Attachment J-3 Monthly Financial Report.pdf

SEDI FFRDC Attachment J-3 HSHQDC-08-R-00157

MONTHLY CONTRACTOR FINANCIAL MANAGEMENT REPORT 1. Report for Month Ending/No. of Working Days:

2. Contractor: 3. Contract Value:

a. Cost: $

b. Fee: $

4. Contract Type: 5. Contract No. and Latest Definitized Modification No.: 6. Fund Limitation:

7. Scope of Work: 8. Authorized Contractor Representative (signature and date) 9. Billing:

a. Invoice Amts Billed: $

b. Total Payments Received: $

11. Cost Incurred/Hours Worked 12. Estimated Cost/Hours To Complete

13. Estimated Final Cost/Hours

During Month Cum. To Date

10. Reporting Category

Actual a.

Planned b.

Actual c.

Planned d.

Planned a.

Balance of Contract b.

Contractor Estimate a.

Contract Value b.

Baseline Plan Identification (Col. 11b & 11d): Revision No.: ____________________ Dated: ________________

INSTRUCTIONS FOR COMPETION OF MONTHLY CONTRACTOR FINANCIAL

MANAGEMENT REPORT

1. Report for Month Ending and Number of Working Days: enter the ending date of the contractor’s accounting month and the number of working days for that accounting month.

2. Contractor: Enter the full name and address of the contractor, and, if applicable, the division performing the contract.

3. Contract Value: Enter the total definitized cost (a) and fee (b) of all currently authorized work to be performed under the contract. Include dollar amounts through the latest definitized modification a noted in item #5.

4. Contract Type: Cost plus fixed fee, cost reimbursement/cost share, etc.

5. Contract No. and Latest Definitized Modification No.: Enter complete letter or contract symbol, number, and number of latest definitized modification.

6. Fund Limitation: Enter the total funds obligated and latest corresponding contract modification number.

7. Scope of Work: Enter a brief description of the contract effort.

8. Authorized Contractor Representative (signature and date): The authorized contractor representative shall sign and date the summary page to reflect approval.

9. Billing:

a. Invoice Amounts Billed: Enter the total amount of invoices billed against the contract and latest invoice number.

b. Total Payments Received: Enter the total amount of payments received for the contract.

10. Reporting Category: enter the captions of the reporting categories specified in the contract.

11. Cost Incurred/Hours Worked: Cost and hour data will be reported in the categories specified in the contract.

a. Actual During Month: Enter the total actual cost incurred/hours worked for the accounting month being reported (item #1).

b. Planned: Enter the Contractor’s planned cost/hours.

c. Actual Cum to Date: Enter the cumulative actual cost incurred/hours worked.

d. Planned: Enter the Contractor’s planned cost/hours.

12. Estimated Cost/Hours to Complete: Enter the current estimates for performing authorized work included in the most recently executed contract modification, plus additional authorized work (directions to proceed) for which execution of modifications is pending. The estimates will be for planning purposed only and will not be binding on either the contractor or DHS.

13. Estimated Final Cost/Hours:

a. Contractor Estimate: Enter the total estimated cost/hours for completion of the contracted effort (this should equal the sum of columns 11c, 12a, and 12b).

b. Contract Value: Enter the distribution of contract value to the reporting categories. The total of this column shall agree with item #3. Significant differences between columns 13a and 13b shall be explained in the “Contractor Narrative Remarks.”