GENERAL SERVICES ADMINISTRATION ACQUISITION MANUAL (GSAM)

## Part 553—Forms

### Subpart 553.1—General

#### 553.101 Requirements for use of forms.

Parts 501–552 and 570 prescribe the requirements for use of GSA forms illustrated or referenced in this part. You may identify the prescription as follows:

(a) Forms available on-line. The list of forms available on-line in 553.370-1 identifies the basic prescription for each referenced form.

(b) Illustrated forms. The prescription for each illustrated form is identified by a cross-reference shown on the illustration. When a form is mentioned in more than one place in this regulation, the section referenced on the illustration is the section that contains the basic prescription.

#### 553.102 Current editions.

You must use the current edition of the forms identified in Subpart 553.3 unless otherwise authorized under this regulation.

#### 553.170 Establishing and revising GSA Forms.

(a) If two or more GSA Services or Offices use a GSA form, the Office of Acquisition Policy maintains the form.

(b) If only one GSA Service or Office uses a GSA form or if the form is used for a contract type unique to one Service or Office (e.g., construction contracts), that Service or Office is responsible for maintaining the form.

(c) Any proposed new or revised GSA acquisition related form must be submitted to the Office of Acquisition Policy for review and concurrence.

### Subpart 553.3—Illustrations of Forms

#### 553.300 Scope of subpart.

This subpart illustrates standard and GSA forms prescribed or referenced in Parts 501–551 and 570. Instructions on completing a form, if included, are identified by the suffix “I” after the GSAR section number.

#### 553.300-70 Forms not illustrated.

This subpart does not illustrate either:

(a) Standard forms illustrated in the FAR.

(b) Forms available on-line. You can access the forms listed below at the location indicated.

Reference | Form No. | Title | On-line Location
--- | --- | --- | ---
570.701 | Standard Form 2 | U.S. Government Lease for Real Property | http://www.gsa.gov/pbs/pe/stancla/stancla.htm
552.238-74 | GSA Form 72A | Contractor’s Report of Sales | http://vsc.gsa.gov
570.702(b) | GSA Form 276 | Supplemental Lease Agreement | http://www.gsa.gov/forms
513.302-70(b) | GSA Form 300 | Order for Supplies and Services | http://www.gsa.gov/forms
Subsection(alpha)70(number) | GSA Form 300A | Order for Supplies and Services (Continuation) | http://www.gsa.gov/forms
509.105-1(a) | GSA Form 527 | Contractor’s Qualifications and Financial Information | http://www.gsa.gov/forms
532.905-71(a) | GSA Form 1142 | Release of Claims | http://www.gsa.gov/forms
570.702(c) | GSA Form 1364 | Proposal to Lease Space | http://www.gsa.gov/forms
514.407-72 | GSA Form 1535 | Recommendation for Award(s) | http://www.gsa.gov/forms
513.106(c)(2) | GSA Form 2010 | Small Purchase Tabulation Source List/Abstract | http://www.gsa.gov/forms
532.905-70 | GSA Form 2419 | Certification of Progress Payments Under Fixed-Price Construction Contracts | http://www.gsa.gov/forms
501.603-3(b)(1) | GSA Form 3409 | Personal Qualifications Statement for Appointment as Contracting Officer | http://www.gsa.gov/forms
504.803(b) | GSA Form 3420 | Contract/Modification File Checklist File Format (Award) | http://www.gsa.gov/forms
503.104-5 | GSA Form 3617 | Record of Authorization of Access to Proprietary or Source Selection Information | http://www.gsa.gov/forms
570.702(a) | GSA Form 3626 | U.S. Government Lease for Real Property (Short Form) | http://www.gsa.gov/pbs/pe/stancla/stancla.htm

#### 553.370-300-I Instructions for using the GSA Form 300, Order for Supplies and Services.

(a) Completing the form.

