BPA_Waiver.pdf

Waiver Control Number: _________ (Assigned by the AF FCC office)

Request for Exception from USAF Mandatory Use Policy Systems and Modular Furniture

Requestor Information

Request Date:___________________________ Requesting POC: _________________________ POC Email:______________________________ Requesting Organization:__________________ Supporting Contracting Office:______________ Base:___________________________________ MAJCOM:_______________________________

Requirement Description

Manufacturer of Requested Product: ___________________________________ Vendor Providing Requested Product: ___________________________________ Estimated cost of Requested Products (total):_____________________________

Description of Requirement:

Justification for why the Program will not meet your requirements:

(if additional space is needed please provide additional attachments to support your justification)

Request Type:

Request Program Scope Determination Request to Procure Requirement from contractor outside program

Request to Procure Requirement from contractor inside program

This form and decision response must be maintained in the purchase file/record.

Requestor Signature:___________________ Endorser’s Signature:______________________ Requester Name:______________________ Endorser Name:__________________________ Rank/Grade:______ DSN:____________ Rank/Grade:______ DSN:_______________ Unit/Agency:_________________________ Unit/Agency:_________________________ Email:_______________________________ Email:__________________________________

Requirements estimated under the micro-purchase threshold may be endorsed by the requesting unit’s Commander.

Requirements estimated over the micro-purchase threshold must be endorsed by a warranted Contracting Officer.

Waiver Control Number: _________ (Assigned by the AF FCC office)

Waiver Determination Response for

Systems and Modular Furniture

Based upon the information provided your request for exemption from the Mandatory Use Policy for USAF Systems and Modular Furniture Program is hereby:

Waiver Authority’s Signature:______________________ Waiver Authority’s Name:__________________________ Rank/Grade:______ DSN:________________ Waiver Authority’s Title:_____________________________

If you feel this determination has been made in error you may submit your reasoning below for consideration.

Disapproved Waiver Appeal Request

I request an appeal regarding the above decision issued by The Air Force Furniture Commodity Council Waiver Approval Authority.

Basis of Appeal: (you may only address the specific facts related to the disapproval decision)

Endorser’s Signature:______________________ Endorser Name:__________________________ Rank/Grade:______ DSN:________________ Unit/Agency:_____________________________ Email:___________________________________

Appeal Decision: Based upon consideration of the facts presented; this appeal is:

Appeal Authority’s Signature:______________________ Appeal Authority’s Name:__________________________ Rank/Grade:______ DSN:________________ Appeal Authority’s Title:_____________________________