Exhibit 3 - FTC-ADM-61 Service CWR.pdf
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- Solicitation number
- HSFLGL-09-R-00004
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EXHIBIT 3
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FTC-ADM-61 (3/90) CONTRACT NO. ______________________________
REQUEST NO.: _________ _________ __________
FY CAT.# SER.#
SERVICE CONTRACT WORK REQUEST
CHECK APPROPRIATE CATEGORY
CATEGORY I CATEGORY III
CATEGORY II CATEGORY IV RETURN BY
ITEM
NO.
DESCRIPTION OF SERVICE
a.
UNIT
b.
UNIT COST
c.
TOTAL COST
JUSTIFICATION
GRAND TOTAL
ORIGINATOR NAME (Type/Print) APPROVAL (Initials)
ORIGINAL – Contracting Officer ___________________________________________________________ Copy 1 – Originator ORIGINATOR SIGNATURE DATE Copy 2 – COTR Copy 3 – Contract Administrator
SECTION J - EXHIBIT 3
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