PWS - Attachment C - Request to Initiate Purchase.pdf

Contractor: RIP Number:

Client: Date:

Project Name:

Project/Interagency

Agreement (IA)

Number:

Associated Line of Task Order Number:

Last Invoice Submitted:

TO: (Insert First and Last Name) , Contracting Officer's CLIN X00X VALUE: -$

CUMULATIVE -$

FROM: (Insert First and Last Name of requestor) CURRENT CLIN X00X -$ THROUGH: (Insert client organization and First and Last Name) , RIP ESTIMATE: -$

NEW CLIN X00X -$

SUBJECT: Request to Initiate Purchase # (insert number)

DATE: (Insert Month Date, Year)

REQUEST TO INITIATE PURCHASE (RIP) FOR EQUIPMENT, MATERIALS, OTHER DIRECT COSTS

(ODCs), AND/OR SERVICES

PURPOSE/JUSTIFICATION OF REQUEST:

If the prime contractor has an approved purchasing system, the contractor shall prepare and submit a RIP to be reviewed and signed by the FEDSIM COR.

FEDSIM is a Client Support Center housed within GSA, FAS, AAS Template Version 11/15/18

Please contact me at (area code) 000-0000 (insert requestor's phone number) if you have any concerns or questions.

FEDSIM COR Approval:

ESTIMATED PURCHASE COST:

Indirect costs authorized by the Task Order (insert as appropriate) Item Cost

Total Not to Exceed (NTE) cost

All equipment, materials, and ODCs shall be purchased in accordance with client requirements. All equipment, materials, and

ODCs shall become the property of the Government and shall be regarded as Government Furnished Property (GFP), and unless previously approved by the Contracting Officer, shall be used only in performance of this Task Order. All materials shall be purchased in accordance with applicable Federal Acquisition Regulation (FAR) and/or Defense Federal Acquisition

Regulation Supplement (DFARS) clauses (choose as appropriate) and approved purchasing procedures. All equipment, materials, and ODCs shall be purchased in accordance with Task Order requirements and shall not exceed the funded amount on this Task Order. The contractor shall ensure that the prices quoted are fair and reasonable at the time of submission and are in the best interest of the Government.

Item: (insert item(s))

Signature Date

Last Invoice Submitted: Last Invoice Submitted:

CLIN X00X VALUE: -$

CUMULATIVE AMOUNT BILLED: -$

CURRENT CLIN X00X BALANCE: -$

TOTAL CLIENT FUNDING ON CLIN X00X: -$

CURRENT CLIN X00X FUNDING AVAILABLE: -$

RIP ESTIMATE: -$

NEW CLIN X00X BALANCE: -$

NEW CLIENT CLIN X00X BALANCE: -$

NOTE: If you have multiple clients or multiple funding sources, you may want to use the structure below ( RED text). Cut and paste the RED text to Columns

C and D, Rows 13 through 23 to track funding at the Contract Line Item

Number (CLIN) and client level to ensure you don't exceed the client's portion of the funding on the CLIN. If you only have one funding source, or don't require the level of detail below, delete the RED text below and use the structure provided to the left.