17-R-RT01_Attachment_L-4.pdf

SOLICITATION NUMBER: N00173-17-R-RT01

ATTACHMENT L-4

A. WILL THIS CONTRACT ACTION BE SUBJECT TO CASB REGULATIONS? ('If "No," explain in proposal)

10. WILL YOU REQUIRE THE USE OF ANY GOVERNMENT PROPERTY IN THE PERFORMANCE OF THIS WORK? (If "Yes," identify)

B. HAS THE CONTRACTOR SUBMITTED A CASB DISCLOSURE STATEMENT (CASB DS-1 0R

2)? ('If "Yes,'" specify in proposal the office to which submitted and if determined to be adequate)

13. IS THIS PROPOSAL CONSISTENT WITH ESTABLISHED ESTIMATING AND

ACCOUNTING PRACTICES AND PROCEDURES AND FAR PART 31 COST PRINCIPLES? (If

PART 1 (To Be Completed by Contractor)

1. Contractor Name:

7. Subcontractor To: (if applicable)

5. Total Dollar Amount:

3. Contractor CAGE Code:

1A. Contractor POC Name/Phone:

9. PROVIDE NAME, ADDRESS, TELEPHONE NUMBER AND E-MAIL ADDRESS FOR THE FOLLOWING (if available)

A. CONTRACT ADMINISTRATION OFFICE

D. IS ANY ASPECT OF THIS PROPOSAL INCONSISTENT WITH DISCLOSED PRACTICES OR

APPLICABLE COST ACCOUNTING STANDARDS? ('If "Yes," explain in proposal)

11A. DO YOU REQUIRE GOVERNMENT CONTRACT

FINANCING TO PERFORM THIS PROPOSED

CONTRACT?(FFP ONLY) (If "Yes," complete Item 11B)

11B. TYPE OF FINANCING (X ONE)

8. Period of Performance:

2. Contractor's Address:

4. RFP No. and/or Contractor's Prop. No.:

B. AUDIT OFFICE

6. Type of Proposal:

(FFP/CPFF/CPAF/CPIF/Other: *Note: Primes may not propose T&M, subcontractors without approved accounting system may propose T&M

12. HAS THE CONTRACTOR BEEN AWARDED ANY CONTRACTS OR SUBCONTRACTS FOR THE SAME OR SIMILAR ITEMS

WITHIN THE PAST 3 YEARS? (If "Yes," identify item(s), customer(s), and contract number(s))

14. COST ACCOUNTING STANDARDS BOARD (CASB) DATA (Public Law 91-379 as amended and FAR PART 30)

C. HAVE YOU BEEN NOTIFIED THAT YOU ARE OR MAY BE IN NONCOMPLIANCE WITH YOUR DISCLOSURE STATEMENT

OR COST ACCOUNTING SYSTEM? ('If "Yes," explain in proposal)

DCAA Rate Check Template

Yes No ADVANCE PAYMENTS

GUARANTEED LOANS

Yes No Yes No

PROGRESS PAYMENTS

Yes No

Yes No Yes No

D. IS ANY ASPECT OF THIS PROPOSAL INCONSISTENT WITH DISCLOSED PRACTICES OR

APPLICABLE COST ACCOUNTING STANDARDS? ('If "Yes," explain in proposal)

C. HAVE YOU BEEN NOTIFIED THAT YOU ARE OR MAY BE IN NONCOMPLIANCE WITH YOUR DISCLOSURE STATEMENT

OR COST ACCOUNTING SYSTEM? ('If "Yes," explain in proposal) Yes Yes NoNo

Proposed: DCAA Rates* Proposed: DCAA Rates* Proposed: DCAA Rates Proposed: DCAA Rates Proposed: DCAA Rates

16. ADDITIONAL INFORMATION (Contract specialist list information requested to be addressed by DCAA):

1). If no audit has been performed within the last 12 months, please provide a copy of the contractor's most recent payroll run and a copy of the last audit report, if available.

*Basis of DCAA Recommendation

3). Additional info requested (uncompensated overtime, weighted averages, etc)

Year 1 Year 2

Contract Specialist:

Contractor Site OH:

Government Site OH:

Fringe:

G&A:

15A. Direct Labor Categories or Employee Name if Actuals Proposed

15B. Indirect Rates

*Include basis of recommendation/date

Escalation:

Year 3 Year 4

2). Please indicate if contractor has an approved accounting system in order to award a cost type contract. Include Audit Report Number and Date of when the accounting system was approved

Cost of Money:

DCAA Recommended Rates

Year 5

*Based on Floor Check/Audit Performed, etc and Date

15. INFORMATION REQUESTED:

Base Year Proposed Rates

PART 2 Contractors complete 15A and 15B "Proposed" categories and rates. DCAA please complete recommendations/basis for recommendation columns and address additional request for information

Phone Number:

E-Mail Address:

17. Requesting Office Information (to be completed by Contract Specialist)

Contracting Officer

Phone Number:

E-Mail Address: