Att_12_Sample_Work_Assignment.pdf
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- Attached to
- RADx Award Management
- Solicitation number
- 75N92026Q00012
About this file
This is a Contract Work Assignment (W.A.) template used to document task orders or assignments issued under an existing federal contract. The form serves as a mechanism for the government to request specific work from a contractor and for the contractor to respond with detailed cost and effort estimates, followed by performance reporting upon completion.
Part I requires the government initiator to provide essential details including the period of performance, work description, assigned work leader, deliverables, and response due date. Part II requires the contractor to respond with estimated costs and effort broken down by labor hours (listing specific personnel and labor categories), labor costs, employee benefits, direct materials, travel, subcontracts, other direct costs, and indirect costs, along with a detailed description of the approach and deliverables. The contractor must not exceed estimated labor hours or the W.A. amount without prior written approval from both the Project Officer and Contracting Officer. Part III documents actual performance, requiring the contractor to report actual costs and effort using the same cost categories, and to describe progress and deliverables delivered. Final approval from both the Contracting Officer Technical Representative (COTR) and Contracting Officer is required to confirm satisfactory delivery and receipt of services or products. A detailed budget must be attached to support all cost proposals and actual expenditure reports.
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Text version
CONTRACT WORK ASSIGNMENT (W.A.)
Contractor: ____________________________________
Contract No: ___________________________________
W.A. No: Modification No: _____
W.A. Title: _________________________________________________________________________________
W.A. Originator: _______________________________________________ Date Prepared: ________________
Contracted Work Area: _______________________________________________________________________
Part I. INITIATOR'S REQUEST
A. Period of Performance: From _______________________ to _______________________
B. Work Assignment Description:
C. Work Assignment Leader: ____________________________________________________
D. Deliverables:
E. W.A. Response Due Date: _________________________________________
Contract Work Assignment (2/2011)
Contractor: ________________________________________ Contract No: ____________________________
W.A. No: ________ Modification No: ______ Date Prepared: __________________________
Part II. CONTRACTOR'S RESPONSE TO W.A. REQUEST
(*The Contractor shall attach a detailed budget to this form to identify all proposed costs.)
A. Estimated Cost and Effort:
1. Labor hours - list W.A. leader, specific individuals to be assigned, labor category, and estimated hours for each.
| 2. | Labor costs - list by labor category and total. |
| 3. | Employee benefits. |
| 4. | Direct materials |
| 5. | Travel |
| 6. | Subcontracts |
| 7. | Other direct costs |
| 8. | Indirect costs |
| 9. | Total estimated costs for this Assignment: ________________* |
B. Detailed description of the approach to be used and of the deliverable(s). (Be specific.):
APPROVAL TO PROCEED: The Contractor shall not exceed the estimated labor hours, estimated W.A. amount, or change the W.A. leader without the prior written approval of the Project Officer and the Contracting Officer.
l. For the Contractor: ______________________________ (Signature)
Typed name: ___________________________________
2. For the Government: ______________________________ Contracting Officer Technical Representative
(COTR)
(Contracting Officer)
Date: ______________
Date: ______________
Date: ______________
Contract Work Assignment
Contractor: ________________________________________ Contract No: ____________________________
W.A. No: ________ Modification No: ______ Date Prepared: __________________________
Part III. CONTRACTOR'S REPORT OF W.A. PERFORMANCE
(*The Contractor shall attach a detailed itemization of costs to this form to identify all expenditures under this W.A.)
A. Actual Cost and Effort:
1. Labor hours - list specific assigned individuals, labor category, and actual hours worked.
2. Labor costs - list labor category, individual, and total amount.
3. Employee benefits
4. Direct Materials
5. Travel
6. Subcontracts
7. Other direct costs
8. Indirect costs
9. Total costs for this W.A: _________________________
B. Report of Progress and/or Deliverables:
REVIEW AND APPROVAL OF SATISFACTORY PERFORMANCE
The signatures below indicate that the services/products required under Work Assignment No. have been delivered, received and satisfactorily meet the requirements of this Work Assignment.
l. For the Contractor: ______________________________ Date: ______________ (Signature)
Typed name: ___________________________________
2. For the Government: ______________________________ Date: ______________ Contracting Officer Technical Representative
(COTR)
Date: ______________ (Contracting Officer)
Contract Work Assignment
| WA Title: |
| WA Originator: |
| Date Prepared: |
| Contracted Work Area: |
| Period of Performance From: |
| Period of Performance to: |
| Work Assignment Description: |
| Work Assignment Leader: |
| Deliverables: |
| Work Assignment Response Due Date: |
| Contractor: |
| Contract Number: |
| WA No: |
| Modification No: |
| Date Prepared_2: |
| Total estimated costs for this Assignment: |
| Detailed Approach & Deliverables: |
| Signature: |
| Date: |
| Typed name: |
| Project Officer (COTR): |
| Date_2: |
| Contracting Officer: |
| Date_3: |
| Contract No: |
| Date Prepared_3: |
| Total costs for this WA: |
| Report of Progress: |
| Signature_2: |
| Date_4: |
| Typed name_2: |
| Project Officer (COTR)_2: |
| Date_5: |
| Contracting Officer_2: |
| Date_6: |
File details come from the government source that posted it. Updated .