FA5587-12-R-0028-0002.pdf

FA5587-12-R-0028

F2P4MD2117A001

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

The purpose of this amendment is to add and remove certain clauses and w ording included in the PWS that does or does not apply.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 38

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 15-Aug-2012

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X FA5587-12-R-0028

X 9B. DATED (SEE ITEM 11)

20-Jul-2012

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer is extended, X is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE

RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN

REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

14-Aug-2012

CODE

48 CONS/LGCA-FA5587

UNIT 5070, BOX 270

APO

09461 UNITED STATES

FA5587 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by reference:

52.223-18 Encouraging Contractor Policies To Ban Text Messaging

While Driving

AUG 2011

The following have been added by full text:

52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR

EXECUTIVE ORDERS--COMMERCIAL ITEMS (JUL 2012)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.222-50, Combating Trafficking in Persons (FEB 2009) (22 U.S.C. 7104(g)).

N/A Alternate I (Aug 2007) of 52.222-50 (22 U.S.C. 7104(g)).

(2) 52.233-3, Protest After Award (AUG 1996) (31 U.S.C. 3553).

(3) 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004) (Pub. L. 108-77, 108-78).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: (Contracting Officer check as appropriate.)

X (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41

U.S.C. 253g and 10 U.S.C. 2402).

X (2) 52.203-13, Contractor Code of Business Ethics and Conduct (Apr 2010) (Pub. L. 110-252, Title VI, Chapter 1

(41 U.S.C. 251 note).

N/A (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (June

2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment

Act of 2009.)

X (4) 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards (Feb 2012) (Pub. L. 109-

282) (31 U.S.C. 6101 note).

N/A (5) 52.204-11, American Recovery and Reinvestment Act—Reporting Requirements (Jul 2010) (Pub. L. 111-

5).

X (6) 52.209-6, Protecting the Government’s Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (Dec 2010) (31 U.S.C. 6101 note).

N/A (7) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (Feb 2012) (41

U.S.C. 2313).

X (8) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (MAY 2012) (section 738 of

Division C of Pub. L. 112-74, section 740 of Division C of Pub. L. 111-117, section 743 of Division D of Pub. L.

111-8, and section 745 of Division D of Pub. L. 110-161).

N/A (9) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (NOV 2011) (15 U.S.C. 657a).

N/A (10) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (Jan 2011) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a).

____ (11) [Reserved]

N/A (12)(i) 52.219-6, Notice of Total Small Business Set-Aside (NOV 2011) (15 U.S.C. 644).

____ (ii) Alternate I (NOV 2011).

____ (iii) Alternate II (NOV 2011).

N/A (13)(i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C. 644).

____ (ii) Alternate I (Oct 1995) of 52.219-7.

____ (iii) Alternate II (Mar 2004) of 52.219-7.

X (14) 52.219-8, Utilization of Small Business Concerns (Jan 2011) (15 U.S.C. 637(d)(2) and (3)).

N/A (15)(i) 52.219-9, Small Business Subcontracting Plan (Jan 2011) (15 U.S.C. 637(d)(4)).

____ (ii) Alternate I (Oct 2001) of 52.219-9.

____ (iii) Alternate II (Oct 2001) of 52.219-9.

____ (iv) Alternate III (Jul 2010) of 52.219-9.

N/A (16) 52.219-13, Notice of Set-Aside of Orders (NOV 2011) (15 U.S.C. 644(r)).

N/A (17) 52.219-14, Limitations on Subcontracting (NOV 2011) (15 U.S.C. 637(a)(14)).

N/A (18) 52.219-16, Liquidated Damages—Subcon-tracting Plan (Jan 1999) (15 U.S.C. 637(d)(4)(F)(i)).

N/A (19)(i) 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns (Oct

2008) (10 U.S.C. 2323) (if the offeror elects to waive the adjustment, it shall so indicate in its offer).

____ (ii) Alternate I (June 2003) of 52.219-23.

N/A (20) 52.219-25, Small Disadvantaged Business Participation Program—Disadvantaged Status and Reporting

(Dec 2010) (Pub. L. 103-355, section 7102, and 10 U.S.C. 2323).

N/A (21) 52.219-26, Small Disadvantaged Business Participation Program— Incentive Subcontracting (Oct 2000)

(Pub. L. 103-355, section 7102, and 10 U.S.C. 2323).

N/A (22) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (NOV 2011) (15 U.S.C.

657f).

N/A (23) 52.219-28, Post Award Small Business Program Rerepresentation (Apr 2012) (15 U.S.C. 632(a)(2)).

N/A (24) 52.219-29, Notice of Set-Aside for Economically Disadvantaged Women-Owned Small Business

(EDWOSB) Concerns (APR 2012) (15 U.S.C. 637(m)).

N/A (25) 52.219-30, Notice of Set-Aside for Women-Owned Small Business (WOSB) Concerns Eligible Under the

WOSB Program (APR 2012) (15 U.S.C. 637(m)).

N/A (26) 52.222-3, Convict Labor (June 2003) (E.O. 11755).

N/A (27) 52.222-19, Child Labor—Cooperation with Authorities and Remedies (MAR 2012) (E.O. 3126).

N/A (28) 52.222-21, Prohibition of Segregated Facilities (Feb 1999).

X (29) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246).

X (30) 52.222-35, Equal Opportunity for Veterans (Sep 2010)(38 U.S.C. 4212).

X (31) 52.222-36, Affirmative Action for Workers with Disabilities (Oct 2010) (29 U.S.C. 793).

