Free SD Form 419, OSD Request for Contracted Advisory and Assistance Services, September 1993 - Federal

(Classification)

OFFICE OF THE SECRETARY OF DEFENSE REQUEST FOR CONTRACTED ADVISORY AND ASSISTANCE SERVICES (CAAS)
(If additional space is required, attach separate sheet and identify by block number) NO YES (Specify and cite appropriate contract number and contract title) 2. DATE OF SUBMISSION (YYMMDD) 4. PROJECT TITLE 5. PROJECT SECURITY CLASSIFICATION 1. OSD/OJCS REQUESTING ACTIVITY ANNUAL PLAN NUMBER 3. IS THIS A CONTRACT MODIFICATION, RENEWAL, OR EXTENSION? (X one)

6a. COGNIZANT OFFICER/CONTRACT OFFICER'S TECHNICAL REPRESENTATIVE (COTR) (1) NAME (Last, First, Middle Initial) (2) ROOM NUMBER b. CONTRACT OFFICER REPRESENTATIVE (COR) (Applicable only if FFRDC (FCRC)) (1) NAME (Last, First, Middle Initial) (2) ROOM NUMBER 7. BUDGET/PROGRAM DATA a. ESTIMATED AMOUNT OF PURCHASE (Attach computation/cost proposal) d. TYPE OF APPROPRIATION (X appropriate block) (1) O&M (2) PROCUREMENT b. FISCAL YEAR OF DOLLARS: FY c. PROGRAM ELEMENT: PE

(3) PHONE NUMBER

(3) PHONE NUMBER

e. OPTION-YEAR CONTRACT (O&M $ ONLY) f. INCREMENTALLY FUNDED (RDT&E $ ONLY)

YES YES

NO NO

(3) RDT&E (4) OTHER FUNDS (Specify) g. FOLLOW-ON ANTICIPATED YES NO h. FUNDS TRANSFER INFORMATION (X and complete one or more as applicable) (1) MILITARY INTERDEPART(Original copy of MIPR must be attached or previously sent to WHS Budget and Finance Directorate.) MENTAL PURCHASE REQUEST (MIPR) FROM: (2) MILITARY INTERDEPARTMENTAL PURCHASE REQUEST (MIPR) TO: (3) INTERAGENCY AGREEMENT (IA) OF MEMORANDUM OF UNDERSTANDING (MOU):
(Provide name of organization, complete mailing address, name of POC, and phone numbers.)

(Attach copy of IA or MOU with name of organization, complete mailing address, name of POC, and phone numbers.)

8. APPROPRIATION AND ACCOUNTING CLASSIFICATION 9. COORDINATION a. TYPED NAME (Last, First, MI) (1) (2) (3) (4) (5) (6) (7) (8) 10. APPROVING OFFICIAL
WHEN THIS FORM IS USED TO PROCURE CONTRACT SERVICES OUTSIDE THE GOVERNMENT, I CERTIFY THAT NO DOD OR GOVERNMENTAL SOURCES ARE AVAILABLE OR ADEQUATE TO PERFORM THE PROPOSED WORK.

b. OFFICE DESIGNATION OSD Study Coordinator

c. FAX NO.

d. DATE

e. INITIALS

a. TYPED NAME (Last, First, MI)

b. TITLE

c. SIGNATURE

d. DATE SIGNED (YYMMDD)

11. DIRECTORATE FOR BUDGET AND FINANCE (WHS), PROGRAM REVIEW VERIFIED AND PROPERLY CHARGEABLE. a. TYPED NAME (Last, First, MI) b. TITLE c. SIGNATURE d. DATE SIGNED (YYMMDD)

SD Form 419, SEP 93
(Classification)

Previous editions may be used until exhausted.

Adobe Professional 8.0

(Classification) 12. STATEMENT OF WORK

13. TERMS OF CONTRACT, SCHEDULE OF PERFORMANCE, REPORTS AND SERVICES TO BE DELIVERED, OR SERVICES TO BE ACQUIRED BY GOVERNMENT.

14a. IS THIS PROCUREMENT IN RESPONSE TO (X one) (1) TECHNICAL REQUEST (2) UNSOLICITED PROPOSAL (3) OTHER (Specify)

14b. IS THIS PROCUREMENT (X one) (1) COMPETITIVE (Attach list of suggested sources in block 15.) (2) FFRDC (FCRC) (3) SOLE SOURCE (Identify contractor in block 15 and attach written justification.)

15. RECOMMENDED SOURCES IF COMPETITIVE. IF SOLE SOURCE, LIST NAME AND ADDRESS OF CONTRACTOR.

16. DEFENSE TECHNICAL INFORMATION CENTER (DTIC)
a. WAS DTIC AND OTHER RESOURCES SEARCHED TO SEE IF SIMILAR SERVICES WERE PERFORMED PREVIOUSLY TO AVOID DUPLICATION?

(1) YES (2) NO

(3) IF NO, WHY NOT?

b. WAS THE INITIATION OF THIS PROJECT/STUDY REPORTED TO DTIC? (3) IF NO, WHY NOT? (1) YES
(Attach DD 1498)

(2) NO 17. CODING DATA (To be provided by sponsoring organization) a. PB 27 CATEGORY b. RECOMMENDED PRODUCT SERVICE CODE c. IS THIS A CONSULTING CONTRACT? (1) YES (2) NO 18. PROPERTY REQUIRED BY CONTRACTOR (X as appropriate and enumerate by attachment.) a. GOVERNMENT b. OTHER

SD Form 419, SEP 93 (BACK)
(Classification)

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