Attachment 36 - AMHE DIDs (DI-DLAMGMT-00013 Certificate of Compliance).pdf
PDF 233 KB Posted
- Attached to
- Logistics Modernization Integration Support (LMIS) for Defense Logistics Agency (DLA) Distribution
- Solicitation number
- SP3300-20-R-5002
- Issued by
-
Defense Logistics Agency Distribution
About this file
This document provides a Data Item Description for a Certificate of Compliance required under the Logistics Modernization Integration Support contract for Defense Logistics Agency Distribution. The Certificate of Compliance must be submitted to the Government in digital format and include the contractor's name, address, phone number, date, contracting agency name, contract number, and statements certifying that all contractual requirements and specifications have been met and work is complete. It must be signed by an authorized contractor representative providing their printed name and title. This affirms the contractor has fully complied with all aspects of contract SP3300-20-R-5002 for Logistics Modernization Integration Support services to support Defense Logistics Agency Distribution activities.
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Text version
Form Approved OMB No. 0704-0188
Page ___ of ___ Pages
PREVIOUS EDITION MAY BE USED.DD FORM 1664, AUG 96 (EG)
DATA ITEM DESCRIPTION
1. TITLE 2. IDENTIFICATION NUMBER
3. DESCRIPTION/PURPOSE
4. APPROVAL DATE
(YYYYMMDD)
5. OFFICE OF PRIMARY RESPONSIBILITY (OPR) 6a. DTIC APPLICABLE 6b. GIDEP APPLICABLE
7. APPLICATION/INTERRELATIONSHIP
8. APPROVAL LIMITATION 9a. APPLICABLE FORMS 9b. AMSC NUMBER
10. PREPARATION INSTRUCTIONS
11. DISTRIBUTION STATEMENT
Distribution Statement A: Approved for public release; distribution is unlimited.
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.
Form Approved OMB No. 0704-0188
Page ___ of ___ Pages
PREVIOUS EDITION MAY BE USED.DD FORM 1664, AUG 96 (EG)
DATA ITEM DESCRIPTION
1. TITLE 2. IDENTIFICATION NUMBER
3. DESCRIPTION/PURPOSE
4. APPROVAL DATE
(YYYYMMDD)
5. OFFICE OF PRIMARY RESPONSIBILITY (OPR) 6a. DTIC APPLICABLE 6b. GIDEP APPLICABLE
7. APPLICATION/INTERRELATIONSHIP
8. APPROVAL LIMITATION 9a. APPLICABLE FORMS 9b. AMSC NUMBER
10. PREPARATION INSTRUCTIONS
11. DISTRIBUTION STATEMENT
Distribution Statement A: Approved for public release; distribution is unlimited.
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.
Certificate of Compliance
From: _______________________________________
(Contractor’s Name and CAGE Code)
Address: _____________________________________
(Contractor’s Address)
Phone Number: ________________________ (Contractor’s Commercial Telephone Number)
Date: ________________
To: __________________ (Contracting Agency)
Contract Number: _____________________________
“The furnished system(s), subsystem(s), component(s), equipment, hardware, and software is in full compliance with all specifications and contract requirements. All Contractor performance and work actions necessary to comply with the requirements as described within the contract are hereby certified as complete."
(Signature of Authorized Contractor Representative)
(Printed Name and Title of Authorized Contractor Representative)
Note: The recording of false, fictitious, or fraudulent statements or entries on this document may be punished as a felony under Federal Statutes.
Figure 1 – Sample format for a Certificate of Compliance
| DI-LMIS-00011 Certificate of Compliance |
| DI-LMIS-00003 Drawings, Engineering, and Associated Lists |
| Untitled |
DD Form 1664 (BLANK)
Certificate of Compliance (Figure 1)
10 PREPARATION INSTRUCTIONS: 10.1 Format: The Certificate of Compliance must be presented to the Government in a format similar to that of Figure 1. Unless stated otherwise on the CDRL, the deliverable to the Government must be provided in digital format and viewable using the latest version of Microsoft Office or Adobe software products as applicable.
10.2 Content: The Certificate of Compliance must contain all of the following:
10.2.a Contractor's Name and CAGE Code.
10.2.b Contractor's Address.
10.2.c Contractor's Commercial Telephone Number.
10.2.d Date.
10.2.e Contracting Agency's Name.
10.2.f Contract Number.
10.2.i A statement certifying that the solution (including all systems, subsystems, components, equipment, hardware, and software) is in full compliance with all specifications and contract requirements.
(Continued)
| PAGE NUMBER 1: 1 |
| 1 TITLE: Certificate of Compliance |
| 2 IDENTIFICATION NUMBER: DI-DLAMGMT-00013 |
| 3 DESCRIPTIONPURPOSE: This documentation provides formal certification that all contractual requirements have been met by the Contractor. This documentation is necessary for Government verification of successful contract completion and retention. |
| 4 APPROVAL DATE YYYYMMDD: N/A |
| 5 OFFICE OF PRIMARY RESPONSIBILITY OPR: DLA Information Operations - J62B |
| 6a DTIC APPLICABLE: N/A |
| 6b GIDEP APPLICABLE: N/A |
| 7 APPLICATIONINTERRELATIONSHIP: 7.1 This Data Item Description (DID) is applicable to all contractor performance and work actions necessary to comply with requirements described within the contract. |
7.2 This DID may be applied to programs or projects during Material Solution Analysis (MSA), Technology Maturation & Risk Reduction (TMRR), Engineering & Manufacturing Development (EMD), Production & Deployment (P&D), and Operations & Support (O&S) phases of the Defense Acquisition Life Cycle.
| 8 APPROVAL LIMITATION: N/A |
| 9a APPLICABLE FORMS: N/A |
| 9b AMSC NUMBER: N/A |
| 1010 PREPARATION INSTRUCTIONS: 10.2.j A statement certifying that Contractor performance and work actions necessary to comply with the requirements as described within the contract are completed. |
10.2.k Authorized Contractor's representative signature.
10.2.l Authorized Contractor's representative printed name and title.
10.2.m A notation with the following statement verbatim: "The recording of false, fictitious, or fraudulent statements or entries on this document may be punished as a felony under Federal Statues."
(Continued)
| PAGE NUMBER 11: 2 |
| PAGE NUMBER 2: 3 |
| From 1: |
| From 2: |
| Address 1: |
| Address 2: |
| Address 3: |
| Contractors Commercial Telephone Number: |
| Date: |
| Contracting Agency: |
| Contract Number: |
| Printed Name and Title of Authorized Contractor Representative: |
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