Discrepancy_Report.doc

HSCG84-18-Q-4SG001

Technical Exhibit #3

U. S. COAST GUARD SECTOR GUAM

CONTRACT DISCREPANCY REPORT (CDR)

1. Contract No. _________________ DO # ___ 2. FY _______ 3. Report # ________

4. TO: (Contractor/ QCI) ________________________________________________

5. FROM: (COR/QAE) ___________________________________________________

6. DATES:

Prepared | Oral Notification | Returned by Contractor | Action Complete |

7. Discrepancy or Problem (Describe in detail; include references to PWS paragraph or other contract clause or provision; attach continuation sheet if necessary; COTR shall cite applicable QC program procedure(s))

Signature: __________________________________________

Signature of COR or Authorized Representative

8. TO:

Contracting Officer ___________________________________________

9. FROM:

Contractor ___________________________________________________

10. Contractor’s response as to cause, corrective action and actions to prevent reoccurrence; attach continuation sheet if necessary;

11. Signature of Contractor’s Representative:

___________________________________________ Date ____________

12. Government Evaluation: acceptance, partial acceptance; rejection’ attached continuation sheet if necessary

13. Government Action: payment deductions; performance evaluation meetings; other actions)

14. Closeout Actions: (contractor notified; by whom/ date; follow-up action pending).