.5 and DFARS subpart 245.5 to notify a contractor that approval of his property control system is withdrawn. Use official letterhead and follow standard procedures for correspondence.
Subpart 5153.3 – Illustration of Forms
This subpart sets forth standard Army formats for specified actions. Contracting officers may tailor these formats where appropriate, and when they are not otherwise limited, to fit the specific acquisition or contracting action.
5153.303-1 Sample contracting officer’s representative (COR) designation.
Subject: Designation of Contracting Officer’s Representative (COR) for Contract (Enter number.).
1. Pursuant to DFARS 201.602-2, you are designated as the contracting officer’s representative (COR) in administration of the following contract:
Contract Number:
For: (Enter item/system/services.)
Contractor:
Contract Period:
2. You are authorized by this designation to take action with respect to the following:
a. Verify that the contractor performs the technical requirements of the contract in accordance with the contract terms, conditions and specifications. Specific emphasis should be placed on the quality provisions, for both adherences to the contract provisions and to the contractor’s own quality control program.
b. Perform, or cause to be performed, inspections necessary in connection with paragraph 2.a. and verify that the contractor has corrected all deficiencies. Perform acceptance for the Government of services performed under this contract.
c. Maintain liaison and direct communications with the contractor. Written communications with the contractor and other documents pertaining to the contract shall be signed as “Contracting Officer’s Representative” and a copy shall be furnished to the contracting officer.
d. Monitor the contractor’s performance, notify the contractor of deficiencies observed during surveillance and direct appropriate action to effect correction. Record and report to the contracting officer incidents of faulty or nonconforming work, delays or problems. In addition, you are required to submit a monthly report concerning performance of services rendered under this contract.
e. Coordinate site entry for contractor personnel, and insure that any Government-furnished property is available when required.
3. You are not empowered to award, agree to or sign any contract (including delivery orders) or contract modification or in any way to obligate the payment of money by the Government. You may not take any action which may affect contract or delivery order schedules, funds or scope. All contractual agreements, commitments, or modifications which involve price, quantity, quality, delivery schedules, or other terms and conditions of the contract must be made by the contacting officer. You may be personally liable for unauthorized acts. You may not re-delegate your COR authority.
4. This designation as a COR will remain in effect through the life of the contract, unless sooner revoked in writing by the contracting officer or unless you are separated from Government service. If you are to be reassigned or to be separated from Government service, you must notify the contracting officer sufficiently in advance of reassignment or separation to permit timely selection and designation of a successor COR. If your designation is revoked for any reason before completion of this contract, turn your records over to the successor COR or obtain disposition instructions from the contracting officer.
5. You are required to maintain adequate records to sufficiently describe the performance of your duties as a COR during the life of this contract and to dispose of such records as directed by the contracting officer. As a minimum, the COR file must contain the following:
a. A copy of your letter of appointment from the contracting officer, a copy of any changes to that letter, and a copy of any termination letter.
b. A copy of the contract or the appropriate part of the contract and all contract modifications.
c. A copy of the applicable quality assurance (QA) surveillance plan.
d. All correspondence initiated by authorized representatives concerning performance of the contract.
e. The names and position titles of individuals who serve on the contract administration team. The contracting officer must approve all those who serve on this team.
f. A record of inspections performed and the results.
g. Memoranda for record or minutes of any pre-performance conferences.
h. Memoranda for record of minutes of any meetings and discussions with the contractor or others pertaining to the contract or contract performance.
i. Applicable laboratory test reports.
j. Records relating to the contractor’s quality control system and plan and the results of the quality control effort.
k. A copy of the surveillance schedule.
l. Documentation pertaining to your acceptance of performance of services, including reports and other data.
6. At the time of contract completion, you will forward all records to the contracting officer for retention in the contract files.
7. All personnel engaged in contracting and related activities shall conduct business dealings with industry in a manner above reproach in every aspect and shall protect the U.S. Government’s interest, as well as maintain its reputation for fair and equal dealings with all contractors. DoD 5500.7-R sets forth standards of conduct for all personnel directly and indirectly involved in contracting.
8. A COR who may have direct or indirect financial interests which would place the COR in a position where there is a conflict between the COR’s private interests and the public interests of the United States shall advise the supervisor and the contracting officer of the conflict so that appropriate actions may be taken. CORs shall avoid the appearance of a conflict of interests to maintain public confidence in the U.S. Government’s conduct of business with the private sector.
9. You are required to summarize the contractor’s contractual performance at least annually using the Contractor Performance Assessment Reporting System (CPARS) at http://www.cpars.gov. The narrative you write must support the rating given based on the rating definitions in the CPARS Guide on the website.
10. You are required to acknowledge receipt of this designation on the duplicate copy and return it to the contracting officer. Your signature also serves as certification that you have read and understand the contents of DoD 5500.7-R. The original copy of this designation should be retained for your file.
Signature Block Of
Contracting Officer
Receipt of this designation is acknowledged.
Name: ___________________(Print or type) Signature: ____________________
Title: ____________________ Date: ________________________
Rank/Grade: ___________________ Telephone: ___________________
5153.303-2 Sample ordering officer appointment.
Subject: Appointment of Ordering Officer
1. Appointment. Under AFARS 5101.602-2-92, you are appointed an Ordering Officer for the purposes set forth in paragraph 2. Your appointment becomes effective (enter date) and will remain effective, unless sooner revoked, until expiration of the contract(s) enumerated in paragraph 2 or until you are reassigned or your employment is terminated. You are responsible to and under the technical supervision of the chief of the (enter name of installation or activity) contracting office for your actions as an Ordering Officer.
2. Authority, Limitations and Requirements. Your appointment is subject to the use of the following method(s) of purchase, limitations and requirements:
a. Subject to your ensuring that local purchase authority exists for the transaction, you may make purchases using imprest funds for payments and using Standard Form 1165, Receipt for Cash - Subvouchers, provided all of the following conditions are satisfied:
(1) The aggregate amount of a purchase transaction is not in excess of $500 under emergency conditions. You may not split purchases to avoid this monetary limitation.
(2) The supplies or nonpersonal services are available for delivery within 60 calendar days, whether at the supplier’s place of business or at destination.
(3) The purchase does not require detailed, technical specifications or technical inspection.
b. Subject to your ensuring that funds are available and that local purchase authority exists for the transaction, you may make purchases using Standard Form 44, Purchase Order -- Invoice -- Voucher, provided all of the following conditions are satisfied:
(1) The aggregate amount of the purchase transaction is not in excess of $3,000. You may not split purchases to avoid this monetary limitation.
(2) Supplies or nonpersonal services are immediately available.
(3) One delivery and one payment shall be made.
c. Subject to your ensuring that funds are available and that local purchase authority exists for the transaction, you may place delivery orders (DD Form 1155) without monetary limitation, except that specified in individual contracts, against --
(1) Brand Name contracts published in Defense Personnel Support Center Supply Bulletins in the SB 10-500 or SB 10-600 series;
(2) Defense Personnel Support Center requirements contracts for subsistence items;
(3) Defense Fuel Supply Center and Defense General Supply Center requirements contracts; and
(4) The following indefinite delivery contracts, copies of which are attached: (List contracts by number and name of contractor.)
d. Subject to your ensuring that funds are available and that local purchase authority exists for the transaction, you may place Service Orders for Household Goods, DD Form 1164, against Commercial Warehousing and Related Services for Household Goods contracts for military and civilian personnel, subject to the criteria and procedures prescribed in DoD 4500.34-R, Chapter 2, and provided that no Service Order shall be in excess of $10,000.
e. You are responsible for --
(1) Distributing and administering delivery orders that you place;
(2) Establishing controls necessary to ensure that all contract terms and conditions are met and that supplies or nonpersonal services ordered conform to contract requirements before acceptance is made or payment authorized, and
(3) Reporting deficiencies in contractor performance promptly to the contracting officer who awarded the contract against which the delivery order was placed. You may not make any changes in the terms or conditions of any contracts against which you place delivery orders.
f. The authority granted in this appointment may not be redelegated to any other person.
