Attachment_7_-FDA_Tobacco_Fixed_Price_InvoiceForm_2018.pdf

Attachment 7 - FDA TOBACCO INSPECTION INVOICE

(a) Designated Billing Office Name and Address:

(b) Contractor’s Name, Address, Point of Contact, TIN, and DUNS or DUNS+4 Number

POC: ______________________________

TIN: ____________________________

DUNS or DUNS+4: ____________________________

(c) Date Invoice Prepared: ____________________________

(d) Invoice Number: ____________________________ Tobacco-last 4 digits Contract #-MM-YYYY-invoice #

(e) Contract No.: ____________________________

(f) Contract Title: ____________________________

(g) Effective Date: ____________________________

(h) Total Estimated Cost of Contract: $____________________

(i) Total Fixed Fee (if applicable): ____________________

(j) Office of Acquisitions:

(k) Bank Name: ____________________________________ Bank Address: ____________________________________ Routing Number: ____________________________ Account Number: ____________________________ Account Type: ☐Checking ☐Savings

(l) This invoice represents reimbursable costs for the period from _______________________ to _____________________.

A. Expenditure Category*

B. Quantity Completed

C. Established

Rate

D. Current

Amounts Billed

E. Previous

Amounts Billed

F. Cumulative Amounts

Billed

G. Total

Contract Value

Contractor Directed Inspections

(1) Undercover Buy FDA Directed Inspections

(2) Undercover Buy

(3) Advertising and Labeling

(4) Training/Travel

(5) Program Management

(6) Grand Totals

“I certify that all payments requested are for appropriate purposes and in accordance with the contract.”

[Name] [Title]

PLEASE DO NOT USE THE SPACE BELOW

Payment of this invoice in the amount of $____________ is recommended. Currently, required reports and deliverables have been received.

COR: Date Center for Tobacco Products

Approved for payment in the cost reimbursement amount of $

Contracting Officer Date

OAGS

*Attach details as specified in the contract or requested by the Contracting Officer

INVOICE INSTRUCTIONS FOR

FDA TOBACCO INSPECTION COST-REIMBURSEMENT CONTRACTS

Format: Submit payment requests on the FDA Tobacco Inspection invoice form in the manner and format prescribed herein and as illustrated in the Sample Invoice. Standard Form 1034, Public Voucher for Purchases and Services Other Than Personal, may be used in lieu of this form provided it contains all of the information shown on the Sample Invoice. DO NOT include a cover letter with the payment request.

Submission Format: Submissions via e-mail are preferred. The Contractor shall simultaneously submit invoices to the Contract Specialist (CS) assigned to the Contract as well as the designated Contracting Officer Representative (COR). All supporting documentation shall also be submitted to by the CS and the COR.

Frequency: Payment requests shall be submitted quarterly unless otherwise agreed.

Cost Incurrence Period: Costs incurred must be within the contract performance period or covered by per contract cost provisions.

Billing of Costs Incurred: If billed costs include (1) costs of a prior billing period, but not previously billed, or (2) costs incurred during the contract period and claimed after the contract period has expired, the Contractor shall site the amount(s) and month(s) in which the costs were incurred.

Contractor's Fiscal Year: Prepare payment requests in such a manner that the Government can identify costs claimed with the Contractor's fiscal year.

Currency: All contracts are expressed in United States dollars.

Costs Requiring Prior Approval: Identify and reference the Contracting Officer's Authorization (COA) Number for costs requiring the Contracting Officer's approval, which are not set forth in an Advance Understanding in the contract. In addition, the Contractor shall show any cost set forth in an Advance Understanding as a separate entry under the appropriate expenditure category on the payment request.

Invoice Identification: Identify each payment request as either:

1) Interim Invoice: These are interim payment requests submitted during the contract performance period.

2) Completion Invoice: Submit the completion invoice promptly upon completion of the work, but no later than one year from the contract completion date, or within 120 days after settlement of the final indirect cost rates covering the year in which the contract is physically complete (whichever date is later). The Contractor shall submit the completion invoice when all costs have been assigned to the contract and all performance provisions have been completed.

3) Final Invoice: A final invoice may be required after the amounts owed have been settled between the Government and the

Contractor (e.g., resolution of all suspensions and audit exceptions).

Preparation and Itemization of the Invoice: The Contractor shall furnish the information set forth in the instructions below. The instructions are keyed to the entries on the Sample Invoice/Financing Request. All information must be legible or the invoice will be considered improper and returned to the Contractor.

(a) Designated Billing Office Name and Address: Enter the designated billing office name and address, as identified in the Invoice Submission Instructions in Section G of the Contract Schedule.

(b) Contractor's Name, Address, Point of Contact, TIN, and DUNS or DUNS+4 Number: Show the Contractor's name and address exactly as they appear in the contract. Also include the name, title, phone number, and e-mail address of the Point of Contact (POC) in case of questions. Any invoice identified as improper will be returned to the POC identified. If the remittance name differs from the legal business name, both names must appear on the invoice. Provide the Contractor's Federal Taxpayer Identification Number (TIN) and Data Universal Numbering System (DUNS) or DUNS+4 number. The DUNS number must identify the Contractor's name and address exactly as stated in the contract, and as registered in the System for Award Management (SAM) at www.sam.gov. Registration is SAM has replaced registering with the Central Contractor Registration (CCR) database. If a Contractor was registered in CCR, it must ensure that its information was properly transferred from CCR to SAM.

When an approved assignment of claims has been executed, the Contractor shall provide the same information for the assignee as is required for the Contractor (i.e., name, address, point of contact, TIN, and DUNS number), with the remittance information clearly identified as such.

(c) Date Invoice Prepared: Insert the date the payment request is prepared.

(d) Invoice Number: Identify each payment request by a unique invoice number, which can only be used one time regardless of the number of contracts or orders held by an organization. For example, if a contractor has already submitted invoice number 05 on one of its contracts or orders, it cannot use that same invoice number on any other contract or order.

Payment requests with duplicate invoice numbers will be considered improper and returned to the contractor.

http://www.sam.gov/

For these reasons, it is recommended that the Contractor use the number format provided (Tobacco-####-MM-YYYY-####), but this format is not mandatory. Invoice numbers are limited to 30 characters. There are no restrictions on the use of special characters, such as colons, dashes, forward slashes, or parentheses. If all or part of an invoice is suspended and the contractor chooses to reclaim those costs on a supplemental invoice, the contractor may use the same unique invoice number followed by an alpha character, such as "R" for revised (example: Tobacco-221C-01-2013-0001R).

(e) Contract Number: Insert the contract number as it appears on the contract.

(f) Contract Title: Insert the contract title listed on the cover page of the contract.

(g) Effective Date: Insert the first day of the period of performance.

(h) Total Estimated Cost of Contract: Insert the total estimated cost of the contract. For contracts/orders with options or incremental funding provisions, enter the amount currently obligated and available for payment.

(i) Total Fixed-Fee: Insert the total fixed-fee (where applicable). For contracts/orders with options or incremental funding provisions, enter the amount currently obligated and available for payment (where applicable).

(j) Office of Acquisitions: Insert the name of the Office of Acquisitions, as identified in the Invoice Submission Instructions in

Section G of the Contract Schedule.

(k) Bank Information: Insert the bank name, address, routing number and account number where payments should be deposited. Please ensure this information matches what is registered in (SAM) at www.sam.gov.

(l) Billing Period: Insert the beginning and ending dates (month, day, and year) of the period in which costs were incurred and for which reimbursement is claimed.

Columns

A. Expenditure Category: These should correspond to approved line items in your business proposal. Provide supporting documentation for only the training/travel item, unless otherwise requested. Quantities of inspections must be verifiable in TIMS. Quantities of the Program Management task must be supported by completion of all required tasks and deliverables during the billing period.

B. Negotiated Quantities for This Performance Period: These values should correspond to the quantities of inspections agreed upon for each type of inspection during the current period of performance. If the billing period includes the base year of the contract, the base year is the current period of performance. If the billing period covers one of the option years under the contract, that option year is the current period of performance.

C. Established Rate: insert the negotiated rate to be charged for each type of inspection. This item must be identical to the rate established by the contract.

D. Current Amounts Billed: Insert the amount claimed for the current billing period by major costs element.

This should include costs incurred between the dates listed in (l).

E. Previous Amounts Billed: Insert the amount previously billed for each cost element during the course of this contract, not including the current amounts billed. If the billing period covers an option year, the amounts should include costs billed during the base year and any previous option years.

F. Cumulative Amounts Billed: Insert the total amounts billed under the current contract, including the base year and all option years. This should equal the Current Amounts Billed and Previous Amounts Billed.

G. Total Contract Value: Insert the total amount obligated to this contract for each cost element. If the billing period includes an option year, include the option year, any previous option years, and the base year.

(m) Inspections: Insert the quantities of inspections below that were performed during the billing period:

1) Contractor Directed Undercover Buy Inspections

2) FDA Directed Undercover Buy

3) FDA Directed Advertising and Labeling

4) Training and Travel: Identify the costs incurred for the Program Coordinator and Backup Program Coordinator to attend the PC Training, if applicable. Provide all supporting documentation as an attachment.

5) Program Management: Insert the quantity completed in number of months http://www.sam.gov/

6.) Grand Totals

The Contractor’s submitting official must sign the payment request certifying that all payments requested are for appropriate purposes and in accordance with the contract.

The Contracting Officer may require the Contractor to submit detailed support for costs claimed on one or more interim payment requests.

(a) Designated Billing Office Name and Address: