J-7_Work_item_042-11-001_Attachment_A.pdf

ATTACHMENT “A” (042-11-001)

Work Item Reservation Task Request/Control Form

Request No.:

Enter Request

No.

Ship/Craft (Name/Hull Number):

USS

SSP No.:

Enter SSP No.

Item No.:

Enter Item No.

Written By: Enter Your Name Date: Enter Date.

Task Performance Period: Enter Start Date through Enter End Date

Statement Of Work/Requirements

Title: Enter Title of Work

1. Location of Work :

1.1. None.

2. References:

2.1. Standard Items

3. Requirements:

3.1.

4. Notes:

4.1. None.

5. GFM:

5.1. None.

Cost for Statement of Work/Requirements:

Contractor Estimate Labor (M/H’s) Material ($’s)

Government Agreed Cost Labor (M/H’s) Material ($’s)

Approval to Start Signatures:

SERMC PM:

Date: __________

Contractor PM:

SERMC

ACO:____________________________________________

Date: __________

Date: __________

Final Acceptance/Completion of Work Signatures:

Ship’s Force: ___________________________________________ Date: __________

Contractor’s Rep: _______________________________________ Date: __________

SERMC SBS: __________________________________________ Date: __________