Attachment 10 - Proposal Cover Sheet.doc
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- Solicitation number
- HSCG32-12-R-R00003
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Attachment 10 - Proposal Cover Sheet
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PROPOSAL COVER SHEET
1. SOLICITATION/CONTRACT/MODIFICATION NUMBER
| 2a. NAME OF OFFEROR |
| 3a. NAME OF OFFEROR’S POINT OF CONTACT (POC): |
| 2b. FIRST LINE ADDRESS |
| 3b. TITLE OF OFFEROR’S POC |
| 2c. STREET ADDRESS |
| 3c. EMAIL ADDRESS OF OFFEROR’S POC |
| 3d. TELEPHONE |
| 3e. FACSIMILE |
| 2d. CITY |
| 2e. STATE |
| 2f. ZIP CODE + FOUR |
| AREA CODE |
| NUMBER |
| AREA CODE |
| NUMBER |
| 4. TYPE OF CONTRACT OR SUBCONTRACT (Check) |
| 5. FORMCHECKBOX |
PRIME OFFEROR
FORMCHECKBOX
FFP
FORMCHECKBOX
FPI
FORMCHECKBOX
CPFF
FORMCHECKBOX
CPIF
FORMCHECKBOX
OTHER (Specify)
FORMCHECKBOX
CPAF
FORMCHECKBOX
SUBCONTRACTOR ___________________________________________
PRIME OFFEROR’S NAME
6. ESTIMATED COST, FEE AND PROFIT INFORMATION
| A. ESTIMATED COST |
| $ |
| B. FIXED FEE |
| $ |
| C. TOTAL COST PLUS FIXED FEE (or) |
| $ |
| D. PROFIT |
| % |
| E. TOTAL PRICE |
| $ |
7. PROVIDE THE FOLLOWING
NAME OF COGNIZANT CONTRACT ADMINISTRATIVE AGENCY:
POINT OF CONTACT:
NAME OF COGNIZANT GOVERNMENT AUDIT AGENCY:
POINT OF CONTACT:
| STREET ADDRESS |
| STREET ADDRESS |
| CITY |
| STATE |
| ZIP CODE + 4 |
| CITY |
| STATE |
| ZIP CODE + 4 |
| TELEPHONE |
| AREA CODE |
| NUMBER |
| TELEPHONE |
| AREA CODE |
| NUMBER |
| FACSIMILE |
| AREA CODE |
| NUMBER |
| FACSIMILE |
| AREA CODE |
| NUMBER |
| PROPERTY SYSTEM |
| FORMCHECKBOX |
Reviewed by cognizant contract administrative agency and determined acceptable
APPROX DATE OF LAST AUDIT
FORMCHECKBOX
Reviewed by cognizant contract administrative agency and determined not acceptable
| PURPOSE OF AUDIT |
| (e.g. proposal review, establishment of billing rates, finalize indirect rates, etc.) |
FORMCHECKBOX
Never reviewed
| COPY OF CURRENT DCAA AUDIT REPORT AND/OR REQUEST TO DCAA FOR APPROVAL OF FORWARD PRICING RATES INCLUDED AS PART OF THE COST PROPOSAL |
| FORMCHECKBOX |
Yes
FORMCHECKBOX
No (explain)
PURCHASING
SYSTEM
FORMCHECKBOX
Reviewed by cognizant contract administrative agency and determined acceptable;
FORMCHECKBOX
Reviewed by cognizant contract; administrative agency and determined not acceptable
FORMCHECKBOX
Never reviewed
| ACCOUNTING SYSTEM |
| FORMCHECKBOX |
Audited and determined acceptable;
FORMCHECKBOX
Audited and determined not acceptable;
FORMCHECKBOX
Never audited
OFFEROR’S FISCAL YEAR
OFFEROR’S DUNS NO:
OFFEROR’S TIN:
8a. NAME OF PERSON WHO SIGNED CONTRACT: (Typed)
TITLE OF PERSON WHO SIGNED CONTRACT: (Typed)
| 8b. SIGNATURE |
| 9. DATE OF SUBMISSION |
Attachment #10
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