Attachment 6 Sample Work Order.rtf

USDA Forest Service ATTACHMENT 6

SRI-6300-12 (1/99)

CONTRACT NUMBER:

ITEM NUMBER:

WORK ORDER AND NOTICE OF NONCOMPLIANCE

50-4568-4-2009 08/04 (Reference FSH 6309.11)

PROJECT:

Road Construction [x

WORK ORDER

NOTICE OF NONCOMPLIANCE

NAME AND ADDRESS OF CONTRACTOR:

WORK ORDER OR NOTICE NO.

DATE ISSUED

PRIORITY NO.

[ X] You are directed to perform the following work in connection with contract with no adjustment in contract time or price(s).

You are advised that the following work being performed or material being supplied or installed does not conform to the contract requirements and may result in rejection

Item No.

Description Estimated Quantity Quantity Limit Measured Quantity 215(03)

215(02)

220(01)

255(16)

Supply and Place GABC

Supply and Placement of Aggregate No. 4

Supply and Placement of Aggregate No. 1

Motorgrader with Operator

90 TN

415 TN

162 TN

8 HR

TOTAL

90 TN

$1993.50

415 TN

$11827.50

162 TN

$4779.00

8 HR

$740.00

$19,340.00

MC - NFXFW7 – 100%

Perform Construction line items describe in Task Order as directed by the Forest Service COR.

Signature Title

/s/ Kevin Korman

CCCC OOOO RRRR

C 0 0 R R

CCCC OOOO R R

ATTACHMENT 6