PART 53 – FORMS

SUBPART 53.2 – PRESCRIPTION OF FORMS

53.213 Small purchase and other simplified purchase procedures.

53.213-90 Blanket purchase agreement delivery ticket (DLA Form 470).

53.213-91 Shipping Instruction (DLA Form 1224).

53.213-92 Request for Quotation (DLA Form 1231).

53.219 Small business and small disadvantaged business concerns.

53.219-90 Referral of Small Business for Certificate of Competency (CoC) Consideration (DLA Form

1756).

SUBPART 53.3 – ILLUSTRATION OF FORMS

53.300 General.

SUBPART 53.90 – FORMATS AND TEMPLATES

53.9001 Appointment of ordering officer.

53.9007 Acquisition planning.

53.9013 Simplified acquisition procedures.

53.9015 Contracting by negotiation.

SUBPART 53.2 – PRESCRIPTION OF FORMS

(Revised September 19, 2016 through PROCLTR 2016-09)

53.213 Small purchase and other simplified purchase procedures.

53.213-90 Blanket purchase agreement delivery ticket (DLA Form 470).

This form may be used when supplies or services are acquired by means of a blanket purchase

agreement (BPA).

(a) General. The Defense Logistics Agency (DLA) Form 470 is a cut sheet form and is designed to be

used by the vendor as an acknowledgment of a call, notice of shipment, packing list, and invoice.

This form eliminates the need for preparation, by the Contractor, of separate forms for these

purposes. Also, Government personnel requiring information on these forms will receive it on a
standard format.

(b) Procedure. A supply of the forms may be provided by the contracting office to each Contractor

who has entered into a BPA with the center. Upon the placing of a call, the Contractor may be

required to complete the BPA delivery ticket based on information contained in the written or oral

call in accordance with detailed instructions to be provided by the contracting office.

(c) General instructions for preparation of DLA Form 470. After the placing of each call, complete

the call, complete the form in accordance with the general instructions below, and any specific

instructions received with the placing of the call.

(1) Block 11. This is the date the supplies are to reach destination, not the date of shipment. Convert

the number of delivery days the Government offered to an actual date. For example, if the

Government offered a 30-day delivery and received the oral or written call on 1 October, enter

10/31/YY as the required date.

(2) Block 12. This is the date the supplies are to be shipped, not delivered.

(3) Blocks 13 through 19. Information for these blocks will be furnished by the contracting office at

the time of the call. Enter the name and address of the consignee in block 15.

(4) Blocks 21 through 23. Entries in these blocks will be made at the time of shipment. Enter actual

date shipped or delivered. No partial shipments to a particular destination may be made. If more

than one shipment is made against a call, prepare two copies of this form for shipment. Copies of the

shipping documents may be attached as an alternative to completing blocks 21 and 22.

(5) When using the form as an acknowledgment of call. Place a check mark on "*" copies of the form

in the box "Acknowledgment of call" (block 9).

(6) When using this form as a notice of shipment. Place a check mark in the box "Packing list" (block

9) on "*" copies of the form in the box "Notice of shipment" (block 9).

(7) When using the form as a packing list. Place a check mark in the box "packing list" (block 9) on

"*" copies of the reproduced form for each consignee. Be sure blocks 21 through 23 have been

completed, as applicable, on the forms used. Send "*" copies to each consignee by placing copies

inside the container or in an envelope attached to the exterior of the container.

(8) When using this form as an invoice. At the end of the billing period, fill in "*" copies of the

reproduced form which includes the shipment data for all destinations of that call as follows:

(i) Place a mark in the box marked invoice (block 9) of each copy of the form.

(ii) Sign and date blocks 24 and 25 of the top copy only of the form. If the BPA under which this call

was issued does not provide for the fast payment procedure, the top copy must contain the signature

and date (blocks 27A and 27B) of the authorized Government representative receiving and/or

accepting for the Government.

"*" The number required shall be in accordance with the needs of the contracting office.

53.213-91 Shipping Instruction (DLA Form 1224).

This form is used against automated simplified acquisitions.
53.213-92 Request for Quotation (DLA Form 1231).

This form is used against automated simplified acquisitions.

53.219 Small business and small disadvantaged business concerns.

53.219-90 Referral of Small Business for Certificate of Competency (CoC) Consideration

(DLA Form 1756).

(a) DLA Form 1756 may be used to provide information for CoC referrals as required by FAR

19.602-1 and DFARS 219.602-1.

(b) General instructions for preparation of DLA Form 1756:

(1) The name, size status, and total dollar value of the next low offeror should be identified, however,

referrals shall not urge a conclusion based upon the size status of the second low offeror.

(2) The remaining blocks of the form are self-explanatory.

SUBPART 53.3 – ILLUSTRATION OF FORMS

(Revised August 14, 2019 through PROCLTR 2019-18)

53.300 General.

DLA forms are electronically maintained at DLA Official Forms ( https://www.dla.mil/Forms/ ).