Block 1, Date of Order. Enter the date the order is signed by the contracting/ordering officer.
Block 2, Order Number. If an order is being placed against an established contract, assign an order number in accordance with the procedures in GSAR 504.7001-3. This block does not apply to open market purchases/contracts.
Block 3, Contract Number. If an order is being placed against an established contract, insert the contract number of the contract that the order is being placed against. If an open market purchase/contract is involved, assign a contract number in accordance with the procedures in GSAR 504.7001-2.
Block 4, ACT Number. Assign an Accounting Control Transaction (ACT) number in accordance with NEAR system procedures. If the purchase is charged to the General Supply Fund (255X), contemplates periodic billing or is for an amount that exceeds $2,500, place the ACT number label on copy 1, the “paying office” copy. The ACT number label will be placed on the invoice for other purchases. NOTE: In some organizations, the “paying office” copy is forwarded to a Budget or Executive Office within the service or staff office where the ACT number label is affixed to the copy and forwarded to the appropriate Finance Division.
Block 5, Accounting Classification. Enter the accounting information in accordance with the procedures contained in the Accounting Classification Handbook (COM P 4240.1). The following blocks are mandatory and must be completed for each order: “FUND,” “ORG CODE,” “B/A CODE,” “O/C CODE,” “FUNC CODE,” and “C/E CODE.” The accounting information on modifications must be the same as the original order, unless the accounting information is being modified.
Block 6, Finance Division. To be completed by the Finance Division.
Block 7, To: Contractor. Enter the contractor's name and address, including zip code.
Block 8, Type of Order. Check “block A” when making an open market purchase/contract and refer to the date of the contractor's oral or written quotation in the space “REFERENCE YOUR.” Check “block B” when placing orders against established contracts. Check “block C” when using a GSA Form 300 to modify another GSA Form 300; enter the modification number and the authority for issuing the change, i.e., “changes” clause or other authority for issuing. Assign modification numbers in accordance with GSAR 504.7001-4.
Block 9, Taxpayer's Identification Number (TIN). This block is mandatory when making open market purchases of services from firms or individuals that are not incorporated (partnerships or sole proprietors). This requirement does not apply to supply purchases/contracts. Obtain the firm's or individual's TIN and enter it in “block A.” The Finance Division will return purchase orders if block 9A is incomplete. If the contractor refuses to provide a TIN, check “block B” to reduce payment by twenty percent. NOTE: The contractor must be informed before checking “block B” that failure to provide the TIN will result in twenty percent of the payment being withheld.
Block 10, Classification. Check the block in 10A that indicates the classification of the contractor. Definitions of “Small Business,” “Disadvantaged Business,” and “Women-owned Business” can be found at FAR 19.001 and 52.219-3. Check the block in 10B that indicates the type of business organization of the contractor. This block is mandatory when making open market purchases of services.
Block 11, Issuing Office. Enter the name, address, including zip code, and telephone number of the office making the purchase/contract.
Block 12, Remittance Address. Ask the contractor for the address that it would like the payment for the supplies or services to be mailed. The Finance Division can only make payments to the address indicated on the order. Therefore, in order for payments to be processed in a timely manner, the contracting officer must ask the contractor for a remittance address and enter it in “block 12.” If the contractor's invoice requests payment to be made to a different address than the one in block 12, the Finance Division will request the contracting officer to modify the order within 5 days to provide the proper “remit to” address. If the Finance Division does not receive a modification within 5 days, the invoice will be considered improper and will be returned to the contractor.
Block 13, Ship to. Enter the consignee address, including zip code, and telephone number.
Block 14, Place of Inspection and Acceptance. Enter the location where inspection and acceptance will occur.
Block 15, Requisition Office. Enter the name, correspondence symbol and telephone number of the office that requested the supplies or services be purchased.
Block 16, F.O.B. Point. Enter the appropriate f.o.b. point. See FAR 47.302 and 47.303 and GSAR 547.300.
Block 17, Government B/L No. When supplies are shipped using a Government Bill of Lading (GBL), enter the GBL number.
Block 18, Delivery f.o.b. point on or before. Enter the date when supplies or services are to be delivered. Terms such as “ASAP” are unacceptable.
Block 19, Payment/Discount Terms. Enter the prompt payment discount terms provided for in the contract when placing an order against an established contract or the discount terms offered if purchasing on the open market.
Block 20, Schedule. Enter a complete description of the supplies or services being procured, including quantity, unit price, total price and any periodic billing requirements. In addition, the estimated freight charges must be included when f.o.b. origin terms are used and a Government Bill of Lading (GBL) is not issued.
Periods for inspection and acceptance of contract deliverables or completed work that are different from the 5 days cited in the Prompt Payment clause on the reverse of the GSA Form 300, must be included in this block.
When a GSA Form 300 is used to modify another GSA Form 300, block 20 must describe in detail what is being modified, e.g., number of units from to , delivery date from to , etc. Indicate the impact of the modification on the total price, e.g., total price is increased from $ to $ , total price is decreased from $ to $ , or the price of the original order is unchanged.
Block 21, Receiving Office. Enter the name, correspondence symbol and telephone number of the office responsible for completing the receiving report.
Block 22, Shipping Point. When the Government is paying the transportation cost or reimbursing the contractor for transportation cost, enter the shipping point for the supplies being purchased. This information should be obtained from the seller.
Block 23, Gross Shipping Weight. When the Government is paying the transportation cost or reimbursing the contractor for transportation cost, enter the shipping weight for the supplies being purchased. This information can usually be obtained from the seller.
Block 24, Mail Invoice to. Enter the address of the issuing office (same as block 11) or other designated program office within the service or region for purchases which do not exceed $2,500 except for procurements charged to the General Supply Fund (255X) and procurements that anticipate periodic billings, e.g., utility contracts, recurring building service contracts, equipment rentals, etc. For all other purchases, enter the address of the appropriate Finance Division. Enter the “Fund” in designated area.
Block 25. If block 24 provides for the invoice to be submitted directly to the appropriate Finance Division, enter the Chief, Accounts Payable Branch in block A and his/her telephone number, including area code, in block B. If block 24 provides for the invoice to be submitted to the issuing office or other designated program office within the service or region, enter the name and telephone number, including area code, of an individual in that office.
Block 26. Enter the name of the contracting/ordering officer in block A and his/her telephone number, including area code, in block B. The name of the contracting/ordering officer typed in block A must correspond with the signature in block C. Obligating documents cannot be signed for a contracting/ordering officer.

(b) Distribution.

(1) The distribution for orders (GSA Form 300) that do not exceed S2,500, except those orders charged to the General Supply Fund (255X) or those which anticipate periodic billing, will be as follows:

Copy 1 | Paying Office (Original)—Retain in the contract file or send to the program office within the service or region responsible for preparing the receiving report (Copy 6). DO NOT send to the paying office until the invoice is received and approved for payment.
Copy 2 | Contractor's original
Copy 3 | Purchase File (Contracting/Ordering Officer)
Copy 4 | Purchase Office (Distribution as necessary)
Copy 5 | Consignee
Copy 6 | Receiving Report (Paying Office)
Copy 7 | Memorandum (Distribution as necessary)

(2) The distribution for orders (GSA Form 300) that exceed $2,500, is charged to the General Supply Fund (255X), or that anticipates periodic billing will be as follows:

Copy 1 | Paying Office (Original)
Copy 2 | Contractor's Original
Copy 3 | Purchase File (Contracting/Ordering Officer)
Copy 4 | Purchase Office (Distribution as necessary)
Copy 5 | Consignee
Copy 6 | Receiving Report (Paying Office)—Not applicable to State A.I.D. overseas orders.
Copy 7 | Memorandum (Distribution as necessary)

(c) Certifying receipt and processing payments for procurements requiring a written purchase order (GSA Form 300).

(1) When supplies or services are received, the contracting/ordering office or designated program office will certify receipt and acceptance and indicate the amount approved for payment on copy 6, Receiving Report, of the GSA Form 300 or 300-1. When multiple deliveries/payments are required, additional copies of the receiving report (copy 6) may be reproduced or the GSA Form 3025 or 3025A, Receiving Report, used to certify receipt and acceptance. Photocopied signatures will not be accepted on the receiving report.

NOTE: It is important that the date of receipt and the date of acceptance entered in the certification on the receiving report be accurate. Those dates are used to calculate the due date for payments, and interest on overdue payments. The contracting/ordering officer or a designated representative should certify receipt and authorize payment by signing the certification on the receiving report.

(2) Invoices received by issuing offices or other designated program offices must be time stamped to indicate the date of receipt, checked to verify the accuracy of the invoiced amount, and forwarded within 5 workdays (after receipt of the invoice or acceptance of the supplies and/or services, whichever is later), to the appropriate Finance Division for payment. Copy 1 of the GSA Form 300/300-1 and a receiving report (Copy 6 of the GSA Form 300/300-1 or GSA Form 3025/3025A, Receiving Report) should be forwarded with the invoice to finance.

(3) When invoices are submitted directly to the Finance Division, contracting/ordering offices or other designated program offices will certify receipt and acceptance and authorize payment for supplies or services by completing copy 6 of GSA Form 300/300-1 or the GSA Form 3025/3025A, Receiving Report, in accordance with paragraph (a)(1) above and sending it to the appropriate Finance Division within 5 workdays after supplies or services are received and accepted.