Attachment C-5 FTC-ADM-61 Service Contract Work Request Form.pdf

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Attached to
Student Support/Facilities Operation Maintenance Services
Solicitation number
70LCHS25RPFB00001
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This is a Department of Homeland Security (DHS) Federal Law Enforcement Training Centers (FLETC) Service Contract Work Request form (FTC-ADM-61) used to request contract services. The form is a template that allows for documenting contract details including contract number, place of performance, labor categories and rates, line items (CLINs/Sub-CLINs), quantities, unit costs, fees, and total costs.

The form includes sections for delivery/performance schedule, place of delivery, accounting data, and justification. It requires signatures from the originator, approval authority, and contracting officer. Distribution instructions indicate the original goes to the contractor with copies to the Fund Administrator, COR, and contract file. The form appears to be blank/unfilled and serves as a standard template for processing service contract work requests within FLETC.

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DEPARTMENT OF HOMELAND SECURITY

FEDERAL LAW ENFORCEMENT TRAINING CENTERS

SERVICE CONTRACT WORK REQUEST

CONTRACT NO. PLACE OF PERFORMANCE: Award Date:

REQUEST NO. Order #

FY CALL # Ser # Complete with an appropriate/applicable labor category and rate for the described work:

Labor Category: Labor Category:

Labor Category: Labor Category:

Labor Category: Labor Category:

ITEM # CLIN

SUB CLIN DESCRIPTION QUANTITY UNIT OF

ISSUE

UNIT COST ESTIMATED

COST

FEE TOTAL

GRAND TOTAL

Delivery or Performance Schedule/Date Place of Delivery or Performance Accounting & Appropriation Data

JUSTIFICATION

Originator (Print/Sign) Date Approval (Print/Sign) Date

Delivery/Performance Schedule Method of Payment & Payment Office (if not specified in the contract)

Contracting Officer (Print/Sign) Date

Original - Contractor Copy to: Fund Administrator

COR

Contract File

FTC-ADM-61 (5/17) Page 1 of 1

9.0.0.2.20120627.2.874785

DEPARTMENT OF HOMELAND SECURITY

FEDERAL LAW ENFORCEMENT TRAINING CENTERS

SERVICE CONTRACT WORK REQUEST

Complete with an appropriate/applicable labor category and rate for the described work:

ITEM #

CLIN SUB CLIN

DESCRIPTION

QUANTITY

UNIT OF ISSUE

UNIT COST

ESTIMATED COST

FEE

TOTAL

GRAND TOTAL

Original - Contractor Copy to: Fund Administrator

COR

Contract File

FTC-ADM-61 (5/17)

Contracting Officer (Print/Sign):
Date 2 digit month, 2 digit day, 4 digit year:
Labor Category::
Delivery or Performance Schedule/Date:
Accounting & Appropriation Data:
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File details come from the government source that posted it. Updated .