3. Standards of Conduct and Contracting Action Reporting Requirements.
a. You shall comply with the standards of conduct prescribed in DoD 5500.7-R.
b. You shall furnish the undersigned and the contracting officer to whom you are responsible such information as may be required for contracting action reporting purposes in the manner and the time specified.
4. Termination of Appointment.
a. Your appointment may be revoked at any time by the undersigned authority or successor and shall be terminated in writing, except that no written termination of your appointment shall be made upon expiration or termination of contracts enumerated in paragraph 2.
b. Should you be reassigned from your present position or separated from Government service while this appointment is in effect, you shall promptly notify the appointing authority in writing. Your appointment will be terminated in writing if you are reassigned; it shall automatically be terminated on the date you are separated from Government service, if it is not revoked sooner.
5. Acknowledgement of Receipt. You are required to acknowledge receipt of this appointment on the duplicate copy and return it to the contracting officer. Your signature also serves as certification that you have read and understand the contents of DoD 5500.7-R. The original copy of this designation should be retained for your file.
Signature Block Of
Appointing Authority
Receipt of this appointment is acknowledged.
Name: ___________________(Print or type) Signature: ____________________
Title: ___________________ Date: ________________________
Rank/Grade: ___________________ Telephone: ___________________
5153.303-4 Format for a justification review document for other than full and open competition.
Control No:
Justification Review Document for Other Than Full and Open Competition
Program/Equipment:
Authority:
Amount:
Prepared by:
Typed Name: DSN: _____________________
Title: Date: _____________________
E-mail:___________________________
Contracting Officer:
Typed Name: DSN: ______________________
Date Reviewed: ___________________
E-Mail: __________________________
Technical Representative:
Typed Name: DSN: _____________________
Title: Date Reviewed: _____________
Requirements Representative:
Typed Name: DSN: ______________________
Title: Date Reviewed: _____________
Reviews: I have reviewed this justification and find it adequate to support other than full and open competition.
Program Manager (1)
Typed Name: DSN: ______________________
Signature: ______________________ Date: ______________________
Legal Counsel
Typed Name: DSN: ______________________
Signature: ______________________ Date: ______________________
Special Competition Advocate
Typed Name: DSN: ______________________
Signature: ______________________ Date: ______________________
Principal Assistant Responsible for Contracting
Typed Name: DSN: ______________________
Signature: ______________________ Date: ______________________
(1) Add Program Executive Officer signature block when item is Program Executive Officer managed.
Head of the Contracting Activity
Typed Name: DSN: ______________________
Signature: ______________________ Date: ______________________
5153.303-5 Format for a justification and approval for other than full and open competition.
This format is mandatory for all justifications and approvals (J&As) in support of other than full and open competition. Contracting officer will tailor the J&A’s format to accommodate other type justifications in accordance with the FAR approval thresholds and required content.
Control No:
Justification and Approval for Other Than Full and
Open Competition
1. Contracting Activity: Specify the contracting activity responsible for this action.
2. Description of Action: State whether the approval is for a new contract or a modification. Include the type of contract, type of funds to be used (Military Construction; Research, Development, Test and Evaluation; Other Procurement, Army; or Operation and Maintenance, Army) and, when applicable, the estimated share and ceiling arrangements, and fee or profit.
3. Description of Supplies/Services: Name and describe the required supplies/services. Include the estimated total value, including options, if any.
4. Authority Cited: Identify the statutory authority permitting other than full and open competition followed by the specific FAR citation and its title. For example: 10 United States Code 2304(c)(1) as implemented in Federal Acquisition Regulation 6.302-1(a)(2)(iii)(B), Only one responsible source and no other supplies or services will satisfy agency requirements.
5. Reason for Authority Cited: Describe how this action requires the use of the authority cited. If applicable, identify the proposed or potential contractor(s) and include a discussion of the proposed contractor’s unique qualifications for fulfilling the contract requirements.
(a) The rationale used for justifying the cited authority should be consistent throughout the document as appropriate.