SUBPART 53.90 – FORMATS AND TEMPLATES

(Revised June 9, 2021 through PROCLTR 2021-11)

53.9001 Appointment of ordering officer.

(a) As prescribed in 1.603-3-91 (c)(2), use the following appointment letter for ordering officers:

Appointment of Ordering Officer

[Contracting officer insert IDC or BPA number and name of procuring organization]

1. Appointment. Under the authority of DLAD 1.603-3-91, you are hereby appointed as an Ordering

Officer with authority as described in paragraph 2 below. Your appointment is effective on [
contracting officer insert date ]. This appointment automatically terminates when the Indefinite

Delivery Contract (IDC) or Blanket Purchase Agreement (BPA) is completed. Your appointment may

also be terminated in accordance with paragraph 4 below.

2. Authority, Limitations, and Requirements. Your ordering authority is only applicable to [

contracting officer insert IDC or BPA number ]. Your appointment is subject to the following

limitations and requirements:

a. You are not authorized to—

(1) Delegate your ordering authority.

(2) Place an order for supplies or services not expressly within the scope of the IDC or BPA.

(3) Take any action that could be considered an alteration of the terms and conditions of the IDC or

BPA in any way, either directly or by implication.

(4) Take any action that could be considered a termination of the IDC or BPA in any way, either

directly or by implication.

(5) Issue modifications to the IDC, BPA, or individual orders.

(6) Issue instructions to the contractor to start or stop work.

(8) Additional limitations: [contracting officer insert if applicable].

b. You shall—

(1) Place orders for supplies or services only when expressly within the scope of the IDC or BPA.

(2) Promptly notify me if you recommend increasing the quantity or dollar value or extending the

ordering period to meet emergency requirements, if the contract terms and conditions permit.

(3) Establish and maintain an official ordering officer file for each IDC and BPA for which you are

authorized as an ordering officer. At a minimum, you shall include in each file the appointment letter

and a spreadsheet listing all orders issued by you.

(4) Provide the list of orders to me by the [ contracting officer insert ] day of each month.

(5) Additional requirements: [contracting officer insert if applicable].

3. Standards of Conduct and Contracting Action Reporting Requirements.

a. You shall comply with the standards of conduct prescribed in DoD Directive 5500.07, Standards of

Conduct, and DoD 5000.07-R, The Joint Ethics Regulation (JER), and FAR Subparts 3.1 and 3.2.

b. You shall provide me information required for contracting action reporting purposes in the

manner and the time specified. (Refer to DFARS 204.6.)

4. Termination of Appointment.

a. Your appointment may be terminated at any time and shall be terminated in writing; except that

your appointment is automatically terminated when the contract is completed or when you leave

Government employment.
b. If you are separated from Government service while this appointment is in effect, you shall

promptly notify me in writing. Your appointment shall automatically be terminated on the date you

are separated from Government service.

c. If you are reassigned from your present position while this appointment is in effect, you shall

promptly notify me in writing. I will terminate your appointment in writing if you are reassigned to a

location or position that is inconsistent with continuing as an ordering officer under this

appointment.

d. Your appointment will be terminated if—

(1) You exceed or fail to perform within the appointment authority.

(2) You fail to complete assigned corrective actions noted during oversight reviews.

5. Disposition of completed ordering officer files. Upon completion of the IDC or BPA, you shall

provide me any hard copy records you maintained. If your appointment is terminated before IDC or

BPA completion, you shall provide the records to me and your successor.

6. Acknowledgement of Receipt. You are required to acknowledge receipt and understanding of this

appointment by signing below. Return a copy of the signed appointment letter to me.

(contracting officer insert) (contracting officer insert) (contracting officer insert)

Contracting Officer Name Contracting Officer Signature Date

(ordering officer insert) (ordering officer insert) (ordering officer insert)

Ordering Officer Name Ordering Officer Signature Date

53.9007 Acquisition planning.

(a) Template - Streamlined Acquisition Plan (SAP).

The following format may be used as prescribed in 7.103 Agency–head responsibilities. (d)(i)(B). This

Streamlined Acquisition Plan (SAP) format is for illustration purposes only. It mirrors the fillable

version in the contract writing system.

For Official Use Only

Source Selection Information -- See FAR 2.101 and 3.104

Streamlined Acquisition Plan (SAP)

(Complete and select the box that is appropriate for the acquisition situation)

Date:      
Contracting office:      Contracting officer name:      

Requiring activity:      Voice (DSN):      

Project title:      Fax (DSN):      

Supply criticality:      

Contracting officer’s e-mail address:      

Purchase request (PR) or control number:      

Construction Service Supply Research and development (R&D)

a. Product Service Code: (Specify for services)      

b. Services Portfolio Category: (Specify for services)      

I. Brief description of requirement (FAR 7.105(a)(1))

a. Government estimate: $       (include all options and surge values)

b. Period of performance       (include options)

c. Delivery schedule:      

II. Proposed acquisition approach

Extent of competition:

Full and open competition

Other than full and open competition* * FAR 6.3 authority (Specify):      

Full and open after exclusion of sources

Competitive non-DoD

For Official Use Only

Source Selection Information -- See FAR 2.101 and 3.104

Mandatory use policy, including waivers (e.g., under Part 8)

