Attachment 2 - Boeing FAEST QASP.docx

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

FOR

Flight Attendant Egress Simulator Training - Boeing

FA445222R0023

31 AUG 22

SCOTT AIR FORCE BASE, IL

TABLE OF CONTENTS

1.0 Mission

2.0 Purpose

3.0 Authority

4.0 Role and Responsibilities

5.0 Contract Surveillance

6.0 Assessing Performance

7.0 Acceptance of Services

8.0 Contract Management

APPENDICES:

1. Electronic COR File Documentation

2. First or Second Notice Template

3. Corrective Action Report (CAR)

1.0 MISSION -

The Operational Support Airlift and Executive Airlift (OSA/EA) mission provides transportation to high-level government employees and Department of Defense (DoD) officials utilizing a fleet composed of military derivatives of the Boeing 737, named the "C-40B/C", the Boeing 757, named the "C-32A", the Boeing 747, named the "VC-25 and E-4B".

2.0 PURPOSE -

This Quality Assurance Surveillance Plan (QASP) is a Government-developed document used to determine and document if the Contractor’s performance meets the performance standards contained in the Performance Work Statement (PWS) and resultant contract/task order. The QASP establishes procedures on how this surveillance/inspection process will be conducted to ensure successful PWS performance. It is designed to provide a systematic method for continuous oversight of requirements identified in the PWS for each contract/task order.

The QASP establishes the following:

· What will be monitored

· How monitoring will take place

· Who will conduct monitoring

· How monitoring efforts and results will be documented

The Contractor is responsible for implementing and delivering performance that meets contract objectives required within the PWS. The QASP provides the structure for the Government’s surveillance of the Contractor’s performance to ensure that it meets contract requirements established in the PWS. The Contracting Officer (CO) shall also ensure the Contractor receives impartial, fair, and equitable treatment under this contract and determines the final assessment of Contractor performance.

The QASP is not part of the contract/task order, and is a living document. Flexibility in the QASP is required to allow for an increase or decrease in the level of surveillance necessary based on Contractor performance.

The Government may provide a copy of the QASP to the Contractor to facilitate open communication. The QASP should allow early identification and resolution of performance issues to minimize impact on the mission. In addition, the Government recognizes that unforeseen circumstances might occur that are outside the control of the Contractor.

3.0 AUTHORITY -

Authority for issuance of this QASP is provided under Federal Acquisition Regulation (FAR) subpart 37.604 and 46.4, and the clause at FAR 52.246-4 (Inspection of Services—Fixed Price), which provides for inspection, acceptance and documentation of the services called for in the PWS, and AFI 63-138. Acceptance is to be executed by the CO or a duly authorized representative.

4.0 ROLES AND RESPONSIBILITIES -

The following personnel comprise the Multi-Functional Team (MFT) and shall oversee and coordinate surveillance activities.

4.1 Government Representatives -

4.1.1 Contracting Officer Representative (COR) Supervisor -

Specific duties of the COR Supervisor include:

· Nominate/Appoint the COR in the Joint Appointment Module (JAM) located on the Procurement Integrated Enterprise Environment (PIEE).

· Review the electronic COR File in the Surveillance and Performance Monitoring (SPM) module also located on PIEE for accuracy and completeness at least annually using the COR File Inspection Checklist located on 763 ESS SharePoint Mission Partner Resources Page.

· Ensure personnel are properly trained and technically qualified before performing COR duties.

· Ensure there are no personal conflicts of interest and continuous contract monitoring by a qualified COR.

· Maintain that COR responsibilities are assessed on performance appraisals.

· Confirms the COR has completed the Annual OGE 450.

Assigned COR Supervisor: TBD Organization: HQ AMC/A3TA Phone:

Email:

4.1.2 Contracting Officer’s Representative (COR) - The COR is responsible for providing continuous program and technical oversight of the Contractor’s performance. The COR must maintain both technical competency and evaluation proficiency in Contractor surveillance procedures. The COR uses the QASP to conduct the oversight/surveillance process. The COR must also have enough knowledge of Contractor activities to properly review and disposition monthly invoices. In accordance with DFARS PGI 201.602-2(d)(vi) the COR shall maintain an electronic COR File in SPM that accurately documents the Contractor’s performance. The purpose is to 1.) ensure that the Contractor meets the performance standards contained in the contract and 2.) have documentation to appropriately support the ratings and narratives given in the annual Contractor Performance Assessment Reporting System (CPARS).

