Att. (7) - Work Request Form (2025.02.03).docx

N0001920R0013 Attachment 5 N0001925R0003

WORK REQUEST FORM

Work Request Number: Date: j

1. REQUEST:

The undersigned Contractor requests authorization to proceed with a proposal for a new requirement anticipated to result in a new task order issued against Indefinite-Delivery/Indefinite-Quantity Contract N0001925R0003 , utilizing CLIN(s) and performed in accordance with Reference (a) and consistent with the information set forth herein.

2. BACKGROUND:

On j, during action being performed at the time , who discovered deficiency discovered deficiency / problem as a result of cause / source of deficiency .

3. CORRECTIVE ACTION REQUIRED:

Description of work, material, and travel required; needed repairs or replacements

PURPOSE/EXPECTED RESULT:

This requirement is necessary in order to desired result / what the work will accomplish / why is it necesary

4. ESTIMATED TOTAL PRICE: .

5. PERFORMANCE SCHEDULE & LOCATION:

Requested Award Date: j Estimated Turn-Around-Time: .

Proposed Period of Performance: j through j The subject requirement is to be performed on aircraft BUNO # , located at Squadron # in City, State .

SUBMITTED BY:

----------------------------- Submit to: Government C-40 Deputy IPTL & Copy Contracts Representative -----------------------------

GOVERNMENT AUTHORIZATION

PROPOSAL SUBMISSION DATE:

The proposal for the subject request shall be submitted by: j

REVIEW: (Government Technical Point of Contact/Contracting Officer’s Representative) TPOC/COR Recommendation: ☐ Approve ☐ Disapprove Comments:

-------------------------------------------------------------- Forward to: Program Management --------------------------------------------------------------

VERIFIFICATION: (Integrated Project Team Lead/Program Management Representative) Program Management Decision: ☐ Approve ☐ Disapprove Comments:

------------------------------------------------------------------------ Forward to: Contracts -----------------------------------------------------------------------

AUTHORIZATION: (Procuring Contracting Officer) PCO Determination: ☐ Authorized ☐ Rejected for the following Reason(s):

Comments:

The following applies to requests approved by the PCO:

** Government approval of this Work Request shall operate in lieu of a formal Request for Proposal (RFP).

This approval shall not be interpreted as a contract or commitment on the part of the Government and the Government is not responsible for any costs associated with the preparation or submission of the proposal.

The Government has reviewed the subject request and verified that the identified work is within scope, is required, and is not covered under existing line items. The Government concurs that, if the assertions contained in the request are fully supported in the proposal, the corrective action set forth is both appropriate and necessary and anticipates funding approval for the amount specified herein.

Authorization to proceed with a proposal is granted with the understanding that the Government fully intends to issue a task order or modification consistent with the information provided herein following the receipt of a fully supported proposal, a successful negotiation of a FFP or NTE price, and subject to actual funding availability. Any work undertaken by the Contractor prior to contract execution shall be at its own risk.

A proposal providing complete pricing information shall be submitted to NAVAIR Contracts within 30 days of this approval. In the event that a FFP cannot be established, a NTE price will be set and a subsequent modification to definitize based on actuals will be issued by DCMA.

Submit to: Government Technical Point of Contact Copy: Contracts