PGI 250.101-3 Records.

(1) Departments and agencies shall-

(i) Prepare a preliminary record when a request for a contract adjustment under FAR 50.103 is filed

(see DFARS 250.103-5(1)).

(ii) Prepare a final record stating the disposition of the request (see PGI 250.103-6).

(iii) Designate the offices or officials responsible for preparing, submitting, and receiving all records

required by DFARS Subpart 250.1. Records shall be maintained by the contract adjustment boards

of the Army, Navy, and Air Force, respectively, and by the headquarters of the defense agencies.

(2) A suggested format for the record is the Record of Request for Adjustment shown at the end of

this section. This format permits the information required for the preliminary and final records to be

combined on one form. The following instructions are provided for those items in the format that are

not self-explanatory:

(i) Extent of performance as of date of request. State the degree of completion of the contract; e.g.,

50 percent completed or performance not yet begun. If work is completed, state the date of

completion and whether final payment has been made.

(ii) Award procedure. State whether the contract was awarded under sealed bidding or negotiated

procedures. Cite the specific authority for using other than full and open competition, if applicable,

e.g., 10 U.S.C. 3204(a).

(iii) Type of contract. State the type of contract (see FAR Part 16); e.g., FFP (firm-fixed-price).

(iv) Category of case. State whether the request involves a modification without consideration, a

mistake, or an informal commitment. If the case involves more than one category, identify both; list

the most significant category first.

(v) Amount or description of request. If the request is expressed in dollars, state the amount and

whether it is an increase or decrease. If the request cannot be expressed in monetary terms, provide

a brief description; e.g., "Cancellation" or "Modification." Even if the adjustment is not easily

expressed in terms of dollars, if the contractor has made an estimate in the request, that estimate

should be stated.

(vi) Action below Secretarial level. State the disposition of the case, the office that took the action

and the date the action was taken. The disposition should be stated as "Withdrawn," "Denied,"

"Approved," or "Forwarded." If the request was approved, in whole or in part, state the dollar

amount or nature of the action (as explained in paragraph (2)(v) of this section). The date should

correspond with the date of the memorandum of decision or of the letter forwarding the request to

the contract adjustment board or other deciding body.

(vii) Action by contract adjustment board and date. State the disposition and date of disposition of

the case by the contract adjustment board. Provide the same information as for paragraph (2)(vi) of

this section.

(viii) Implementation and date. State the appropriate action; e.g., "Modification," "New Contract," or

"Letter of Denial."
□ PRELIMINARY

RECORD OF

REQUEST FOR ADJUSTMENT

PUBLIC LAW 85-804

FINAL □

DATE OF

REQUEST

DATE RECEIVED

BY

GOVERNMENT

CONTRACTOR'S NAME AND ADDRESS

□ SMALL BUSINESS

NAME AND ADDRESS OF CONTRACTOR'S REPRESENTATIVE, IF ANY

COGNIZANT CONTRACTING

OFFICER OR OFFICE PROCURING ACTIVITY

PROPERTY OR SERVICE

INVOLVED

EXTENT OF PERFORMANCE AS OF DATE OF

REQUEST

CONTRACT NUMBER DATE

ADVERTISED

OR

NEGOTIATED

TYPE OF CONTRACT

CATEGORY OF CASE AMOUNT OF DESCRIPTION OF REQUEST

ACTION BELOW SECRETARIAL LEVEL DATE

ACTION BY CAB DATE

IMPLEMENTATION DATE

ADDITIONAL DATA OR REMARKS

DATE THIS RECORD SIGNED SIGNATURE

Parent topic: PGI 250.101 General.