08_DIR_T F_ATTACHMENTB-F12-18-2007.doc

ATTACHMENT B

BILLING INSTRUCTIONS

Billing instructions are applicable to all cost-reimbursement contracts.

I. INTRODUCTION

These instructions reflect the standards of the Health Resource and Services Administration (HRSA) for adequately prepared vouchers or invoices. Prompt payment of your claims will be promoted by your compliance. All vouchers submitted under this contract are subject to audit; therefore, all costs claimed must be adequately supported by accounting records and other data that can be audited.

II. VOUCHER SUBMISSION

A. Forms–In claiming reimbursement use: The Standard Form (SF) 1034, Public Voucher for Purchases and Services Other Than Personal (with continuation sheet SF 1035) Public Voucher for Purchases and Services Other Than Personal, which can be found at http://www.onr.navy.mil/02/024/forms. The billing content should include all applicable information contained below:

(k) Amount Funded

(l Variance

(m)

Current

(i) Cumulative

(j)

Direct Costs:

(1) Direct Labor/Hourly Rate

(2) Fringe Benefits

(3) Accountable Property

(4) Materials & Supplies

(5) Premium pay -if applicable

(6) Consultant Hourly Rate

(7) Travel

(8) Subcontracts

(9) Other

Total Direct Costs

Overhead

G&A

Fixed Fee

Total Amount Claimed

Adjustments

Grand Totals

B. Number of Copies–For submission purposes each voucher will be prepared in an original and two (2) copies. See Section G.4. for submission of invoices/vouchers information.

C. Time for Submission–Vouchers may be submitted at the beginning of each calendar month for costs incurred during the preceding month. Costs incurred earlier than the preceding month, but not previously billed for, may be included, but the amount and month(s) in which such costs were incurred must be stated in the voucher.

D. Resubmission of Costs–Costs resubmitted after suspension should be claimed in a separate public voucher and marked "Resubmission of Costs".

E. Cost Incurrence Period–Costs must be incurred and the dates of the related "billed for" period must fall within the contract performance period as set forth in the original contract and any amendments thereof.

F. Contractor's Fiscal Year–Vouchers should be prepared in such a manner that costs claimed can be associated or identified with the contractor's fiscal year. This will ensure proper application of an indirect cost rate(s) to the direct costs of a particular fiscal year.

G. Supporting Documentation–Vouchers shall include all documents/receipts that support each cost incurred and claimed on the voucher.

III. PREPARATION GUIDE

A. Completion of Form 1034 or Contractor Equivalent–On the Form 1034 or equivalent, the following information is required. Complete the blocks entitled:

Voucher No., U.S. Department, Bureau, or Establishment and Location, Date Voucher Prepared, Contract Number and Date, Payee’s Name and Address, Number and Date of Order, Date of Delivery of Service Articles or Services, Amount, and Total. Leave all other blocks blank.

Instructions:

· In block entitled, U.S. Department, Bureau or Establishment and Location enter:

HHS/Health Resources and Services Administration

Acquisitions Branch

5600 Fishers Lane, Room 13A-19

Rockville, MD 20857

· In block entitled, Payee’s Name and Address, enter the name and address to which payment should be made, except in case of assignment of claims, and the address of the organization to which payments have been assigned.

· In block entitled, Number and Date of Order, enter the number and date of the applicable order only if the billings are consequent to work assignments or task orders.

· In block entitled, Date of Delivery or Service, enter the specific month/year, or months/year if quarterly.

· In block entitled, Articles or Services, enter the following statement: “For reimbursement of costs incurred under Contract No HHSH240200735003C, as detailed in attachments.”

· In blocks entitled, Amount and Total, enter the total dollar amount of this billing.

B. Completion of Summary of Expenditures–This page follows directly behind the Form SF 1034 and contains two main categories of information: 1) gross summary of costs by category showing amount previously claimed, amount claimed under this voucher, and cumulative through this voucher and 2) necessary certifications and signature.