N/A (32) 52.222-37, Employment Reports on Veterans (Sep 2010) (38 U.S.C. 4212).

X (33) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (Dec 2010) (E.O.

13496).

X (34) 52.222-54, Employment Eligibility Verification (Jul 2012). (Executive Order 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in

22.1803.)

N/A (35)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA–Designated Items (May

2008) (42 U.S.C. 6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

____ (ii) Alternate I (May 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

N/A (36) 52.223-15, Energy Efficiency in Energy-Consuming Products (Dec 2007) (42 U.S.C. 8259b).

N/A (37)(i) 52.223-16, IEEE 1680 Standard for the Environmental Assessment of Personal Computer Products

(Dec 2007) (E.O. 13423).

____ (ii) Alternate I (Dec 2007) of 52.223-16.

X (38) 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving (Aug 2011) (E.O. 13513).

N/A (39) 52.225-1, Buy American Act—Supplies (Feb 2009) (41 U.S.C. 10a-10d).

N/A(40)(i) 52.225-3, Buy American Act--Free Trade Agreements--Israeli Trade Act (MAY 2012) (41 U.S.C.

chapter 83, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C. 3805 note, 19 U.S.C. 4001 note, Pub. L. 103-182, 108-77, 108-78, 108-286, 108-302, 109-53, 109-169, 109-283, 110-138, 112-41, and 112-42).

____ (ii) Alternate I (Mar 2012) of 52.225-3.

____ (iii) Alternate II (Mar 2012) of 52.225-3.

____ (iv) Alternate III (Mar 2012) of 52.225-3.

N/A (41) 52.225-5, Trade Agreements (MAY 2012) (19 U.S.C. 2501, et seq., 19 U.S.C. 3301 note).

N/A (42) 52.225-13, Restrictions on Certain Foreign Purchases (June 2008) (E.O.’s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury).

N/A (43) 52.226-4, Notice of Disaster or Emergency Area Set-Aside (Nov 2007) (42 U.S.C. 5150

N/A (44) 52.226-5, Restrictions on Subcontracting Outside Disaster or Emergency Area (Nov 2007) (42 U.S.C.

5150).

N/A (45) 52.232-29, Terms for Financing of Purchases of Commercial Items (Feb 2002) (41 U.S.C. 255(f), 10

U.S.C. 2307(f)).

N/A (46) 52.232-30, Installment Payments for Commercial Items (Oct 1995) (41 U.S.C. 255(f), 10 U.S.C. 2307(f)).

X (47) 52.232-33, Payment by Electronic Funds Transfer—Central Contractor Registration (Oct 2003) (31 U.S.C.

3332).

N/A (48) 52.232-34, Payment by Electronic Funds Transfer—Other than Central Contractor Registration (May

1999) (31 U.S.C. 3332).

N/A (49) 52.232-36, Payment by Third Party (Feb 2010) (31 U.S.C. 3332).

X (50) 52.239-1, Privacy or Security Safeguards (Aug 1996) (5 U.S.C. 552a).

N/A (51)(i) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C.

Appx. 1241(b) and 10 U.S.C. 2631).

____ (ii) Alternate I (Apr 2003) of 52.247-64.

(c) The Contractor shall comply with the FAR clauses in this paragraph (c), applicable to commercial services, that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: (Contracting Officer check as appropriate.)

X (1) 52.222-41, Service Contract Act of 1965 (Nov 2007) (41 U.S.C. 351, et seq.).

N/A (2) 52.222-42, Statement of Equivalent Rates for Federal Hires (May 1989) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.).

N/A (3) 52.222-43, Fair Labor Standards Act and Service Contract Act—Price Adjustment (Multiple Year and

Option Contracts) (Sep 2009) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.).

N/A (4) 52.222-44, Fair Labor Standards Act and Service Contract Act—Price Adjustment (Sep 2009) (29 U.S.C.

206 and 41 U.S.C. 351, et seq.).

N/A (5) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment—Requirements (Nov 2007) (41 351, et seq.).

X (6) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain Services—

Requirements (Feb 2009) (41 U.S.C. 351, et seq.).

N/A (7) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations (Mar 2009) (Pub. L. 110-247).

N/A (8) 52.237-11, Accepting and Dispensing of $1 Coin (Sept 2008) (31 U.S.C. 5112(p)(1)).

(d) Comptroller General Examination of Record. The Contractor shall comply with the provisions of this paragraph

(d) if this contract was awarded using other than sealed bid, is in excess of the simplified acquisition threshold, and does not contain the clause at 52.215-2, Audit and Records--Negotiation.

(1) The Comptroller General of the United States, or an authorized representative of the Comptroller General, shall have access to and right to examine any of the Contractor's directly pertinent records involving transactions related to this contract.

(2) The Contractor shall make available at its offices at all reasonable times the records, materials, and other evidence for examination, audit, or reproduction, until 3 years after final payment under this contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the other clauses of this contract. If this contract is completely or partially terminated, the records relating to the work terminated shall be made available for 3 years after any resulting final termination settlement. Records relating to appeals under the disputes clause or to litigation or the settlement of claims arising under or relating to this contract shall be made available until such appeals, litigation, or claims are finally resolved.

(3) As used in this clause, records include books, documents, accounting procedures and practices, and other data, regardless of type and regardless of form. This does not require the Contractor to create or maintain any record that the Contractor does not maintain in the ordinary course of business or pursuant to a provision of law.

