Attachment_6_-_Form_DD200_-_FLIPL.pdf

PDF 67 KB Posted Feb 20, 2018

Attached to: Consequence Management Support Center (CoMSupCen) Federal contract opportunity
Solicitation number: W9133L-18-R-0008
Issued by: Department of the Army National Guard

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Attachment 6 - Form DD200 - FLIPL

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Other files for this federal contract opportunity

Other files attached to Consequence Management Support Center (CoMSupCen), newest first.
File	Type	Posted
W9133L-18-R-0008-0005.pdf	PDF	Apr 12, 2018
Revised_Final_Clarification.pdf	PDF	Apr 12, 2018
Clarification_Q&A_Government_Responses.pdf	PDF	Apr 9, 2018
W9133L-18-R-0008-0004.pdf	PDF	Apr 9, 2018
W9133L-18-R-0008-03.pdf	PDF	Apr 4, 2018
W9133L-18-R-0008-0002.pdf	PDF	Mar 28, 2018
W9133L-18-R-0008_AMENDMENT_01_FINAL.pdf	PDF	Mar 20, 2018
Remaining_CoMSupCen_Questions_20_MAR_18.xlsx	XLSX spreadsheet	Mar 20, 2018
Q&A_CoMSupCen_W9133L-18-R-0008.xlsx	XLSX spreadsheet	Mar 15, 2018
CoMSupCen_PPQ_Form.pdf	PDF	Mar 12, 2018
CoMSupCen_101_Brief.pptx	PPTX presentation	Mar 12, 2018
Pre-Proposal_Slides.pptx	PPTX presentation	Mar 12, 2018
Attachment_12_-_CoMSupCen_-_DD-0254.pdf	PDF	Feb 20, 2018
Attachment_7_-_Historical_Workload_Data.pdf	PDF	Feb 20, 2018
Attachment_10_-_SCA_Wage_Determination_15-4683_-_Rev_03.pdf	PDF	Feb 20, 2018
Attachment_13_-_Within_Scope_Tasks.pdf	PDF	Feb 20, 2018
Attachment_4_-_Authorized_Stockage_List.pdf	PDF	Feb 20, 2018
Pre-Proposal_Conference_Agenda.pdf	PDF	Feb 20, 2018
Attachment_5_-_Government_Furnished_Equipment.pdf	PDF	Feb 20, 2018
Attachment_11_-_CoMSupCen_-_PWS_-_v18.pdf	PDF	Feb 20, 2018
Attachment_14_-_Pricing_Worksheet.xlsx	XLSX spreadsheet	Feb 20, 2018
W9133L-18-R-0008_FINAL.pdf	PDF	Feb 20, 2018
Attachment_8_-_Examples_of_the_current_equipment_shelf-life_and_calibration_requirements.pdf	PDF	Feb 20, 2018
Attachment_2_-_Building_Photographs.pdf	PDF	Feb 20, 2018
Attachment_9_-_Equipment_Certifications.pdf	PDF	Feb 20, 2018
Attachment_1_-_Facility_Layout.pdf	PDF	Feb 20, 2018
Attachment_3_-_Mission_Essential_Equipment_List.pdf	PDF	Feb 20, 2018
Attachment_6_-_Form_DD200_-_FLIPL.pdf	PDF	Nov 17, 2017
Attachment_7_-_Historical_Workload_Data.pdf	PDF	Nov 17, 2017
Attachment_4_-_Authorized_Stockage_List.pdf	PDF	Nov 17, 2017
Attachment_8_-_Examples_of_the_current_equipment_shelf-life_and_calibration_requirements.pdf	PDF	Nov 17, 2017
Attachment_1_-_Facility_Layout.pdf	PDF	Nov 17, 2017
Attachment_11_-_CoMSupCen_-_PWS_-_v18.pdf	PDF	Nov 17, 2017
Attachment_2_-_Building_Photographs.pdf	PDF	Nov 17, 2017
Attachment_9_-_Equipment_Certifications.pdf	PDF	Nov 17, 2017
Attachment_5_-_Government_Furnished_Equipment.pdf	PDF	Nov 17, 2017
W9133L-18-R-0008_17NOV17.pdf	PDF	Nov 17, 2017
Attachment_3_-_Mission_Essential_Equipment_List.pdf	PDF	Nov 17, 2017
Attachment_10_-_SCA_Wage_Determination_15-4683_-_Rev_03.pdf	PDF	Nov 17, 2017

