N3904026Q5120 Attachment 2 Work Request Form.pdf
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- Solicitation number
- N3904026Q5120
About this file
This document is a Work Request Unscheduled Repair Authorization Request form used to document and approve unplanned repair work. The form requires detailed documentation of repair needs, including sections for Original Equipment Manufacturer (OEM) and Non-OEM parts/materials, with specific requirements for cost justification and supporting documentation. The form mandates contractors provide proof of cost, compare OEM and non-OEM pricing, and detail non-OEM specifications for verification.
The form includes multiple approval sections requiring signatures from the Contractor, Project Manager (PM), Contracting Officer's Representative (COR), and Contracting Officer (KO). It captures labor hours, agreed-upon labor rates, material costs, and markup rates. Critically, work cannot commence until all required parties approve the request and sign the document, ensuring transparency, cost control, and alignment with contractual terms. The form emphasizes that all costs, labor rates, and markup rates must match pre-approved contract rates and be separately itemized on invoices.
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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 aƯected 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) o 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 OƯicer’s Representative (COR) and Contracting OƯicer (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 eƯort (number of hours) is commensurate with the work being performed.
2. Project Manager (PM): __________________________ Date: __________________________
Title: __________________________
COR approves Section 1A or 1B, 2, and 3: SuƯicient 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 suƯicient funds are available to cover the labor cost.
3. Contracting OƯicer Representative_________________________ Date:_______________________
4. Contracting OƯicer: __________________________ Date: __________________________
Additional Notes or Special Conditions:
Use this space or see attachment for any special instructions.
File details come from the government source that posted it. Updated .