Attachment 3_ Data Item Transmittal Form.doc

Solicitation: N68520-21-R-0004 Attachment: 3/

Contract: TBD at Award

DATA ITEM TRANSMITTAL/ACCEPTANCE/REJECTION FORM

Contract TBD

CLIN/ELIN: / TITLE:

Block 14 Distribution:

Other:

Doc. Ref. No.: Date:

From:

To:

ATTN:

The above detailed CDRL item is forwarded for review and acceptance/ rejection. This item is due . The Government review period is days.

Sincerely, Signature: _____________________________________ Typed Name/Title: ______________________________

FIRST ENDORSEMENT: Date Received:

( ) Accepted.

( ) Accepted. Attached comments must be incorporated into the next scheduled submission.

(This block is for use with periodically submitted items only.)

( ) Rejected, comments attached. Change pages ( ) are ( ) not sufficient for correction.

Contractor is allowed ( ) 30 days or ( ) days to resubmit.

Signature:___________________________________________ Typed Name/Title:____________________________________

Code: Date:_______________

VIA: Date:

VIA: PD Date:

SECOND ENDORSEMENT:

( ) Accepted.

( ) Accepted conditionally. Attached comments must be incorporated in the next scheduled submission.

( ) Rejected, comments attached. Resubmit no later than .

Signature:___________________________________________ Typed Name/Title:____________________________________

Code: Date:_______________

CC w/Encl.:

CC w/o Encl.:

Source Selection Information For Official Use Only

See FAR 3.104 and 2.101