Attachment 4 - Contract Discrepancy Report.pdf

PDF 61 KB Posted

Attached to
7G20--Medical Emergency Alert Devices RFP
Solicitation number
36C10G24R0014
Issued by

About this file

This document is a Contract Discrepancy Report template to be used by the Department of Veterans Affairs. It outlines a process for documenting and resolving issues with contractor performance on a medical emergency alert devices contract. The solicitation seeks proposals for a base period of twelve months plus four additional twelve-month option periods to provide medical emergency alert devices. The contracting agency is the Department of Veterans Affairs Headquarters. The template includes sections for describing discrepancies in detail with reference to performance work statements, documenting contractor responses and corrective actions, and sections for signatures and dates from the contractor, contracting officer, and quality assurance evaluator upon resolution.

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Other files

File Type Posted
36C10G24R0014 0005.docx DOCX document
Attachment 1 - Schedule of Supplies 36C10G24R0014 0005.xlsx XLSX spreadsheet
Attachment 1 - Schedule of Supplies 36C10G24R0014 0004.xlsx XLSX spreadsheet
36C10G24R0014 0004.docx DOCX document
Attachment 6 - Past Performance Questionnaire 36C10G24R0014 0004.docx DOCX document
Attachment 5 - MEAD Questions and Answers 36C10G24R0014 0004.xlsx XLSX spreadsheet
NAICS - Notice and Order.pdf PDF
36C10G24R0014 0003.docx DOCX document
36C10G24R0014 0002.docx DOCX document
36C10G24R0014 02.docx DOCX document
36C10G24R0014 0001.docx DOCX document
36C10G24R0014.docx DOCX document
Attachment 6 - Past Performance Questionnaire.docx DOCX document
Attachment 1 - Schedule of Supplies 36C10G24R0014.xlsx XLSX spreadsheet
Attachment 2 - Pay.gov Vendor Submittal Instructions.docx DOCX document
Attachment 5 - MEAD Questions.xlsx XLSX spreadsheet
Attachment 3 - Quarterly Reporting Tool.xlsx XLSX spreadsheet
Show all 17

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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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