(e) (1) Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c), and (d) of this clause, the

Contractor is not required to flow down any FAR clause, other than those in this paragraph (e)(1)in a subcontract for commercial items. Unless otherwise indicated below, the extent of the flow down shall be as required by the clause—

(i) 52.203-13, Contractor Code of Business Ethics and Conduct (APR 2010) (Pub. L. 110-252, Title VI, Chapter 1

(41 U.S.C. 251 note).

(ii) 52.219-8, Utilization of Small Business Concerns (DEC 2010) (15 U.S.C. 637(d)(2) and (3)), in all subcontracts that offer further subcontracting opportunities. If the subcontract (except subcontracts to small business concerns) exceeds $650,000 ($1.5 million for construction of any public facility), the subcontractor must include 52.219-8 in lower tier subcontracts that offer subcontracting opportunities.

(iii) Reserved.

(iv) 52.222-26, Equal Opportunity (MAR 2007) (E.O. 11246).

(v) 52.222-35, Equal Opportunity for Veterans (SEP 2010) (38 U.S.C. 4212).

(vi) 52.222-36, Affirmative Action for Workers with Disabilities (OCT 1998) (29 U.S.C. 793).

(vii) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010) (E.O.

13496). Flow down required in accordance with paragraph (f) of FAR clause 52.222-40.

(viii) 52.222-41, Service Contract Act of 1965 (Nov 2007) (41 U.S.C. 351, et seq.).

(ix) 52.222-50, Combating Trafficking in Persons (FEB 2009) (22 U.S.C. 7104(g)).

Alternate I (AUG 2007) of 52.222-50 (22 U.S.C. 7104(g)).

(x) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements (Nov 2007) (41 U.S.C. 351, et seq.).

(xi) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain Services--

Requirements (FEB 2009) (41 U.S.C. 351, et seq.).

(xii) 52.222-54, Employment Eligibility Verification (JUL 2012).

(xiii) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (MAR 2009) (Pub. L. 110-247). Flow down required in accordance with paragraph (e) of FAR clause 52.226-6.

(xiv) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (FEB 2006) (46 U.S.C. Appx

1241(b) and 10 U.S.C. 2631). Flow down required in accordance with paragraph (d) of FAR clause 52.247-64.

(2) While not required, the contractor May include in its subcontracts for commercial items a minimal number of additional clauses necessary to satisfy its contractual obligations.

(End of clause)

252.212-7001 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR

EXECUTIVE ORDERS APPLICABLE TO DEFENSE ACQUISITIONS OF COMMERCIAL ITEMS (JUN 2012)

(a) The Contractor agrees to comply with the following Federal Acquisition Regulation (FAR) clause which, if checked, is included in this contract by reference to implement a provision of law applicable to acquisitions of commercial items or components.

X 52.203-3, Gratuities (APR 1984) (10 U.S.C. 2207).

(b) The Contractor agrees to comply with any clause that is checked on the following list of Defense FAR

Supplement clauses which, if checked, is included in this contract by reference to implement provisions of law or

Executive orders applicable to acquisitions of commercial items or components.

(1) X 252.203-7000, Requirements Relating to Compensation of Former DoD Officials (SEP 2011) (Section 847 of

Pub. L. 110-181).

(2) ____ 252.203-7003, Agency Office of the Inspector General (APR 2012)(section 6101 of Pub. L. 110-252, 41

U.S.C. 3509).

(3) ____ 252.205-7000, Provision of Information to Cooperative Agreement Holders (DEC 1991) (10 U.S.C. 2416).

(4) ____ 252.219-7003, Small Business Subcontracting Plan (DoD Contracts) (JUN 2012) (15 U.S.C. 637).

(5) ____ 252.219-7004, Small Business Subcontracting Plan (Test Program) (JAN 2011) (15 U.S.C. 637 note).

(6)(i) ____ 252.225-7001, Buy American and Balance of Payments Program (JUN 2012) (41 U.S.C. chapter 83, E.O. 10582).

(ii) ____ Alternate I (OCT 2011) of 252.225-7001.

(7) ____ 252.225-7008, Restriction on Acquisition of Specialty Metals (JUL 2009) (10 U.S.C. 2533b).

(8) ____ 252.225-7009, Restriction on Acquisition of Certain Articles Containing Specialty Metals (JUN 2012) (10

U.S.C. 2533b).

(9) ____ 252.225-7012, Preference for Certain Domestic Commodities (JUN 2012) (10 U.S.C. 2533a).

(10) ____ 252.225-7015, Restriction on Acquisition of Hand or Measuring Tools (JUN 2005) (10 U.S.C. 2533a).

(11) ____ 252.225-7016, Restriction on Acquisition of Ball and Roller Bearings (JUN 2011) (Section 8065 of Pub.

L. 107-117 and the same restriction in subsequent DoD appropriations acts).

12) ____ 252.225-7017, Photovoltaic Devices (JUN 2012) (Section 846 of Pub. L. 111-383).

13)(i) ____ 252.225-7021, Trade Agreements (JUN 2012) (19 U.S.C. 2501-2518 and 19 U.S.C. 3301 note).

(ii) ____ Alternate I (OCT 2011) of 252.225-7021.

(iii) ____ Alternate II (OCT 2011) of 252.225-7021.

(14) ____ 252.225-7027, Restriction on Contingent Fees for Foreign Military Sales (APR 2003) (22 U.S.C. 2779).

(15) ____ 252.225-7028, Exclusionary Policies and Practices of Foreign Governments (APR 2003) (22 U.S.C.