1. Gross Summary–include only major categories of costs in the order illustrated.

2. Certifications and Signature are illustrated in Exhibit B. The Certification of Costs/Fee is mandatory; the Price Stabilization Certification is required only when called for in the Submission of Invoices and Place of Payment article of the contract. The next page in order should be the SF 1035.

C. Completions of Form 1034–On the “Detail” Form 1035, provide a breakdown to support the total amount cited in both Form 1034 and Summary of Expenditures. The purpose of the detailed information is to assist the HRSA Contracting officer and program personnel in relating costs incurred to work performed. The several categories of cost will be itemized and described as follows:

1. Direct labor costs consist of salaries and wages paid for work performed directly for the contract and pursuant to its terms. Such labor costs (excluding fringe benefits and overtime premium pay) will be billed as follows:

· Provide the job title or classification of the worker and provide for each classification: the number of hours worked, the hourly rate, and the total wage or salary. The name of the worker should be provided, but when a great number of routine workers are involved, the position classifications only will suffice.

The cost of direct labor charged to the contract must be supported by time records maintained in the contractor’s office; if salaries are involved, reasonable estimates on a post basis may be used in lieu of time records.

2. Fringe benefits are to be treated according to the contractor's established practice:

· If fringe benefits, bonuses, etc. are included in the overhead pool, no specific entry is required.

· Fringe benefits can be treated as direct costs, in which case enters the fringe benefits expressed as a percentage factor of the direct labor base or show the Actual Fringe Benefits cost.

3. Materials and supplies should include only those items that the contractor normally treats as "direct costs". Bill these costs under major classifications or categories such as office supplies, chemicals, electronics parts, etc., unless any one particular item within a class exceeds $300.00, in which case all such item(s) exceeding $300.00 must be specifically identified.

Note: Under no circumstances shall any item of non-expendable equipment be included within these classifications (see 8 below).

4. Premium pay of any kind (including overtime) must be authorized by the Contracting Officer in advance. Billings for unauthorized premium pay cause frequent delays in payment due to suspensions and exchange of correspondence. Generally such pay is not included in the direct labor base and should not be included in the billing for "direct labor" unless the contractor has consistently followed this practice in the past as a matter of policy. Make entries as follows:

1. In Summary of Expenditures –List as a single item.

2. In SF 1035–itemize for each position or job category referencing the Contracting Officer's letter of authorization. Note on Special Authorizations: According to the contract, certain costs require specific authorization in writing by the Contracting Officer. Whenever, the voucher includes costs pursuant to C.O. authorization, include for example, the reference: "C.O. letter (date)" or "approval number 57/74/115" if the C.O. cites said number in his letter.

5. Travel, as authorized by the contract, shall include the following in the SF 1035.

a. Travel by contractor shall provide:

· Name of traveler or title

· Dates of departure and return to departure point

· Transportation costs

· If claim for subsistence is on per diem basis, show number of days, rate, and amount, as authorized in contract. If claim is based on actual cost of subsistence, show on a daily basis the amounts claimed for lodging and meals separately.

· References to Contracting Officer's letter of authorization if approval is necessary

b. Travel by consultants shall provide detail similar to contractor travel above.

6. Consultant fees must reflect each consultant's name, daily honorarium, and number of days claimed. Travel for consultants (if applicable) must be itemized separately.

7. Subcontract requires the name of each subcontractor involved and the dollar amount claimed. Costs claimed by cost reimbursement subcontractors must be on an "as incurred" basis and subcontractor back-up information similar to the SF 1035 must be obtained and attached for each subcontractor.

8. Equipment is an article of personal property, complete in itself, that is of a durable nature with an expected service life of one year or more. Equipment does not ordinarily lose its identity or become a component part of another article when put to use. For the purposes of invoicing and reporting under HRSA contracts, the definition of non-expendable property and equipment are equivalent because the HRSA definition of non-expendable property does not include a dollar limitation. (The standard definition of "non-expendable property" considers items costing $200.00 or more–excluding transportation, installation, taxes–with a useful life of a year or more and property sensitive to conversation to private use (no cost limit).