While the COR may serve as a direct conduit to provide Government guidance and feedback to the Contractor on technical matters, they are not empowered to make any contractual commitments or any contract changes on the Government’s behalf. The COR is responsible for reporting and identifying performance problems early on to the CO/CS and may use applicable appendix items for documenting Contractor performance. The COR is required to complete an annual performance assessment via the CPARS which will be used in documenting past performance. Ratings in the annual CPARS should not come as a surprise to anyone. CO, CS, COR and Contractor should all be aware of any performance issues prior to the annual CPARS.

Specific duties of the COR include:

· Receive required training before performing any COR duties (IAW MP5301.602-2(d)).

· Nominate/Appoint themselves as COR for a particular solicitation/contract utilizing JAM.

· Notify the CO/CS so they can terminate CORs appointment/designation in JAM, prior to CORs departure.

· Perform only those duties/responsibilities delegated by the CO in the COR Designation Letter.

· Establish and maintain an electronic COR File in SPM for purpose of evaluation and documentation of Contractor performance (Appendix 1) in accordance with DFARS PGI 201.602-2(d)(vi).

· Recommend any changes necessary to the contract, PWS, QASP, or other items to provide more effective operations and/or eliminate unnecessary costs.

· Remain abreast of changes to terms and conditions of the contract/task order resulting from modification.

· Utilize electronic COR File surveillance documentation in SPM to assist in the preparation of annual CPARS reports.

· Notify the CO/CS immediately regarding Contractor non-compliance with FAR 52.222-50, “Combating Trafficking in Persons.”

Assigned Primary COR: TBD Organization: HQ AMC/A3TA Phone:

Email:

4.1.3 Contracting Officer (CO) - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO is the only Government agent authorized to award or modify contracts; therefore, the CO is the only person authorized to contractually obligate the Government. The CO is also the individual who will sign any notifications to Contractors regarding performance issues, accepts Government surveillance methods utilized for each contract/task order, and determines the final assessment of the Contractor’s performance.

Specific duties of the CO include:

· Delegate authority for inspection and/or acceptance to the COR in accordance with the terms and conditions of the contract.

· Inform the Contractor of the names, duties, and limitations of authority for all CORs assigned to the contract.

· Utilize JAM to formally appoint/designate CORs for each solicitation/contract.

· Terminate CORs in JAM, when required, prior to CORs departure.

· Ensure that the COR maintains an electronic COR File in SPM that accurately documents the Contractor’s actual performance.

· Review COR Status Reports in SPM. Approve/reject, if required.

· At a minimum, review the COR File annually for accuracy and completeness utilizing the Annual COR File Inspection Checklist located on 763 ESS SharePoint Mission Partner Resources Page.

· Construct/upload the Annual COR File Inspection Checklist to SPM IAW DFARS PGI 201.602-2(d)(vii) and MP5301.602-2(d), para. 1.2.4.

· At a minimum, provide an annual assessment of the COR’s performance to the COR supervisor. If unacceptable, the CO must provide a written assessment and identify specific deficiencies to the COR, and request additional information or a new COR nomination.

· Manage Contractor performance surveillance data, including submitting annual CPARS reports and Electronic Subcontractor Reporting System (eSRS) reports, when applicable.

· Ensure the MFT reviews the QASP annually (at a minimum) for recommended changes.

· Provide contract-specific training administered by CO or CS to all appointed CORs.

Assigned CO: PORT, ANGELA M Organization: 763 ESS/PKA Phone: 618-256-9990 Email: angela.port@us.af.mil

4.1.4 Quality Assurance Program Coordinator (QAPC) - The QAPC is responsible for developing, managing, and implementing the Quality Assurance Program.

Specific duties of the QAPC include:

· Train CORs and COR management on the contracting requirements associated with the quality assurance program and procedures prior to contract award.

· Assist the CO in providing contract-specific training and ensuring required training is accomplished in accordance with DoDI 5000.72, DoD Standard for Contracting Officer’s Representative (COR) Certification, 26 Mar 15, Change 2, 06 Nov 20.

· Monitor the inputs and use of JAM/SPM.

· Assist COR, CO and CS where necessary in utilizing JAM/SPM.

