Att 1(g) - Contract Discrepancy Report.doc

CONTRACT DISCREPANCY REPORT

1. CONTRACT NUMBER

GOVERNMENT ACTION

2. TO (Contractor and Manager Name)

3. FROM (Name of Government Representative)

4. DISCREPANCY OR PROBLEM (Describe in Detail, include reference in specification. Attach continuation sheet if necessary.)

5. CONTRACTOR NOTIFIED (Date, Time, Contact point)

6. SIGNATURE OF CONTRACTING OFFICER

7. DATE

CONTRACTING ACTION

8. TO: (Contracting Officer)

9. FROM: (Contractor)

10. Contractor response as to cause, corrective action and actions to prevent recurrence (Attach continuation sheet if necessary).

11. SIGNATURE OF CONTRACTOR REPRESENTATIVE

12. DATE

GOVERNMENT CLOSE OUT

13. GOVERNMENT EVALUATION (Acceptance, partial acceptance, rejection. Attach continuation sheet if necessary.)

14. GOVERNMENT ACTIONS (Payment deduction, cure notice, show cause, other.)

15. SIGNATURE OF CONTRACTING OFFICER

16. DATE

17. SIGNATURE OF REVIEWING OFFICIAL (As Applicable)

18. DATE