36C26018Q0075-00001002.docx

CONTRACT DISCREPANCY REPORT

Instructions: Service Line POC/COR fills in blocks 1, 3, 4, 5 (prepared), and 6. Contractor fills in blocks 9 and 10.

6. DISCREPANCY OR PROBLEM: (Describe in detail: include applicable SOW/Contract references: attach continuation sheet if necessary.)

7. SIGNATURE OF CONTRACTING OFFICER

9. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE: ATTACH CONTINUATION SHEET IF NECESSARY. (Cite applicable Q.C. program procedures or new Q.C. procedures.)

10. SIGNATURE OF CONTRACTOR REPRESENTATIVE

DATE

11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, rejection; attach continuation sheet if necessary.)

12. GOVERNMENT ACTIONS (Reduced payment, cure notice, show cause, other.)

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