Appendix_C--Work_Request_Form.pdf

Solicitation #: FA4855-xxxx Appendix C Contract # FA4855-xxxx 29 May 2019

C-1

APPENDIX C WORK REQUEST FORM

Government Control Number __________ Contractor Control Number __________

Description of work to be performed:

Costs:

Labor: The total labor price shall include all labor costs.

Labor Number Price Total Classification of Hours Per Hour Labor price

Total of Labor Costs $ _____________

Materials, Supplies, Equipment. Contractor shall identify all materials, supplies, and equipment required regardless of cost. For any single item in excess of $2,500 the Contractor shall provide at least 3 competing vendor quotes.

Vendor Name & Contact Info Item Cost

Total of Materials, Supplies, Equipment Costs $ ____________

Total of all work request costs $ ____________

Warranty period: Parts ___________ Labor ____________

Schedule of Work: Start ___________ Complete ____________ Days and Hours ____________

Other Conditions:

Contractor Government COR Signature & Date Signature & Date

APPROVED (For $__________)/DISAPPROVED

Contracting Officer Signature & Date