Attachment 1 - Perfomance Work Statement Amendment 2.pdf

SP7000-20-R-1021 Attachment 1 – Performance Work Statement

MFD MAINTENANCE PERFORMANCE WORK STATEMENT

Period of Performance: DLA Information Operations seeks to enter into a 36 month Multi-Functional Device Maintenance indefinite delivery indefinite quantity contract. Task orders for service not to exceed (NTE) a 24 month period with DLA Information Operations.

1.0 GENERAL MAINTENANCE INFORMATION. The Contractor shall provide on-site labor and materials to maintain the equipment for preventive maintenance to be performed per manufacturer’s maintenance schedule. Repair services shall also be executed as requested by the customer.

1.0.1 Pricing proposals shall reflect Firm Fixed Base Pricing. See enclosure 2 for Volume Bands.

1.0.2 The devices shall receive adjustments, repairs and preventive care from Certified Personnel only.

Pricing shall include OEM parts, consumables (except paper) and labor.

1.1 The Contractor shall comply with all rules and regulations to obtain installation access in order to meet all response times stated in the PWS. The Contractor shall comply with base access and vehicle registration requirements regarding Contractor-owned and Contractor employee privately owned vehicles as set forth in the base/command regulations. All vehicles, including those with passes or decals, are subject to random search at any time.

1.1.1 The Contractor’s personnel shall be subject to the Government's approval of access to all

Government installations. All Contractor’s employees who need installation access to perform the contract shall pass a suitable investigation for access to Government installations.

1.1.2 Any and all fees including the application process and or enrollment to access any installation or facilities shall be the sole financial responsibility of the Contractor.

1.2 All services provided under this contract require an Acknowledgement Form (Enclosure 3) be signed and dated by the DLA Information Operations’ customer.

1.2.1 Upon completion of maintenance service or any support action, the Contractor shall provide the customer with the Acknowledgement Form, for their signature as a means of acknowledgement by the agency/command that the action was completed.

1.2.2 The Acknowledgement Form shall be signed to include the following: (1) activity name, (2) model and serial numbers; (3) maintenance services provided; (4) device locations, to include building numbers, room numbers, (5) customer’s name and signature.

1.2.3 The Acknowledgement Form shall be submitted to the COR within 10 calendar days of completing any maintenance services.

1.3 Invoices shall be submitted on a monthly basis via Wide Area Work Flow (WAWF) and shall include a Microsoft

Excel spreadsheet (version 2003 or newer) with the serial numbers and locations of each device. Invoices shall be in United States Dollars. The first invoice shall not be paid unless the spreadsheet referenced in Paragraph 6.5 of the Performance Work Statement has been provided. The initial invoice shall not be approved without a fully completed spreadsheet and the signed Acknowledgement Form. There shall be no interest penalty incurred by

Date created/revised:

FY20-1 April 30, 2020

SP7000-20-R-1021 Attachment 1 – Performance Work Statement the Government for delay of payment due to a vendor delay in providing the spreadsheet and Acknowledgement Form.

2.0 SERVICED DEVICES. The Contractor shall:

2.1 Provide support for all manufacturers, including but not limited to:

• Canon

• Dell

• Hewlett Packard

• Konica-Minolta

• Kyocera

• Lexmark

• Ricoh

• Samsung

• Sharp

• Xerox

2.2 The Contractor shall provide a toll free telephone number(s) to place service maintenance calls and order consumable supplies. At the initial site visit, the Contractor shall affix a sticker with its toll free telephone number(s) and the following phrase “Contractual support on this device is scheduled to expire on MMM DD, YYYY” on each device placed on this contract, as well as the DLA Information Operations EMS sticker (DLA Information Operations shall provide the EMS stickers). In addition, the Contractor shall ensure each device has the manufacturer’s name, model number, and machine serial number legibly stamped or affixed to the device in a readily accessible location. The Contractor shall provide English speaking personnel at the toll-free number(s) it provides in this paragraph.

