Attachment 7 - Bereavement Leave Certification Form.docx

DOCX document 14 KB Posted

Attached to
Shelf Stocking, Receiving/Storage/Holding Area (RSHA), and Custodial Operations at the Davis-Monthan Air Force Base (AFB) Commissary
Solicitation number
HDEC08-21-R-0009
Issued by

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This document contains a bereavement leave certification form and information for the Shelf Stocking, Receiving/Storage/Holding Area (RSHA), and Custodial Operations at the Davis-Monthan Air Force Base (AFB) Commissary solicitation.

The bereavement leave certification form is to be used by contractors to request reimbursement for bereavement leave taken by employees in accordance with the applicable collective bargaining agreement. It requires the contractor signature and information on the deceased and dates of leave.

The solicitation seeks to furnish supervision, personnel, equipment, and supplies necessary to perform shelf stocking, RSHA, and custodial operations at the Davis-Monthan AFB Commissary located near Tucson, Arizona. The base period is from March 1, 2022 through February 28, 2023 with four one-year option periods. It is a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses as determined by SBA, with a NAICS code of 561990 and size standard of $12 million. The solicitation and attachments will be available on SAM.gov on or about June 10, 2021. An optional site visit is scheduled for June 17, 2021.

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Amendment 0002 - HDEC08-21-R-0009.pdf PDF
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Attachment 2 - Collective Bargaining Agreement.pdf PDF
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Attachment 7 Solicitation Number: HDEC08-21-R-0009 Commissary: Davis-Monthan AFB, AZ

BEREAVEMENT LEAVE CERTIFICATION

REQUEST FOR PAYMENT

Contract: ____________________________________

Name of Employee: ____________________________

Area of Operation (circle one) Shelf Stocking Custodial RSHA

Name of Deceased: __________________________

Relationship to Employee: _____________________

Dates of Bereavement Leave: ___________________

I certify that the above named individual took Bereavement Leave in accordance with the provision of the Collective Bargaining Agreement (CBA) applicable to abovementioned contract and that the individual was paid according to its provisions. Pursuant to said agreement, the contractor is entitled to reimbursement.

_________________________________
(Signature)
_________________________________
(Name, Position, and Date)

File details come from the government source that posted it. Updated .