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FINANCIAL LIABILITY INVESTIGATION OF PROPERTY LOSS

1. DATE INITIATED (YYYYMMDD)

3. DATE LOSS DISCOVERED

(YYYYMMDD)

2. INQUIRY/INVESTIGATION NUMBER

4. NATIONAL STOCK NO.

5. ITEM DESCRIPTION

6. QUANTITY

8. TOTAL COST

7. UNIT COST

9. CIRCUMSTANCES UNDER WHICH PROPERTY WAS (X one) (Attach additional pages as necessary)

10. ACTIONS TAKEN TO CORRECT CIRCUMSTANCES REPORTED IN BLOCK 9 AND PREVENT FUTURE OCCURRENCES (Attach additional pages as necessary) Lost Organization

OCIE

Installation Destroyed Damaged

11. INDIVIDUAL COMPLETING BLOCKS 1 THROUGH 10

13. APPOINTING AUTHORITY

d. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

c. LEGAL REVIEW

COMPLETED IF

REQUIRED (X one)

b. COMMENTS/RATIONALE

a. RECOMMENDATION (X one)

14. APPROVING AUTHORITY

12. (X one)

a. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

g. DATE SIGNED

e. DSN NUMBER

d. TYPED NAME (Last, First, Middle Initial)

c. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

g. SIGNATURE

h. DATE SIGNED

f. DSN NUMBER

e. TYPED NAME (Last, First, Middle Initial)

h. DATE SIGNED

f. DSN NUMBER

e. TYPED NAME (Last, First, Middle Initial)

d. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

b. TYPED NAME (Last, First, Middle Initial)

d. SIGNATURE

f. SIGNATURE

c. DSN NUMBER

e. DATE SIGNED

RESPONSIBLE OFFICER (PROPERTY RECORD ITEMS

REVIEWING AUTHORITY (SUPPLY SYSTEM STOCKS)

a. NEGLIGENCE OR

ABUSE EVIDENT/

SUSPECTED (X one)

b. COMMENTS/RECOMMENDATIONS

b. COMMENTS/RATIONALE

a. RECOMMENDATION (X one)

c. FINANCIAL LIABILITY

OFFICER APPOINTED

(X one)

YES

APPROVE

DISAPPROVE

APPROVE

DISAPPROVE

DD FORM 200, JUL 2009

PREVIOUS EDITION IS OBSOLETE.

Adobe Designer 8.0

YES

N/A

15. FINANCIAL LIABILITY OFFICER

a. FINDINGS AND RECOMMENDATIONS (Attach additional pages as necessary)

a. DOCUMENT NUMBER(S) USED TO ADJUST PROPERTY RECORD

a. I HAVE EXAMINED THE FINDINGS AND RECOMMENDATIONS OF THE FINANCIAL LIABILITY OFFICER AND (X one)

b. I HAVE BEEN INFORMED OF MY RIGHT TO LEGAL ADVICE. MY SIGNATURE IS NOT AN ADMISSION OF LIABILITY.

b. DOLLAR AMOUNT OF LOSS

d. RECOMMENDED FINANCIAL LIABILITY

c. MONTHLY BASIC PAY

g. DSN NUMBER

d. DSN NUMBER

e. DSN NUMBER

f. TYPED NAME (Last, First, Middle Initial)

h. DATE SUBMITTED TO APPOINTING

AUTHORITY (YYYYMMDD)

i. DATE APPOINTED

(YYYYMMDD)

e. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

d. TYPED NAME (Last, First, Middle Initial)

c. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

c. TYPED NAME (Last, First, Middle Initial)

b. ORGANIZATIONAL ADDRESS (Unit Designation, Office Symbol, Base, State/Country, ZIP Code)

k. DATE SIGNED

j. SIGNATURE

g. DATE SIGNED

f. SIGNATURE

f. DATE SIGNED

e. SIGNATURE

16. INDIVIDUAL CHARGED

17. ACCOUNTABLE OFFICER

Submit the attached statement of objection.

