Attachment IV - DR.doc

HSCG40-12-R-20001

Attachment IV

GOVERNMENT FURNISHED PROPERTY

DISCREPANCY REPORT

Should any items provided as government furnished property under this contract/order fail to conform to the requirements of the contract/order, the contractor shall complete this form and return it to the Contracting Officer/Contract Administrator within 10 calendar days after receipt of the government furnished property.

The Contractor shall complete and submit this form if the government-furnished material is not received at the contractor’s facility within 14 calendar days after receipt of order. This form shall be faxed to the Contracting Officer/Contract Administrator at (410) 762-6270 or submitted electronically to Ashley.A.Fetherman@uscg.mil.

Upon receipt of this discrepancy report, the Contracting Officer/Contract Administrator shall provide disposition instructions to the Contractor no later than 10 calendar days after receipt.

1. DATE OF PREPARATION:

2. CONTRACT/PURCHASE ORDER NUMBER:

3. TO (Name and address of Contracting Agency)

4. FROM (Name, address, and telephone number)

5. GOVERNMENT-FURNISHED MATERIAL TO BE RECEIVED (Provide the item name, stock number, part number, serial number, quantity, etc., that should have been received under the contract/purchase order) (Continue on separate piece of paper if necessary)

ITEM NAME

6. ACTUAL MATERIAL RECEIVED (Provide the item name, stock number, part number, serial number, quantity, etc., that was actually received) (Continue on separate piece of paper if necessary)

ITEM NAME

Describe deficiencies of material identified above.

7. TYPED OR PRINTED NAME OF SUBMITTER

NOTE: Contractor shall provide copies of any and all documentation that accompanied the shipment or is packaged inside the container.