RFP-Attachment_7-Work_Assignmt.pdf

CONTRACT WORK ASSIGNMENT (W.A.)

Contractor: ____________________________________

Contract No: ___________________________________

W.A. No: Modification No: _____

W.A. Title: _________________________________________________________________________________

W.A. Originator: _______________________________________________ Date Prepared: ________________

Contracted Work Area: _______________________________________________________________________

Part I. INITIATOR'S REQUEST

A. Period of Performance: From _______________________ to _______________________

B. Work Assignment Description:

C. Work Assignment Leader: ____________________________________________________

D. Deliverables:

E. W.A. Response Due Date: _________________________________________

Contract Work Assignment (2/2011)

Contractor: ________________________________________ Contract No: ____________________________

W.A. No: ________ Modification No: ______ Date Prepared: __________________________

Part II. CONTRACTOR'S RESPONSE TO W.A. REQUEST

(*The Contractor shall attach a detailed budget to this form to identify all proposed costs.)

A. Estimated Cost and Effort:

1. Labor hours - list W.A. leader, specific individuals to be assigned, labor category, and estimated hours for each.

B. Detailed description of the approach to be used and of the deliverable(s). (Be specific.):

APPROVAL TO PROCEED: The Contractor shall not exceed the estimated labor hours, estimated W.A. amount, or change the W.A. leader without the prior written approval of the Project Officer and the Contracting Officer.

l. For the Contractor: ______________________________ (Signature)

Typed name: ___________________________________

2. For the Government: ______________________________ Contracting Officer Technical Representative

(COTR)

(Contracting Officer)

Date: ______________

Date: ______________

Date: ______________

Contract Work Assignment

Contractor: ________________________________________ Contract No: ____________________________

W.A. No: ________ Modification No: ______ Date Prepared: __________________________

Part III. CONTRACTOR'S REPORT OF W.A. PERFORMANCE

(*The Contractor shall attach a detailed itemization of costs to this form to identify all expenditures under this W.A.)

A. Actual Cost and Effort:

1. Labor hours - list specific assigned individuals, labor category, and actual hours worked.

2. Labor costs - list labor category, individual, and total amount.

3. Employee benefits

4. Direct Materials

5. Travel

6. Subcontracts

7. Other direct costs

8. Indirect costs

9. Total costs for this W.A: _________________________

B. Report of Progress and/or Deliverables:

REVIEW AND APPROVAL OF SATISFACTORY PERFORMANCE

The signatures below indicate that the services/products required under Work Assignment No. have been delivered, received and satisfactorily meet the requirements of this Work Assignment.

l. For the Contractor: ______________________________ Date: ______________ (Signature)

Typed name: ___________________________________

2. For the Government: ______________________________ Date: ______________ Contracting Officer Technical Representative

(COTR)

Date: ______________ (Contracting Officer)

Contract Work Assignment