Attachment 4 - Services Rendered Form.pdf
PDF 585 KB Posted
- Attached to
- Fuel Truck Repair
- Solicitation number
- 70Z03826QE0000036
About this file
This is a Notification of Services Rendered Form template used for documenting completion of onsite contractual services at the Aviation Training Center (ATC) Mobile in Alabama. The form serves as a standardized document for both contractors and Government Points of Contact (POCs) to certify service completion and authorize payment.
The form requires completion within two business days of service completion and applies to onsite contractual services with a period of performance of less than 90 days or as deemed necessary by the Contracting Officer. Eligible services include calibration, equipment troubleshooting/maintenance/repair, and IT services. The form captures essential information including contract or order number, service completion date, contracting officer/representative details, division (ESD), service location (Mobile, AL), service description, contractor company information, and contractor representative signature. A critical component is Block J, where the Government POC must indicate either acceptance of the service (enabling Contracting Officer approval to pay the associated invoice) or rejection with detailed explanation of why the service does not meet contract requirements. The form is designated as Attachment 4 to contract 70Z03826QE0000036 and was effective as of July 2018.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 2 - Statement of Work.pdf | ||
| Attachment 3 - Terms and Conditions.pdf | ||
| Attachment 1 - Schedule of Services.xlsx | XLSX spreadsheet |
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Text version
70Z03826QE0000036
Notification of Services Rendered Form
Attachment 4
JUL 2018
Government POC:
Government POC Signature:
Date:
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 Training Center (ATC)Mobile 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.
E) Building or Location of Service:
G) Contractor Company:
H) Contractor Company Representative:
I) Contractor Company Representative Signature:
Mobile, AL
F) Description of the Service:
J) Government POC Acceptance or Rejection of the Service: (Check One of the Boxes Below)
A) Contract or Order Number:
B) Date of Service Completion:
C) Contracting Officer or Representative:
D) Division: ESD
File details come from the government source that posted it. Updated .