2755).

(16)(i) ____ 252.225-7036, Buy American Act—Free Trade Agreements—Balance of Payments Program (JUN

2012) (41 U.S.C. chapter 83 and 19 U.S.C. 3301 note).

(ii) ____ Alternate I (JUN 2012) of 252.225-7036.

(iii) ____ Alternate II (JUN 2012) of 252.225-7036.

(iv) ____ Alternate III (JUN 2012) of 252.225-7036.

(v) ____ Alternate IV (JUN 2012) of 252.225-7036.

(vi) ____Alternate V (JUN 2012) of 252.225-7036.

(17) ____ 252.225-7038, Restriction on Acquisition of Air Circuit Breakers (JUN 2005) (10 U.S.C. 2534(a)(3)).

(18) ____ 252.225-7039, Contractors Performing Private Security Functions (JUN 2012) (Section 862 of Pub. L.

110-181, as amended by section 853 of Pub. L. 110-417 and sections 831 and 832 of Pub. L. 111-383).

(19) ____ 252.226-7001, Utilization of Indian Organizations, Indian-Owned Economic Enterprises, and Native

Hawaiian Small Business Concerns (SEP 2004) (Section 8021 of Pub. L. 107-248 and similar sections in subsequent

DoD appropriations acts).

(20) ____ 252.227-7013, Rights in Technical Data--Noncommercial Items (FEB 2012), if applicable (see

227.7103-6(a)).

(21) ____ 252.227-7015, Technical Data—Commercial Items (DEC 2011) (10 U.S.C. 2320).

(22) ____ 252.227-7037, Validation of Restrictive Markings on Technical Data (JUN 2012), if applicable (see

227.7102-4(c)))(10 U.S.C. 2321).

(23) X 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports (MAR 2008) (10 U.S.C.

2227).

(24) X 252.237-7010, Prohibition on Interrogation of Detainees by Contractor Personnel (NOV 2010) (Section 1038 of Pub. L. 111-84)

(25) ____ 252.237-7019, Training for Contractor Personnel Interacting with Detainees (SEP 2006) (Section 1092 of

Pub. L. 108-375).

(26) X 252.243-7002, Requests for Equitable Adjustment (MAR 1998) (10 U.S.C. 2410).

(27) ____ 252.246-7004, Safety of Facilities, Infrastructure, and Equipment For Military Operations (OCT 2010)

(Section 807 of Pub. L. 111-84).

(28) ____ 252.247-7003, Pass-Through of Motor Carrier Fuel Surcharge Adjustment to the Cost Bearer (SEP 2010)

(Section 884 of Pub. L. 110-417).

(29)(i) X 252.247-7023, Transportation of Supplies by Sea (MAY 2002) (10 U.S.C. 2631).

(ii) ____ Alternate I (MAR 2000) of 252.247-7023.

(iii) ____ Alternate II (MAR 2000) of 252.247-7023.

(iv) ____ Alternate III (MAY 2002) of 252.247-7023.

(30) ____ 252.247-7024, Notification of Transportation of Supplies by Sea (MAR (2000) (10 U.S.C. 2631).

(31) ____ 252.247-7027, Riding Gang Member Requirements (OCT 2011) (Section 3504 of Pub. L. 110-417).

c) In addition to the clauses listed in paragraph (e) of the Contract Terms and Conditions Required to Implement

Statutes or Executive Orders--Commercial Items clause of this contract (FAR 52.212-5), the Contractor shall include the terms of the following clauses, if applicable, in subcontracts for commercial items or commercial components, awarded at any tier under this contract:

(1) 252.225-7039, Contractors Performing Private Security Functions (JUN 2012) (Section 862 of Pub. L. 110-181, as amended by section 853 of Pub. L. 110-417 and sections 831 and 832 of Pub. L. 111-383).

2) 252.227-7013, Rights in Technical Data--Noncommercial Items (FEB 2012), if applicable (see 227.7103-6(a)).

(3) 252.227-7015, Technical Data--Commercial Items (DEC 2011), if applicable (see 227.7102-4(a)).

(4) 252.227-7037, Validation of Restrictive Markings on Technical Data (JUN 2012), if applicable (see 227.7102-

4(c)).

(5) 252.237-7010, Prohibition on Interrogation of Detainees by Contractor Personnel (NOV 2010) (Section 1038 of

Pub. L. 111-84).

(6) 252.237-7019, Training for Contractor Personnel Interacting with Detainees (SEP 2006) (Section 1092 of Pub.

L. 108-375).

(7) 252.247-7003, Pass-Through of Motor Carrier Fuel Surcharge Adjustment to the Cost Bearer (SEP 2010)

(Section 884 of Pub. L. 110-417).

(8) 252.247-7023, Transportation of Supplies by Sea (MAY 2002) (10 U.S.C. 2631).

(9) 252.247-7024, Notification of Transportation of Supplies by Sea (MAR 2000) (10 U.S.C. 2631).

(End of clause)

SECTION SF 1449 - CONTINUATION SHEET

The following have been modified:

PERFORMANCE WORK STATEMENT

FOR

Clinical Psychologist (BHOP)

AT

RAF LAKENHEATH, UNITED KINGDOM

Clinical Psychologist

Non-Personal Services

1. SCOPE OF WORK. The Government requires one (1) Full Time Equivalent (FTE)

Clinical Psychologist for this contract at the established facilities at the 48th Medical

Group, RAF Lakenheath, England, also referred to as the “Medical Treatment Facility”

(MTF) herein. Performance shall be in accordance with the requirements contained in this

Performance Work Statement (PWS), and standards of the Joint Commission and Health

Services Inspection (HSI).