Assigned QAPC: TBD Organization: 763 ESS/PKS Phone:

Email:

4.2 Contractor Representatives - (Complete this section after contract award)

Contractor – Complies fully with the terms and conditions of the contract/task order and ensures non-conforming contract/task order services are identified and corrected.

Specific duties of the Contractor include:

· Participate as a member of the MFT in the post-award management phase.

· Maintain and implement their commercial quality procedures that ensure contract/task order requirements are met.

· Tender to the Government for acceptance, only those services that conform to contract/task order requirements.

· Recommend any changes to the contract/task order that will provide more effective operations and/or eliminate unnecessary costs.

4.2.1 Project Manager - The Contractor’s Project Manager is responsible for the overall execution of the contract/task order. This individual will serve as the focal point for the CO/CS assigned to the contract/task order and may interface with the Mission Partner, as needed.

Project Manager: <upon award, insert name> Title: <insert title> Phone: <insert phone number> Email: <insert Email address>

5.0 CONTRACT SURVEILLANCE - The goal of the QASP is to ensure that Contractor performance is effectively monitored and documented. The COR function is responsible for a wide range of surveillance requirements that effectively measure and evaluate the Contractor’s performance. The COR uses the QASP and the PWS to ensure the Contractor is compliant with the contract/task order requirements. The Contractor, is responsible for contract management and quality control/quality assurance actions to meet the terms of the contract/task order. The Government can inspect or test all services called for by the contract/task order, to the extent practicable, at all times and places, during the term of the contract. The CORs contribution is comprised of professional, non-adversarial relationships, which include positive and open communications with the CO, CS, PM, QAPC, and the Contractor. The foundation of this relationship is built upon regular, objective, fair, and consistent COR evaluations of Contractor performance against contract requirements, and the ability to discuss inspection results, trends, and items of mutual interest with the Contractor.

5.1 Method(s) of Surveillance - The Government has the right to inspect all contract deliverables at any time prior to acceptance. Inspections may be announced or unannounced, but they must not unduly delay work, nor must they include directions that would change the contract. The Government also has the right to reject any deliverables that do not meet contract requirements.

The COR documents all results of inspection actions, and subsequent Contractor re-performance taskings in the electronic COR Status Reports in SPM.

5.1.1 100% Inspection - This method is used for Contractor submissions, products, and deliverables (tangible items) where all outputs are observed. CORs use the One Hundred Percent Inspection method to evaluate all reports delivered. The COR, with assistance from the COR Supervisor and CO, if necessary, accepts or rejects these products based on the criteria and performance standards as outlined in the Services Summary (SS). The COR also documents all results of inspection actions and subsequent Contractor re-performance taskings, if applicable.

5.2 Surveillance Documents –

5.2.1 Data Deliverables - The Data Deliverables (Table 1) will be reviewed for timeliness, accuracy and format. If a deliverable due date falls on a weekend or holiday, the Contractor shall submit the deliverable on the last work day prior to the due date.

Table 1: Data Deliverables

5.2.2 Services Summary - The Services Summary (SS) (Table 2) is the list of critical tasks that must be performed by the Contractor. The performance objectives and thresholds (standards) that must be performed by the Contractor are identified within the PWS. The COR will validate/inspect these tasks listed in the SS. Inspection of each objective will be documented in the electronic COR File in SPM. The Performance Objective defines the desired outcomes and Performance hresholds (standard) defines the level of service required under the contract/task order to successfully meet the performance objective.

Table 2: Services Summary Performance -Objective

Contractor shall provide Simulator training in a fuselage/cabin similar in size and function, and include aircraft specific Plug Type Doors for the C-40B/C, C-32A, VC-25 and E-4B aircrafts.

Fire Fighting Procedures/Training Performance is acceptable when:

Simulation mock drills are performed and Fire-Fighting/Smoke training equipment all is in working condition.

Water Survival Training

6.0 ASSESSING PERFORMANCE - CORs must document Contractor performance on each contract, to include scope and purpose of any inspections. CORs will assess and rate Contractor performance as it relates to contract/task order requirements. Performance Assessment shall take the form of notes in the COR Status Reports, assessment results from the Surveillance Checklist, non-conformance notifications, and annual CPARS. Each builds on the other and provides a thorough documented history of Contractor performance. Documentation will be maintained in the electronic COR File in SPM.

6.1 COR Status Reports - This serves as the basis for any formal documentation of non-conformances or deficiencies and provides the backbone for formal reports on Contractor performance, such as annual CPARS. The COR Status Reports also provide continuity should COR duties shift in the course of contract/task order performance. COR Status Reports are completed and maintained in SPM. COR Status Reports for this requirement shall be completed quarterly.

6.2 Inspections - The COR may perform inspection/surveillance at any time during contract/task order performance IAW FAR 52.246-2 through 5, as applicable. The COR submits all audit and inspection documentation to the electronic COR File in SPM.

6.3 Combating Trafficking In Persons (CTIP) – FAR 52.222-50 (Combating Trafficking in Persons) is a mandatory clause in all contracts. The COR must inform the Contracting Officer (CO) if they become aware that the contractor, contractor personnel, subcontractor, or subcontractor personnel have failed to comply with the requirements of the clause at FA52.222-50. DoD CTIP policy is provided in DoDI 2200.01.

Notes:

· DoD has a zero tolerance policy for human trafficking.

· The COR must report any suspected violations or activities to the CO (see FAR Subpart 22.17 and DFARS Subpart 222.17).

· CORs should NOT personally investigate suspected incidents of trafficking in persons but should forward all reported or suspected violations to the CO immediately.

Violations and remedies - If the CO receives information indicating that the Contractor, a Contractor employee, a Subcontractor, or a Subcontractor employee has failed to comply with the requirements of the clause at FAR 52-222-50, the CO shall:

· Through the CO’s local commander or other designated representative, immediately notify the Combatant Commander responsible for the geographical area in which the incident has occurred.

· Information for investigation and enforcement may be made to; DoD Inspector General Hotline at 800-424-9098 or http://www.dodig.mil/hotline, Program Manager on-line at http://ctip.defense.gov or by email to ctipreports@osd.pentagon.mil, National CTIP Hotline at 1-888-373-7888 or to the CTIP Hotline website at https://polarisproject.org.

· And immediately issue a notice of non-conformance.

6.4 Non-Conformances and Deficiencies - Results that fall below contract/task order standards shall be identified as minor non-conformances or major non-conformances. The COR will notify the contactor and document all non-conformances in the COR Status Report, referencing the specific contract/task order requirement that the Contractor did not meet, document the name of the individual contacted, and date and time of notification. If the Contractor fails to take corrective actions in a reasonable time-frame, the COR will notify the CO/CS for further actions.

6.4.1 Minor Non-Conformance - A minor non-conformance is a deficiency, which by itself does not adversely impact mission, safety of personnel and/or equipment, performance (quality), schedule (delivery), or cost. A minor non-conformance normally does not increase risk to the Government.

6.4.2 Major Non-Conformance - A major non-conformance is a deficiency that has a significant adverse impact on the quality of service, such as those stated below. If at any time the COR identifies a deficiency, the COR shall document their findings on the Corrective Action Report (CAR) and immediately forward to the CO/CS (see Appendix 3). All major deficiencies will be reported by the COR in writing; however, copies of written correspondence will be coordinated with the CO/CS prior to issuance to the contactor representative, and must contain the CO’s signature. Some examples of major deficiencies: Contractor failure to meet a performance objective, failure to provide adequate corrective action to preclude recurrence of Government-identified findings, failure to provide corrective action within a prescribed suspense period, or failure to adhere to security regulations that result in a security incident.

NOTE: All minor non-conformances and major non-conformance shall be documented in the electronic COR File located in SPM.

6.4.3 Non-Conformance and Deficiency Notifications - If a non-conformance or deficiency is found during inspection of the Contractor’s performance, the COR will determine the type of notification based on the category of the non-conformance or deficiency (Table 3) and pursue resolution.

Corrective Action reporting is divided into two categories, which are as follows: minor and major.

TABLE 3 – NOTIFICATIONS

Step 2: Second Notice

6.4.4 First or Second Notices - (Appendix 2) as shown in Table 3, First and Second Notices provide written notification from the Government to the Contractor of minor non-conformances. Initial minor non-conformances should be addressed with a First Notice to the applicable Contractor representative. The COR will notify both the CO/CS of the issue, and prepare the notice for CO signature. If the CO determines the First or Second Notice is justified, the First and/or Second notice will be sent to the Contractor with a suspense date for the Contractor’s reply, sending a courtesy-copy email to both the QAPC and the COR. The Contractor shall respond with the completed first or second notice to the CO. If the Contractor fails to respond by the specified due date, the CO should notify the COR to annotate the Contractor’s non-responsiveness in the electronic COR Status Report. If the Contractor fails to resolve the issue as documented in the Notice, the CO may elevate the issue to the next level (Second Notice or CAR). Corrective/preventive actions initiated and/or completed by the Contractor will be verified by Primary COR on scheduled subsequent inspection and documented accordingly.

6.4.5 Corrective Action Requests (CAR) - (Appendix 3) as shown in Table 3, a CAR provides written notification from the Government to the Contractor for major deficiencies. The COR will recommend to the CO/CS that a CAR be issued when previous notifications failed to result in corrective actions or when major deficiencies exist. If a CAR is deemed necessary, the COR will fill out the CAR with the assistance of the CO. The draft CAR will be routed NLT ten duty days after the event to the CO for review and signature. The CO is the only person who has authority to issue a CAR to the Contractor.

To satisfactorily close-out a CAR, the following criteria must be met: The Contractor must meet the suspense date given for corrective action and the Contractor's actions must correct the deficiency within specified standards.

If the corrective action is deemed unsatisfactory, the COR annotates the CAR accordingly and forwards it to the CO with a brief explanation, including an estimate of the Government's loss due to the deficient performance. The estimate may account for loss or destruction of property, supplies, or equipment, and hours lost to re-perform the task. If the task cannot be re-performed, indicate the number of hours it ordinarily would have taken to do the task. The COR will maintain all non-conformance documentation in the electronic COR File in SPM.

6.5 Contractor Performance Assessment Reporting System (CPARS) - CPARS https://www.cpars.gov/ is the DoD Enterprise Solution for collection of Contractor Past Performance Information (PPI) as required by the Federal Acquisition Regulation (FAR). CPARS is a web-enabled application that collects and manages a library of automated Contractor report cards. An annual CPARS will be written on all contracts/task orders that exceed $1M total value, in most cases. The written assessment in CPARS will generally cover a12-month period of performance. The COR will utilize objective evidence from the electronic COR File (i.e., COR Status Reports, 1st/2nd notices, CARS, and correspondence letters) for CPARS assessment. Ratings will be IAW the definitions in FAR 42.1503(h)(4) “Evaluation Ratings Definitions.”

7.0 ACCEPTANCE OF SERVICES - The COR will certify that acceptable services were received, in accordance with the terms and conditions of the contract/task order. The COR will accept or reject all Receiving Reports submitted by the Contactor in Wide Area Workflow (WAWF) via PIEE within seven business days of submittal by the Contractor. To avoid payment of interest penalties, if the invoice is unacceptable and is rejected in WAWF system the CO/CS should be notified immediately.

7.1 Inspect/Validate Receiving Reports - The COR will inspect/validate all receiving reports via WAWF prior to certifying/accepting receiving reports (Shipment Number in WAWF) ensuring that:

· The Contractor submitted a combination invoice/receiving report.

· The report reflects the correct contract/task order number.

· Beginning and ending dates being billed are stated and accurate.

· The correct CLIN(s) is/are charged for billing period.

· A description of the services is provided (FFP, Travel, materials).

· The correct amount is charged.

· Invoiced travel was pre-approved.

· Back-up documentation is attached that includes Contractor invoice.

· A breakout of any other charges, as required by the contract/task order.

7.2 Certifying and Accepting Receiving Reports - The COR will certify/accept all receiving reports via WAWF (Shipment Number in WAWF) ensuring that:

Certification of services is ALWAYS performed by the appointed COR. After validation of services is performed by the COR, the COR will select the “CQA” (Contract Quality Assurance) button to verify that the invoice was accurate, this step will normally select the “Acceptance” button also. If anyone other than the COR (typically the Resource Advisor (RA)) is accepting services for the contract/task order, the COR MUST certify in writing to the acceptor that services have been inspected/validated, the acceptor (RA) must then state in the comments block (under Misc. Info tab) that the COR has reviewed, validated and certified services/invoices. In all cases, the COR will retain documentation (electronic) showing COR validation and certification, as well as final acceptance of Contractor invoices.