Limited sources (e.g. under Part 8.405-6):      

b. Small business set-aside: (See FAR Part 19)

Competitive small business set-aside (SBSA)

Competitive 8a Sole source 8a

Service Disabled Veteran Owned Small Business (SDVOSB) Set-Aside

SDVOSB sole source
Historically underutilized business zone (HubZone) Sole Source

HubZone set-aside

Small disadvantaged women owned business (SDWOB)

Economically disadvantaged women owned small business (EDWOSB)

Historically Black colleges and universities / minority institutions (HBCU/MI)

Not applicable (NA) (If acquisition is unrestricted)

Other (Specify):      

c. Procedures: (Check all that apply)

FAR 8.404 (GSA/Non-DoD Competitive) FAR 12 Commercial Items

FAR 13 Simplified Acquisition Procedures FAR 14 Sealed Bidding

FAR 15 Negotiation FAR 36 Construction and Architect and Engineer (A&E) and design build

d. Contracting method

Invitation for bid (IFB)

Competitive request for proposal (RFP)

Sole source RFP

Other (fill-in)

e.Basis of award:

Sealed bid – Part 14

Negotiation – Part 15

Lowest price technically acceptable

Performance price trade-off without technical factors/proposal

Performance price trade-off with technical factors/proposal

Full trade off source selection (an acquisition plan is highly recommended)

General Services Administration (GSA)/non-DoD competitive

Other (explain):      

Identify evaluation factors:      

For Official Use Only

Source Selection Information -- See FAR 2.101 and 3.104
f. Contract type (Check all that apply):

Fixed-price Time and material/labor hour agreements Economic price adjustment

Incentive Award fee Cost-reimbursement Redetermination

Indefinite delivery contract (IDC) Multiply Award

Single Award (Provide rationale why single award)      

Other (Specify):      

g. Sustainability:

Contains sustainability requirements.

Sustainability exception applies: (Specify)      

Sustainability requirements waived, approved by: (Specify)      

h. Other considerations (Check all that apply):

Progress payment Warranty First article test (FAT)

Government furnished property(GFP) / Government furnished material (GFM) / Government

furnished equipment (GFE) involved

Other (specify). Other items/considerations may include, Non-Economy Act or Economy Act assisted

acquisitions and use of reverse auction)      

III. Prior procurement history: (If applicable)

IV. Market research: (Discuss the purpose, nature, extent, involved personnel/offices and

results/status, commerciality, and estimated completion date of any market research initiated/to be

initiated in support of the instant purchase request or anticipated future requirements (see also

FAR, DFARS, and DLAD Parts 10, 11)

V. Problems /risk/vulnerabilities (See FAR 7.105 and DFARS PGI 207.105)

VI. Projected key milestone dates:

Receive purchase request (PR):      

Issue solicitation:      

Receive bids/offers:      

Complete evaluations:      

Award contract:      

Contract start:      

Contracting Officer Name and SignatureDate
VII. Approvals:

For Official Use Only

Source Selection Information -- See FAR 2.101 and 3.104

**The following section is to be completed by reviewer/approving official.**

Reviewer’s name:       Reviewer’s DSN/ phone number:      

Reviewer’s e-mail:      

Streamlined acquisition plan (SAP) approved as submitted      

SAP conditionally approved subject to comments below

SAP disapproved (reviewers are required to include comments below)

Requirement has been reviewed and validated by (specify):      

Reviewer’s comments:      

Reviewer’s signature: ______________________

** The following section is to be completed by the small business specialist when required**

Small business specialist coordination _____________________________

Small business specialist's comments:      

** The following section is to be completed by the competition advocate when required**

Competition Advocate coordination _____________________________

Competition advocate’s comments:      

53.9013 Simplified acquisition procedures.

(a) Simplified Acquisition Award Documentation (SAAD).

Contracting officers at DLA Aviation, DLA Land and Maritime, and DLA Troop Support shall use the

following format as prescribed in 13.106-3 Award and documentation. (b), 13.501 Special

documentation requirements.(b) (3), and 15.406-1 Prenegotiation objectives.. (Mark “FOR OFFICIAL

USE ONLY”, when applicable, at the bottom of the outside of the front cover (if there is one), the

title page, the first page, and the outside of the back cover (if there is one) pursuant to DOD Manual

5200.1, Vol 4, Enclosure 3, 2.c.(3)(b).) This Simplified Acquisition Award Documentation (SAAD)

format is for illustration purposes only. It mirrors the fillable version in the contract writing system.

