Attach_1_Appendix_D_Over_and_Above_Work_Request_Form_(2015-05-05).docx

DOCX document 27 KB Posted Jun 10, 2015

Attached to: Revised Proposal Due Date Federal contract opportunity
Solicitation number: N00019-15-R-0106
Issued by: Department of the Navy Naval Air Systems Command

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Attachment 1 - Appendix D

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N00019-15-R-0106 Appendix D 05 May 2015

OVER AND ABOVE WORK REQUEST FORM

To:	Procuring Contracting Officer
Via:	COR

Subj: Request for Authorization to Proceed with an Over and Above Work Requirement

Ref: (a) _________________________________________(Device/Site)

1. The undersigned Contractor requests authorization to proceed with an over and above work requirement under Item __________ of Contract _________________, Task Order ________ in accordance with the Over and Above Work clause of the contract as described below:

Needed Repairs:

_______________________________________________________________________________

Corrective Action Required:

_______________________________________________________________________________

Estimated Man-Hours: __________________________________________________________

Estimated Cost: $_________________________________________________________

Estimated Duration: __________________________________________________________

Detailed cost breakdown:

· submit on separate sheet

· include necessary parts and materials

SUBMITTED BY: (Contractor) REVIEWED BY: (COR)

________________________________________	________________________________________
Signature/Date		Signature/Date

			COR Recommend:	[ ] Approval
					[ ] Disapproval
2.	PCO:	[ ] Approved
	[ ] Disapproved for the following reason(s)
	______________________________________________________________________

		________________________________________
CONTRACTING OFFICER	DATE

File details come from the government source that posted it. Updated Nov 14, 2017.