N3904026Q0004 Attachment 2 - Work Request Form.docx
DOCX document 23 KB Posted
- Attached to
- PNSY Diesel Generator Maintenance
- Solicitation number
- N3904026Q0004
About this file
This is a Work Request Form template for unscheduled repair authorization under the PNSY Diesel Generator Maintenance contract (N3904026Q0004). The form establishes the procedural framework and documentation requirements for contractors to request approval before commencing repair or service work on diesel generator equipment at Portsmouth Naval Shipyard.
The form requires contractors to provide detailed scope descriptions and itemized costs organized into four primary sections: OEM parts and materials with fair and reasonable price justification; non-OEM parts and materials with cost comparisons to OEM equivalents and detailed specifications; contractor-approved material markups that must align with pre-approved contract rates; and labor costs by category with agreed-upon hourly rates. All costs must be separated on the contractor's invoice with supporting documentation, including catalog prices, commercial invoices, or online listings for material costs. The approval chain requires sign-off from the Project Manager (PM), Contracting Officer's Representative (COR), and Contracting Officer (KO) before work authorization. The PM must verify that parts are genuine and manufacturer-approved (unless expressly waived), that labor hours are commensurate with work scope, and that markup rates match contract terms. The COR and KO must confirm sufficient available funds and rate compliance. This template is a blank form used for processing individual work requests throughout contract performance rather than a substantive statement of work.
View the file
Other files
Show all 14
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
WORK REQUEST UNSCHEDULED REPAIR AUTHORIZATION REQUEST -
Date of Request:
Work Request Number: (e.g. 1, 2) Project Name/Number: Contract Number:
1. __________________________________ ____________________ Contractor Signature Date:
SECTION 1: SCOPE OF WORK & REPAIR DESCRIPTION
1.1 Provide a concise description of the repair or service needed, referencing the affected equipment, issue(s) observed, and any relevant background details:
SECTION 1A: OEM Parts/Materials – Complete as applicable or see attached estimate
| Item (Part/material) Description |
| QTY |
| Cost to Contractor |
| Discounts Passed to Government |
| Total Cost to Government |
· Supporting Documentation: Contractor must provide “proof of cost” Fair and Reasonable Price Justification (e.g., catalog prices, commercial invoices, online listings)
· Parts must be genuine, manufacturer-approved unless expressly waived (fill out section 1B) Section 1B: Non-OEM Parts/Materials – Complete as applicable or see attached estimate
| Item (Part/material) Description |
| QTY |
| Cost to Contractor (Non-OEM) |
| Cost of OEM Equivalent |
| Non-OEM Specifications |
| Total Cost to Government |
· Additional Requirements for Non-OEM:
1. Contractor must provide cost comparison (OEM vs. Non-OEM) for fair and reasonable determination.
2. Contractor must provide detailed Non-OEM specifications for PM to verify suitability.
SECTION 2: CONTRACTOR APPROVED MARKUP ON MATERIALS
| Total Cost of Parts/Materials (OEM + Non-OEM) |
| Pre-Approved Markup Rate (%) |
| Markup Amount ($) |
| Total Cost with Markup |
· Notes: Cost of parts and markup must match contract approved rates and be separated on the contractor’s invoice.
SECTION 3: LABOR
| Description of Work |
| Estimated Hours |
| Agreed-Upon Labor Rate ($/hr) for each labor category |
| Total Unburdened Labor Cost ($) |
SECTION 4: APPROVAL AND AUTHORIZATION
Statement: Work may commence only upon approval of this Work Request by the Project Manager (PM), Contracting Officer’s Representative (COR) and Contracting Officer (KO).
Contractor will Separate costs on invoice, all labor and markup rates match approved rates, and support material costs with approved supporting documentation. No work will commence until PM/KO signs below and returns to Contractor.
PM approves Section 1A or 1B: Part/Material OEM or waived for Non-OEM are needed for the work being performed.
PM approves Section 3: The level of effort (number of hours) is commensurate with the work being performed.
1. _______________________________ ____________________ Project Manager (PM): Date:
Title: __________________________
COR approves Section 1A or 1B, 2, and 3: Sufficient funds are available to cover the Part/Materials, markup, and the markup rate matches the agreed-upon rate in the contract. Labor rate matches the contract, and sufficient funds are available to cover the labor cost.
2. __________________________________ ____________________ Contracting Officer Representative Date:
3. __________________________________ ____________________ Contracting Officer Date:
Additional Notes or Special Conditions:
Use this space or see the attachment for any special instructions.
File details come from the government source that posted it. Updated .