Attachment C-5 FTC-ADM-61 Service Contract Work Request Form.pdf
PDF 543 KB Posted
- Attached to
- Student Support/Facilities Operation Maintenance Services Federal contract opportunity
- Solicitation number
- 70LCHS25RPFB00001
About this file
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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Text version
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: |
| Reset Form Button: |
File details come from the government source that posted it. Updated .