Att 3_OAWR Form.docx

OVER AND ABOVE WORK REQUEST FORM

Sequential Task Number ________ Date ________

To: Procuring Contracting Officer Via: TPOC

Subj: REQUEST FOR AUTHORIZATION TO PROCEED WITH AN OVER AND ABOVE WORK

REQUIREMENT

Ref: (a) _________________________________________(Device/Site)

1. The undersigned Contractor requests authorization to proceed with an over and above work requirement under Item __________ of Contract N61340-____________ , Delivery Order ________ in accordance with the Over and Above Work Requirement Request clause of the contract schedule as described below:

NEEDED REPAIRS:________________________________________________

CORRECTIVE ACTION REQUIRED:__________________________________

ESTIMATED MAN-HOURS:_________________________________________

ESTIMATED COST: $______________________________________________

Detailed cost breakdown: (submit on separate sheet) (include any necessary parts and materials)

SUBMITTED BY: (Contractor) REVIEWED BY: (TPOC)

(Signature/Date) (Signature/Date)

TPOC Recommend: / / Approval / / Disapproval

2. PCO: [ ] Approved [ ] Disapproved for the following reason(s)______________________________

CONTRACTING OFFICER DATE

NSST ID/IQ

Attachment (3)