Attachment_J4_-_Sample_Completion_Report.pdf

08 Jan 2015

DATE:

TO: DITCO/(Contract Specialist)

FROM VENDOR:

VENDOR ADDRESS:

SUBJECT: COMPLETION NOTICE

1. DITCO CSA NUMBER:

2. TSR NUMBER:

3. TYPE ACTION:

(NOTE: IDENTIFY THE TYPE ACTION COMPLETED (E.G., START, CHANGE, DISCONTINUE, ETC.))

4. SERVICE DATE REQUESTED:

(NOTE: FROM THE ORDER)

5. COMPLETION DATE:

(NOTE: IDENTIFY THE DATE THE CONTRACTED TELECOMMUNICATIONS SERVICE AND/OR

EQUIPMENT WAS ACTUALLY PROVIDED TO THE GOVERNMENT FOR USE, OR CHANGED, OR

DISCONTINUED BASED ON TYPE OF ACTION.)

6. COMMERCIAL CIRCUIT IDENTIFIER OR PHONE NUMBER:

7. LOCATION

A:

B:

(NOTE: IDENTIFY ALL CUSTOMER PREMISE EQUIPMENT (CPE) INSTALLED OR REMOVED, BY

SERVICE POINT. ADDITIONALLY, IDENTIFY ANY CPE THAT WAS NOT REMOVED ON THE DATE THAT

THE TELECOMMUNICATIONS SERVICE WAS DISCONTINUED, ALONG WITH THE DATE THAT THIS

EQUIPMENT WILL BE REMOVED. FOR MULTIPOINT SERVICE, ADD ADDITIONAL LOCATIONS C, D, ETC.)

8. GOVERNMENT ACCEPTANCE AGENCY

NAME:

PHONE NUMBER:

E-MAIL ADDRESS:

9. VENDOR REPRESENTATIVE:

NAME:

PHONE NUMBER:

E-MAIL ADDRESS: