PR Checklist (ANAD 715-34-E) - TMS OS Upgrade_signed.pdf

ANAD Form 715-34-E, 9 Oct 2019 Previous Editions are Obsolete

PR CHECKLIST AND REQUEST FOR ANAD DOC CONTRACTING SUPPORT

(IAW TACOM LCMC Regulation 715-15)

1. TO BE COMPLETED BY THE CUSTOMER:

1A. Project Name: (AAP Name if Applicable)

1B. PCF Cabinet Number 1C. AAP # 1D. Priority* 1E. Requiring Dir.

1F. Brief Description:

2. CONTACT INFORMATION: Must be Government employees 2A. Requester's Name (POC): Directorate: Phone Number: E-Mail Address:

2B. Potential COR (Service Contracts > $2500): Directorate: Phone Number: E-Mail Address:

3. CONTRACT ACTION INFORMATION & HISTORY:

3A. What is being procured: Supplies Equipment Services Construction (MILCON) IT SW Spt

3B. If Services, is a Request for Services Contract Approval Form (RSCA) Required (see instructions in the RSCA Form)?

Yes Legal review required. No Exception: ______________________________________ 3C. CPAC Coordination (If service contract package value is greater than $250K)

Coordination with Labor Relations Specialist (CPAC) regarding union negotiation rights was required.

Final response from CPAC received.

3D. Management Decision Document (MDD) required? Yes (Must Include) No

4. TYPE OF CONTRACT ACTION:

Exercising a Funded Option on an existing contract

Contract #: Option #:

CHESS Order on Contract #:

GSA Contract Order on Contract #:

Delivery Order on Contract #:

Task Order on Contract #:

Amount being Funded:

Quantity of CLINS being Funded:

List of CLINS:

This is a new contract action

Base $___________________________

Option 1 $___________________________

Option 2 $___________________________

Option 3 $___________________________

Option 4 $___________________________

$___________________________ TOTAL

Previous Contract Number:

Estimated Qty of CLINS/Yr:

Previous Editions are Obsolete

5. SHIPPING ADDRESS:

5A. Ship-To DODAAC: 5B. Hand Receipt #, if known: 5C. Full Delivery Address including Mailstop:

5D. Acceptor: Directorate Phone Number: E-Mail Address:

6. BUDGET/BUSINESS INFORMATION:

6A. Funding Type: AWCF CIP OMA Other (Specify)

6B. Funds provided by: ANAD FMS Other (Specify)

6C. Are funds Available? Yes No If No, is this a Requirements Contract? Yes No

6D. Cost Center 6E. SIO# 6F. WBS# 6G. External Order # 6H. EOR

6I. Directorate Budget Office Approval:

7. SUPPORTING DOCUMENT CHECKLIST: Complete and attach the applicable documents. See the Package Prep Matrix 7A. Market Research Summary: Suggested Vendor(s) (include up to 3) (If General Services Administration (GSA), write in Federal Supply Schedule):

VENDOR NAME POINT OF CONTACT TOTAL ESTIMATE QUOTE # (If Available)

7B. Market Research (Required for new contracts) (Select all that apply).

This this a Commercial Item or Services More than one source can provide this item or service

A Warranty is Required (Choose a Type): Standard Specialized (Description in Requirements Document)

A Brand Name item is requested. Is an “Equal” Acceptable? Yes No (Sources are Limited – Treat as Sole Source)

7C. Competition Recommendation:

Full and Open Competition (All responsible sources may compete.)

Urgent - Base award on earliest delivery

Sole Source or Limited Source (Solicit and negotiate with one or limited sources).

If request amount is < $250K, Complete Sole Source Justification Form

If request amount is > $250K, Submit a Justification and Approval (J&A). For GSA buys, use GSA Template.

8. DIRECTORATE APPROVAL:

Director Approval:

I concur with this requirement for my Directorate and I concur with the Priority level listed in Section 1D based on the definitions below.

* Priorities are: 13 – Standard

ANAD Form 715-34-E, 9 Oct 2019

6 – May stop production line in 30 days. 3 – Production line is down, Need Immediately

PHONE #

10.0.2.20120224.1.869952 Services Yes No New

AWCF

ANAD

Yes No Sole or Limited

Estimated Period of Performance: 1 Dec 23 - 30 Nov 24.

PCS Code: DA10