Attachment 5_Data Item Transmittal Form.pdf

DATA ITEM TRANSMITTAL/ACCEPTANCE/REJECTION FORM

Contract Number:

CLIN/ELIN: ____ ___/______ TITLE: ___________________________________

Block 14 Distribution:

Other:

____ Date: ____________________________ Doc. Ref. No.:

From:

To: ACC-Orlando

CCOR-CDD-B

12211 Science Drive Orlando, FL 32826

ATTN:

_ The above detailed CDRL item is forwarded for review and acceptance/ rejection. This item is due _________, The Government review period is days.

Signature:

Typed Name/Title:

FIRST ENDORSEMENT: Date Received:

( ) Accepted.

( ) Accepted. Attached comments must be incorporated into the next scheduled submission. (This block is for use with periodically submitted items only.)

( ) Rejected, comments attached. Change pages ( ) are ( ) not sufficient for correction. Contractor is allowed ( ) 30 days or ( ) days to resubmit.

Signature:

Typed Name/Title: _____________________________________________

Code: ____ Date: _________________

VIA: Date:

VIA: PD Date:

SECOND ENDORSEMENT:

( ) Accepted.

( ) Accepted conditionally. Attached comments must be incorporated in the next scheduled submission.

( ) Rejected, comments attached. Resubmit no later than ________ .

Signature:

Typed Name/Title: __________________________ Date: ________________

Contracting Officer

CC w/Encl.:

CC w/o Encl.: