Contract Deficiency Report.pdf
PDF 106 KB Posted
- Attached to
- Q402--Community Nursing Home-VISN15
- Solicitation number
- 36C25521R0016
About this file
This document contains a sample Contract Discrepancy Report (CDR) template and details of a related federal contract opportunity to provide Community Nursing Home Care Services. The CDR template is to be used by the Contracting Officer's Representative (COR) to document any non-conformances to contract terms and conditions by a contractor. It includes sections for the contract and report numbers, dates, a description of the discrepancy, and signatures.
The related federal contract opportunity is an open and continuous solicitation issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 15 to provide Community Nursing Home Care Services across parts of Kansas, Missouri, Arkansas, Illinois, Indiana and Kentucky. The VA intends to award multiple single IDIQ contracts of indefinite duration and indefinite quantity as a result. The solicited offers may be received at any time and Contracting Officers will determine requirements and solicit specific offers from awardees.
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Other files
| File | Type | Posted |
|---|---|---|
| Subcontracting Plan Template_A0002.pdf | ||
| 36C25521R0016 0002.pdf | ||
| 36C25521R0016 0001.pdf | ||
| SubcontractingPlan.pdf | ||
| CapabilitiesQuestionnaire.pdf | ||
| Sample QASP.pdf | ||
| Capabilities Questionnaire.pdf | ||
| Supplement to Invoices.pdf | ||
| INFORMATION ON WAGE DETERMINATION.pdf | ||
| VISN 15 Placement.pdf | ||
| Sample UB-04.pdf | ||
| Subcontracting Plan.pdf | ||
| AOR Maps.pdf | ||
| 36C25521R0016_3.pdf |
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Text version
Attachment 5, Sample Contract Discrepancy Report
CONTRACT DISCREPANCY REPORT
1. CONTRACT NUMBER 2. REPORT NUMBER FOR THIS DISCREPANCY
3. TO: (Contracting Officer) 4. FROM: (Name of COR)
5. DATES
a. CDR 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.)
COR to enter sufficient detail to describe non-conformance to contract terms and conditions, e.g. incorrect invoicing, over-billing, patient care, etc.
******Notes No Patient Personally Identifiable Information Allowed on this document or attachments.
1. No Patient Protected Health Information Allowed on this document or attachments.
Reference: HIPAA
7. SIGNATURE OF COR X Date:
8. SIGNATURE OF CONTRACTING OFFICER
X
Date:
9a. TO (Contracting Officer) 9a. FROM (Contractor)
10. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable quality control program procedures or new procedures. Attach continuation sheet(s) if necessary.)
**Please use separate sheet, or indicate corrective action plan on attached inspection report.
11. SIGNATURE OF CONTRACTOR REPRESENTATIVE Date:
12. GOVERNMENT EVALUATION. (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)
13. GOVERNMENT ACTIONS (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)
14. CLOSE OUT
NAME TITLE SIGNATURE DATE
a. CONTRACTOR
NOTIFIED
b. COR
c. CONTRACTING
OFFICER
File details come from the government source that posted it. Updated .