PWS Att 06 (pulled 27MAY2022) - Form DD200 - FLIPL.pdf

67 KB Posted

Attached to
Consequence Management Support Center (CoMSupCen) Services
Solicitation number
W9133L-24-R-3801
Issued by

About this file

Written by GovTribe AI ·

This document is a Financial Liability Investigation of Property Loss (DD Form 200) template for reporting lost, damaged, or destroyed government property. Key details include: the form is used to document circumstances of property loss and recommend corrective actions; it requires information such as the date, inquiry number, description and value of lost item(s), and circumstances of loss; signatures are required from officials investigating the loss, their chain of command, and the individual charged or accountable officer. The template also includes spaces for continuation pages and adjustments to property records.

The related federal contract opportunity is a Request for Proposal to provide Consequence Management Support Center services to the Department of the Army National Guard Readiness Center. Services required include operating the Consequence Management Support Center to assist with emergency response planning, training, exercises, and real-world responses to incidents involving chemical, biological, radiological, nuclear, or high-yield explosive weapons. The solicitation number is W9133L-24-R-3801 and responses are due based on the dates specified in the RFP attachments.

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FINANCIAL LIABILITY INVESTIGATION OF PROPERTY LOSS

1. DATE INITIATED (YYYYMMDD)

3. DATE LOSS DISCOVERED

(YYYYMMDD)

2. INQUIRY/INVESTIGATION NUMBER

4. NATIONAL STOCK NO.

5. ITEM DESCRIPTION

6. QUANTITY

8. TOTAL COST

7. UNIT COST

9. CIRCUMSTANCES UNDER WHICH PROPERTY WAS (X one) (Attach additional pages as necessary)

10. ACTIONS TAKEN TO CORRECT CIRCUMSTANCES REPORTED IN BLOCK 9 AND PREVENT FUTURE OCCURRENCES (Attach additional pages as necessary) Lost Organization

OCIE

Installation Destroyed Damaged

11. INDIVIDUAL COMPLETING BLOCKS 1 THROUGH 10

13. APPOINTING AUTHORITY

d. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

c. LEGAL REVIEW

COMPLETED IF

REQUIRED (X one)

b. COMMENTS/RATIONALE

a. RECOMMENDATION (X one)

14. APPROVING AUTHORITY

12. (X one)

a. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

g. DATE SIGNED

e. DSN NUMBER

d. TYPED NAME (Last, First, Middle Initial)

c. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

g. SIGNATURE

g. SIGNATURE

h. DATE SIGNED

f. DSN NUMBER

e. TYPED NAME (Last, First, Middle Initial)

h. DATE SIGNED

f. DSN NUMBER

e. TYPED NAME (Last, First, Middle Initial)

d. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

b. TYPED NAME (Last, First, Middle Initial)

d. SIGNATURE

f. SIGNATURE

c. DSN NUMBER

e. DATE SIGNED

RESPONSIBLE OFFICER (PROPERTY RECORD ITEMS

REVIEWING AUTHORITY (SUPPLY SYSTEM STOCKS)

a. NEGLIGENCE OR

ABUSE EVIDENT/

SUSPECTED (X one)

b. COMMENTS/RECOMMENDATIONS

b. COMMENTS/RATIONALE

a. RECOMMENDATION (X one)

c. FINANCIAL LIABILITY

OFFICER APPOINTED

(X one)

YES

NO

YES

NO

APPROVE

DISAPPROVE

APPROVE

DISAPPROVE

DD FORM 200, JUL 2009

PREVIOUS EDITION IS OBSOLETE.

Adobe Designer 8.0

YES

N/A

NO

15. FINANCIAL LIABILITY OFFICER

a. FINDINGS AND RECOMMENDATIONS (Attach additional pages as necessary)

a. DOCUMENT NUMBER(S) USED TO ADJUST PROPERTY RECORD

a. I HAVE EXAMINED THE FINDINGS AND RECOMMENDATIONS OF THE FINANCIAL LIABILITY OFFICER AND (X one)

b. I HAVE BEEN INFORMED OF MY RIGHT TO LEGAL ADVICE. MY SIGNATURE IS NOT AN ADMISSION OF LIABILITY.

b. DOLLAR AMOUNT OF LOSS

d. RECOMMENDED FINANCIAL LIABILITY

c. MONTHLY BASIC PAY

g. DSN NUMBER

d. DSN NUMBER

e. DSN NUMBER

f. TYPED NAME (Last, First, Middle Initial)

h. DATE SUBMITTED TO APPOINTING

AUTHORITY (YYYYMMDD)

i. DATE APPOINTED

(YYYYMMDD)

e. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

d. TYPED NAME (Last, First, Middle Initial)

c. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

c. TYPED NAME (Last, First, Middle Initial)

b. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

k. DATE SIGNED

j. SIGNATURE

g. DATE SIGNED

f. SIGNATURE

f. DATE SIGNED

e. SIGNATURE

16. INDIVIDUAL CHARGED

17. ACCOUNTABLE OFFICER

Submit the attached statement of objection.

Do not intend to make such a statement.

DD FORM 200 (BACK), JUL 2009

2. INQUIRY/INVESTIGATION NUMBER

1. DATE INITIATED (YYYYMMDD)

CONTINUATION OF BLOCKS 4 - 8

8.

TOTAL COST

7.

UNIT COST

6.

QUANTITY

ITEM

NO.

5.

ITEM DESCRIPTION

4. NATIONAL STOCK NO.

LINE ITEM NO.

Page Pages of

FOR INTERMITTENT PAGES, ENTER SUBTOTAL:

IF LAST PAGE, ENTER GRAND TOTAL:

DD FORM 200, JUL 2009

2. INQUIRY/INVESTIGATION NUMBER

1. DATE INITIATED (YYYYMMDD)

Pages of Page CONTINUATION OF BLOCKS 9, 10, AND/OR 15.a.

Use this area to continue each item as necessary. Specify item number.

DD FORM 200, JUL 2009

8.0.1291.1.339988.308172

WHS/ESD/IMD

DD Form 200, Financial Liability Investigation of Property Loss, July 2009

1. Date initiated (4 digit year, 2 digit month, 2 digit day, no dividers).:
2. Inquiry/investigation number.:
3. Date loss discovered (4 digit year, 2 digit month, 2 digit day).:
4. National stock number.:
5. Item description.:
6. Quantity.:
7. Unit cost.:
7. Unit cost.:
16. Individual charged. a. I have examined the findings and recommendations and: X first box if submitt attached statement of objection or second box if do not intend to make such a statement.:
9. Circumstances under which property was lost, destroyed, or damaged. Attach additional pages as necessary.:
10. Actions taken to correct circumstances reported in block 9 and prevent future occurrences.:
d. Organizational address (unit designation, office symbol, base, state/country, zip code).:
b. Comments/rationale.:
g. Date signed (4 digit year, 2 digit month, 2 digit day).:
e. DSN number.:
d. Typed name (last, first, middle initial).:
c. Organizational address (unit designation, office symbol, base, state/country, zip code).:
h. Date signed (4 digit year, 2 digit month, 2 digit day).:
f. DSN number.:
e. Typed name (last, first, middle initial).:
h. Date signed (4 digit year, 2 digit month, 2 digit day).:
f. DSN number.:
e. Typed name (last, first, middle initial).:
d. Organizational address (unit designation, office symbol, base, state/country, zip code).:
11. Individual completing blocks 1 through 10. a. Organizational address (unit designation, office symbol, base, state/country, zip code).:
b. Typed name (last, first, middle initial).:
c. DSN number.:
e. Signature.:
e. Date signed (4 digit year, 2 digit month, 2 digit day).:
b. Comments/rationale.:
b. Comments/recommendations.:
Button1:
Button2:
15. Financial liability officer. a. Findings and recommendations. Attach additional pages as necessary.:
b. Dollar amount of loss.:
d. Recommended financial liability.:
c. Monthly basic pay.:
g. DSN number.:
d. DSN number.:
e. DSN number.:
f. Typed name (last, first, middle initial).:
e. Organizational address (unit designation, office symbol, base, state/country, zip code).:
d. Typed name (last, first, middle initial).:
c. Organizational address (unit designation, office symbol, base, state/country, zip code).:
c. Typed name (last, first, middle initial).:
b. Organizational address (unit designation, office symbol, base, state/country, zip code).:
h. Date submitted to appointing authority (4 digit year, 2 digit month, 2 digit day).:
i. Date appointed (4 digit year, 2 digit month, 2 digit day).:
k. Date signed (4 digit year, 2 digit month, 2 digit day).:
g. Date signed (4 digit year, 2 digit month, 2 digit day).:
f. Date signed (4 digit year, 2 digit month, 2 digit day).:
17. Accountable officer. a. Document number(s) used to adjust property record.:
Click this Reset button to erase data from all fields.:
7. Unit cost.:
7. Unit cost.:
6. Quantity.:
Item number.:
Grand total.:
Subtotal of this page.:
Page number of this page.:
Total number of pages.:
Button3:
continue:

File details come from the government source that posted it. Updated .