Attachment 2 Work Request Template.pdf

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.