RFP 280-21-0560 Attachment 3_Voucher Review Sheet.docx
DOCX document 23 KB Posted
- Attached to
- SAMHSA’s Tribal Training and Technical Assistance Center Federal contract opportunity
- Solicitation number
- 280-21-0560
About this file
This document includes a request for proposals and related attachments for a federal contract opportunity. The Substance Abuse and Mental Health Services Administration is seeking proposals to provide tribal training and technical assistance services to address and prevent mental and substance use disorders, suicide, and promote mental health in native communities and families. Proposals are due by March 18, 2021. The selected contractor will provide culturally relevant training and technical assistance that honors tribal culture and ways of life as well as respects government-to-government relations. Questions about the solicitation are due by February 26th, and an intent to propose form is also requested by that date to assist with planning. Proposals must be submitted electronically using the specified website, and the focus of the contract work is to support local tribal solutions and increase protective factors for communities, families, and youth.
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Text version
RFP No. 280-21-0560 Attachment 3: Voucher Review Sheet
VOUCHER REVIEW SHEET
Contract No.:
Ref. No.
Contractor:
DUNS:
Received in DCM/OFR:
| X |
| Cost Reimbursement |
Today’s Date:
Fixed Price
Date Due in DCM:
IQC Work Order
Date Due in PSC/DFS:
Letter of Credit
Contract Financing
(N/A if letter of credit)
To: __________________, Contracting Officer Representative (COR)
From: ____________________, Division of Contracts Management, OFR, SAMHSA, 5600 Fishers Lane
Subject: Voucher No. ________________ Period Covered: __________________________________ Contractor Point of Contract: ______________________ Telephone: _______________ Email: ________________
COR:
Please review the Voucher, answer the following question and return to DCM by the date shown above.
| YES |
| NO |
| 1. Are costs commensurate with efforts expended? |
| _____ |
| _____ |
| 2. Are all elements of cost reasonable, in support of contract performance and consistent with amounts negotiated? |
| _____ |
| _____ |
| 3. Have deliverables received during the period been timely and acceptable? |
| _____ |
| _____ |
| 4. Do you recommend payment be made as claimed? |
| _____ |
| _____ |
5. Do you question any costs claimed? If yes, explain below.
| _____ |
| _____ |
(ATTACH ADDITIONAL SHEET OF PAPER IF NEEDED.)
COR sign and date here: ________________________________________ Date: __________________
| To: Program Support Center |
| PAY THIS AMOUNT: |
| _______________________ |
| DFO Accounting Operations |
| AMOUNT CLAIMED: |
| _______________________ |
| AMOUNT TO BE SUSPENDED FROM PAYMENT: |
| _______________________ |
In accordance with the Prompt Payment Provisions (Subsection (b)(4)), INTEREST [ ] IS / [ ] IS NOT payable under this Invoice or “Contract Financing Payment.” TO BE PAID NO LATER THAN _____________________.
* NOTE: THIS INVOICE/VOUCHER IS APPROVED FOR PROVISIONAL PAYMENT ONLY. All payments are subject to change pending final audit.
Reason for Suspension:
| Approved for payment: ______________________________________________ | Date: __________________ | |
| Contract Specialist |
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