Simplified Acquisition Award Documentation (SAAD)

The SAAD documents Best Value, Price Reasonableness, and Responsibility determinations for this

procurement.
Particulars Regarding This Procurement:

Buyer:

PR#:

NSN (if applicable):

Item/Requirement Description:

Awardee CAGE Code:

Check all that apply and insert narrative when required:

☐ Procurement is a First Time Buy

☐ Commercial

☐ For non-competitive actions over $1M Contract Business Analysis Repository (CBAR) was checked

IAW DLAD 15.404-1 Proposal analysis techniques.(a)(5)(S-90)

☐ Fast Pay (FAR 13.402(a)-(f))

☐ Special Emergency Procurement Authority (SEPA) Acquisition (FAR 18.001)

☐ Simplified Indefinite-Delivery Contract (SIDC). The contracting officer established a guaranteed

minimum (GM) quantity or GM dollar value for the period of performance of the basic SIDC,

recorded an obligation in the amount of the GM purchase requirement ($________) at time of award,

and placed the EBS screen shot documenting the obligation in the contract file IAW DLAD

13.390(a)(2)(i).

Best Value Tradeoff Determination: Required when awarding to other than the lowest

price/highest SPRS rating (or to other than the lowest price/highest scored when using

FAR 13.5 or when other evaluation factors apply).

☐ Based on the evaluation factors stated within the solicitation, the proposed awardee’s quote is the

best value for the Government as set forth in the narrative below.

Narrative:

CUI Designation Indicator

Controlled by: [Name of Procuring Organization]

Controlled by: [Name of Office or Branch]

CUI Category: PROCURE (General Procurement)

Distribution/Dissemination Control: FED ONLY

POC: [Phone or email address]

Price Reasonableness Determination
Limitation on Price Increases (DFARS 217.7505/DLAD 17.7505 Limitations on price increases.

):

For Micro-Purchases:

☐ Unit Price has not increased 51% or more within the past 12 months.

☐ Unit Price has increased 51% or more within the past 12 months. Contracting officer has evaluated

price and will notify HCA (or HCA’s designee) prior to award.

For actions above the micro-purchase threshold documented using simplified acquisition

procedures:

☐ Unit Price has not increased 25% or more within the past 12 months.

☐ Unit Price has increased 25% or more within the past 12 months. Contracting officer has evaluated

price and will notify HCA (or HCA’s designee) prior to award.

Price Reasonableness Code (PRC):

Basis for Award- FAR 13.106-3(a), DLAD 13.106-3(a) & DLAD 15.406-3 Documenting the

negotiation. (a)(11)15.406-3 Documenting the negotiation. :

Price is Fair and Reasonable in accordance with (check blocks below as applicable AND

complete Narrative at end of this section);

☐ Adequate Price Competition – Manufacturer Competition

☐ Adequate Price Competition – Among Providers of Services

☐ Adequate Price Competition – Dealer Competition (only use below SAT). Offered prices are

independent, and otherwise successful offeror’s price is not unreasonable. Provide documentation

in Narrative block.

☐ No Competition (single quote or noncompetitive price range).

Select one of the following:

☐ Market Research (describe in Narrative block; or attach and reference in Narrative block)

☐ Item price set by law or regulation

☐ Independent Government Estimate (IGE). Attach the IGE, if Contracting Officer determines IGE

required adjustment, address in Narrative block.

☐ Comparison of the proposed price to prices found reasonable on previous purchases: Provide

analysis in Narrative block.

☐ Same Item: ☐ Similar Item (NSN or Item Description):

Contract(s):

Unit Price(s):
Quantity:

PRC applicable previous purchase:

Prior award determined fair and reasonable based on:

☐ Current price list, catalog, or advertised unit price: Describe in Narrative block.

☐ Contracting officer’s knowledge of the item. Describe in Narrative block.

☐ Any other reasonable basis (e.g., informal cost breakdown) Describe in Narrative block.

Price is other than Fair and Reasonable and proceeding after proper elevation IAW DLAD

15.405(d)(S-90) (check blocks below as applicable AND complete Narrative at end of this section);

☐ Price is unfair and unreasonable. Complete Narrative block.

☐ Price could not be determined fair and reasonable. Complete Narrative block.

Narrative (Must address any price increase since last purchase along with any negotiations

that were conducted. Attach or provide the location within the contract file for all

supporting documentation):

Determination of Responsibility:

Check all applicable blocks and complete Narrative when required:

☐ Confirmed whether contractor is on the Defense Contract Review List (DCRL) and followed

applicable Treatment Codes.

☐ Contracting officer checked SAM.gov (FAR 9.405(d)(4)). Awardee is not debarred, suspended, or

proposed for suspension/debarment. Awardee is currently in SAM.

Date SAM Checked:____________________

☐ For competitive solicitations for supplies using FAR part 13 simplified acquisition procedures,

including acquisitions valued at less than or equal to $1 million under the authority at FAR subpart

13.5, contracting officer reviewed the Supplier Performance Risk System (SPRS) IAW DFARS

213.106-2(b)(i).

The contracting officer’s signature on the award document constitutes evidence that the

contracting officer has considered the issues listed and described above and arrived at the

findings, determinations, and conclusions also enumerated above for the above-identified

procurement.

(b) Market Research for Commerciality Determination Memorandum for Record (MRCDM).

The contracting officer shall use the MRCDM format as prescribed in 13.501 Special documentation

requirements. The contracting officer shall include a “Source Selection Information” legend when

applicable pursuant to FAR 2.101 and 3.104. Procuring organizations may append the MRCDM to

the acquisition plan, and the acquisition plan may refer to the MRCDM in sections regarding market
research and sustainability. This Market Research for Commerciality Determination Memorandum

(MRCDM) format is for illustration purposes only. It mirrors the fillable version in the contract

writing system.

