Example PS Form 8203.pdf

For R eview - N ot S ignature

ORDER / SOLICITATION / OFFER / AWARD

15. BILLING ADDRESS

SEE SCHEDULE

BLOCK IS CHECKED

ORAL

RFP

12. DELIVERY FOR FOB10. ACO

CODE

RFQ

DESTINATION UNLESS

13.SOLICITATION

PAYMENT TERMS

OFFERED BY OFFEROR

7. For Information Call 8. OFFER DUE DATE/TIMEb. TELEPHONE NO.a. NAME

4. MASTER/AGENCY CONTRACT NO.3. AWARD/ 6. SOLICITATION 5. SOLICITATION NO.

OFFEROR TO COMPLETE BLOCKS 13, 14, 16, 22, 23 and 27

1. REQUISITION NO. PAGE

14 SUPPLIER

9. ISSUED BY

2. CONTRACT/ORDER NO.

EFFECTIVE DATE ISSUE DATE

c. FAX NO.

11. SOLICITATION

METHOD

EMAIL:

TEL: FAX:

EMAIL:

16. REMITTANCE ADDRESS 17. DELIVERY ADDRESS

TELEPHONE NO:

DELIVER BY/END DATE:

2B-20-A-0079 08/01/2020

DIANE N. BROWN (303) 743-1263 08/30/2020 1500 MT

Employee Services Employee, Financial, & Tactical Services CMC United States Postal Service 3300 South Parker Road, Suite 400 Aurora CO 80014-3500

Diane.N.Brown@usps.gov

2BEMPS

OF

X

CODE 2BEMPS

CODE

CODE

TEL: FAX:

EMAIL:

CHECK EFT

23.

AMOUNT

22.

UNIT PRICE

21.

UNIT

20.

QUANTITY

19.

SCHEDULE OF SUPPLIES/SERVICES

18.

ITEM NO

Solicitation for EEO Investigators

The supplier will provide responses in accordance with Provision 4-2 and the attached documents including Proposal Instructions, Statement of

Work, and Terms & Conditions.

Only one response to the solicitation will be accepted during its posting.

Clause 2-20: Option Period (October 2019)

Continued ...

copies to the issuing office. The supplier agrees, subject to the terms and conditions specified herein, to provide and deliver all items identified above and on any additional sheets.

28c. DATE SIGNED

28a. UNITED STATES POSTAL SERVICE

27c. DATE SIGNED 28b. PRINTED NAME OF CONTRACTING OFFICER

TOTAL AWARD AMOUNT

27b. PRINTED NAME AND TITLE OF SUPPLIER

27a. SIGNATURE OF SUPPLIER

The supplier is required to sign this document and return

24a.

(USPS Use Only)

25.

26. Award of Contract: Your offer on Solicitation (block 5) is accepted as to items

(SIGNATURE OF CONTRACTING OFFICER)

JEREMIAH D. BAKER

X

24b.

PAYMENT TERMS

PS Form 8203 (January 2017) ot S ignature

2 2

OFPAGEREQUISITION NO.

08/01/2020

ISSUE DATE

SOLICITATION

2B-20-A-0079

SOLICITATION NO.MASTER/AGENCY CONTRACT NO.

EFFECTIVE DATE

AWARD/CONTRACT/ORDER NO.

ITEM NO AMOUNTUNIT PRICEUNITQUANTITYSCHEDULE OF SUPPLIES / SERVICES

CONTINUATION SHEET

The Postal Service may extend the term of this contract within the limits and at the prices stated in the schedule. The contracting officer may exercise this option at any time within the contract term or by giving the supplier at least

60 days [unless a different number of days is specified within the schedule] written notice prior to the expiration of the contract term. If the Postal Service exercises this option, the extended contract includes this option clause as applicable to any remaining option periods stated in the schedule. The total duration of this contract, including exercised option period extensions, may not exceed the time limit set forth in the schedule.

PS Form 8203 (January 2017) ot S ignature

1 - PART 1 - COVER SHEET AND SCHEDULE

ACKNOWLEDGMENT OF AMENDMENTS

INVOICE STATEMENT

DUNS NUMBER REQUEST

PRIVACY ACT STATEMENT

2 - PART 2 - PROVISIONS

PROVISIONS INCORPORATED BY REFERENCE

PROVISIONS BY FULL TEXT

3 - PART 3 - CONTRACT CLAUSES

CLAUSES INCORPORATED BY REFERENCE

CLAUSES BY FULL TEXT

4 - PART 4 - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACHMENTS

LIST OF ATTACHMENTS

ot S ignature

1 - PART 1 - COVER SHEET AND SCHEDULE

ACKNOWLEDGMENT OF AMENDMENTS

The offeror acknowledges receipt of amendments to the solicitation numbered and dated as follows:

Amendment Number Date Amendment Number Date

INVOICE STATEMENT

All invoices MUST reference the Award Number and corresponding line item number listed on this purchase document. Invoices not in compliance may result in delayed payment.

Invoices that do not include the Supplier's Name as stated on the original award document or latest modification will be returned.

All payments for this award and related orders will be transmitted or sent to the Remittance Address on the Award document or latest modification, regardless of any Remittance Address on the invoice. The Supplier must notify the Contracting Officer of any change to the Supplier name and/or Remittance Address.

DUNS NUMBER REQUEST

As the United States Postal Service continues to automate its cradle to grave contracting process, there is a need to have a unique way of identifying the Supplier for communication purposes that excludes the Supplier’s Tax Identification Number and easily known by the Supplier’s personnel. Therefore, to effectively establish this communication link, USPS’ Contracting and Authoring Management System (CAMS) must have the Supplier's Data Universal Numbering System (DUNS) number in the Supplier's record within CAMS.

Please furnish the below information to the Buyer/Contracting Officer of this ot S ignature document.

DUNS #: ____________________

TIN #, associated to the above DUNS #: __________________________

PRIVACY ACT STATEMENT

To the extent that the information you provide is about an individual, the Privacy Act will apply. Collection of that information is authorized by 39 USC § 401. As a routine use, the information may be disclosed to an appropriate government agency, domestic or foreign, for law enforcement purposes; where pertinent, in a legal proceeding to which the USPS is a party or has an interest; to a government agency in order to obtain information relevant to a USPS decision concerning employment, security clearances, contracts, licenses, grants, permits, or other benefits; to a government agency upon its request when relevant to its decision concerning employment, security clearances, security, or suitability investigations, contracts, licenses, grants, or other benefits; to a congressional office at your request; to an expert, consultant, or other person under contract with the USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and Budget for review of private relief legislation; to an independent certified public accountant during an official audit of USPS finances; to an investigator, administrative judge or complaints examiner appointed by the Equal Employment Opportunity Commission for investigation of a formal EEO complaint under 29 CFR 1614; to the Merit Systems Protection Board or Office of Special Counsel for proceedings or investigations involving personnel practices and other matters within their jurisdiction; to a labor organization as required by the National Labor Relations Act; to a federal, state or local agency, financial institution or other appropriate entity for the purpose of verifying an individual's or entity's eligibility or suitability for engaging in a transaction. In addition, the following disclosures may be made to any person: a solicitation mailing list when a purchase is highly competitive and competitions will not be harmed by release, or to provide an opportunity for potential subcontractors seeking business; a list of lessors of real or personal property to the Postal Service; a list of entities with whom the Postal Service transacts for goods or services, interests in real property, construction, financial instruments, or intellectual property; and the identity of the successful offeror. Completion of this form is voluntary; however, if this information is not provided, we will be unable to process your request.

ot S ignature

2 - PART 2 - PROVISIONS

PROVISIONS INCORPORATED BY REFERENCE

The above provisions are incorporated by reference as if set forth in full text. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. The text of these provisions may be accessed electronically at this address: http://about.usps.com/manuals/spp/spp.pdf or, upon request, will be provided by the contracting officer.

PROVISIONS BY FULL TEXT

ot S ignature

3 - PART 3 - CONTRACT CLAUSES

CLAUSES INCORPORATED BY REFERENCE

The above clauses are incorporated by reference as if set forth in full text. The text of these clauses may be accessed electronically at this address:

http://about.usps.com/manuals/spp/spp.pdf or, upon request, will be provided by the contracting officer.

CLAUSES BY FULL TEXT

ot S ignature

4 - PART 4 - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACHMENTS

LIST OF ATTACHMENTS

Attachment Number Title Number of

Pages