Therefore, when billing for non-expendable property (equipment) costs, the Contractor must attach live (5) copies of a completed form, HEW 565 Report of Non-expendable Government Property in Possession of Contractor, to the original invoice copy. The contractor will retain the sixth copy. Only that property being billed for during the applicable billing period shall be included in the HEW 565. In addition, one (1) copy of each vendor invoice covering purchased property shall be attached to the original invoice.

9. Overhead will be charged at provisional rates resulting from audit determination and\or negotiation. Provisional rates will apply pending the establishment of final negotiated overhead rates for the contractor's fiscal year.

10. Other direct costs are minor costs that cannot be placed within any of the categories listed above. Identify by categories to the extent both possible and reasonable.

11. Fixed fee, when applicable, should be billed by prorating the negotiated total fixed fee to costs incurred. Applying a fee percentage to the fee percentage to the fee base will achieve this effect. Refer to the contract provisions for guidance.

VOUCHER SUBMISSION ADDRESS:

Submit one copy to:

Project Officer:

Parklawn Building, Room

5600 Fishers Lane

Rockville, Maryland 20857

Submit one original and one copy to:

HRSA/Office of Management/ DPM/GAB Parklawn Building, Room 13A-19 5600 Fishers Lane Rockville, Maryland 20857

ATTACHMENT C

CONTRACTOR PERFORMANCE REPORT

{ } INTERIM { } FINAL REPORT PERIOD:

FROM: ___ TO: _____________________

Contractor Name and Address:

Contract Number:

Contract Value: $ Contract Award Date:

Contract Completion Date:

How Awarded:

{ } Competitive

{ } Noncompetitive

{ } 8(a) { } Buy-Indian

{ } Small Business Set-Aside { } Sealed Bid

{ } Negotiated

Type of Contract: (Check all that apply) -- [ ] FP; [ ] FPI; [ ] FP-EPA; [ ] Award-Fee;

[ ] CPFF - Completion; [ ] CPFF-Term; [ ] CPIF; [ ] ID/IQ; [ ] BOA; [ ] Requirements;

[ ] Labor-Hour; [ ] T&M; [ ] SBIR

Description of Requirement:

Quality of Service or Product:

Cost Control:

Timeliness of Performance:

Customer Satisfaction/

Business Relations

(Project Officer):

Customer Satisfaction/ Business Relations

(End User):

Key Personnel:

Project Manager -

Name:

Dates of Employment:

From: To: Present

Other - Personnel

Name:

Dates of Employment:

From: To: Present

Name:

Dates of Employment:

From: To: Present

Name:

Dates of Employment:

From: To: Present

Was the contractor: { } Terminated for Default? { } Terminated for Convenience? { } Partial { } Complete

Comments:

Would you select this contractor again?

{ } Yes

{ } No Comments:

Subcontracting:

List subcontracting company names (where more than 10% of the work required under the contract was completed by a subcontractor):

Company: Project Manager:

Phone number:

Company: Project Manager:

Phone number:

Company: Project Manager:

Phone number:

Company: Project Manager:

Phone number:

Comments:_____________________________________________________

(Please attach additional sheets as necessary)

Rating:

Element Score (Raw score) - (1-5):

Customer Satisfaction/

Quality Cost Control Timeliness Business Relations:

Mean Raw Score (average of individual elements):

Rating Officials:

Project Officer:

Name: Phone number:

Signature: Date:

Contract Specialist:

Name: Phone number:

Signature: Date:

Contracting Officer:

Name: Phone number:

Signature:________________________ Date:_____________

Contractor Review:

Date mailed to Contractor: Date returned:

Comments provided:

{ } Yes { } No

Name of Contractor's Representative:

Title:

Phone number:

Signature: Date: ___________

Agency Review (A level above the Contracting Officer):

{ } Yes { } No { } Not Required

If review required, attach comments and final rating. Otherwise, mean raw score will serve as final rating.