MEMORANDUM FOR RECORD

SUBJECT: Market Research for Commerciality Determination (MRCDM) (FAR 10.002, FAR 2.101,

and FAR 13.5)

(Mark “FOR OFFICIAL USE ONLY”, when applicable, at the bottom of the outside of the front cover

(if there is one), the title page, the first page, and the outside of the back cover (if there is one)

pursuant to DOD Manual 5200.1, Vol 4, Enclosure 3, 2.c.(3)(b).)

Market research has been conducted prior to solicitation:

Solicitation #: (contracting officer insert) NSN(s) (if applicable): (contracting officer insert)

Item/Requirement Description: (contracting officer insert)

PR#: (contracting officer insert)

PART I

In accordance with FAR 10.002(b) and FAR 2.101, Definitions, the cognizant functional element of

the procuring organization has conducted a review of the item description(s) to determine if

commercial items or non-developmental items are available to meet the government’s needs or could

be modified to meet the government’s . The reviewer(s) considered the following: (contracting

officer insert response)

a. Whether items of a type are customarily available in the commercial marketplace; annotate

evidence of actual sale, lease, or license to the general public, or evidence of items being offered for

sale, lease or license to the general public: (contracting officer insert response)

b. Whether items of a type are customarily available in the commercial marketplace with

modifications; annotate evidence of actual sale, lease, or license to the general public and type of

modification: (contracting officer insert response)

c. Whether items are used exclusively for governmental purposes; annotate evidence that the items

were (1) developed exclusively at private expense, and (2) sold competitively in substantial

quantities to multiple state and local governments: (contracting officer insert response)

d. Customary practices regarding customizing, modifying or tailoring of items to meet customers’

needs and associated costs; annotate evidence of customary availability of the modification in the

commercial marketplace or the technical relationship between the modified items: (contracting

officer insert response)

e. Customary practices, including warranty, buyer financing, discounts, contract type considering

the nature and risk associated with the requirement, etc., under which commercial sales of the

products or services are made: (contracting officer insert response)

f. The applicability of any laws and/or regulations unique to the item being acquired: (contracting

officer insert response)
g. The availability of items that contain recovered materials and items that are energy efficient:

(contracting officer insert response)

h. The distribution and support capabilities of potential suppliers, including alternative

arrangements and cost estimates: (contracting officer insert response)

i. The size and status of potential sources: (contracting officer insert response)

j. Services of a type offered and sold competitively in substantial quantities in the commercial

marketplace based on established catalog or market prices for specific tasks performed or specific

outcomes to be achieved and under standard commercial terms and conditions: (contracting officer

insert response)

k. Whether existing contract solutions (including Best-In-Class (BIC) can be used to satisfy the

requirement (IAW with Office of Management and Budget (OMB) Memorandum M-17-29):

(contracting officer insert response)

PART II

Check one or more of the following, as applicable, to identify techniques the reviewer(s) used to

conduct market research and determine commerciality:

a. ( ) Commercial-Off-the-Shelf Field is coded;

b. ( ) If item has been coded in SAP as commercial but non-commercial practices are required (e.g.,

QCCs, packaging, etc.), the justification for the use of these practices has been entered in SAP in the

internal comments field;

c. ( ) Contacted knowledgeable individuals in government and industry regarding market capabilities

to meet requirements;

d. ( ) Published formal requests for information in appropriate technical or scientific journals or

business publications;

e. ( ) Queried the Government-wide database of contracts and other procurement instruments

intended for use by multiple agencies available at https://www.fpds.gov and other government and

commercial databases that provide information relevant to agency acquisitions;

f. ( ) Participated in interactive, on-line communication among industry, acquisition personnel, and

customers;

g. ( ) Obtained source lists of similar items from other contracting activities, agencies, trade

associations, or sources;

h. ( ) Reviewed the results of recent market research undertaken to meet similar or identical

requirements;

I. ( ) Reviewed catalogs and other available product literature published, or [provided] on-line, by

manufacturers, distributors, and dealers;

j. ( ) Conducted interchange meetings or held presolicitation conferences to involve potential

offerors;
k. ( ) Queried the Central Contractor Registration (CCR) via the System for Award Management

(SAM) for small business sources, as applicable. (See FAR/DFARS Part 4 for information on SAM).

l. ( ) Other ( contracting officer insert response)

Provide supporting documentation (to include a review of the Material Master in SAP for applicable

items) for any of the blocks above in c. through l. that have been checked in this part of the form.

