Attachment 3 Authorization Form for UPPR.pdf
PDF 179 KB Posted
- Solicitation number
- N3904026Q0041
About this file
This document is a Work Request Unscheduled Repair Authorization Request form used to request approval for unplanned repair or maintenance work under an existing federal contract. The form requires the contractor to submit detailed information across four main sections for government approval before work commences.
Section 1 requires a concise description of the repair or service needed, including affected equipment and relevant background details. Sections 1A and 1B address parts and materials, with Section 1A covering Original Equipment Manufacturer (OEM) parts and Section 1B covering non-OEM alternatives. For OEM parts, the contractor must provide proof of cost and fair and reasonable price justification (e.g., catalog prices, commercial invoices, online listings), and parts must be genuine and manufacturer-approved unless expressly waived. For non-OEM parts, the contractor must provide a cost comparison between OEM and non-OEM options and detailed specifications for Project Manager verification of suitability. Section 2 requires separation of parts/materials costs and pre-approved markup rates on the contractor's invoice, with markup rates matching contract-approved rates. Section 3 addresses labor costs, requiring description of work, estimated hours, agreed-upon labor rates by category, and total unburdened labor cost.
Section 4 establishes the approval and authorization requirements. Work may only commence upon approval by the Project Manager, Contracting Officer's Representative, and Contracting Officer. All three officials must sign and date the form, confirming that parts/materials are appropriate, effort levels are commensurate with work scope, sufficient funds are available, and all rates match contract terms. The contractor is responsible for separating costs on invoices and providing supporting documentation for all material costs.
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Other files
| File | Type | Posted |
|---|---|---|
| N3904026Q0041 Combined Synopsis.pdf | ||
| LSJ_Redacted.pdf | ||
| Exhibit A CDRL Redacted.pdf | ||
| Attachment 2 Wage Determination.pdf | ||
| Attachment 1 OPSEC Redacted.pdf |
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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.
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