Do not intend to make such a statement.

DD FORM 200 (BACK), JUL 2009

2. INQUIRY/INVESTIGATION NUMBER

1. DATE INITIATED (YYYYMMDD)

CONTINUATION OF BLOCKS 4 - 8

TOTAL COST

UNIT COST

QUANTITY

ITEM

NO.

ITEM DESCRIPTION

4. NATIONAL STOCK NO.

LINE ITEM NO.

Page Pages of

FOR INTERMITTENT PAGES, ENTER SUBTOTAL:

IF LAST PAGE, ENTER GRAND TOTAL:

DD FORM 200, JUL 2009

2. INQUIRY/INVESTIGATION NUMBER

1. DATE INITIATED (YYYYMMDD)

Pages of Page CONTINUATION OF BLOCKS 9, 10, AND/OR 15.a.

Use this area to continue each item as necessary. Specify item number.

DD FORM 200, JUL 2009

8.0.1291.1.339988.308172

WHS/ESD/IMD

DD Form 200, Financial Liability Investigation of Property Loss, July 2009

1. Date initiated (4 digit year, 2 digit month, 2 digit day, no dividers).:

2. Inquiry/investigation number.:

3. Date loss discovered (4 digit year, 2 digit month, 2 digit day).:

4. National stock number.:

5. Item description.:

6. Quantity.:

7. Unit cost.:

16. Individual charged. a. I have examined the findings and recommendations and: X first box if submitt attached statement of objection or second box if do not intend to make such a statement.:

9. Circumstances under which property was lost, destroyed, or damaged. Attach additional pages as necessary.:

10. Actions taken to correct circumstances reported in block 9 and prevent future occurrences.:

d. Organizational address (unit designation, office symbol, base, state/country, zip code).:

b. Comments/rationale.:

g. Date signed (4 digit year, 2 digit month, 2 digit day).:

e. DSN number.:

d. Typed name (last, first, middle initial).:

c. Organizational address (unit designation, office symbol, base, state/country, zip code).:

h. Date signed (4 digit year, 2 digit month, 2 digit day).:

f. DSN number.:

e. Typed name (last, first, middle initial).:

h. Date signed (4 digit year, 2 digit month, 2 digit day).:

f. DSN number.:

e. Typed name (last, first, middle initial).:

d. Organizational address (unit designation, office symbol, base, state/country, zip code).:

11. Individual completing blocks 1 through 10. a. Organizational address (unit designation, office symbol, base, state/country, zip code).:

b. Typed name (last, first, middle initial).:

c. DSN number.:

e. Signature.:

e. Date signed (4 digit year, 2 digit month, 2 digit day).:

b. Comments/rationale.:

b. Comments/recommendations.:

Button1:

Button2:

15. Financial liability officer. a. Findings and recommendations. Attach additional pages as necessary.:

b. Dollar amount of loss.:

d. Recommended financial liability.:

c. Monthly basic pay.:

g. DSN number.:

d. DSN number.:

e. DSN number.:

f. Typed name (last, first, middle initial).:

e. Organizational address (unit designation, office symbol, base, state/country, zip code).:

d. Typed name (last, first, middle initial).:

c. Organizational address (unit designation, office symbol, base, state/country, zip code).:

c. Typed name (last, first, middle initial).:

b. Organizational address (unit designation, office symbol, base, state/country, zip code).:

h. Date submitted to appointing authority (4 digit year, 2 digit month, 2 digit day).:

i. Date appointed (4 digit year, 2 digit month, 2 digit day).:

k. Date signed (4 digit year, 2 digit month, 2 digit day).:

g. Date signed (4 digit year, 2 digit month, 2 digit day).:

f. Date signed (4 digit year, 2 digit month, 2 digit day).:

17. Accountable officer. a. Document number(s) used to adjust property record.:

Click this Reset button to erase data from all fields.:

7. Unit cost.:

6. Quantity.:

Item number.:

Grand total.:

Subtotal of this page.:

Page number of this page.:

Total number of pages.:

Button3:

continue:

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