Check the following block(s), as applicable:

( ) Documentation is attached

( ) Documentation is located in Records Management file/folder: (contracting officer insert response)

SUMMARY OF MARKET RESEARCH:

Contacted product specialist or other technical representative on: (contracting officer insert

response)

OR

Product specialist/technical representative provided market research with the requirement on:

(contracting officer insert response)

Name of Product Specialist/Technical Representative: (contracting officer insert response)

Date: (contracting officer insert response)

Product specialist/technical representative provided concurrence:

() Yes. If “Yes,” has the Material Master been updated: (contracting officer insert response)

() No. If “No,” state reason for nonconcurrence and how resolved: (contracting officer insert

response)

Part III

Check one of the following to indicate the type of contract:

() Firm Fixed Price (FFP)

() Fixed Price with Economic Price Adjustment (FP w/EPA)

NOTE: For acquisitions of commercial items, the contracting officer may only award FFP or FP

w/EPA type contracts, with limited exceptions (see FAR 12.207). If the contracting officer

determines the requirement is not commercial, document the contract type selection in the

acquisition plan.

Part IV

Check one of the following to indicate if consolidation or bundling applies:
() Consolidation (see attached report/determination)

() Bundling (see attached report/determination)

CONCLUSION:

Based on the market research conducted, item(s) to be solicited against subject solicitation have

been determined to be (check one of the following):

() Commercial

() Noncommercial

APPROVALS:

Name of Contracting Officer: (contracting officer insert response)

Signature: (contracting officer insert signature)

Date: (contracting officer insert date)

Name of Approving Official (One Level Above Contracting Officer): (contracting officer insert

response)

Title: (contracting officer insert response)

Signature: (approving official insert signature)

Date: (approving official insert date)

(Applies when contracting officer based commercial item determination on subsections (1)(ii), (3),

(4), or (6) of the “commercial item” definition at FAR 2.101.)

(c) Alternate Simplified Acquisition Award Documentation (SAAD). Contracting officers at DLA

Distribution, DLA Disposition Services, DLA Contracting Services Office, DLA Strategic Materials,

and DLA Energy shall use the SAAD (Alternate) 10-27-21.pdf

(https://dlamil.dps.mil/teams/C12/N608/FormTemplates/SAAD%20(Alternate)%2010-27-21.pdf) as

prescribed in 13.106-3 Award and documentation.(b), 13.501 Special documentation

requirements.(b)(3), and 15.406-1 Prenegotiation objectives.(b)(1). DLA Distribution maintains the

Alternate SAAD online. The contracting officer must sign the format.

53.9015 Contracting by negotiation.

(a) Price Negotiation Memorandum Format – Competitive. Contracting officers shall use the PNM

Format – Competitive as prescribed in 15.406-3(a)(S-90) and 15.406-3(a)(S-91). This Price

Negotiation Format – Competitive is for illustration purposes only. It mirrors the fillable version in

the contract writing system.

Source Selection Information - See FAR 2.101 and 3.104

PRICE NEGOTIATION MEMORANDUM FORMAT–COMPETITIVE
PNM Contents Yes No N/A

The contracting officer shall include a “Source Selection Information” legend when applicable pursuant to FAR 2.101 and 3.104.

Refer to DFARS PGI 215.406-3(11)(A) for documents uploaded into CBAR. Mark “CONTROLLED UNCLASSIFIED INFORMATION

(CUI)” pursuant to DoD Instruction 5200.48, Controlled Unclassified Information (CUI) (

https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/520048p.PDF?ver=2020-03-06-100640-800 ) and DLA Instruction

5200.48, Controlled Unclassified Information (CUI) (

https://issuances.dla.mil/Published_Issuances/Controlled%20Unclassified%20Information%20(CUI).pdf?ver=2020-03-06-100640-800

).

1. Subject

a. Contractor name, division or group and location

b. Contract or RFP number

c. Item or service acquired

2. Introductory summary

a. Contractor and proposal selected for award and date

b. Offerors

c. Tabular Summary of: proposed price, government estimate, and final proposal revision

Major Price Items or CLINS

Total

Profit/fee %

CPAF (base and award fee) ($ and %)

Contract type

d. Clearance authority

(1) Approval authority

(2) Approval date, meeting dates, and participants

3. Details

a. Description of item or services

b. Explain method used for line item or unit prices

c. Personnel: List names, title, organization and telephone number of participants in price analysis and as applicable, cost realism

discussions

d. Significant dates:

(1) Proposal date

(2) Discussion (s)/date (s)

(3) Final proposal revision date

(4) Other significant date (s) (acquisition review board dates, competitive range determination, solicitation amendments, etc.)

4. Acquisition situation

a. Acquisition background

b. Discuss period of performance and delivery schedule
c. Outside influences or unusual time constraints (i.e., Funding limitations, higher level, Congressional influences)

d. Unique features or special pricing provisions (economic price adjustment, incentives, warranties, special progress payments, etc.)

e. Fast Payment Procedures – Discuss the authority for using fast payment procedures and whether they will apply to delivery

orders issued under the contract. If using fast payment procedures, cite the applicable threshold from 13.402(a) or FAR 13.402(a).

If DFARS 213.402(a)(ii) applies, state that individual orders may exceed the SAT. Ensure compliance with all FAR and DLAD fast

payment procedures for contracts that will authorize use of these procedures.

f. Indefinite-Quantity Contract (IQC). The contracting officer established a guaranteed minimum (GM) quantity or GM dollar value

for the period of performance of the basic IQC, recorded an obligation in the amount of the GM purchase requirement ($________) at

time of award, and placed the EBS screen shot documenting the obligation in the contract file IAW DLAD 16.504(a)(1)(S-90).

g. Requirements contract. If the award includes a GM, paragraph f. applies.

5. Evaluation summary

a. Reasonableness, completeness, cost realism if applicable, and balance

(1) Description of price analysis technique (s) used, results, and appropriateness in determining price reasonableness and

completeness

(a) Description of the basis of any escalation rates used for adjusting historical prices or for forecasting option year prices. See DoD

Contract Pricing Reference Guide, Volume 2 Quantitative Techniques, Chapter 1 Using Price Index Numbers for potential sources of

information, calculating adjustments, and other relevant topics. .

(b) Description of GSA Schedule prices, if any. Contracting officer must check GSA for any relevant price information and document

the results

(2) Description of the cost realism analysis technique (s) and their result (s) (if performed)

(3) Description of assessment of unbalanced pricing and any associated risks

(4) Document decision to conduct discussions and date (s). Document decision to award without discussions.

(5) Description and listing of major differences between the proposal and the final proposal revision prices

b. Adequate price competition determination description

(1) Basis of determination statement of adequate price competition

(a) Best value to the Government and the significance of cost or price to all evaluation factors combined;

(b) Lowest evaluated price; or

(c) Adequate price competition

(2) Definitive statement the offered price selected is fair and reasonable based on adequate price competition.

6. ADVISORY REPORTS/KEY DOCUMENTS

Listing of Government advisory reports (pricing, technical, should-cost, etc.)

7. SIGNATURES

8. Attachments

Attachments as identified in the document

CUI Source Selection Information – See FAR 2.101 and 3.104

(b) Price Negotiation Memorandum Format – Non-Competitive. Contracting officers shall use the

PNM Format – Non-Competitive as prescribed in 15.406-3 Documenting the negotiation. and

15.406-3 Documenting the negotiation.. This Price Negotiation Memorandum Format –NonCompetitive is for illustration purposes only. It mirrors the fillable version in the contract writing
system.

PRICE NEGOTIATION MEMORANDUM FORMAT – NON-COMPETITIVE

PNM Contents Yes No N/A

Mark “CONTROLLED UNCLASSIFIED INFORMATION (CUI)” pursuant to DoD Instruction 5200.48, Controlled Unclassified

Information (CUI) ( https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/520048p.PDF?ver=2020-03-06-100640-800 )

and DLA Instruction 5200.48, Controlled Unclassified Information (CUI) (

https://issuances.dla.mil/Published_Issuances/Controlled%20Unclassified%20Information%20(CUI).pdf?ver=2020-03-06-100640-800

).

The contracting officer shall include a “Source Selection Information” legend when applicable pursuant to FAR 2.101 and 3.104.

Refer to DFARS PGI 215.406-3(11)(A) for documents uploaded into CBAR.

1. Subject

a. Contractor name, division or group and location

b. Contract or RFP Number (as applicable include modification number)

c. Item or service acquired

d. Delivery and/or Period of Performance

2. Introductory summary

a. Date (s) of Negotiation and Agreement

b. Contract action type (new contract, supplemental agreement, etc.)

c. Tabular summary of cost, FCCOM, profit or fee and price:

(1) Proposed and objective positions

(2) Proposed, objective and considered negotiated positions

(3) Separate summaries for options, etc.

(4) Fee or profit rate for each position

(5) Award fee pool for each position (as applicable) Ceiling price and percentage for each position (as applicable for cost contracts)

(6) Contract type for each position (FFP, FP/EPA, CPFF, CPAF, etc.)

d. Approval authority

(1) Approval authority

(2) Approval date, meeting date (s), and participants

(3) Limitations and specific approving authority conditions

3. Details

a. Item or service identification:

(1) Quantity and type

(2) Previous buys for the same or similar items

(A) Date (s) of recent buys

(B) Quantity

(C) Contract type
(D) Prior unit or total prices (target and finals if applicable and available: document separately recurring and nonrecurring costs)

(E) Current unit or CLIN prices (may attach) with name of item, NSN, part number, quantities, etc., as applicable (document

separately recurring nonrecurring costs)

(F) Summary explanation of significant differences between the instant buy and most recent historical price (s)

(G) Stock Position of Items (include date stock position, current unfilled orders, inventory consumption rate, due-in quantities, etc.