Reviewer's Name:

Title:

Signature: Date:

RATINGS GUIDELINES

Summarize contractor performance in each of the rating areas. Assign each area a rating of:

1 (Unacceptable), 2 (Marginal), 3 (Acceptable), 4 (Good), 5 (Excellent), or ++ (Exceptional). Use the following instructions as guidance in making these evaluations.

Flexible

Proactive

Effective contractor recommended solutions

Effective small/small disadvantaged business subcontracting program

(0) Nonconformances require Cost issues require major Delays require major Response to inquiries technical/

Unacceptable major Agency resources to Agency resources to Agency resources to ensure service administrative issues ensure achievement of ensure achievement of achievement of contract is marginally effective and contract requirements. contract requirements. requirements. responsive.

(1) Nonconformances require Cost issues require minor Delays require minor Response to inquiries technical/

Marginal minor Agency resources to Agency resources to Agency resources to ensure service administrative issues ensure achievement of ensure achievement of achievement of contract is marginally effective and contract requirements. contract requirements. requirements. responsive.

(2) Nonconformances do not Cost issues do not impact Delays do not impact Response to inquiries technical/

Acceptable impact achievement of achievement of contract achievement of contract service administrative issues is contract requirements requirements. requirements. usually effective and responsive.

(3) There are no quality There are no cost issues. There are no delays. Response to inquiries technical/

Good problems. service administrative issues in an effective and responsive manner.

(4) The contractor has demonstrated an excellent performance level in all of the above four categories. There have been no Excellent performance problems and the contractor has demonstrated initiative to enhance/exceed contractual requirements and objectives. The contractor also has maintained an excellent contractor/government relationship throughout contract performance.

(5) The contractor has demonstrated a level of performance which exceeds the performance level described as "Excellent" (5).

Exceptional It is expected that this rating will be used in those rare instances when contractor performance clearly demonstrates a level

++ (Plus-Plus) of quality/innovation/performance well beyond the contract requirements warranting the assignment of the highest possible rating.

CONTRACTOR PERFORMANCE REPORT INSTRUCTIONS

(Block numbers are indicated for internal use only)

Contractor Performance Report (Block 1): Indicate whether this is an interim report (during the contract period) or final report (after the contract has expired). Also, indicate the report period covered by the evaluation. For an interim report, the report period will be from the date of contract award to the date of evaluation, or from the date of the last interim evaluation to the present. The report period for a final evaluation will be from the date of contract award to the date of contract expiration.

Contractor Name and Address (Block 2): Indicate the contractor's current name and full address. Identify the specific division being evaluated if there is more than one.

Contract Number, Value, and Dates (Block 3): Indicate the contract number. Also indicate the total contract value, which is the base amount of the contract including all possible options which may be exercised for interim evaluations and the base amount of the contract including all options which were exercised for final evaluations. In addition, indicate the original date of contract award and the scheduled or actual contract completion date, as appropriate.

How Awarded (Block 4): Indicate whether the original contract award was competitive or noncompetitive.

8(a), Buy Indian, etc. (Block 5): Indicate whether the contract was awarded as an 8(a) or small-business set-aside and whether the sealed bidding or negotiated method was used.

Type of Contract (Block 6): Indicate the type of contract by checking the block that applies.

Description of Requirement (Block 7): Provide a brief description of the work being done under the contract and identify the key performance indicators. This description will allow agencies calling for reference checks to compare statements of work.

Rating of Elements (Block 8): The Project Officer and Contract Specialist/Contracting Officer should jointly develop a rating for each element requiring a score in the far right column. In addition, a joint rating for the relative importance of each element should be developed. In the middle column provide a brief narrative for each of the elements and identify key performance indicators. Indicate the contract requirements that were exceeded or were not met by the contractor and by how much. For those elements not requiring an individual score please provide comments on these elements and factor the performance of these elements into other elements as instructed on the form.

Was the Contractor Terminated (Block 9): Indicate whether the contract was terminated and, if so, the type of termination. Provide detailed comments on the facts concerning any termination.

Would You Select This Contractor Again (Block 10): If given a choice, please explain why you would or would not select the contractors for this contract again.