1.1 If the vendor is a US military dependent, please disclose DEROS information.

Additionally, prospective vendors shall provide pricing only on those option CLINs in which they will be available to perform in their entirety or specify their availability within the performance period of any CLIN if not available for the entire year.

2. GENERAL CONTRACTOR REQUIREMENTS AND RESPONSIBILITIES

2.1 HOURS OF WORK. Providers working in BHOP will average approximately 10-12 patients per day or 50-60 patients per week. These target productivity standards should be attenuated in consideration of any meetings the provider is required to attend by their supervisor and/or the MTF. Work Schedules. A normal work week is 40 hours (8 hours per day). Duty hours will be dayshift hours, no weekends and no Federal Holidays. Duty hours may include Air Force down days or base exercise days where limited military staffing is available and UK holidays. The Contractor will be compensated only for time actually devoted to delivery of services in this contract unless a base or MTF closure prevents the provider from performing a normal, scheduled duty day. For all locations, there may be occasions when mission and workload changes require employees to adjust work schedules to meet demand. The provider will not perform overtime or on-call duties under this contract.

In the instance where the Government directs the provider to remain on duty in excess of their scheduled shift due to an unforeseen emergency or to complete patient treatment where lack of continuity of care would otherwise jeopardize patient health, the provider shall remain on duty. This provision is not intended to apply to the time required to complete routine tasks (e.g., completion of paperwork or routine administrative tasks at the end of a shift), which are to be completed as part of the normal shift. The provider’s schedule shall be adjusted for the additional hours such that the number of hours on the contract is not exceeded and no overtime is required.

2.1.1 On occasion, services may be required to support an activation or exercise of contingency plans outside the normal duty hours for a crisis declared by the national command authority or overseas combatant commander. Emergency situations (i.e., accident and rescue operations, civil disturbances, natural disasters, military contingency operations, and exercises) may necessitate the contractor provide increased or reduced support as determined by the contracting officer. If necessary, the Government will negotiate an equitable adjustment for the cost of these emergency requirements.

2.1.2 As directed by the MTF, will be required to attend Government provided additional training in patient care aspects and procedures.

2.2 INDIVIDUAL LOGISTICAL SUPPORT. Individual logistical support is provided under this contract in accordance with FAR 25.802, DFARS 225.802, and the policies and procedures of DoD 4525.6-M and AFI 36-3026. Policies and procedures are subject to change. Examples of support are: DOD Common Access Card (CAC); Commissary

(including rationed items); Base Exchange (including rationed items); MWR Facilities (e.g.

chapels, clubs, cinema, fitness center); Military Banking Facilities; Military Postal Service

(APO/FPO); Mortuary Services (on reimbursable basis); POV (Privately-Owned Vehicle license); Purchase of POL (Petroleum and Oil products); Transient Billets or Visiting

Officers Quarters (VOQ) on space-available and reimbursable basis when travel is performed on Official Government Orders; Department of Defense Dependent Schools

(DODDS) on a space guaranteed and tuition paying basis; Medical services on a reimbursable basis; Dental care only for emergency conditions on a reimbursable basis;

Pet/Firearm Registration and Control and Housing Referral.

2.2.1 Logistical support is not authorized for Local National hires as it is forbidden by the

Status of Forces Agreement (SOFA). Local National hires may be authorized a CAC if their duties require access to Government computer programs.

2.3 ABSENCE. Scheduled absences (i.e. leave or holidays) are to be coordinated a minimum of 2 weeks in advance. Notify the Flight Commander or designee as early as possible of unscheduled absences to allow for planning of service coverage and workload distribution.

2.3.1 The MTF will notify contract personnel in advance of upcoming down days to the greatest extent possible for scheduling purposes. In the event of unplanned closure of the facility due to natural disasters, military emergency, or severe weather, contract employees will not perform duties and the Government will not be charged billable hours.

2.3.2 The contractor is required to provide temporary replacement staff for Contractor personnel absences, scheduled or unscheduled, of more than or equal to 30 calendar days.

2.4 DRESS AND APPEARANCE. Contractor personnel shall present a professional, conservative, and neat appearance. Contractor personnel shall report for duty in a professional manner, in appropriate attire befitting a health care setting, and having complied with socially acceptable standards of personal hygiene expected of health care workers.

2.4.1 While on duty, Contractor personnel shall be neat and clean (free from visible dirt and stains), well groomed and appropriately dressed. The personnel’s clothing shall fit correctly to provide a professional, modest appearance, in keeping with normally accepted community standards of dress for the work being performed.

2.4.2 Contractor personnel shall display legible MTF-provided identification media on their outer clothing.

2.4.3 Facial hair (including beards, mustaches, and sideburns) shall be controlled

(restrained) or trimmed. It shall not interfere with safe work practices, look unkempt, or be unclean.

2.4.4 When required and supplied by the Government, wear special protective clothing and shoe covers. When duties will be performed in specified areas, a disposable protective hood shall be worn to ensure infection control standards are met. These items shall remain the property of the Government and shall not be removed from the MTF. After use, protective clothing shall be turned in or destroyed as directed by the Chief of Service.

2.5 OFFICE SKILLS. Contractor staff shall possess working knowledge of computers, specifically the internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows

Operating System.

2.6 SECURITY.

2.6.1 See Appendix 1 for information regarding Host Agency Checks (HAC) and National

Agency Checks (NAC).

2.6.2 During performance, report any information or circumstances observed that may pose a threat to the security of DoD personnel, contractor personnel, resources, and defense information to the Security Forces. The Flight Commander will brief the contractor upon initial on-base assignment and as required thereafter. Comply with the requirements of

Volume 1, AFI 71-101, Criminal Investigations, and paragraph 1.1 of Volume 2, Protective

Service Matters.

2.6.3 Adhere to local base procedures for entry to Air Force controlled/restricted areas.

2.6.4 Ensure keys issued by the government are properly safeguarded and not used by unauthorized personnel. Do not duplicate keys issued by the government.

2.6.5 Lost keys shall be reported immediately to the facility manager. The government replaces lost keys or performs re-keying.

3. HEALTHCARE REQUIREMENTS.

3.1 In accordance with Federal Acquisition Regulation 37.401 with regard to Non-Personal

Services for health care services, the following information is provided:

3.1.1 This is a NON-PERSONAL health care services contract, as defined in FAR 37.101, under which the contractor is an independent contractor.

3.1.2 The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered

(e.g., professional judgments, diagnosis, for specific medical treatment).

3.1.3 The contractor hereby indemnifies the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance.

3.2 Contractor staff must comply with 48

th

Medical Group and unit standards of care as well as the healthcare practices of their specific profession. See Appendix 2 for a list of applicable publications and forms; this list is not exhaustive.

3.2.1 Recognize adverse signs and symptoms and react quickly in emergency situations.

3.2.2 Provide patients with the utmost care and undivided attention.

3.2.3 Ensure a safe work environment and employee safe work habits.

3.2.4 Participate in Quality Inspection and Risk Management activities to the extent that falls within the scope of this PWS.

3.3 HIPAA. All patients shall be assured of their privacy and personal dignity. Follow guidelines for confidentiality and privacy based on the Health Insurance Portability and

Accountability Act (HIPAA). See Appendix 3 for more information.

3.4 RELEASE OF INFORMATION AND RECORDS MANAGEMENT.

3.4.1 Only release medical information obtained during the course of this contract to MTF staff involved in the care and treatment of that individual patient.

3.4.2 Lists and/or names of patients shall not be disclosed or revealed in any way for any use outside the MTF without prior written permission by the Chief of Hospital Services.

3.4.3 Refer all other requests for records to the Outpatient records center.

3.4.4 Prepare all documentation/records to meet or exceed established standards of the

MTF, to include, but not limited to, timeliness, accuracy, content and signature. Only MTF and Air Force-approved abbreviations shall be used for documentation of the patient health record. For unapproved abbreviation list see MDGI 44-116, attachment 2 and 3.

3.4.5 Generate and manage IAW DoD 5400-7R, DoD Freedom of Information Act Program, Chapter 4; AFI 33-129, Web Management and Internet Use, paragraphs 7.4, 8.2.3, 16 and

17; and AFI 33-201, Communications Security (COMSEC), Table 1.

3.4.6 Mark IAW instructions identified in DoD 5400-7R paragraph C4.2.1. Safeguard all sensitive data IAW DoD Regulation 5400.7/Air Force Supplement, paragraph C4.4.

3.4.7 When authorized for destruction, shred the records so that the pieces cannot be reconstructed. Degauss or overwrite magnetic tapes or other magnetic media.

3.4.8 Patient lists, no matter how developed are FOUO and shall be marked: “FOR

OFFICIAL USE ONLY. This document contains information exempt from mandatory disclosure under the Freedom of Information Act (FOIA), Title 5 U.S.C. 552(b)(2) High and

(b)(6) apply.”

3.5 Proof of eligibility

3.5.1 Contractors shall have and provide a current certification in Basic Life Support

(BLS). Licensed practitioners shall have and maintain an active, valid unrestricted, current license (with no limitations, stipulations or pending adverse actions). All licenses must be unencumbered and remain in effect during contract employment. The contractor shall be in good standing, and under no clinical restrictions, with the state licensure board in any state in which a license is held or has been held within the last 10 years.

3.5.2 The contractor shall maintain current certification in their specialty. The contractor shall be current with and have completed all continuing education requirements specified by their US professional licensure or certification.

3.5.3 An annual physical examination is required. The contractor must provide proof of the medical examination by a qualified medical practitioner and required immunizations prescribed by the MTF for continued employment within the facility. Report all information necessary to assure hospital records can be maintained correctly, and therefore comply with the Joint Commission, Operational Safety and Health

Administration (OSHA), and Center for Disease Control (CDC) health record requirements.

3.6.4 Reserved.

4. POSITION QUALIFICATION REQUIREMENTS.

4.1 Education

4.1.1 Have a Doctor of Philosophy (Ph.D.) or (Psy.D.) degree in clinical or counseling psychology from an American Psychological Association (APA) accredited psychology program.

4.1.2 Shall have completed an American Psychological Association (APA) accredited internship/residency in professional psychology.

4.1.3 Maintain a current, unrestricted state license in clinical/counseling psychology

(Psychologists practice medicine?) in any one of the 50 states, the District of Columbia, Puerto Rico, or the U.S. Virgin Islands. A license is defined as a license that allows the psychiatrist to practice independently without clinical supervision.

4.2 Experience

4.2.1 Have a minimum of two (2) years within the past five (5) years in clinical practice in either an adult population or a child/adolescent population.

