E1_Attachment 4 - RGS.pdf

Marine Force Storage Command Consolidated Storage Program

Request for Reimbursable Goods or Services Section I

Requeste Contract

SDN:

CLIN:

Request N

Date of Request:

Direct Cost:

Sales Tax:

Freight:

Total Amount Requested:

Approval of Request

Contracting Officer Representative (COR)

ContractGovernment Representative Date

Approved Amount:

(shall not be exceeded without written approval from the Contracting Officer (KO)

Goods to be ordered or services to be completed no later than

MCLC Contracting Officer (KO)

MDMC

REVISED 04 August 2023

Date

Goods Services T avel

Date r d by:

Number:

umber:

or Program Manager (PM) Date

G8 Date

ATTACHMENT (4)

Purpose and Use

Purpose: The Request for Reimbursable Goods and Services (RGS) form is used to request and approve contract Mission Support Expenditures such as to support deployments, contingency operations, hostilities, war, national emergencies, critical mission systems and other unusual, critical operations and support potential outside factors that could affect MDMC’s mission. MS tasks shall include, but are not limited to surge, overtime, quality control, audits, MDMC IT system software, building moves, issues applicable to safety and security, after hour operations, and other tasks identified in this PWS. Contractor shall ensure operations are not degraded during increased operational periods such as surge.

Below are instructions, beginning TOP RIGHT, for formatting and filling out the RGS.

TOP RIGHT

Select “Goods”, “Services”, or both.

Section I

Top Left Date of Request: MM/DD/YYYY Direct Cost: $0,000.00 subtotal of all requested goods and services Sales Tax: 00% if applicable, taxes charged by the vendor Freight: $0,000.00 if applicable, shipping costs charged by the vendor Total Amount Requested: $00,000.00 Total requested reimbursable amount after all add on charges

Top Right Requested by: Initiating Government Employee Contract Number: Contract Number

SDN: SDN

CLIN: CLIN

Request Number: Generated by G8 Albany Financial Management Specialist, Tech Services Operations, or Operations Contract Project Manager

Nomenclature- Description of goods or services required Qty-Quantity Price- Unit Price Total Price- Total cost for the requested goods or services in that Remarks- Optional remarks regarding request

Government Representative - Digital signature required/date Contractor Program Manager (PM) - Digital signature required/date

Approval of Request

Approved Amount - will be populated by the G8 Branch Head

Goods to be ordered or services to be completed no later than - will be completed by G8 Branch Head

Contracting Officer Representative (COR) - Digital signature required/date

G8 Branch Head - Digital signature/date

MCLC Contracting Officer (KO) - Digital signature/date

Instructions for digitally signing this document:

1. Click the signature box that you want to digitally sign in

2. Select the appropriate certificate

3. Click Continue

4. Click Sign

5. A save menu will pop-up, name the file appropriately

6. Click Save

Request for Reimbursable Goods or Services