(b) Justifications citing FAR 6.302-1(a)(2)(ii) or (iii) as the authority for less than full and open competition on a follow-on contract must reflect (1) substantial duplication of cost that is not expected to be recovered through competition and/or (2) unacceptable delays in filling agency requirements. If the authority cited is substantial duplication of costs, then paragraph 5 should compare the duplicate costs the government would incur to create competition and the estimated savings expected to be recovered through subsequent competition. In addition, the justification must include an explanation for how the requesting office derived their estimates and why they believe they are a substantial duplication. Justifications citing unacceptable delays must identify firm schedule limitations that do not result from a lack of planning. For example, firm schedule limitations could include an approved Army campaign plan or significant loss of life or property.
(c) Justifications citing FAR 6.302-2 must explain how failure to limit sources would seriously injure the Government, and include a discussion of the required delivery schedule and lead-time involved. If the delay associated with the requirement for first article testing is the principal reason for not awarding the contract on a full and open basis, clearly describe the reasons why first article testing is required and why other quality assurance techniques are inadequate. Contracting officers may submit J&As citing this authority for approval after the contract has been awarded (see FAR 6.302-2(c)(1)).
(d) Justifications citing FAR 6.302-2 or 6 must request offers from as many potential sources as practicable under the circumstances.
(e) If applicable, explain why technical data packages, specifications, engineering descriptions, statements of work or purchase descriptions suitable for full and open competition were not developed or are not available.
6. Efforts to Obtain Competition: Describe the efforts to solicit offers from as many potential sources as is practicable.
a. Effective competition. Describe the extent of effective competition anticipated for this acquisition.
b. Subcontracting competition. In single source situations, address efforts by the Government to assure that the prime contractor obtains as much competition as possible in its subcontracting.
7. Actions to Increase Competition: There may be instances when it is not possible to compete the current acquisition. In these cases, include a statement of the actions taken, or to be taken, to increase competition (e.g., procure needed technical data for full and open competition or breakout subsystems or components for full and open competition) before any subsequent acquisition of the supplies or services. If future competition will be based on the procurement of technical data, provide the approximate date the technical data package will be available.
8. Market Research: Describe the extent and the results of the market research (FAR Part 10) conducted to identify all qualified sources. Research must have been meaningful (demonstrated attempt to discover all relevant material) and conducted within the previous 12 months.
9. Interested Sources: Include a listing of the sources that have written to express interest in the acquisition. If applicable, clearly state “To date, no other sources have written to express an interest.” If 10 U.S.C. 2304(c)(1)/FAR 6.302-1 is the authority cited, explain why other sources were rejected. Also, state that the notices required by FAR 5.201 shall be or have been published, and that any bids or proposals received shall be considered. If a notice is not posted, state which exception in FAR 5.202 applies.
10. Other Facts: Discuss any other facts supporting the use of other than full and open competition, such as the following:
a. Procurement history. Reasonable efforts to retrieve the following items from computer records, contract files, competition advocate office files or other sources are expected:
(1) Contract numbers and dates of the last several contracts for these same requirements.
(2) The competitive status of these actions.
(3) Authority previously cited if less than full and open competition was used.
(4) If a justification was prepared to support the procurement made before this one, a summary of the contents of paragraph 7 of the justification for that procurement and an explanation of the results.
(5) If any prior contract for this requirement was accomplished using full and open competition, include a detailed explanation of the changed circumstances causing this action to now limit the sources.
(6) An explanation of any unusual patterns that may be revealed by the history, e.g., several consecutive, urgent buys.
(7) If a justification was prepared to support the procurement made before this one, briefly describe the circumstances justifying the procurement and whether there have been any significant changes.
b. Other facts. Provide any other facts necessary to justify limiting competition that were not previously stated.
(Certifications will normally be provided on a separate page at the end of the J&A to allow minor, administrative changes to be made during the review process.)
11. Technical Certification: Include the following statement:
I certify that the supporting data under my cognizance, which are included in the justification are accurate and complete to the best of my knowledge and belief.
Typed Name: Date: __________________________
Title: Signature: ______________________
12. Requirements Certification: Include the following statement:
I certify that the supporting data under my cognizance, which are included in the justification are accurate and complete to the best of my knowledge and belief.
Typed Name: Date: __________________________
Title: Signature: ______________________
Only the most senior persons within the organization responsible for acquiring the supplies or services described in the justification (e.g. program manager, depot commander, or senior program engineer) and with specific knowledge of the individual requirement (commodity, technology, and/or function) shall sign the technical and requirements certifications.
13. Fair and Reasonable Cost Determination: Include the following determination:
I hereby determine that the anticipated cost to the Government for this contract action will be fair and reasonable.
Provide the basis for this determination (e.g., describe techniques to be used to determine fair and reasonable price, such as cost analysis, price analysis, audit, should cost, independent Government estimate, etc.). As part of the basis, indicate whether certified cost or pricing data will be required or if one of the exceptions in FAR 15.403 applies.
Typed Name: Date: __________________________
Title: Signature: ______________________
14. Contracting Officer Certification: This certification shall be made by the contracting officer who will sign the contract resulting from this justification and approval. Include the following statement:
I certify that this justification is accurate and complete to the best of my knowledge and belief.
Typed Name: Date: __________________________
Title: Signature: ______________________
Note: It is recommended for the contracting officer to annotate at the bottom of each J&A page the following marking, as appropriate, prior to posting on the internet: “For Official Use Only”.
Approval
(The approval statement is drafted on a separate page from the certifications and tailored to the instant contract action)
Based on the foregoing justification, I hereby approve the procurement of (state equipment/services being procured) on an other than full and open competition basis pursuant to the authority of 10 U.S.C. 2304(c) (insert authority and general title), subject to availability of funds, and provided that the services and property herein described have otherwise been authorized for acquisition.
Date: ___________________ Signature: ___________________
5153.303-6 Format for a bid protest action report.
Bid Protest Action Report
(RCS DD-DR&E(AR)1669)
Protester: ________________________________________________________________
Protest number: ___________________________________________________________
Protest Forum (GAO/AGENCY): ____________________________________________
Has there been a Freedom of Information Act request or Congressional, Office of the Secretary of Defense; Headquarters, Department of Army; media, or other high level interest in any aspect of the protested acquisition or action (including the period prior to any protest)?
Circle One: Pre-award/Post Award Negotiated/Sealed Bid
Best Value: Yes No
Description of item or service:
Solicitation Number:
Contract Number:
Awardee:
Award Date: ______________________. Award Amount:
Estimated Amount (if pre-award):
(Do not round off/abbreviate dollar amounts)
Stop Work? Yes No. If Yes, date issued:
Attorney assigned to the protest (include phone):
Contracting Officer (include phone):
Lessons Learned and legal/acquisition costs are to be submitted by letter covering a copy of decision. Include information concerning whether or not a GAO dismissal or withdrawal of a GAO protest was the result of a corrective action taken by the contracting office.
5153.303-7 Format for a quarterly bid protest analysis report.
Quarterly Bid Protest Analysis Report
(Separate Report for Government Accountability Office (GAO) Protests)
For the period covering:
1. Protests filed this quarter:
a. Total number:
b. Numbers filed by Army Command/Major Subordinate Command, Heads of Contracting Activities (HCAs):
2. Number of protests sustained/granted in this quarter:
3. Number of protests resolved using GAO Flexible Alternative Procedures in accordance with 4 CFR 21.10 this quarter:
4. Costs:
a. Costs and fees awarded by GAO to protester:
b. Dollar value of award:
(1) Preaward protests:
(2) Postaward protests:
5. Lessons Learned, Issues and Trends, Divergence from Precedent. Provide a copy of all decisions for sustained protests along with the lessons learned.
5153.303-8 Withdrawal of approval of property control system.
(Official Letter Head)
Office Symbol
Contractor’s Name and Address
Government contract (insert contract number) requires (insert contractor’s name) to establish and maintain, in accordance with FAR Subpart 45.5 and DFARS Subpart 245.5, a system to control, protect, preserve, and maintain Government property in your possession. The applicable provisions of the referenced contract provide that failure of the contractor to maintain and administer an acceptable program or system shall be presumed to be a failure resulting from willful misconduct or lack of good faith on the part of the contractor’s managerial personnel.
