QUANTITY

QTY

$

QTY

$

QTY

$

No.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

Date

(See Instructions on Reverse)

SETTLEMENT PROPOSAL

$ $

$ $

Jacket No.

Purchase Order No.

Program / Print Order No.

LABOR

OVERHEAD

GENERAL & ADMINISTRATIVE EXPENSE

PROFIT

$ $

$ $

$ $

Name of Company Signature of Authorized Official Title

The undersigned certifies that the above proposed settlement includes only charges allocable to the terminated portion of the contract, that the 

total charges (Item 14) and disposal credits (Item 15) are fair and reasonable, that pricing data in support of the proposed settlement are 

accurate, complete, and current as of the date of submission of this settlement proposal, and that this proposal has been prepared with 

knowledge that it will, or may be, used directly or indirectly as a basis for settlement of a claim(s) against the United States or an agency 

thereof. The penalty for making false statements to the government is prescribed in 18 U.S.C.1001.

GROSS PROPOSED SETTLEMENT

DISPOSAL AND OTHER CREDITS

NET PROPOSED SETTLEMENT

ADVANCE PROGRESS AND PARTIAL PAYMENTS

NET PAYMENT REQUESTED

REMARKS

TOTAL

ACCEPTABLE FINISHED PRODUCTS NOT COVERED BY INVOICING

SETTLEMENT EXPENSES

SETTLEMENT WITH SUBCONTRACTOR(S)

STORAGE

OTHER (Support with Detailed Schedules)

MATERIAL

LABOR

OVERHEAD

OTHER COST (Explain)

GENERAL AND ADMINISTRATIVE EXPENSE

TOTAL COST

PROFIT

Section III - Settlement Proposal

ATTACH SEPARATE SUPPORTING SCHEDULES IF SPACE PROVIDED IS NOT SUFFICIENT

Section I - BID COST BREAKDOWN

COST ELEMENT UNIT RATE TOTAL COST

MATERIAL (List All Materials & Attach Suppliers' Vouchers)

UNFINISHED OR NOT 

STARTED

FINISHED

ON HAND

Section II - Status of Contract at Effective Date of Termination

PRODUCTS COVERED BY 

TERMINATED CONTRACT

ITEM (Include only items allowable to the Terminated Portion of the contract) AMOUNT OF CHARGE

To Be 

Completed 

(Partial Term 

Only)

Previously 

Shipped & 

Invoiced

Shipped, Not 

Yet Invoiced

Finished, Not 

yet Shipped

Not To Be 

Completed

TOTAL 

COVERED 

BY 

CONTRACT
�NSTRUCTIONS 

Section I-Bid Price Cost Breakdown 

The total contract price will be broken down into unit price/hourly rates. The unit rate will be further 

broken down to show the elements of cost that make up that price. This data should be obtained from the 

worl<sheets or records used to prepare the bid. 

Section II-Status of Contract at Effective Date of Termination 

This section will be completed to show the precise status of the contract upon the effective date of the 

termination. If no work was started, this section does not apply. 

Section Ill-Settlement Proposal 

All costs to be claimed unde� the terminated contract will be detailed in this section. 

a. Review any provisions of the contract relating to termination and consult the Contracting Officer. A claim

for fair compensation should be prepared on the basis of the costs shown by accounting records. Where costs 

are not so shown, any reasonable basis for estimating costs may be used which will provide for fair compensation 

for the preparations rnade and work done for the terminated portion of the contract, including a reasonable profit 

on such preparation and work. 

b. The settlement proposal may include, among others, under items 1-6, 7, 10, and 11, the following:

Costs-Costs incurred which are reasonably necessary and are properly allocable to the terminated

portion of the contract under recognized commercial accounting practices, including direct and indirect

manufacturing, selling and distribution, and other costs and expenses incurred.

Profit-A reasonable profit with respect to the preparations made and work actually done for the termi•

nated portion of the contract. No profit should be included with respect to work which has not been done,

nor shall profit be included with respect to settlement expenses, or with respect to settlement with

subcontractors.

Settlement expenses-Reasonable costs of protecting and preserving the termination inventory in your

possession and preparing of the claim.

Settlement with subcontractors-Reasonable settlements of claims of subcontractors allocable to the

terminated portion of the subcontract. Copies of such settlements will be attached hereto.

· ' 

GPO FORM 911 

(R-11-22)