7.3 Rejecting Receiving Reports - If a receiving report is rejected in WAWF, the COR will go to the Miscellaneous Info Tab to complete the comments block as follows.

· List details regarding all unsatisfactory services or incorrect invoice information.

AND

· Instruct the Contractor to contact DFAS to have the invoice rejected back to the Contractor; this will allow the Contractor to make the same correction on both the receiving report and invoice, since combination invoices/receiving reports are required.

8.0 CONTRACT MANAGEMENT - The MFT shall conduct periodic progress meetings to review the Contractor’s performance. At these meetings the CO/CS will apprise the Contractor of how the Government views the Contractor’s performance and the Contractor will apprise the Government of problems, if any, being experienced. The Contractor shall immediately notify the CO/CS and/or COR of any work being performed that the Contractor considers over and above the requirements of the contract/task order. Appropriate action shall be taken to resolve any outstanding issues (i.e. CPARS, customer complaint reports, etc.).

The MFT shall also provide any recommended changes to the QASP to the CO at the progress meetings or on an annual basis (at a minimum).

Appendix 1

MANDATORY Items - Electronic COR File Documentation

This appendix contains a list of documents that shall be maintained in the electronic COR File located in JAM/SPM, unless otherwise noted. The electronic COR File is to be inspected, at a minimum annually by both the COR Supervisor and the CO/CS. 763 ESS maintains the Annual COR File Inspection Checklist on SharePoint at “Mission Partner Resources” page. NOTE: All surveillance documentation is to be considered “Controlled Unclassified Information.” The required documentation shall include, but is not limited to:

COR training documents/certificates/professional licenses Contract Specific Training Certificate provided by the CO/CS Request for COR Support Letter, if applicable Refresher Training COR Designation Letter COR Termination Letter Quality Assurance Surveillance Plan (QASP) All surveillance documentation Written correspondence Documented correspondence COR Status Reports Meeting Minutes Trip Reports Annual COR File Inspection Checklist

Signed Contract – EDA

PWS/SOW – EDA

Contract Data Requirements List (CDRL) – EDA All invoices and pay documentation – WAWF/MyInvoice Performance Assessment – CPARS Required Regulation – Available via the WEB

Appendix 2

Quality Assurance Surveillance Plan First or Second Notice Template

(Date) MEMORANDUM FOR (Contractor)

ATTN: (Contractor POC)

FROM: (CO’s office symbol)

SUBJECT: First/Second Notice on Contract # FA4452-XX-X-XXXX for (brief name for non-conformance)

1. Contracting Officer Representative: (First and Last)

1. Office: (COR Office symbol)

1. Date of First Notice: (dd-mm-yyyy)

1. Reference: (PWS section and paragraph; Deliverable, Services Summary (SS), or email)

1. Reference Text: (State what action the Contractor should have performed IAW the reference above)

1. Description of Non-Conformity: (provide objective evidence of the Contractor’s performance discrepancy(ies))

1. Date response due from Contractor: (dd-mm-yyyy)

1. Contractor POC: (First and Last)

1. Contractor’s Input: (Provide correction action):

1. COR Review: (COR comments to reply):

1. Date Closed: (dd-mm-yyyy)

(CO signature block) cc: COR Email address

Appendix 3

Corrective Action Report

CORRECTIVE ACTION REPORT (CAR)

(If more space is needed, use reverse and identify by number)

1. CONTRACTOR

2. CONTRACT NUMBER

3. TYPE OF SERVICES

4. FUNCTIONAL AREA

5. SUSPENSE DATE

6. CONTROL NUMBER

7. DEFICIENCY |_| MAJOR |_| MINOR

FINDING:

FINDING IMPACT:

Please respond with a written corrective action plan that details the corrective action of the cited deficiency, the cause of the deficiency, and actions taken to prevent recurrence by Suspense Date in Block 5. If date was not entered in Block 5, the contractor is not required to provide a response.

8. CONTRACTING OFFICER’S REPRESENTATIVE (COR)

TYPED NAME AND GRADE

SIGNATURE AND DATE

9. ISSUING AUTHORITY

TYPED NAME AND GRADE

SIGNATURE AND DATE

10. COR RESPONSE TO CONTRACTOR CORRECTIVE ACTION AND ACTION TAKEN TO PREVENT RECURRENCE

11. COR DETERMINATION

|_| ACCEPTED |_| REJECTED

12. CLOSE DATE