4.3 Certifications

4.3.1 Public Health clearance is required and the contractor shall submit immunization records and physical health certification with their proposal. The records must show proof of immunization against Hepatitis A and B, Measles, Mumps, Rubella, Varicella, and

Influenza.

The offeror shall also provide proof of negative TB skin test taken within the past 12 months. If the TB test was positive, submit proof of negative chest x-ray within the past 12 months. After start of work, the government will provide post blood borne exposure protocols according to applicable AFIs. The health certification shall state the date on which the physical examination was completed, the name of the doctor who performed the examination, and a statement concerning the physical health of the individual. The certification shall also contain the following statement: “(Name of contractor personnel) is suffering from no contagious diseases to include, but not limited to, Tuberculosis, Hepatitis

A and B and HIV.”

4.3.2 Credentials must be verified prior to awarding contract. Credentialing paperwork

(attached) must be submitted with application. The 48 MDG will verify credentials of selected applicants upon receipt from 48 CONS. Selected applicant will be required to finalize the credentials process on location at the 48 MDG in the CCQAS system. Note:

Staffing Agencies will be allowed to submit up to 3 qualified application packages along with their proposal.

4.4 CREDENTIAL MAINTENANCE

4.4.1 Providers will be subject to the credentials and privileging requirements of AFI 44-

119, Clinical Performance Improvement as well as adverse actions.

4.4.2 The MTF Chief of the Medical Staff, or his/her representative, will define the equipment and facility capabilities and verify contracted employees credentialing package meets the MTFs requirements.

4.4.3 Providers shall be able to obtain privileges through the applicable MTF Credentials

Committee. The Contractor shall provide a complete, current and accurate credentialing package for each individual as required in AFI 44-119, Chapter 4.

4.4.4 The Government shall review the credentials of all providers. The MTF must award privileges before a provider may start work at the MTF. The MTF needs a minimum of 30 days after receipt of a complete package to grant privileges.

4.4.5 Any clinical or administrative adverse actions will be handled and processed IAW applicable Air Force instruction(s).

4.4.6 The Government will conduct criminal background checks on all providers during the AIS/security. The Contractor is responsible for ensuring the required security forms.

4.5 SPECIFIC TASKS.

4.5.1 Attends and participates in meetings during normal duty hours, professional staff conferences and other appropriate professional activities such as the following: quality improvement meetings, professional staff meetings, commander's staff meetings, mental health flight meetings, and other meetings required by applicable regulations, MTF guidance, or as directed by the mental health flight Commander or his/her designated representative.

4.5.2 Conduct applied research and clinical investigations in clinical/behavioral health psychology.

4.5.3 Clinical/Counseling Psychology. Responsible for and applies psychological procedures and techniques, including interviewing, behavioral assessment, evidenced – based therapies, and psychological testing/ psychodiagnostic testing, in the evaluation, diagnosis, and treatment of psychological and neuropsychological disorders.

4.5.4 Individual, family and group psychotherapy, and couples therapy, alcohol and drug treatment evaluations.

4.5.5 Consults with medical personnel, legal authorities, military commanders and school districts, as required.

4.5.6 Maintains accurate and current notes in the Mental Health records, inpatient medical records and electronic medical records of all patients seen, as appropriate, and produces reports of evaluation and/or treatment, as required.

4.5.7 Participates in military specific training (e.g., training to perform Command Directed

Evaluations, security clearances, Military Training Instructor clearances, use of the Air

Force Guide to Managing Suicidal Behavior, pre-post deployment screening, PTSD, and combat stress) and others as directed by the mental health flight Commander or AF policy.

4.6 Behavioral Health Consultant in the Patient Centered Medical Home (PCMH). The type of work may include the following:

4.6.1 Participates in and successfully completes Air Force BHC training. Demonstrates core competency skills to an expert trainer within 90 days of starting to see patients in primary care. The 90-day threshold for demonstration of core competency skills will be extended if the Air Force is unable to provide training opportunities within 90 days.

4.6.2 Provides brief (typically no more than four appointments) cognitive/behavioral interventions in primary care under the Air Force consultation model (i.e., per the Air

Force Behavioral Health Optimization Program Practice Manual). Services will mimic the pace of primary care (i.e., patients seen for 15- to 30-minute appointments).

4.6.3 Provides classes and/or groups in format appropriate for primary care (e.g., drop-in stress management class, group medical visit for a chronic condition).

4.6.4 Successfully consults with PCMs on-demand about general issues or specific patients.

4.6.5 Ensures PCMs receive same-day verbal and/or written feedback on patients referred.

4.6.6 Delivers brief presentations/trainings to primary care team members regarding behavioral health issues and BHC services.

4.6.7 Participates in team efforts to develop, implement, evaluate, and revise clinical pathway programs needed in the clinic.

4.6.8 Maintain accurate and current notes in the electronic medical records of all patients seen.

4.6.9 Consults with medical personnel, legal authorities, and military commanders as required.

4.6.10 Participates in military specific training (e.g., use of the Air Force Guide to

Managing Suicidal Behavior, pre-post deployment screening, PTSD, and combat stress, etc).

4.6.11 Attends and participates in meetings during normal duty hours and professional staff conferences and other appropriate professional activities such as, but not limited to the following: quality improvement meetings, professional staff meetings, commander's staff meetings, primary care staff meetings, appropriate meetings of the mental health flight, High Interest Log case staffing, and others required by applicable regulations, MTF guidance, or as directed by supervisor.

