Attach_5_-_Contract_Discrepancy_Report.pdf
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- Solicitation number
- W911WN18T3002
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Attachment 5 - Contract Discrepancy Report
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Text version
CONTRACT DISCREPANCY REPORT
1. CONTRACT NUMBER 2. REPORT NUMBER FOR THIS DISCREPANCY
3. TO (Contractor and Manager's Name) 4. FROM (Name of QAE)
5. DATES (YYYYMMDD)
a. 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 CONTRACTING OFFICER
8a. TO (Contracting Officer) b. FROM (Contractor)
9. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. (Cite applicable Q.C.
program procedures or new Q.C. procedures. Attach continuation sheet(s) if necessary.)
10. SIGNATURE OF CONTRACTOR REPRESENTATIVE b. DATE (YYYYMMDD)
11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, reflection. Attach continuation sheet(s) if necessary)
12. GOVERNMENT ACTIONS (Reduced payment, cure notice, show cause, other)
13. CLOSE OUT
NAME
(1)
TITLE
(2)
SIGNATURE
(3)
DATE (YYYYMMDD)
(4)
a. CONTRACTOR
NOTIFIED
b. QAE
c. ACO
DD FORM 2772, SEP 1998 (EG) REPLACES MT FORM 352-R, WHICH IS OBSOLETE. Designed using Perform Pro, WHS/DIOR, Sep 98
ATTACHMENT 5
| 1_CONTRACT_NUMBER: |
| 2_REPORT_NUMBER_FOR_THIS: |
| 3_TO_Contractor_and_Manag: |
| 4_FROM_Name_of_QAE: |
| a_PREPARED: |
| b_RETURNED_BY_CONTRACTOR: |
| c_ACTION_COMPLETE: |
| 6_DISCREPANCY_OR_PROBLEM: |
| 7_SIGNATURE_OF_CONTRACTIN: |
| 8a_TO_Contracting_Officer: |
| b_FROM_Contractor: |
| 9_CONTRACTOR_RESPONSE_AS: |
| 10_SIGNATURE_OF_CONTRACTO: |
| b_DATE_YYYYMMDD: |
| 11_GOVERNMENT_EVALUATION: |
| 12_GOVERNMENT_ACTIONS_Red: |
| NAME_1: |
| TITLE_2: |
| SIGNATURE_3: |
| DATE_YYYYMMDD_4: |
| NAME_2: |
| TITLE_1: |
| SIGNATURE_1: |
| DATE_YYYYMMDD_1: |
| NAME_3: |
| TITLE_3: |
| SIGNATURE_2: |
| DATE_YYYYMMDD_2: |
| Reset: |
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