Attachment_4_Data_ItemTransmittal_Form.pdf

DATA ITEM TRANSMITTAL/ACCEPTANCE/REJECTION FORM

Contract Number:

CLIN/ELIN: ____ ___/______ TITLE: ___________________________________

Block 14 Distribution:

Other:

Doc. Ref. No.: ____ Date: ____________________________

From:

To: Acquisition Center U.S. Army PEO STRI 12350 Research Parkway Orlando, FL 32826

ATTN: _____________________________________

The above detailed CDRL item is forwarded for review and acceptance/ rejection. This item is due _________, The Government review period is days.

Signature:

Typed Name/Title:

FIRST ENDORSEMENT: Date Received:

( ) Accepted.

( ) Accepted. Attached comments must be incorporated into the next scheduled submission. (This block is for use with periodically submitted items only.)

( ) Rejected, comments attached. Change pages ( ) are ( ) not sufficient for correction. Contractor is allowed ( ) 30 days or ( ) days to resubmit.

Signature:

Typed Name/Title: _____________________________________________ Code: ____ Date: _________________

VIA: Date:

VIA: PD Date:

SECOND ENDORSEMENT:

( ) Accepted.

( ) Accepted conditionally. Attached comments must be incorporated in the next scheduled submission.

( ) Rejected, comments attached. Resubmit no later than ________ .

Signature:

Typed Name/Title: __________________________ Date: ________________ Contracting Officer

CC w/Encl.:

CC w/o Encl.: