Attachment 9 - Proposal Cover Sheet.doc

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Systems Engineering and Technical Assistance (SETA)
Solicitation number
HSCG32-12-R-R00004
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Attachment 9 - Proposal Cover Sheet

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Text version

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 #9

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