Subcontracting (Block 11): List any significant subcontracts under the contract and provide the subcontractor’s name, Project Manager’s name, and a telephone number. If additional space is needed, attach additional sheets.

Rating Summary (Block 12): The Project Officer and the Contract Specialist and/or the Contracting Officer should enter the scores for each element and the respective importance ratings in the appropriate boxes. The average of the element scores should be calculated (without importance weighing) and entered into the block entitled “Mean Raw Score”. This number will be provided to other agencies which may require information on a prospective contractor’s past performance. The Adjusted Mean Weighted Score should also be calculated by adding all individual element scores including importance ratings and dividing this figure by 12. This will adjust the overall weighted score to the 5-point system. This adjusted score will be invaluable to the Health Resources and Services Administration’s evaluation of contractors for possible future contract awards by considering not only how a contractor performed on certain elements, but also how important each of these elements was in the performance of this specific contract.

Signatures of Rating Officials (Block 13): Upon completion of the rating process, the performance report form must be signed by the Project Officer, the Contract Specialist, and the Contracting Officer. If the Contracting Officer is serving as Contract Specialist for this contract, the Contracting Officer should sign as both Contracting Officer and Contract Specialist.

Contractor Review (Block 14): Upon completion of the performance report, a copy of the report form must be sent to the contractor for review and comment. The contractor has thirty (30) days to respond to the report. The dates of mailing and receipt and pertinent contractor information should be entered as indicated.

Agency Review (Block 15): If additional information or comments are received from the contractor, the entire performance report and contractor comment/information should be provided to the Director, Division of Grants and Procurement Management, OMPS/HRSA/HHS for final review and rating.

ATTACHMENT D

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden disclosure)

1. Type of Federal Action: _______

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. Status of Federal Action: ________

a. bid/offer/application

b. initial award

c. post-award

3. Report Type: ___________

a. initial filing

b. material change

For Material Change Only:

year __________ quarter date of last report

4. Name and Address of Reporting Entity:

Prime

Subawardee

Tier ___, if known:

Congressional District, if known:

5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Congressional District, if known:

6. Federal Department/Agency:

7. Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known:

9. Award Amount, if known:

10. a.

Name and Address of Lobbying Entity

(if individual, last name, first name, MI):

b.

Individuals Performing Services (including address if different from No. 10a)

(last name, first name, MI):

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

11. Amount of Payment (check all that apply):

( actual ( planned

12. Type of Payment (check all that apply)

( a. retainer

( b. one-time fee

( c. commission

( d. contingent fee

( e. deferred

( f. other; specify

13. Form of Payment (check all that apply):

( a. cash

( b. in-kind: specify:

nature ___________ value ____________

14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment indicated in Item 11:

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

15. Continuation Sheet(s) SF-LLL-A attached:

( Yes ( No

Signature:

Print Name:

Title:

Telephone No.:

Date:

Standard Form - LLL

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, as the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entry for this covered Federal action.

4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants, and contract awards under grants.

5. If the organization filing the report in item 4 checks "Subawardee", then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001".

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. a. Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action.

b. Enter the full names of the individual(s) performing services, and include full address, if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).

11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.

12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment.

13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.

14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contracted or the officer(s), employee(s), or Member(s) of Congress that were contacted.

15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.

16. The certifying official shall sign and date the form; print his/her name, title, and telephone number.

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction project (0348-0046), Washington, DC 20503.

ATTACHMENT E

Date:

Dear Client:

We are currently responding to the Health Resources and Services Administration (HRSA) Solicitation No. ________________ entitled, “______________________________.” The Government is placing increased emphasis in its acquisition process on past performance as a source selection factor and is requiring that clients of firms responding to HRSA solicitations be identified and their participation in the evaluation process be requested.

