Atch__9__Blank_Sample_AF_Form_3064.pdf

PDF 14 KB Posted

Attached to
Civil Engineering Multiple Award Construction Contract (CEMACC) Federal contract opportunity
Solicitation number
FA8501-17-R-0001
Issued by
Department of the Air Force Materiel Command Lifecycle Management Center Robins Air Force Base

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Blank Sample AF Form 3064

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X/XX/2017

#VALUE! DATE SIGNED

XXXXXX

X/XX/2017

LINE NO. XXXXXX.XX

A XXXXX.XX Aug Sep Oct Nov Dec Jan Feb Mar X/X/2017

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Fence 20 2.17%

CONTRACTOR'S NAME (LAST, FIRST, I) ADDRESS

(STREET, CITY, STATE, ZIP)

CLIN 1

Form Approved OMB NO. 0704-0188

10. APPROVAL RECOMMENDED BY

INSTALLATION'S ENGINEER'S SIGNATURE

FA8501-XX-X-XXXX

2. STARTING DATE/ NTP

CONTRACT PROGRESS SCHEDULE (See Contractor's Instructions on Reverse)

DATE SIGNED

8. PROJECT TITLE

Project Title, Robins AFB, GA

9. SUBMITTED BY:

1. CONTRACT NO.

11. APPROVED BY

% WORK ELEMENTS

3. COMPLETION DATE

CONTRACTING OFFICER'S SIGNATUREDATE SIGNED

6. ACTUAL STARTING DATE

7. ACTUAL COMP DATE

5. PROJECT NO.

4. PURCHASE REQUEST NO.

CONTRACTOR'S

SIGNATURE

0.00%

CLIN 2

Total

Public reporting burden for this collection of information is estimated to average 15 minutes per response including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of the collection of information including suggestions for reducing this burden in Department of Defense, Washington Headquarters Service. Directorate for information Operations and Report. 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22292-4302, and to the Office of Management and Budget, Paperwork Reduction Project 0704-0188, Washington, DC 20503. Please DON NOT RETURN your (form questionnaire) to either of these addresses. Send your completed (form questionnaire) to: SAF AQCO, Washington, DC 20330-1000.

AF FORM 3064, JUN 90 PREVIOUST EDITION IS OBSOLETE

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