# AFARS PART 5153

Subpart 5153.2 -- Prescription of Forms

- 5153.204 -- Administrative Matters.

- 5153.204-70 -- DD Form 350, Individual Contracting Action Report.
- 5153.204-71 -- DD Form 1057, Monthly Contracting Summary of Actions $25,000 or Less.
- 5153.213-70 -- Completion of DD Form 1155, order for supplies or services.

Subpart 5153.90 -- Standard Army Formats.

- 5153.9000 -- General.
- 5153.9001 -- Sample Contracting Officer’s Representative (COR) designation.
- 5153.9002 -- Sample Ordering Officer Appointment.
- 5153.9003 – Sample Memorandum for Waiver of the Berry Amendment.
- 5153.9004 -- Format for a Justification Review Document for Other Than Full and Open Competition.
- 5153.9005 -- Format for a Justification and Approval for Other Than Full and Open Competition.
- 5153.9006 -- Format for a Bid Protest Action Report.
- 5153.9007 -- Format for the Quarterly Bid Protest Analysis Report.
- 5153.9009 -- Withdrawal of Approval of Property Control System.
- 5153.9010 – Congressional Notification Format. (See next page) [AFARS Revision #001, dated Nov 29, 2001] [AFARS Revision #21, dated May 22, 2007]

AFARS -- Part 5153
Forms

Subpart 5153.2 -- Prescription of Forms

5153.204 -- Administrative Matters.

5153.204-70 -- DD Form 350, Individual Contracting Action Report.

(a) Part A of the DD Form 350.

(1) Block A1, Type of Report.

(ii) Code 1 -- Canceling. Enter the data contained in the original action in all blocks, except Block A1 of the canceling action which must contain a “1.” The canceling action must pass the current DoD edit specifications. If the action fails the edit because codes have changed since the original action was submitted, update the canceling action as necessary so it will pass the edit.

(iii) Code 2 -- Correcting. Use Code 2 only when correcting a report that has already been successfully submitted. A correcting report must be submitted with entries in all applicable blocks to pass the DoD edit specifications. If the correcting report does not pass the edit, verify the entries against the current edit specifications.

(b) Part B of the DD Form 350.

(1) Block B1, Contract Number.

(A) For actions covered by DFARS 204.670-6(b)(6) (USACCE utilities vouchers), enter the contract number under which the largest payment is made when more than one contract number applies to transactions being reported on a single DD Form 350.

(B) For actions covered by DFARS 204.670-6(b)(6) (USACCE utilities vouchers), enter the six-digit activity identifier followed by the two-digit fiscal year, the letter “Z” and four zeroes, e.g., DAKF1290Z0000.

(5) Block B5, Contractor Identification Information.

(ii)

(A) Block B5A, Establishment Code. For actions covered by DFARS 204.670-6(b)(6)(USACCE utilities vouchers), enter 15491629A.

(B) Block B5B, Cage Code. For actions covered by DFARS 204.670-6(b)(6) (USACCE utilities vouchers), enter 0BU33 (first position is zero).

(C) Block B5C, Contractor Name and Division Name. For actions covered by DFARS 204.670-6(b)(6) (USACCE utilities vouchers), enter European Utility Companies.

(e) Part E of the DD Form 350.

(4) Block E8: For actions covered by DFARS 204.670-6(b)(6) (USACCE utilities vouchers), enter the number of actions that were consolidated on the single DD Form 350.

5153.204-71 -- DD Form 1057, Monthly Contracting Summary of Actions $25,000 or Less.

(d)(7)

(ii) Enter the subtotals for the number and dollar value of contracting actions as prescribed in DFARS 253.204-71(d)(7)(ii)(A) through (E).

5153.213-70 -- Completion of DD Form 1155, order for supplies or services.

See DFARS PGI 253.213-70.

(e) Instructions for DD Form 1155 entries.

Block 19 Schedule of Supplies or Services -- For delivery order under JOC, see 17.9004-3(h).

[AFARS Revision #21, dated May 22, 2007]

Subpart 5153.90 -- Standard Army Formats.

5153.9000 -- General.

This subpart sets forth standard formats for specified actions. These formats may be tailored, where appropriate, to fit the specific acquisition or contracting action.

