Attachment_4_Contract_Discrepancy_Report_03-09-2017.pdf

Attachment #4

ICE RFP # HSCEDM-17-R-00005 125

Attachment #4

CONTRACT DISCREPANCY REPORT

1. CONTRACT NUMBER

Report Number: Date:

2. TO: (Contractor and Manager Name) 3. FROM: (Name of COTR)

DATES

CONTRACTOR NOTIFICATION CONTRACTOR RESPONSE DUE

BY

RETURNED BY CONTRACTOR ACTION COMPLETE

4. DISCREPANCY OR PROBLEM (Describe in Detail: Include reference in PWS / Directive: Attach continuation sheet if necessary.)

5. SIGNATURE OF CONTRACTING OFFICER’S TECHNICAL REPRESENTATIVE (COTR)

6. TO: (COTR)

7. FROM: (Contractor)

8. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. ATTACH

CONTINUATION SHEET IF NECESSARY. (Cite applicable Q.A. program procedures or new A.W. procedures.)

9. SIGNATURE OF CONTRACTOR REPRESENTATIVE 10. DATE

11. GOVERNMENT EVALUATION OF CONTRACTOR RESPONSE/RESOLUTION PLAN: (Acceptable response/plan, partial acceptance of response/plan, rejection: attach continuation sheet if necessary)

12. GOVERNMENT ACTIONS (Payment withholding, cure notice, show cause, other.)

CLOSE OUT

NAME AND TITLE SIGNATURE DATE

CONTRACTOR

NOTIFIED

COTR

CONTRACTING

OFFICER

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