Appendix C - DA Form 5479 - CDR.pdf
PDF 38 KB Posted
- Attached to
- Protective Coatings
- Solicitation number
- W911S820B0002
About this file
This document contains a federal contract opportunity solicitation and a contract discrepancy report form. The solicitation seeks proposals to provide protective coatings services at Joint Base Lewis-McChord in Washington and supported satellites. The contractor will be responsible for furnishing all materials, equipment, and personnel to manage and complete a variety of protective coatings applications and construction tasks through individual task orders issued by the government over the contract period. The solicitation was issued by the Department of the Army Materiel Command Mission and Installation Contracting Command. The contract discrepancy report form is a template used to document any problems or discrepancies with contractor performance and corrective actions under a federal contract.
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Text version
6.
2. 3.
PREPARED ORAL NOTIFICATION RETURNED BY CONTRACTOR ACTION COMPLETE
4. DISCREPANCY OR PROBLEM (Describe in Detail: Include reference in PWS / Directive: Attach continuation sheet if necessary.)
5. SIGNATURE OF CONTRACTING OFFICER
7.
8. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. ATTACH
1. CONTRACT NUMBER
9. SIGNATURE OF CONTRACTOR REPRESENTATIVE 10. DATE
11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, rejection: attach continuation sheet if necessary)
12. GOVERNMENT ACTIONS (Payment deduction, cure notice, show cause, other.)
CONTRACT DISCREPANCY REPORT
For use of this form, see DA PAM 5-20; the proponent agency is ACSIM.
TO: (Contractor and Manager Name)
DATES
CLOSE OUT
CONTRACTOR
NOTIFIED
NAME AND TITLE SIGNATURE DATE
QAE
CONTRACTING
OFFICER
CONTINUATION SHEET IF NECESSARY. (Cite applicable Q.A. program procedures or new A.W. procedures.)
DA FORM 5479, MAR 2008 APD LC v1.01ES
FROM: (Name of QAE)
TO: (Contracting Officer) FROM: (Contractor)
PREVIOUS EDITIONS ARE OBSOLETE.
6.
2.
3.
PREPARED
ORAL NOTIFICATION
RETURNED BY CONTRACTOR
ACTION COMPLETE
4. DISCREPANCY OR PROBLEM
(Describe in Detail: Include reference in PWS / Directive: Attach continuation sheet if necessary.)
5. SIGNATURE OF CONTRACTING OFFICER
7.
8. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. ATTACH
1. CONTRACT NUMBER
9. SIGNATURE OF CONTRACTOR REPRESENTATIVE
10. DATE
11. GOVERNMENT EVALUATION
(Acceptance, partial acceptance, rejection: attach continuation sheet if necessary)
12. GOVERNMENT ACTIONS
(Payment deduction, cure notice, show cause, other.)
CONTRACT DISCREPANCY REPORT
For use of this form, see DA PAM 5-20; the proponent agency is ACSIM.
TO:
(Contractor and Manager Name)
DATES
CLOSE OUT
CONTRACTOR
NOTIFIED
NAME AND TITLE
SIGNATURE
DATE
QAE
CONTRACTING
OFFICER
CONTINUATION SHEET IF NECESSARY.
(Cite applicable Q.A. program procedures or new A.W. procedures.)
DA FORM 5479, MAR 2008
APD LC v1.01ES
FROM:
(Name of QAE)
TO:
(Contracting Officer)
FROM:
(Contractor)
PREVIOUS EDITIONS ARE OBSOLETE.
1.01
DA FORM 5479, MAR 2008
CONTRACT DISCREPANCY REPORT
APD
| CONTRACT: |
| TO_A: |
| FROM_A: |
| PREPARED: |
| ORALNOTE: |
| RETURN: |
| ACTION: |
| PROBLEM: |
| SIGN_A: |
| signature_BUTTON1: |
| TO_B: |
| FROM_B: |
| CONTRACTR: |
| SIGN_B: |
| signature_BUTTON2: |
| DATE_A: |
| GOVERNMNT: |
| GOVMTACTN: |
| NAME_A: |
| signature_BUTTON3: |
| SIGN_C: |
| DATE_B: |
| NAME_B: |
| signature_BUTTON4: |
| SIGN_D: |
| DATE_C: |
| NAME_C: |
| signature_BUTTON5: |
| SIGN_E: |
| DATE_D: |
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