Attachment IV - Notification of Services Rendered Form.pdf
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- Solicitation number
- 70Z03826QK0000001
About this file
This document is a Notification of Services Rendered Form (Attachment IV) for Combined Synopsis/Solicitation 70Z03826QK0000001, dated July 2018. The form is specifically designed for documenting "onsite contractual services" performed at the Aviation Logistics Center, defined as services with a performance period of less than 90 days or as determined by the Contracting Officer. Examples of qualifying services include calibration, equipment troubleshooting/maintenance/repair, and IT services.
The form requires both the Contractor and Government Point of Contact (POC) to complete and submit it within two business days of service completion. It provides a structured mechanism for the Government POC to either accept or reject the performed service by checking the appropriate box. If accepted, the Government POC certifies the service meets contract requirements and authorizes invoice payment. If rejected, the POC must provide additional details explaining why the service is unacceptable. The form includes fields for contract number, service completion date, Contracting Officer details, division, service location, service description, contractor information, and signatures.
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Text version
Combined Synopsis/Solicitation 70Z03826QK0000001 Notification of Services Rendered Form
Attachment IV
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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