5153.9001 -- Sample Contracting Officer’s Representative (COR) designation.

Use official letterhead and follow standard procedures for correspondence. Address the designation to the individual by name, including rank or grade, and full mailing address.

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 2a 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.

5. At the time of contract completion, you will forward all records to the contracting officer for retention in the contract files.

6. 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.

7. 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.

8. 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

5153.9002 -- Sample Ordering Officer Appointment.

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.

Subject: Appointment of Ordering Officer

1. Appointment. Under AFARS 5101.602-2-91, 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:

5153.9003 – Sample Memorandum for Waiver of the Berry Amendment.

MEMORANDUM FOR –[Insert name of requiring activity].

SUBJECT: Waiver of the Berry Amendment

I have reviewed the request for waiver of the provisions of the Berry Amendment (10 U.S.C. 2241, note) from –[insert name of requiring activity]—pertaining to the purchase and use of—[insert name of item(s)]—in the manufacture of –[insert name of item(s)]. In the course of this review, I have considered the alternatives which would not require approval of this waiver, and I find them to be unacceptable.

Accordingly, I determine that the provisions of the Berry Amendment are waived for the item(s)/program(s) set forth within this request. Specifically, my determination shall cover the –[insert name of item(s)/program(s)].

This approval expires [insert number] months from this date or sooner if a U.S. product becomes available.

[Insert Secretary of the Army name]

5153.9004 -- 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: ____________________
Principal Assistant Responsible for Contracting
Typed Name: DSN: ______________________
Signature: __ Date: ____________________

(1) Add PEO signature block when item is PEO managed.

Special Competition Advocate

Typed Name: DSN:_____________________

Signature: Date:_____________________

Head of the Contracting Activity

Typed Name: DSN:_____________________

Signature: Date:_____________________

5153.9005 -- Format for a Justification and Approval for Other Than Full and Open Competition.

Control No:

Justification and Approval for Other Than Full and

Open Competition Justification

1. Contracting Activity: Specify the contracting activity responsible for this action.

2. Description of Action: State whether approval is being requested for a new contract or a modification. Include type of contract, type of funds to be used (R&D, OPA, OMA) and, when applicable, the estimated share and ceiling arrangements, and fee or profit. The format specified in AFARS 5153.9005 is mandatory for contract actions greater than $78,500,000.

3. Description of Supplies/Services: Describe the supplies/services. Include the estimated total value, including options, if any. [AFARS Revision #003, dated Jan 25, 2002]

4. Authority Cited: Identify the statutory authority permitting other than full and open competition, followed by the FAR citation and FAR citation title.

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.

If the authority FAR 6.302-1 is cited for follow-on acquisitions, include an estimate of the cost to the Government that would be duplicated and how the estimate was derived. If the authority is FAR 6.302-2, include the required delivery schedule and lead-time involved as well as a discussion of the serious injury to the Government which would result if award of a contract is delayed.

(c)(1), follow-on major system or highly specialized equipment must be based on result in (1) substantial duplication of costs to the Government not expected to recover through competition or (2) unacceptable delays in filling agency needs.

(c)(2), must explain harm – the Government would be seriously injured unless permitted to limit sources. J&A for this authority can be after the fact.

(c)(2) or (6), must request offers from as many potential sources as practicable under the circumstances.

6. Efforts to Obtain Competition: Describe efforts to ensure that offers are solicited from as many potential sources as is practicable. Also describe the extent of effective competition anticipated for this acquisition.

7. Actions to Increase Competition: There may be instances when it is not possible to compete the current acquisition. Include a statement of the actions taken, or to be taken, to increase competition (e.g., breakout) before any subsequent acquisition of the supplies or services. 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 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 that “To date, no other sources have written to express an interest.” If 10 U.S.C.2304(c)(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 awards.

(2) Competitive status of these actions.

(3) Authority previously used for less than full and open competition.

(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 award was accomplished by full and open competition, a detailed explanation of the changed circumstances.

