Attachment 15 - Contract Discrepancy Report - template.pdf
PDF 42 KB Posted
- Attached to
- ICE Medical Staffing Federal contract opportunity
- Solicitation number
- 70CDCR21R00000008
- Issued by
- Immigration and Customs Enforcement
About this file
This solicitation requests proposals for an Indefinite Delivery Indefinite Quantity contract to provide on-site medical staffing services to Immigration and Customs Enforcement detainees. Prospective offerors must complete and submit a non-disclosure agreement to receive policy documents, directives, guides, memoranda, and medical by-laws from ICE and the ICE Health Service Corps. The contract aims to provide health care services to ICE residents and detainees 24 hours a day, 7 days a week, and 365 days a year across multiple ICE Health Service Corps clinic sites established in associated task orders. The primary purpose is for on-site medical staffing to ensure a continuum of health care to ICE detainees.
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Text version
CONTRACT DISCREPANCY REPORT
1. CONTRACT NUMBER 2. REPORT NUMBER FOR THIS DISCREPANCY
3. TO (Contractor and Manager's Name) 4. FROM (Name of QAE)
5. DATES (YYYYMMDD)
a. PREPARED b. RETURNED BY CONTRACTOR c. ACTION COMPLETE
6. DISCREPANCY OR PROBLEM (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)
7. SIGNATURE OF CONTRACTING OFFICER
8a. TO (Contracting Officer) b. FROM (Contractor)
9. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable Q.C.
program procedures or new Q.C. procedures. Attach continuation sheet(s) if necessary.)
10. SIGNATURE OF CONTRACTOR REPRESENTATIVE b. DATE (YYYYMMDD)
11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary)
12. GOVERNMENT ACTIONS (Reduced payment, cure notice, show cause, other)
13. CLOSE OUT
NAME
(1)
TITLE
(2)
SIGNATURE
(3)
DATE (YYYYMMDD)
(4)
a. CONTRACTOR
NOTIFIED
b. QAE
c. ACO
DD FORM 2772, SEP 1998 REPLACES MT FORM 352-R, WHICH IS OBSOLETE. Adobe Professional 8.0
| ctr_no: |
| rpt_no: |
| to: |
| from: |
| prep_date: |
| ret_date: |
| comp_date: |
| discrep: |
| to_ctr: |
| from_ctr: |
| ctr_resp: |
| rep_date: |
| govt_eval: |
| govt_act: |
| notif_name: |
| notif_title: |
| notif_date: |
| qae_name: |
| qae_title: |
| qae_date: |
| aco_name: |
| aco_title: |
| aco_date: |
| Reset: |
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