Attachment 1 Work Request Form for UPPR.pdf
PDF 233 KB Posted
- Attached to
- INTENT TO SOLE SOURCE: KARDEX PARTS CAROUSELS
- Solicitation number
- N3904025Q0115
About this file
This document is a Work Request Unscheduled Repair Authorization Request form used to document and obtain approval for unplanned equipment repairs. The form requires contractors to provide detailed information about repair work, including a scope of work description, parts/materials needed (both OEM and non-OEM), associated costs, labor hours, and estimated labor costs. The form includes multiple sections for documenting material costs, markup rates, and labor expenses, with specific requirements for supporting documentation and cost justification. Approval is contingent on signatures from the Project Manager, Contracting Officer's Representative, and Contracting Officer, who must verify that sufficient funds are available and that proposed labor and markup rates align with the existing contract terms. The form ensures transparency and cost control for unscheduled repair work by mandating detailed documentation and multi-level administrative review before work can commence.
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Text version
WORK REQUEST UNSCHEDULED REPAIR AUTHORIZATION REQUEST -
Date of Request:
Work Request Number: (e.g. 1, 2) Project Name/Number: Contract Number:
1. Contractor Signature: __________________________ Date: __________________________
SECTION 1: SCOPE OF WORK & REPAIR DESCRIPTION
1.1 Provide a concise description of the repair or service needed, referencing the aƯected equipment, issue(s) observed, and any relevant background details:
SECTION 1A: OEM Parts/Materials – Complete as applicable or see attached estimate
Item (Part/material) Description QTY Cost to
Contractor Discounts Passed to Government Total Cost to Government
Supporting Documentation: Contractor must provide “proof of cost” Fair and Reasonable Price Justification (e.g., catalog prices, commercial invoices, online listings) o Parts must be genuine, manufacturer-approved unless expressly waived (fill out section 1B)
Section 1B: Non-OEM Parts/Materials – Complete as applicable or see attached estimate
Item (Part/material) Description QTY Cost to
Contractor (Non-OEM)
Cost of
OEM
Equivalent
Non-OEM Specifications
Total Cost to Government
Additional Requirements for Non-OEM:
1. Contractor must provide cost comparison (OEM vs. Non-OEM) for fair and reasonable determination.
2. Contractor must provide detailed Non-OEM specifications for PM to verify suitability.
SECTION 2: CONTRACTOR APPROVED MARKUP ON MATERIALS
Total Cost of Parts/Materials (OEM + Non-OEM)
Pre-Approved Markup Rate (%)
Markup Amount
Total Cost with Markup
Notes: Cost of parts and markup must match contract approved rates and be separated on the contractor’s invoice.
SECTION 3: LABOR
Description of Work Estimated
Hours
Agreed-Upon Labor Rate ($/hr) for each labor category
Total Unburdened Labor Cost ($)
SECTION 4: APPROVAL AND AUTHORIZATION
Statement: Work may commence only upon approval of this Work Request by the Project Manager (PM), Contracting OƯicer’s Representative (COR) and Contracting OƯicer (KO).
Contractor will Separate costs on invoice, all labor and markup rates match approved rates, and support material costs with approved supporting documentation. No work will commence until PM/KO signs below and returns to Contractor.
PM approves Section 1A or 1B: Part/Material OEM or waived for Non-OEM are needed for the work being performed.
PM approves Section 3: The level of eƯort (number of hours) is commensurate with the work being performed.
2. Project Manager (PM): __________________________ Date: __________________________
Title: __________________________
COR approves Section 1A or 1B, 2, and 3: SuƯicient funds are available to cover the Part/Materials, markup, and the markup rate matches the agreed-upon rate in the contract. Labor rate matches the contract, and suƯicient funds are available to cover the labor cost.
3. Contracting OƯicer Representative_________________________ Date:_______________________
4. Contracting OƯicer: __________________________ Date: __________________________
Additional Notes or Special Conditions:
Use this space or see attachment for any special instructions.
File details come from the government source that posted it. Updated .