4.7 Behavioral Health Care Facilitator (BHCF) in a Patient Centered Medical Home

(PCMH). The type of work may include, but is not limited to, the following:

4.7.1 Participates in and successfully completes Air Force BHCF training.

4.7.2 Contact referred patients to assess treatment adherence.

4.7.3 Use validated symptom inventories to assess current symptom severity.

4.7.4 Assess barriers to treatment adherence and help patient problem-solve solutions to barriers.

4.7.5 Provide patients with education regarding their mental health condition and treatment regimen.

4.7.6 Maintain patient information in a patient registry.

4.7.7 Maintain accurate and current notes in the electronic medical records of all patients contacted for review by the managing physician.

4.7.8 Routinely staffs difficult cases with the referring provider, behavioral health consultant and/or psychiatry consultant.

4.7.9 Liaises between patients, medical clinics, and occasionally military Chains of

Command in case management functions that ensures the coordination of care and most suitable clinical disposition of patients’ cases.

4.8 ADDITIONAL TASKS. The duties include but are not limited to the following:

4.8.1 Evaluates service members for Command Directed Evaluations and prepares/submits reports within a 24 hr. period.

4.8.2 Advises on problems related to mental health and prevention of mental disorders.

4.8.3 Serves as mental health consultant to commanders non-psychiatric practitioners.

5. SERVICE SUMMARY AND QUALITY ASSURANCE

5.1 If contractor fails to perform IAW the PWS the QAP/COR shall complete a Corrective

Action Report (CAR) and submit it to the Contracting Office. This form is used to document a contractor’s failure to meet critical Service Summary requirements, but may be used for other contract related infractions. It is encouraged to resolve minor infractions at the lowest level possible, but ensuring the Contracting Office is in the chain. At no time may a contractor be instructed not to contact the Contracting Office. This is a non-personal service and the contractor’s recourse is always with the Contracting Office.

5.2 SERVICE SUMMARY

Performance Objective Ref Threshold Monitoring Method

Provides professional

Patient care

PWS 3.2.2 No more than 3 validated complaints per year

100% Inspection of submitted complaints

Protects patient confidentiality and privacy

PWS 3.3 Zero breaches of confidentiality and/or privacy

Immediate review of complaints alleging breach of privacy/confidentiality.

Accurate and Proper

Records Management

PWS 3.4 -

3.4.8

No more than 2 discrepancies per quarter

Periodic Inspection

Accurate and proper records management

PWS 4.5.6 Zero use of identified “DO NOT

USE” abbreviations in clinical notes

Periodic inspection

Accurate and proper records management

PWS 4.5.6 98% of all documentation of clinical care is completed within 72 hours of service delivery

Periodic Inspection

Accurate and proper records

PWS 4.5.6 98% of all BHOP notes contain the name of the referring PCM and the referral question clearly documented

Periodic inspection

Accurate and proper records

PWS 4.5.6 98% of all BHOP notes contain documentation of an education or prevention topic

(2nd P of SOAPP) note as having been discussed with patient, as well as assessment of patient’s comprehension?

Periodic inspection

Ensuring patient safety and proper records management

PWS 4.6.9 100% of intake appointment notes contain risk assessment that addresses presence/absence of suicidal ideation, Periodic inspection homicidal ideation, non-suicidal self-injury, and psychotic processes, as well as an overall estimation of risk level

6. ADDITIONAL INFORMATION.

6.1 Contractor shall be provided Government-controlled working space, material, equipment, services (including automatic data processing), or other support which the

Government determines can be made available at RAF Lakenheath where this contract shall be performed.

APPENDIX 1

NATIONAL AGENCY CHECK (NAC)/HOST AGENCY CHECK (HAC). The government will submit an investigation request for the awardee on AF Form 2583, “Request for Personnel Security Action”, at no additional cost to the contractor. The contractor must successfully pass a National Agency Check (NAC) US or Host Agency

Check (HAC) UK to be eligible for contract award. Any contractor receiving an unfavorable NAC/HAC shall be terminated for the Default.

UNESCORTED ENTRY - CAC:

1. Those personnel requiring CAC cards are issued one because they are either authorized Logistical Support (i.e. Commissary, BX, and Gas Station) and/or computer access. US personnel shall have a NAC initiated by the gaining units

Security Manager or for UK personnel the gaining units HAC POC. It is the

Trusted Agents (TA) responsibility to ensure these checks are initiated.

2. The contract award document contains the information whether or not an individual is authorized Logistical Support or requires computer access in performance of their job. This has to be verified by the contractors TA.

3. TA’s are individuals assigned by their unit to “sponsor” contractors in Contractor

Verification System (CVS) allowing them to be issued a CAC. The TA will initially load the contractor in CVS which prompts the contractor to go into CVS and verify the information. The TA will provide instructions on how this is accomplished.

4. DD Form 1172-2, Application for Department of Defense Common Access Card

DEERS Enrollment, must be completed and submitted with the DD Form 557, Appointment/Termination Record- Authorized Signature. The TA must fill out the

DD Form 1172-2, all typed, if there is any hand written information on the form

(other than signatures) the MPF office will reject the form. The TA must fill in

Section I, Employee Information; Section II, Employee Declaration and Remarks, here is where the contractor’s security clearance information (NAC or HAC) goes and all authorized Logistical Support, the contractor signs and dates boxes 37 and

38; and Section III, Authorized/Verified By, is where the TA fills in their information. They verify the contractors’ signature in Section II and then the TA signs Section III. The DD Form 577, Appointment/Termination Record- Authorized

Signature, and as the name implies, verifies the TA’s name and signature.