Discuss any over or under position)

b. Explain method for line item or unit prices

c. Fact-finding and negotiation dates, places, names, titles, and office symbols for the government and the contractor

d. Principal government and contractor negotiator identified

4. Acquisition situation

a. Acquisition background (contract type, pricing, etc.) indefinite-delivery contract and why it does or does not apply, surge and

sustainment, etc.

b. Period of performance and delivery schedule (address resolution of differences between required, proposed and negotiated)

c. Outside influences and unusual time constraints

d. Government furnished facilities, equipment or other support unique to this acquisition

e. Unique features such as should cost, design-to-cost, life cycle cost, special payment procedures, and special provisions (clauses:

savings, EPA, progress payments, performance based payments, validation of critical safety item and date , incentives, etc.)

f. Fast Payment Procedures. Discuss the authority for using fast payment procedures and whether they will apply to delivery orders

issued under the contract. If using fast payment procedures, cite the applicable threshold from 13.402(a) or FAR 13.402(a). If

DFARS 213.402(a)(ii) applies, state that individual orders may exceed the SAT. Ensure compliance with all FAR and DLAD fast

payment procedures for contracts that will authorize use of these procedures.

g. Indefinite-Quantity Contract (IQC). The contracting officer established a guaranteed minimum (GM) quantity or GM dollar value

for the period of performance of the basic IQC, recorded an obligation in the amount of the GM purchase requirement ($________) at

time of award, and placed the EBS screen shot documenting the obligation in the contract file IAW DLAD 16.504(a)(1)(S-90).

h. Requirements Contract. If award includes a GM, paragraph g. applies.

5. Negotiation summary

a. Discussion of contractor price analysis, government price analysis, or no analysis performed

(1) Price element summary for proposed, objective, and considered negotiated amount. Discuss the position for proposed, objective

and considered negotiated positions by topic.

(2) Price reasonableness basis or estimating technique (attach exemption or waiver if used instead of certified cost or pricing data).

If using GSA schedule, the contracting officer must include a GSA contract for any relevant price information and document the

results

(3) Identify submission of data other than cost or pricing data necessary to determine a reasonable price. Discuss rationale and

required updates (attach sales data, catalogues, competitive price list, independent market prices, other data, etc.)

(4) Identifies submission of subcontractor cost or pricing data necessary to determine a reasonable price. (Even if HCA waived the

submission for prime contractor)

(5) Price analysis and objective adjustments resulting from requirement changes

(6) Significant differences between objective and negotiated amounts

(7) Use of advisory information and report (s) to support the objective, including significant differences, objective, and final

negotiated agreement.

b. Discuss analysis and support for proposed, objective and (PNM) negotiated positions

c. Identify proposal of record used to baseline the objective.
d. When receiving certified cost and pricing data, a statement of the extent to which the contracting officer relied on contractor

provided data except where specifically identified (including agreed to cut-off dates)

e. For noncompetitive actions exceeding $1M, the contracting officer must search the Contract Business Analysis Repository (CBAR)

and document the results of CBAR search.

f. When performing cost analysis, major cost element summary with subparagraph index for proposed, objective and considered

negotiated amounts (including direct and indirect costs for labor, materials,)

g. Discussions of cost analysis performed for each major cost element for contractor proposed, government objective and

considered negotiated positions in the following areas:

(1) Summary breakout of major cost items

(A) Labor hours by rate category

(B) Identify and discuss indirect rate (s)

(C) Materials and other costs by category

(D) Subcontractor cost or pricing data

1. Requirement, availability, adequacy of and reliance on subcontractor cost or pricing data

2. Sole source or competitive

3. Extent and adequacy of the prime's review

4. Why the contracting officer did not receive certified cost or pricing data when required (attach waiver or describe exemption)

5. Why the contracting officer received certified cost or pricing data when not required

(E) Basis or estimating method used

(F) Explanation of contractor data not relied on and reason for using other than contractor's data, identify data used to develop the

government's position

(G) Rationale, sources, and currency of the data used to set the objective (include modification change determined to be

noncommercial where originally determined commercial)

(H) Significant differences between the objective and negotiated amounts

(I) Use of advisory reports supporting the objective, including significant differences between them, the objective, and the final

negotiated agreement

(J) For undefinitized contract actions: actual costs to date, % of completion, trends and, as applicable, the contractor's estimate to

complete

(2) With incentive arrangements, describe the basis for share ratio (s) and ceiling price (s)

(3) Profit (Fee). Explain how the contracting officer developed the objective

(A) If using WGM, state assigned weights and provide reasoning when weights are below or above normal. (DD 1547 Attached to the

PNM)

(B) If not using WGM, explain why and how the contracting officer developed the profit objective

(C) List profit or fee rate (s) negotiated. If the contracting officer did not achieve WGM profit objectives during negotiations, explain

why and support profit or fee rate negotiated

h. Summarize and include a definitive statement on why the negotiated price is fair and reasonable. (Address the 25% limitation on

price increases (DFARS 217.7505)

i. Description of the basis of any escalation rates used for adjusting historical prices and for forecasting option year prices. See DoD

Contract Pricing Reference Guide, Volume 2 Quantitative Techniques, Chapter 1 Using Price Index Numbers for potential sources of

information, calculating adjustments, and other relevant topics.

6. ADVISORY REPORTS/KEY DOCUMENTS
Listing of Government advisory reports (pricing, technical, should cost, etc.)

7. Signatures

Include signatures of the author of the PNM, contracting officer and (as applicable) approval authority

8. Attachments

a. DD Form 1547 - Weighted Guidelines

b. DD Form 1861 - Facilities Capital Cost of Money (objective only)

c. Other attachments identified in the PNM