3.0 MAINTENANCE (Including Operational Standards & Performance). The Contractor shall:

3.1 Respond within one business day (not to exceed 24 hours) of a service call. A telephone call (unless it results in solving the problem) shall not be deemed as an acceptable service response. The service technician shall call the end user within an hour to discuss service problem and time of arrival.

3.2 Provide service technician support Monday through Friday from 8:00 a.m. – 4:30 p.m. local time, with the exception of Federal or local Holidays. The Contractor shall provide a service technician who speaks English.

3.3 Maintain each device at a minimum 75% monthly available rate based on the 21 standard federal work days in a month. Maintaining the devices includes, but is not limited to the cost of:

3.3.1 Preventive maintenance.

3.3.2 Service calls.

3.3.3 Repairs.

3.3.4 Troubleshooting.

3.3.5 Connectivity.

3.3.6 All associated labor and travel.

SP7000-20-R-1021 Attachment 1 – Performance Work Statement

3.4 If a device is determined by the Contractor to be non-repairable, to include damaged devices, the Contractor shall inform the designated COR within two (2) business days of making this determination. Both parties must agree that the device is non-repairable. Once this determination is agreed upon, the non-repairable device shall be permanently removed from the contract and the cost of the device will be prorated according to the date the Contractor notifies DLA, in writing, that a supported device is deemed non-repairable.

3.5 Contractors shall monitor industry standard vulnerability sites (e.g. http://nvd.nist.gov/, https://www.us-cert.gov/ncas/alerts, http://oval.mitre.org/) and take appropriate actions if the supported device is subject to a known vulnerability. When vulnerabilities are identified by either the Contractor or the customer, the Contractor shall provide remediation for distribution to all installed equipment in accordance with USCYBERCOM TASKORD regulations unless a different time period is directed by USCYBERCOM via DLA Information Operations. The TASKORD is For Official Use Only and is quoted below for reference:

3.5.1 Assured Compliance Assessment Solution (ACAS) assigns severity scored of critical, high, medium and low to plug-in findings.

3.5.1.1 Critical findings reflect discovery of a common vulnerability and exposure (CVE) that poses significant risk to the confidentiality, integrity, and availability of DODIN Networks. Actions to mitigate or remediate critical vulnerabilities should be initiated upon discover with the goal of mitigation/remediation within seven (7) calendar days.

3.5.1.2 Findings with a severity score of high should be addressed in the same manner as vulnerabilities addressed via Information Assurance Vulnerability Alert (IAVA) directives and mitigated or remediated within twenty-one (21) calendar days of discovery.

3.5.1.3 Findings with severity scores of medium and low should be addressed in accordance with local

Approving Official (AO), Information System Security Manager (ISSM), or Information System Security Officer (ISSO) guidance until further notice.

3.5.1.4 In all instances, DoD components should consider exposure to threat, mission impact, sensitivity of data, and current mitigating security controls when prioritizing implementation of fix actions.

3.5.2 In the event remediation cannot be achieved within the mandated timeline, a Plan of Actions and

Milestones shall be approved by the Customer’s agency Authorizing Official or designee for risk acceptance.

3.6 In the case of devices cleared for CLASSIFIED material, the Contractor’s repair technicians CONUS shall have a

Department of Defense (DOD) security clearance equal to or higher than the classification of the device or shall be escorted by Government personnel with the appropriate security clearance. Repair technicians shall be able to provide verification when requested.

3.7 In the case of devices cleared for CLASSIFIED material OCONUS, the Contractor’s foreign-national technicians shall be escorted at all times by Government personnel with the appropriate security clearance. Technicians shall be able to produce proper identification/credentials when requested.

3.8 Inform the COR within two (2) business days of the determination that device is non-repairable.

3.9 Additional Optional Services

3.9.1 The Contractor shall provide an onsite technician to respond to all service calls. At the order level, the

Government shall dedicate a workspace equipped with a desk, chair, and phone for the onsite http://nvd.nist.gov/ https://www.us-cert.gov/ncas/alerts https://www.us-cert.gov/ncas/alerts http://oval.mitre.org/

SP7000-20-R-1021 Attachment 1 – Performance Work Statement technician. The onsite technician shall be responsible for the maintenance of the equipment to include installation of replacement devices, troubleshooting, preventive maintenance and service calls.

The onsite technician is not responsible for the delivery of paper. The Contractor is responsible for all labor and travel associated with the onsite technician’s responsibilities. Other direct costs are not included in this contract (CLIN 0012 and 0025).

4.0 CONSUMABLE SUPPLIES. The Contractor shall:

4.1 Provide all consumable supplies (including staples) necessary for the operation of the devices. Paper is excluded as a consumable supply.

4.2 Deliver all required consumable supplies to the designated locations listed on the delivery schedule within three

(3) business days after receipt of a request for supplies.

4.3 Customers may maintain one complete set of extra supplies per device.

5.0 FIRMWARE/SOFTWARE UPDATES:

5.1 In order to maintain DoD authority to operate, devices are required to have the most up to date firmware. The

Contractor shall provide the most recent versions of firmware, software and installation instructions for distribution to local IT staff, coordinated through the COR.

5.2 Upon request, for an additional fee (see CLIN 0013 and 0026), the Contractor shall install, in person (not remotely), up to date firmware and software, i.e. Common Access Card (CAC) to Personal Identity Verification (PIV) updates, firmware security updates, on each device and ensure each device maintains all functionality from prior to the upgrade.

6.0 REPORTS. The Contractor shall:

6.1 Submit a Device Maintenance Report to the designated COR within ten (10) calendar days after serviced. Each maintenance report shall include a Microsoft Excel spreadsheet (version 2003 or newer) that provides the Maintenance Order Number (PO#) along with the following: (1) date of maintenance; (2) serial numbers/CLIN; (3) maintenance location (to include building number, room number, customer name, phone number, and email address).

6.2 Provide to the designated COR a Usage Report (Microsoft Excel format, version 2003 or newer) with the total and average monthly production volumes by serial number for all devices. The Usage Report shall be submitted to the COR within five (5) business days upon request.

6.3 Provide Service History Reports containing frequency of service calls, production volume between repairs, type of repairs, parts required, and device down time to the designated COR within five (5) business days upon request for information.

6.4 Provide to the designated COR a Device Downtime Report which shall identify the time the equipment was inoperable/non-functional. Downtime is defined as the time the customer places the call and notifies the Contractor’s representative that the equipment is inoperable/non-functional or when the Technician begins service on the equipment, if the device is operable/functional upon arrival. In addition, the report shall include information relative to the frequency of service calls, production volume between service calls, types of repairs as well as parts required. The Device Downtime Report shall be submitted to the COR within five (5) business days upon request.

6.5 Maintain an accurate listing of all devices under contract (model, serial number, location) and provide a

SP7000-20-R-1021 Attachment 1 – Performance Work Statement spreadsheet to the designated COR (Microsoft Excel format, version 2003 or newer) with the monthly invoice.

The Contractor shall invoice in and be paid in U.S. Dollars.

SP7000-20-R-1021 Attachment 1 – Performance Work Statement

Enclosure 1 - Quality Assurance Surveillance Plan for Maintenance Only PWS

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) is a Government developed and applied document used to make sure that systematic quality assurance methods are used in the administration of the Performance Work Statement (PWS) standards that shall be included in the contract. The intent is to ensure that the Contractor performs in accordance with performance metrics set forth in the contract documents, that the Government receives the quality of services called for in the contract and that the Government only pays for the acceptable level of services received.

2. AUTHORITY

Authority for issuance of this QASP is provided under FAR 52.212-4(a), Inspection/Acceptance, and FAR 52.212-4(m), Termination for cause, and documentation called for in the contract to be accomplished by the Contracting Officer or his duly authorized representative.

3. SCOPE

The QASP is put in place to provide Government surveillance oversight of the Contractor’s quality control efforts to assure that they are timely, effective and are delivering the results specified in the contract. The QASP is not a part of the contract nor is it intended to duplicate the Contractor’s Management Plan.

4. GOVERNMENT RESOURCES

The following definitions for Government resources are applicable to this plan:

Contracting Officer – A person duly appointed with the authority to enter into, administer, or terminate contracts and make related determination and findings on behalf of the Government.

Contracting Officer Representative (COR) – An individual designated in writing by the Contracting Officer to act as his authorized representative to assist in administering a contract. The source and authority for a COR is the Contracting Officer. COR limitations are contained in the written letter of appointment.

5. RESPONSIBILITIES

The Government resources shall have responsibilities for the implementation of this QASP as follows:

Contracting Officer – The Contracting Officer ensures performance of all necessary actions for effective contracting, ensures compliance with the terms of the contract and safeguards the interests of the United States in the contractual relationship. It is the Contracting Officer that assures the Contractor receives impartial, fair, and equitable treatment under the contract. The Contracting Officer is ultimately responsible for the final determination of the adequacy of the Contractor’s performance.

Contracting Officer Representative (COR) – The COR is responsible for administration of the contract and assures proper Government surveillance of the Contractor’s performance. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf. Any changes that the Contractor deems may affect contract, price, terms, or conditions shall be referred to the Contracting Officer for action.

6. METHODS OF QA SURVEILLANCE

SP7000-20-R-1021 Attachment 1 – Performance Work Statement

Contractor Performance Assessment Reporting System (CPARS) Requirements:

(a) The Contractor, in performing this contract, shall be subject to past performance assessment in accordance with FAR 42.15 and the Contractor Performance Assessment Reporting System (CPARS) Guide at:

http://www.cpars.navy.mil/cparsfiles/pdfs/navycparsmanual/pdf. All information contained in the assessment may be used by the Government, within the limitations of FAR 42.15, for future source selections in accordance with FAR 15.304 where past performance is an evaluation factor. Assessments shall be conducted as prescribed by CPARS guidance.

(b) The Contractor shall be provided with a copy of the assessment. The Contractor shall have 30 calendar days to submit comments, additional information, or rebut statements if warranted or desired. The Contractor shall strictly control access to the assessment while in the Contractor’s possession and shall ensure that the assessment is never released to persons or entities outside of the Contractor’s control. After receipt of Contractor’s comments or expiration of the 30 day comment period, whichever occurs first, and depending on the Contractor’s response, the Government shall:

(i) If no comments are received; close the CPARS by the assessing official rep and Reviewing Official.

(ii) If Contractor concurs with the assessment; accept/update and close the CPARS and forward comments to all reviewers.

(iii) If Contractor does not concur with the assessment, coordinate a final response with Reviewing Official, Assessing Official Representative, and Assessing Official.

(iv) Enter the final Government response and close CPARS.

(c) After completion of one of the appropriate actions, the Assessing Official shall notify all individuals that the report is complete. The assessment is considered complete when signed by the Assessing or Reviewing Official.

(d) The official responsible for the corporate operating unit being assessed can submit a written request to receive a copy of the completed CPARS assessment. The assessment is not subject to the Disputes clause of the contract, nor is it subject to appeal beyond the review and comment procedures described above and in the CPARS Guide.

Refer to: http://www.cpars.csd.disa.mil/ for details and additional information related to CPARS, CPARS user access (which includes obtaining a PKI certificate), how contract performance assessments are conducted, and how Contractors participate.

7. PERFORMANCE MEASUREMENT

QUALITY ASSURANCE SURVEILLANCE PLAN:

(a) Provide a toll free telephone number(s) to place service maintenance calls and order consumable supplies. The Contractor shall affix its toll free telephone number(s) on each device placed on this contract, as well as the DLA Information Operations EMS sticker (DLA Information Operations shall provide the EMS stickers). In addition, the Contractor shall ensure each device has the manufacturer’s name, model number, and machine serial number legibly stamped or affixed to the device in a readily accessible location. See PWS for all details.

PWS reference: 2.2 APL: 100% compliant Reporting Tools: CPARS, CORT Tracking Tool and other Past Performance Records Surveillance Method: COR/Customer Feedback http://www.cpars.navy.mil/cparsfiles/pdfs/navycparsmanual/pdf http://www.cpars.csd.disa.mil/

SP7000-20-R-1021 Attachment 1 – Performance Work Statement

(b) Maintain each device at a minimum of 75% monthly available rate. Respond within one business day (not to exceed 24 hours) of service call. See PWS for all details.

PWS reference: 3.1 – 3.6 APL: 100% timely & compliant

(c) Inform the designated COR within two (2) business days of the determination that device is non-repairable.

PWS reference: 3.9 APL: 100% timely

(d) Provide all required supplies (including staples) necessary for the operation of the devices. Paper is excluded as a consumable supply. Deliver all required consumable supplies to the designated locations listed on the delivery schedule within three (3) business days after receipt of an order.

PWS reference: 4.1 – 4.2 APL: 100% timely & compliant

(e) Provide to the designated COR Usage Reports within 5 business days of request from the COR. See PWS for report requirements. See PWS for all details.

PWS reference: 6.2 APL: 100% timely

(f) Provide service history reports to the designated COR within five (5) business days of the request. See PWS for report requirements.

PWS reference: 6.3 APL: 100% timely

(g) Maintain an accurate listing of all devices under contract and provide to the designated COR with the monthly invoice. See PWS for requirements for listing.

PWS reference: 6.5 APL: 100% timely

SP7000-20-R-1021 Attachment 1 – Performance Work Statement

Enclosure 2 - LOT 1 (CONUS) and LOT 2 (OCONUS) CLINs/Volume Bands

CONUS

LOT 1

CLIN Volume Band

Description

LOT 1 0001 VB-0M

Desktop Monochrome Multifunctional Devices: Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 10,000 monochrome impressions/month. Monthly cost up to 24 months.

LOT 1 0002 VB-0C

Desktop Color Multifunctional Devices: Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 10,000 impressions/month (5,000 monochrome and 5,000 color). Monthly cost up to 24 months.

LOT 1 0003 VB-1M

Floor-Standing Low Volume Monochrome Multifunctional Devices: Minimum 25 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 5,000 monochrome impressions/month. Monthly cost up to 24 months.

LOT 1 0004 VB-1C

Floor-Standing Low Volume Color Multifunctional Devices: Minimum 25 pages per minute.

Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 5,000 impressions/month (3,000 monochrome and 2,000 color). Monthly cost up to 24 months.

LOT 1 0005 VB-2M

Floor-Standing Mid Volume Monochrome Multifunctional Devices: Minimum 30 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 10,000 monochrome impressions/month. Monthly cost up to 24 months.

LOT 1 0006 VB-2C

Floor-Standing Mid Volume Color Multifunctional Devices: Minimum 30 pages per minute.

Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 10,000 impressions/month (5,000 monochrome and 5,000 color). Monthly cost up to 24 months.

LOT 1 0007 VB-3M

Floor-Standing High Volume Monochrome Multifunctional Devices: Minimum 40 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 20,000

LOT 1 0008 VB-3C

Floor-Standing High Volume Color Multifunctional Devices: Minimum 35 pages per minute.

Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 20,000 impressions/month (10,000 monochrome and 10,000 color). Monthly cost up to 24 months.

LOT 1 0009 VB-4M

Floor-Standing High Volume/High speed Monochrome Multifunctional Devices: Minimum 50 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 35,000

LOT 1 0010 VB-4C

Floor-Standing High Volume/High speed Color Multifunctional Devices: Minimum 40 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past impressions/month (20,000 monochrome and 15,000 color). Monthly cost up to 24 months.

LOT 1 0011 VB-5M

Floor-Standing High Volume/High speed Monochrome Multifunctional Devices: Minimum 55 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 70,000

LOT 1 0012 OST

Onsite Technician. Monthly cost up to 24 months.(PWS Section 3.9.1)

LOT 1 0013 FSU

Firmware/Software Updated by Contractor. (PWS Section 6.2)

SP7000-20-R-1021 Attachment 1 – Performance Work Statement

OCONUS

LOT 2

CLIN Volume Band

Description

LOT 2 0014 VB-0M

Desktop Monochrome Multifunctional Devices: Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 10,000 monochrome impressions/month. Monthly cost up to 24 months.

LOT 2 0015 VB-0C

Desktop Color Multifunctional Devices: Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 10,000 impressions/month (5,000 monochrome and 5,000 color). Monthly cost up to 24 months.

LOT 2 0016 VB-1M

Floor-Standing Low Volume Monochrome Multifunctional Devices: Minimum 25 pages per minute.

Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 5,000 monochrome impressions/month.

Monthly cost up to 24 months.

LOT 2 0017 VB-1C

Floor-Standing Low Volume Color Multifunctional Devices: Minimum 25 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 5,000 impressions/month (3,000 monochrome and 2,000 color). Monthly cost up to 24 months.

LOT 2 0018 VB-2M

Floor-Standing Mid Volume Monochrome Multifunctional Devices: Minimum 30 pages per minute.

Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 10,000 monochrome impressions/month.

LOT 2 0019 VB-2C

Floor-Standing Mid Volume Color Multifunctional Devices: Minimum 30 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 10,000 impressions/month (5,000 monochrome and 5,000 color). Monthly cost up to 24 months.

LOT 2 0020 VB-3M

Floor-Standing High Volume Monochrome Multifunctional Devices: Minimum 40 pages per minute.

Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 20,000 monochrome impressions/month.

LOT 2 0021 VB-3C

Floor-Standing High Volume Color Multifunctional Devices: Minimum 35 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 20,000 impressions/month (10,000 monochrome and 10,000 color). Monthly cost up to 24 months.

LOT 2 0022 VB-4M

Floor-Standing High Volume/High speed Monochrome Multifunctional Devices: Minimum 50 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 35,000 monochrome

LOT 2 0023 VB-4C

Floor-Standing High Volume/High speed Color Multifunctional Devices: Minimum 40 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past impressions/month (20,000 monochrome and 15,000 color). Monthly cost up to 24 months.

LOT 2 0024 VB-5M

Floor-Standing High Volume/High speed Monochrome Multifunctional Devices: Minimum 55 pages per minute. Applies to all makes and models manufactured in 2014 and newer, not past manufacturer’s end of support during contract term. Estimated maximum of 70,000 monochrome

LOT 2 0025 OSTs Onsite Technician. Monthly cost up to 24 months. (PWS Section 3.9.1)

LOT 2 0026 FSU

Firmware/Software Updated by Contractor. (PWS Section 6.2)

SP7000-20-R-1021 Attachment 1 – Performance Work Statement

Enclosure 3

ACKNOWLEDGEMENT FORM

Activity Name: Customer Address:

Customer POC Phone Number: Customer POC Email Address:

Contract Number:

NOTE: This document is required for all maintenance services, deliveries and removals.

Use bottom and back for multiple devices.

Device Manufacturer: Model #:

Serial Number: CLIN #:

Service Date:

(MM/DD/YYYY): Service Location (Bldg. #/Floor #/ Room #):

Maintenance Firmware/Software Update

Delivery of Supplies/Parts

Other (Describe here or on Back):

Contractor Technician Name (Print): Technician Signature:

Customer (Print): Customer Signature:

CLIN#: Model #: Serial Number: Service Location (Building #/Floor #/Room #):

Acknowledgement Form (Page 1 of 2)

SP7000-20-R-1021 Attachment 1 – Performance Work Statement

Acknowledgment Form (Page 2 of 2)

CLIN#: Model #: Serial Number: Service Location (Building #/Floor #/Room #):

NOTE: This space below is for any action other than an installation, maintenance and/or removal.