Attachment C-5 FTC-ADM-61 Service Contract Work Request Form.pdf
PDF 543 KB Posted
- Attached to
- Student Support/Facilities Operation Maintenance Services Federal contract opportunity
- Solicitation number
- 70LCHS25RPFB00001
About this file
This is a Department of Homeland Security (DHS) Federal Law Enforcement Training Centers (FLETC) service contract work request form (FTC-ADM-61) used to request contractor services under an existing contract. The form serves as a task order template to specify labor categories, quantities, costs, and performance requirements.
The form includes fields for contract number, place of performance, labor categories and rates, CLIN/Sub-CLIN details, delivery schedule, accounting data, and justification. It requires signatures from the originator, approver, and contracting officer. The document is structured as a standardized government form template that would be filled out to request specific contractor services, with copies distributed to the contractor, fund administrator, COR, and contract file upon completion.
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Text version
DEPARTMENT OF HOMELAND SECURITY
FEDERAL LAW ENFORCEMENT TRAINING CENTERS
SERVICE CONTRACT WORK REQUEST
CONTRACT NO. PLACE OF PERFORMANCE: Award Date:
REQUEST NO. Order #
FY CALL # Ser # Complete with an appropriate/applicable labor category and rate for the described work:
Labor Category: Labor Category:
Labor Category: Labor Category:
Labor Category: Labor Category:
ITEM # CLIN
SUB CLIN DESCRIPTION QUANTITY UNIT OF
ISSUE
UNIT COST ESTIMATED
COST
FEE TOTAL
GRAND TOTAL
Delivery or Performance Schedule/Date Place of Delivery or Performance Accounting & Appropriation Data
JUSTIFICATION
Originator (Print/Sign) Date Approval (Print/Sign) Date
Delivery/Performance Schedule Method of Payment & Payment Office (if not specified in the contract)
Contracting Officer (Print/Sign) Date
Original - Contractor Copy to: Fund Administrator
COR
Contract File
FTC-ADM-61 (5/17) Page 1 of 1
9.0.0.2.20120627.2.874785
DEPARTMENT OF HOMELAND SECURITY
FEDERAL LAW ENFORCEMENT TRAINING CENTERS
SERVICE CONTRACT WORK REQUEST
Complete with an appropriate/applicable labor category and rate for the described work:
ITEM #
CLIN SUB CLIN
DESCRIPTION
QUANTITY
UNIT OF ISSUE
UNIT COST
ESTIMATED COST
FEE
TOTAL
GRAND TOTAL
Original - Contractor Copy to: Fund Administrator
COR
Contract File
FTC-ADM-61 (5/17)
| Contracting Officer (Print/Sign): |
| Date 2 digit month, 2 digit day, 4 digit year: |
| Labor Category:: |
| Delivery or Performance Schedule/Date: |
| Accounting & Appropriation Data: |
| Reset Form Button: |
File details come from the government source that posted it. Updated .