Attachment 6 - Notification of Services Rendered Form - 70Z03825QK0000014.pdf

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Attached to
Rinse Water Control System Upgrade Federal contract opportunity
Solicitation number
70Z03825QK0000014
Issued by
Department of Homeland Security US Coast Guard

About this file

The document is a Notification of Services Rendered Form for a federal contract (70Z03825QK0000014) related to the United States Coast Guard Aviation Logistics Center. The form is designed to be completed by the contractor and government point of contact (POC) upon completion of an onsite contractual service lasting less than 90 days, such as calibration, equipment maintenance, repair, or IT services. The form requires documentation of service completion, including specific details like contract number, service description, building/location, contractor information, and government acceptance or rejection of the service.

The associated federal contract opportunity is for a Rinse Water Control System Upgrade at the Coast Guard's Elizabeth City, North Carolina location. The solicitation is a sole-source procurement targeting Siemens Industry, Inc. for upgrading the Siemens Rinse Water Delivery System (SRWDS). The contract includes two phase line items, each with a 90-day delivery requirement after receipt of order. The solicitation is unrestricted, with a small business size standard of $34 Million, and requires a firm-fixed price purchase order. Quotations are due by 19 March 2025 at 2:00 PM EDT, with an anticipated award date of 24 March 2025. Quotations should be emailed to Samuel.J.Ownley2@uscg.mil, with all questions submitted by 14 March 2025.

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Text version

Combined Synopsis/Solicitation 70Z03825QK0000014 Notification of Services

Rendered Form

Attachment 6

JUL 2018

Government POC:

Government POC Signature:

Date:

The service described in Block F has been complete in accordance with the requirements of the contract or order listed in Block A. By signing below, I certify as the Government POC that I accept the service provided by the Contractor listed in Block G and give the Contracting Officer approval to pay the invoice associated with this service.

The service described in Block F has NOT been complete in accordance with the requirements of the contract listed in Block A. As the Government POC I DO NOT accept the service provided by the Contractor listed in Block G. (If this is block is checked, the Government POC shall provide additional information below detailing why the service is unacceptable)

Notification of Services Rendered Form

The Contractor and Government POC shall complete this form upon completion of an "onsite contractual service". The Contractor and Government POC shall submit the signed form to the Contracting Officer or their representative listed in block C below within two (2) business days of contractual service completion.

For the purpose of this form, "onsite contractual service" is defined as any service performed at the Aviation Logistics Center with a period of performance of less than 90 days or as deemed necessary by the Contracting Officer. Example of onsite services meeting this definition include, calibration services, equipment troubleshooting / maintenance / repair and IT services.

E) Building or Location of Service:

G) Contractor Company:

H) Contractor Company Representative:

I) Contractor Company Representative Signature:

F) Description of the Service:

J) Government POC Acceptance or Rejection of the Service: (Check One of the Boxes Below)

A) Contract or Order Number:

B) Date of Service Completion:

C) Contracting Officer or Representative:

D) Division:

Sheet1

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