DA_Fm5479_MAR2008.pdf
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- FACILITIES INVESTMENT SERVICES_REGION 6 FOR THE 63d READINESS DIVISION (RD) US ARMY RESERVES
- Solicitation number
- W9127S21Q0056
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6.
2. 3.
PREPARED ORAL NOTIFICATION RETURNED BY CONTRACTOR ACTION COMPLETE
4. DISCREPANCY OR PROBLEM (Describe in Detail: Include reference in PWS / Directive: Attach continuation sheet if necessary.)
5. SIGNATURE OF CONTRACTING OFFICER
7.
8. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. ATTACH
1. CONTRACT NUMBER
9. SIGNATURE OF CONTRACTOR REPRESENTATIVE 10. DATE
11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, rejection: attach continuation sheet if necessary)
12. GOVERNMENT ACTIONS (Payment deduction, cure notice, show cause, other.)
CONTRACT DISCREPANCY REPORT
For use of this form, see DA PAM 5-20; the proponent agency is ACSIM.
TO: (Contractor and Manager Name)
DATES
CLOSE OUT
CONTRACTOR
NOTIFIED
NAME AND TITLE SIGNATURE DATE
QAE
CONTRACTING
OFFICER
CONTINUATION SHEET IF NECESSARY. (Cite applicable Q.A. program procedures or new A.W. procedures.)
DA FORM 5479, MAR 2008 APD LC v1.01ES
FROM: (Name of QAE)
TO: (Contracting Officer) FROM: (Contractor)
PREVIOUS EDITIONS ARE OBSOLETE.
6.
2.
3.
PREPARED
ORAL NOTIFICATION
RETURNED BY CONTRACTOR
ACTION COMPLETE
4. DISCREPANCY OR PROBLEM
(Describe in Detail: Include reference in PWS / Directive: Attach continuation sheet if necessary.)
5. SIGNATURE OF CONTRACTING OFFICER
7.
8. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE. ATTACH
1. CONTRACT NUMBER
9. SIGNATURE OF CONTRACTOR REPRESENTATIVE
10. DATE
11. GOVERNMENT EVALUATION
(Acceptance, partial acceptance, rejection: attach continuation sheet if necessary)
12. GOVERNMENT ACTIONS
(Payment deduction, cure notice, show cause, other.)
CONTRACT DISCREPANCY REPORT
For use of this form, see DA PAM 5-20; the proponent agency is ACSIM.
TO:
(Contractor and Manager Name)
DATES
CLOSE OUT
CONTRACTOR
NOTIFIED
NAME AND TITLE
SIGNATURE
DATE
QAE
CONTRACTING
OFFICER
CONTINUATION SHEET IF NECESSARY.
(Cite applicable Q.A. program procedures or new A.W. procedures.)
DA FORM 5479, MAR 2008
APD LC v1.01ES
FROM:
(Name of QAE)
TO:
(Contracting Officer)
FROM:
(Contractor)
PREVIOUS EDITIONS ARE OBSOLETE.
1.01
DA FORM 5479, MAR 2008
CONTRACT DISCREPANCY REPORT
APD
| CONTRACT: |
| TO_A: |
| FROM_A: |
| PREPARED: |
| ORALNOTE: |
| RETURN: |
| ACTION: |
| PROBLEM: |
| SIGN_A: |
| signature_BUTTON1: |
| TO_B: |
| FROM_B: |
| CONTRACTR: |
| SIGN_B: |
| signature_BUTTON2: |
| DATE_A: |
| GOVERNMNT: |
| GOVMTACTN: |
| NAME_A: |
| signature_BUTTON3: |
| SIGN_C: |
| DATE_B: |
| NAME_B: |
| signature_BUTTON4: |
| SIGN_D: |
| DATE_C: |
| NAME_C: |
| signature_BUTTON5: |
| SIGN_E: |
| DATE_D: |
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