Appendix_H__-_Form_Data_Elements.xlsx
XLSX spreadsheet 66 KB Posted
- Attached to
- Household Goods (HHG) Relocation Services Federal contract opportunity
- Solicitation number
- HTC711-19-R-R004
About this file
This document contains instructions and required data elements for household goods relocation services. The United States Transportation Command is seeking information through a Request for Information to identify capabilities of small businesses and contractors available to provide household goods relocation services. The RFI does not constitute a request for proposal or commitment to purchase. Responses will be used for planning purposes only. The instructions outline four tabs of required data elements for counseling services, personally procured moves, statements of accessorial services, and excess cost notifications. Elements include customer information, origin and destination details, estimated and actual weights and costs, storage dates, services performed, and excess cost basis.
Appendix H - Form Data Elements
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Instructions
| Appendix H: Contract Document(s) Required Data Elements |
| All electronic and or hard copy document(s) required for the services identified herein shall include the data elements identified in Tabs 1 - 4 as applicable. |
HTC711-19-R-R004
Tab 1-Counseling Elements
| Upon completion of Customer Counseling Services (PWS 1.2.5.2.), the contractor shall create an electronic and/or hard copy record of the customer's application for household goods relocation services inclusive of the following information as applicable: |
| Full name (Last, First, Middle Initial) |
| Counseled/Issue Date(s) |
| Total number of shipments |
| Last Four SSAN |
| DOD ID Number |
| Rank/Grade |
| Service Branch/Agency |
| Origin PPSO |
| Origin duty station |
| Destination duty station |
| Shipment Type (identify |
| Dependents (Y/N) |
| Number of Dependents |
| Weight Entitlement |
| Estimated Weight for each shipment |
| Origin <GELOC> |
| Origin/Pick-up Address |
| Authorized Origin Address |
| Secondary Origin/Pick-up Address |
| Destination PPSO |
| Destination <GELOC> |
| Destination Address |
| Authorized Destination Address |
| Customer ETA at Destination |
| Desired Survey Date |
| Desired Pack Begin |
| Requested Pickup Date |
| Requested Delivery Date |
| Pick-up Email |
| Pick-up Phone |
| Type Orders |
| Travel Authorization Number |
| Travel Authorization Date |
| Travel Authorization Issuing HQ |
| Intransit Email |
| Intransit Phone |
| NTS Release Info (if applicable) |
| NTS Expiration (if applicable) |
| Electronic Copy of Orders |
| Remarks field (included any notes provided by customer pertaining to shipment) |
| Country specific forms (customs related or any others applicable) |
| Customer signature/confirmation. Required for certification of their shipment responsibilities and storage responsibilities. |
Tab 2-PPM Elements
| For Counseling Services for Personally Procured Moves (PWS 1.2.5.2.1.), the contractor shall create an electronic and/or hard copy record of the customer's application for household goods relocation services inclusive of the following information: |
| All applicable elements identified in Tab 1 plus the following as applicable: |
| Government Constructive Cost (Maximum Entitlement) |
| 95% GCC (based on Maximum) |
| SIT obligation (Maximum) |
| Advance (Maximum) |
| Estimated Government Constructive Cost (based on customers estimated weight ) |
| 95% GCC (based on Estimate) |
| SIT obligation (Estimate) |
| Advance (Estimate) |
| Customer signature/confirmation (required for certification of understanding of their tax implications, all entitlements and advance requirements) |
| PPM Closeout Info |
| Total number of shipments |
| Actual Weight (at closeout) |
| Actual Government Constructive Cost (Shipment) |
| Actual Government Constructive Cost (Storage) |
| 95% GCC (based on Actual) |
| SIT obligation (Actual) |
| Advance (Actual) |
| Line of Accounting/SDN or SAC) |
| TAC |
| Previously submitted PPM claims |
| Member paid expenses (total) |
| GTC paid expenses |
| Member paid SIT |
