HDEC05-14-R-0002_DOLLAR_VALUE_INVENTORY_CERTIFICATION.pdf

(For use of this form, see DeCAD 40-1: OPR is CICST)

CONTRACT NUMBER:

DELIVERY ORDER

NUMBER:

As required by the PWS, the Government provided a "walk-through" of the facility to review inventory preparation.

(Optional) My comments on this "walk-through" are as follows.

Signature, Contractor Representative//Printed Title

Date(s) CONDUCTED:

SCHEDULED START TIME: SCHEDULED END TIME:

ACTUAL START TIME: ACTUAL END TIME:

SCHEDULED START TIME: SCHEDULED END TIME:

ACTUAL START TIME: ACTUAL END TIME:

Show the total number of work hours GROCERY DEPARTMENT

SALESFLOOR TOTAL: $0.00

WAREHOUSE TOTAL: $0.00

TOTAL CONTRACTOR

WORK HOURS

WAREHOUSE TOTAL

(Remote, if applicable):

DEPARTMENT TOTAL: $0.00

a. THAT PERFORMANCE PERIOD (DATES, STARTING AND ENDING TIMES) INDICATED ABOVE ARE CORRECT.

e. THAT NO TOBACCO PRODUCTS ARE INCLUDED IN THE INVENTORY VALUES SHOWN ABOVE.

ENDING TIME EXCEEDED DUE TO: (enter 'not applicable' if inventory was completed prior to required end time.)

CONTRACTOR'S REPRESENTATIVE: DATE: DeCA STORE DIRECTOR:

Printed/typed Name: Printed/typed Name:

d. THAT SECTIONS THAT THE GOVERNMENT HAD SELECTED FOR VALIDATION WERE NOT REVEALED TO THE CONTRACTOR UNTIL AFTER THE CONTRACTOR

HAD COMPLETED THE INITIAL COUNT OF A VALIDATION SECTION.

REMARKS

DATE:

Signature: Signature:

including supervisory hours that the Contractor used to conduct inventory

WE, THE UNDERSIGNED, CERTIFY THE FOLLOWING:

b. THAT, EXCEPT AS PROVIDED IN 3. FOR "DAMAGED AND MISPLACED ITEMS," THE CONTRACTOR HAS DETERMINED THE SECTION VALUES SHOWN ON THE INVENTORY CONTROL LOG AND THE TOTALS RECORDED ABOVE, INDEPENDENT OF GOVERNMENT INTERVENTION OR INPUT.

c. THAT ALL SECTION VALUES SHOWN ON THE INVENTORY CONTROL LOG AND THE VALUES RECORDED ON THIS CERTIFICATION ARE CORRECT TO THE BEST

OF OUR KNOWLEDGE.

# OF CONTRACTOR WORK HOURS TOTAL DOLLAR AMOUNT :

DOLLAR VALUE INVENTORY CERTIFICATION

IAW THE PWS, A DOLLAR VALUE INVENTORY WAS CONDUCTED AT (Enter Name of Store)

GOVERNMENT "WALK-THROUGH" WITH CONTRACTOR

0-Jan-00

FIRST DAY:

SECOND DAY

(if applicable)