ATTACHMENT - Contract Discrepancy Report.pdf
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- Attached to
- 6515--Orthotic Softgoods and Prosthetic Supplies
- Solicitation number
- 36S79725R0002
About this file
This document is a DD Form 2772 Contract Discrepancy Report, a standard federal form used to document and track contract performance issues. The form provides a structured template for reporting specific contract discrepancies, detailing the nature of the problem, requesting a contractor's response and corrective action, and allowing government officials to evaluate and document the resolution process. Key sections include spaces for contract number, dates, detailed problem description, contractor's response to the issue, government evaluation, potential actions (such as reduced payment), and close-out documentation with signatures from relevant parties like the contractor, Quality Assurance Evaluator (QAE), and Administrative Contracting Officer (ACO).
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Text version
Prescribed by: 5220.22-V2; FAR 4.4;
PREVIOUS EDITION IS OBSOLETE.
DD FORM 2772, SEP 1998
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
DRAFT
SAMPLE
PREVIOUS EDITION IS OBSOLETE.
DD FORM 2772, SEP 1998
NEEDS DD67
Page of Prescribed by: 5220.22-V2; FAR 4.4;
DRAFT
INSTRUCTIONS
NEEDS DD67
PREVIOUS EDITION IS OBSOLETE.
DD FORM XXXX, 20YYMMDD DRAFT
Page of
CONTRACT DISCREPANCY REPORT
5. DATES (YYYYMMDD)
13. CLOSE OUT
NAME (1)
TITLE (2)
SIGNATURE (3)
DATE (YYYYMMDD)
(4)
a. CONTRACTOR NOTIFIED
b. QAE
c. ACO 9.0.0.2.20120627.2.874785 DD Form 2772, "CONTRACT DISCREPANCY REPORT"
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| 5. DATES (YYYYMMDD) - a. PREPARED: |
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| 8a. TO (Contracting Officer) - enter recipient information: |
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| 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.): |
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| 13. CLOSE OUT - a. CONTRACTOR NOTIFIED - (1) NAME: |
| 13. CLOSE OUT - a. CONTRACTOR NOTIFIED - (2) TITLE: |
| 13. CLOSE OUT - a. CONTRACTOR NOTIFIED - (3) SIGNATURE: |
| 13. CLOSE OUT - a. CONTRACTOR NOTIFIED - (4) DATE (YYYYMMDD): |
| 13. CLOSE OUT - b. QAE - (1) NAME: |
| 13. CLOSE OUT - b. QAE - (2) TITLE: |
| 13. CLOSE OUT - b. QAE - (3) SIGNATURE: |
| 13. CLOSE OUT - b. QAE - (4) DATE (YYYYMMDD): |
| 13. CLOSE OUT - c. ACO - (1) NAME: |
| 13. CLOSE OUT - c. ACO - (2) TITLE: |
| 13. CLOSE OUT - c. ACO - (3) SIGNATURE: |
| 13. CLOSE OUT - c. ACO - (4) DATE (YYYYMMDD): |
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