| GTC paid SIT |
| Claimable expenses (breakout) i.e. Contracted expenses, rental equipment, consumable packing materials, weighing fees, Gas, Tolls, Oil, Other |
| Orders with all amendments |
| Empty Weight ticket(s) |
| Full weight ticket(s) |
| Reimbursable expense receipts |
| Vehicle registration |
| DD-FMS-2231 Direct Deposit Form (pre-populated with basic information) |
| DD1352-1 (pre-populated with basic information) |
Tab 3-Stmt of Access.Svcs
| The contractor shall create an electronic and hard copy record of shipments requiring storage in transit (SIT) and accessorial services requested, approved and performed throughout the customer's household goods relocation services inclusive of the following information: |
| Last Name |
| First Name |
| Middle Initial |
| DOD ID Number |
| Rank/Grade |
| Service Branch/Agency |
| Origin duty station |
| Destination duty station |
| Shipment Type |
| Weight Entitlement |
| Estimated Weight |
| Actual Weight |
| Date of Pickup at Origin |
| Ordering Activity/Installation Name |
| Origin <GELOC> |
| Applicable Pick-up Address |
| Destination <GELOC> |
| Applicable Destination Address |
| Type Orders |
| Travel Authorization Number |
| Travel Authorization Date |
| Travel Authorization Issuing HQ |
| Phone |
| Remarks field (Provide any details on accessorial services for this shipment.) |
| Total number of shipments |
| Crating Remarks: Contractor shall annotate the actual dimensions of the item being crated (Length, Width, Height in inches) in remarks as well as proposed crating dimensions. No rounding of cubic dimensions, size will be truncated to two decimal places (e.g., 6.8055555 cu ft will be invoiced in DPS as 6.80 cu ft). |
| Shuttle Services Remarks and Documentation: |
The request must include notes explaining the limitations preventing the linehaul equipment from accessing the origin/destination. The following additional documentation may be requested to support payment and post payment audit (GSA):
a. Signed dispatch logs indicating the driver and equipment specifics used to perform the truck to truck transfer, with dates.
b. Paid equipment rental receipts (if utilized) and/or Driver Cab Logs (whichever is applicable) indicating
(1) equipment type,
(2) duration of use,
(3) date used, and
(4) location of use.
c. Copy of the vehicle registration if a vehicle from an agent was used.
| Other Service remarks |
| Storage in transit FADD (The contractor’s period of SIT eligibility begins on the FADD, and ends by the 5th working day (excluding Saturday, Sunday and holidays) after the requested delivery date(s) from storage or the actual delivery date, whichever is earlier.) |
| Storage in transit Begin Date |
| Name and address of SIT Facility |
| Storage in transit Requested Delivery out Date |
| Customer Requested Delivery Date |
| Date Customer Provided Requested Delivery Date |
| Storage in transit end date (The contractor’s period of SIT eligibility begins on the FADD, and ends by the 5th working day (excluding Saturday, Sunday and holidays) after the requested delivery date(s) from storage or the actual delivery date, whichever is earlier.) |
| Total Days in SIT |
| Services provided at Origin/Destination/Other |
| Customer signature/confirmation (Establishing certification of that materials were furnished/accessorial services were performed at origin, destination, or both.) |
| Signature of TSP Representative |
Tab 4 -Excess Cost Written Ack
| All Excess Cost Notifications, IAW PWS 1.2.8.4. shall include the following information: |
| All applicable elements in Tab 1 and the following: |
| Detailed basis to support the Excess Cost determination (e.g. unauthorized location, multiple lots, over weight entitlement) |
| Estimated cost overage and basis for the determination. |
| Customer signature/confirmation -- Required to certify acknowledgement of their responsibility for excess costs as well as projected excess costs. |
| Provide basis for excess costs (e.g. unauthorized location, multiple lots, over weight) and estimated excess cost amount and basis for calculation |
| Remarks field |
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