The Property Administrator, by letter dated (insert date) gave notification that (insert contractor’s name) system for the maintenance, protection, preservation, and control of Government property was reviewed and found not to meet the requirements of FAR Subpart 45.5 and DFARS Subpart 245.5 in the following respects:
(list all deficiencies)
By letter of (insert date) you were advised that approval of the property control system would be withdrawn unless the noted deficiencies were corrected by (insert date). As of this date, these corrections have not been accomplished. This undue delay in complying with your contractual requirements concerning Government property and your continued delay in rectifying noted deficiencies indicate a lack of concern by (insert contractor’s name) managerial personnel. Therefore, the approval of your Property Control System is withdrawn as of (insert date). As a result of this action, (insert contractor’s name) shall be liable for any loss or damage to the Government property occurring after receipt of this notice in accordance with the provisions of the contract.
A copy of this letter is being furnished to the Chief of the Contracting Office. Your failure to maintain an acceptable property control system could adversely affect future recommendations for the award of contracts. Restoration of approval of your property system is dependent upon the correction of the above listed deficiencies to the satisfaction of the contracting officer.
Sincerely,
(Signature)
Contracting Officer
(Note: Send by registered or certified mail.)
5153.303-9 Contractor Performance Assessment Report System initial registration consolidated format.
(Submit a copy to the Contractor Performance Assessment Report System (CPARS) focal point upon award, along with the CPARS access request format at 5153.303-10. Other formats may be used if all applicable information below is included. )
CONTRACT NUMBER: ________________________
ORDER NUMBER ________________ (Include General Services Administration (GSA) number and basic procurement instrument identification “F” order number.)
CONTRACT TITLE/EFFORT DESCRIPTION: ____________________________________________________________________________________________________________________________________________________________
CAGE CODE:________ DUNS:________________ PSC:________ NAICS: ____________
CONTRACTOR NAME, ADDRESS (as listed in System for Award Management, www.sam.gov): _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________
BUSINESS SECTOR (Circle one): Systems or Non-systems
LOCATION OF CONTRACTOR PERFORMANCE (if other than contractor address above): _____________________________________________________________________________
CONTRACT AWARD DATE ____________ EFFECTIVE DATE: ___________________
COMPLETION DATE (Include last possible date, if all options exercised): ______________
DOLLAR VALUES:
AWARDED VALUE (Grand total, including unexercised options): _______________ CURRENT VALUE (Current funded amount as of registration date. Use target price or total estimated amount for incentive contracts.): ____________________________
CONTRACT TYPE (Circle one. For hybrid, put a “P” next to the predominate type and identify other type with an “O” next to it.):
FFP __ FPI ___ FPR ___ CPFF ___ CPIF ___ CPAF ___ HYBRID ___ OTHER: _________________
COMPETITIVE (Basis of award): YES or NO
PROGRAM/PRODUCT/PROJECT MANAGER ___________________
E-MAIL: _____________________________ TELE: _________________
CONTRACT SPECIALIST ___________________
E-MAIL: ____________________________ TELE: _________________
CONTRACTING OFFICER ___________________
E-MAIL:____________________ TELE: _________________
GOVERMENT CONTRACTING OFFICER’S REPRESENTATIVE/QUALITY ASSURANCE EVALUATOR ___________________
E-MAIL:_____________________________ TELE: _________________
CONTRACTOR PROGRAM MANAGER:______________________________ TELE:_________________E-MAIL: ___________________________________
PERIOD OF PERFORMANCE (POP) FOR 1ST ASSESSMENT:
FROM:____________ TO:___________ CPAR COMPLETED:_________
OPTION 1 POP FROM:___________ TO:___________ CPAR COMPLETED:_________
OPTION 2 POP FROM:___________ TO:___________ CPAR COMPLETED:_________
OPTION 3 POP FROM:___________ TO:___________ CPAR COMPLETED:_________
OPTION 4 POP FROM:___________ TO:___________ CPAR COMPLETED:_________
(View completed reports in the Past Performance Information Retrieval System-Report Card, available via the Internet at https://www.ppirs.gov.)
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