(6) An explanation of any unusual patterns which 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 buy and whether there have been any significant changes.

b. Acquisition data availability. Explain why technical data packages, specifications, engineering descriptions, statements of work or purchase descriptions suitable for full and open competition have not been developed or are not available. Describe actions taken or planned to remedy this situation.

c. Unusual and compelling urgency. When FAR 6.302-2 is cited, provide data, estimated cost or other rationale to explain the nature and extent of the injury to the Government. 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 that first article testing is required on this procurement and why other means of assuring quality are not being used.

d. Subcontracting competition. In single source situations, address efforts to be taken by the Government to assure that the prime contractor obtains as much competition as possible in its subcontracting.

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: _______________

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 this basis, indicate whether certified cost or pricing data will be required or if one of the exceptions in FAR 15.403 will apply.

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: _______________

Approval

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), subject to availability of funds, and provided that the services and property herein described have otherwise been authorized for acquisition.

Date: ___________________
Signature: _______________

[AFARS Revision #22, dated September 12, 2007][AFARS Revision #23, dated May 16,2008]

5153.9006 -- 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 FOIA request or Congressional, OSD, HQDA, media, or other high level interest in any aspect of the protested acquisition or action (including the time period prior to any protest)?

Circle One: Preaward/Post Award Negotiated/Sealed Bid

Best Value: Yes No

Description of item or service:
Solicitation No:
Contract No:
Awardee:
Award Date: ______________________. Award Amount:

Estimated Amount (if preaward):
(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.

5153.9007 -- Format for the Quarterly Bid Protest Analysis Report.

Quarterly Bid Protest Analysis Report

(Separate Report for GAO Protests)

For The Period Covering:

1. Protests filed this quarter:

a. Total number:

b. Numbers filed by Army Command/Major Subordinate Command (HCAs)

HCA No.

2. Number of protests sustained/granted in this quarter:

3. Costs:

a. Costs and fees awarded by GAO to protester:
b. Dollar value of award:

(1) Preaward protests:
(2) Postaward protests:

4. Lessons Learned, Issues and Trends, Divergence from Precedent. Provide a copy of all decisions for sustained protests along with the lessons learned.

5153.9009 -- 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.)

5153.9010 – Congressional Notification Format. (See next page) [AFARS Revision #001, dated Nov 29, 2001] [AFARS Revision #21, dated May 22, 2007]

CONGRESSIONAL NOTIFICATION

(IAW DFARS 205.303 and AFARS 5105.303)

SUBMIT TO: BUSINESS OPERATIONS AND ENTERPSE SYSTEMS DIRECTORATE -SAAL-PB

E-MAIL: CONG.NOTIF@HQDA.ARMY.MIL; OR FAX # (703) 681-9304 OR DSN 761-9304

SAAL-PB POC (703) 681-9782, OR 9783

SERIAL No:

(For DA use only)

CONTRACT NO: | MOD, DELIVERY ORDER OR OTHER NUMBER:
DATE & TIME OF AWARD: (5:00 P. M., WASH, DC Time)
ANNOUNCEMENT AMOUNT: $ | ESTIMATED FACE VALUE:
CONTRACT WITH OPTIONS BASE YEAR AWARD: $ TOTAL IF ALL OPTIONS EXERCISED: $ | CUM TOTAL OF THIS CONTRACT: $
INCREMENTALLY FUNDED: YES ☐ NO ☐ THIS INCREMENT = $ TOTAL ALL INCREMENTS (ESTIMATE) =$ | MULTI-YEAR: YES ☐ NO ☐
TYPE OF CONTRACT: TYPE OF FUNDS (complete appropriation, FY, type of funds & amount): CONTRACTOR: ADDRESS:
ITEM (QTY) OR SERVICE PROCURED (One or two lines in complete sentences):
SOL OR RFP ISSUE DATE: | BIDS SOLICITED:
EST COMPLETED DATE: | BIDS RECEIVED:
FOREIGN MILITARY SALES: YES NO IF YES, NAME OF COUNTRY
LARGE BUSINESS SMALL BUSINESS
PERFORMANCE LOCATION (S), CITY, STATE AND ZIP CODE WITH PERCENTAGES AND DOLLAR AMOUNT:
CONGRESSIONAL DISTRICT OR ZIP CODE:
REPORTING CONTRACT OFFICE:
REPORTED BY: PHONE NUMBER: PRIMARY POC
SECONDARY POC | PHONE NUMBER:
FOR OFFICIAL USE ONLY