Therefore, enclosed is a past performance questionnaire for your completion. We are requesting that you complete the questionnaire and send it directly to HRSA at the following address:

ATTN: Aileen Broider (08-DIR-ORC-T&F-MEETINGS) HRSA/Division of Procurement Management

Parklawn Building

5600 Fishers Lane, Room 13A-19

Rockville, Maryland 20857

Phone: 301‑443‑5231 Fax: 301‑443‑5462 or 301-443-6038 Since this information will be used as one of the evaluation factors for contract award, we are requesting that you complete this questionnaire and return it to the HRSA Contract Specialist at the above address no later than JANUARY 18, 2008 at 10:00 am EST by fax (301) 443-5462 or (301) 443-6038 (no exceptions).

We thank you for your prompt response in this matter.

Sincerely, (To be signed by Offeror)

ATTACHMENT E

PAST PERFORMANCE INFORMATION SURVEY QUESTIONNAIRE

FOR: ________________________________________________________________________

Name of Company

PLEASE RETURN COMPLETED SURVEY TO:

HRSA/DPM – Attn: Aileen Broider (08-_08-DIR-ORC-T&F-MEETINGS _) Parklawn Building

5600 Fishers Lane, Room 13A-19

Rockville, Maryland 20857

Phone: 301-443-5231 Fax: 301-443-5462 or 301-443-6038

PLEASE FILL IN THE FOLLOWING:

Your Name: ____________________________ Your Agency:________________________ Address:___________________________________________________________________ Phone Number:_________________________ Fax :________________________________ Signature of Person Completing Survey:___________________________________________ Contract Number/Solicitation Number: ____________________________________________ YOUR ROLE IN THIS CONTRACT (circle one) Project Officer

Contracting Officer

Contract Specialist

Approximate Percentage of Work Competed by Subcontractors: ______ %

General Description or work or Title of Contract: _____________________________________________

RATINGS

Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible.

Standard

Contractor Performance Report

Evaluation Type: Interim _ Final _ (check one)

Additional or Alternate Contractor Name:

Requirement Description:

Ratings

Summarize contractor performance and check the number which corresponds to the rating for each rating category (See attached Rating Guidelines).

Quality of Product or Service

_0=Unsatisfactory _1=Poor _2=Fair

_3=Good _4=Excellent

_5=Outstanding

Comments for Quality of Product or Service (2000 characters maximum):

Cost Control (Rating and Comments for Cost Control are not required if contract type is Fixed-Price)

_0=Unsatisfactory _1=Poor _2=Fair

_3=Good

Comments for Cost Control (2000 characters maximum):

Timeliness of Performance

_0=Unsatisfactory _1=Poor _2=Fair

_3=Good

Comments for Timeliness of Performance (2000 characters maximum):

_0=Unsatisfactory _1=Poor _2=Fair

_3=Good

Comments for Business Relations (2000 characters maximum):

Rating Guidelines

Quality of Product or Service

0 = Unsatisfactory 1 = Poor 2 = Fair 3 = Good 4 = Excellent 5 = Outstanding

Cost Control

0 = Unsatisfactory 1 = Poor 2 = Fair 3 = Good 4 = Excellent 5 = Outstanding

Timeliness of Performance

ATTACHMENT F

CERTIFICATE OF CURRENT COST OR PRICING DATA

FAR 15.406-2

This is to certify that, to the best of my knowledge and belief, the cost or pricing data (as defined in section 2.101 of the Federal Acquisition Regulation (FAR) and required under FAR subsection 15.403-4) submitted, either actually or by specific identification in writing, to the Contracting Officer or to the Contracting Officer's representative in support of _______________* are accurate, complete, and current as of ____________________**. This certification includes the cost or pricing data supporting any advance agreements and forward pricing rate agreements between the Offeror and the Government that are part of the proposal.

Firm _____________________________________

Signature ________________________________

Name _____________________________________

Title ____________________________________

Date of execution*** _____________________

*Identify the proposal, request for price adjustment, or other submission involved, giving the appropriate identifying number (e.g., RFP No.).

**Insert the day, month, and year when price negotiations were concluded and price agreement was reached or if applicable, an earlier date agreed upon between the parties that is as close as practicable to the date of agreement on price.

***Insert the day, month, and year of signing, which should be as close as practicable to the date when the price negotiations were concluded and the contract price was agreed to.

(End of certificate)