4-Notification of Receipt of Services Rendered Form.pdf

Attachment 4 -- Notification of Services Rendered Form

Combined Synopsis/Solicitation 70Z03823QK0000002

A) Contract or Order Number:

B) Date of Service Completion:

C) Contracting Officer or Representative:

D) Division:

J) Government POC Acceptance or Rejection of the Service: (Check One of the Boxes Below)

E) Building or Location of Service:

G) Contractor Company:

H) Contractor Company Representative:

I) Contractor Company Representative Signature:

F) Description of the Service:

The service described in Block F has been complete in accordance with the requirements of the contract or order listed in

Block A. By signing below, I certify as the Government POC that I accept the service provided by the Contractor listed in

Block G and give the Contracting Officer approval to pay the invoice associated with this service.

The service described in Block F has NOT been complete in accordance with the requirements of the contract listed in

Block A. As the Government POC I DO NOT accept the service provided by the Contractor listed in Block G. (If this is block is checked, the Government POC shall provide additional information below detailing why the service is unacceptable)

Notification of Services Rendered Form

The Contractor and Government POC shall complete this form upon completion of an "onsite contractual service". The

Contractor and Government POC shall submit the signed form to the Contracting Officer or their representative listed in block C below within two (2) business days of contractual service completion.

For the purpose of this form, "onsite contractual service" is defined as any service performed at the Aviation Logistics Center with a period of performance of less than 90 days or as deemed necessary by the Contracting Officer. Example of onsite services meeting this definition include, calibration services, equipment troubleshooting / maintenance / repair and IT services.

JUL 2018

Government POC:

Government POC Signature:

Date: