S02 Attachment 5 - Contract Deficiency Report.docx

DOCX document 28 KB Posted

Attached to
Hemodialysis Federal contract opportunity
Solicitation number
36C25520R0061_1
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 15

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S02 Attachment 4 Sub-Contracting Plan Model.docx DOCX document
S02 Attachment 3 QASP.docx DOCX document
S02 Attachment 8 - VHA Form 10-5345 - Request For And Authorization To Release Medical Records Or Health Information print.pdf PDF
S02 Attachment 3 By-Laws Wichita VA Medical Center.pdf PDF
36C25520R0061_1 09.09.2020 Final.docx DOCX document
S02 Attachment 7 - VA Form 3288 _ Request For And Consent To Release Of Information From Individual_s Records print.pdf PDF

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Attachment 5 36C25520R0024 Contract Deficiency Report

CONTRACT DISCREPANCY REPORT

1. CONTRACT NUMBER
2. REPORT NUMBER FOR THIS DISCREPANCY
3. TO: (Contracting Officer)
4. FROM: (Name of COR)

5. DATES

a. CDR PREPARED

b. RETURNED BY CONTRACTOR:
c. ACTION COMPLETE

6. DISCREPANCY OR PROBLEM (Describe in detail. Include reference to PWS Directive; attach continuation sheet if necessary.)

7. SIGNATURE OF COR
Date:
8. SIGNATURE OF CONTRACTING OFFICER
Date:
9a. TO (Contracting Officer)
9a. FROM (Contractor)

10. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable quality control program procedures or new procedures. Attach continuation sheet(s) if necessary.)

11. SIGNATURE OF CONTRACTOR REPRESENTATIVE
Date:

12. GOVERNMENT EVALUATION. (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)

13. GOVERNMENT ACTIONS (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary.)

14. CLOSE OUT

NAME
TITLE
SIGNATURE
DATE

a. CONTRACTOR NOTIFIED

b. COR

c. CONTRACTING OFFICER

VHAPM Part801.603-70 COR SOP Revision 07 Page 1 of 1 Original Date: 05/20/2011 Revision 07 Date: 02/07/2020

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