Program: 268-S

Term: Date of Award to July 31, 2023

Title: Forms 6084 SAP, ACE Dunning Letters, Form 6084 SC, 612 Surety Report, 

and IRS Forms 1099G and 1099C

BASIS OF

ITEM NO. DESCRIPTION AWARD UNIT RATE COST UNIT RATE COST UNIT RATE COST UNIT RATE COST

I. ELECTRONIC PREPRESS:

 (a) Digital Color content proofs of One-off color proofs (forms and 

envelopes).............................................................per trim/page size unit... 94 30.00 $2,820.00 0.10 $9.40 10.00 $940.00

 (b) Adobe Acrobat PDF soft proof (5 names).........per file.......................... 6 No Charge $0.00 20.00 $120.00 50.00 $300.00

 (c) System Timework.................................................per hour.................. 6 75.00 $450.00 80.00 $480.00 150.00 $900.00

II. PRINTING, IMAGING, BINDING, AND CONSTRUCTION:

 (a) Form 6084 SAP....................................................per form..........................

 (1) Makeready and/or Setup 657 75.00 $49,275.00 ----------------- ------------------- 90.00 $59,130.00

 (2) Running Per 100 Copies 8,008 4.26 $34,114.08 6.50 $52,052.00 5.00 $40,040.00

 (b) Form 6084 SC......................................................per form...........................

 (1) Makeready and/or Setup 55 75.00 $4,125.00 ----------------- ------------------- 100.00 $5,500.00

 (2) Running Per 100 Copies 1,074 4.26 $4,575.24 6.50 $6,981.00 5.00 $5,370.00

 (c) ACE Dunning Letters.........................................per page............................

 (1) Makeready and/or Setup 206 150.00 $30,900.00 ----------------- ------------------- 4.00 $824.00

 (2) Running Per 100 Copies 166 4.26 $707.16 8.50 $1,411.00 6.00 $996.00

 (d) 612 Surety Report............................................per page..............................

 (1) Makeready and/or Setup 608 150.00 $91,200.00 ----------------- ------------------- 4.00 $2,432.00

 (2) Running Per 100 Copies 508 105.36 $53,522.88 8.50 $4,318.00 5.00 $2,540.00

 (e) IRS Tax Forms 1099G and 1099C...................per form.............................

 (1) Makeready and/or Setup 2 680.00 $1,360.00 ----------------- ------------------- 250.00 $500.00

 (2) Running Per 100 Copies 15 15.00 $225.00 5.00 $75.00 100.00 $1,500.00

 (f) No. 9 Return Envelope (3-7/8 x 8-7/8") 

with window....................................................per envelope.....................

 (1) Makeready and/or Setup 12 50.00 $600.00 ----------------- ------------------- No Charge $0.00

 (2) Running Per 100 Copies 8,008 1.99 $15,935.92 1.50 $12,012.00 $1.50 $12,012.00

 (g) No. 10 Mail-Out Envelope (4-1/8 x 9-1/2") 

with window...................................................per envelope.....................

 (1) Makeready and/or Setup 38 50.00 $1,900.00 ----------------- ------------------- No Charge $0.00

 (2) Running Per 100 Copies 9,141 2.44 $22,304.04 1.50 $13,711.50 2.30 $21,024.30

EXTENSIVELY

REVISED

SPECIFICATION

Amsive

CURRENT CONTRACTOR

DIAMOND COMM.

SOLUTIONS THE DATA CENTER AMSIVE

Carol Stream, IL Salt Lake, UT Miamisburg, OH

Page 1 of 2
Program: 268-S

Term: Date of Award to July 31, 2023

Title: Forms 6084 SAP, ACE Dunning Letters, Form 6084 SC, 612 Surety Report, 

and IRS Forms 1099G and 1099C

BASIS OF

ITEM NO. DESCRIPTION AWARD UNIT RATE COST UNIT RATE COST UNIT RATE COST UNIT RATE COST

Amsive

CURRENT CONTRACTOR

DIAMOND COMM.

SOLUTIONS THE DATA CENTER AMSIVE

Carol Stream, IL Salt Lake, UT Miamisburg, OH

III. PAPER: Per 100 Leaves

 1. Form 6084 SAP, and Form 6084 SC, ACE Dunning Letters,

 (a) White Optical Character Recognition (OCR) Bond (24-lb.)................................. 9,198 1.20 $11,037.60 3.15 $28,973.70 2.50 $22,995.00

 2. Surety Report

 (a) White Optical Character Recognition (OCR) Bond (24-lb.)................................. 254 1.20 $304.80 9.10 $2,311.40 3.40 $863.60

 3. IRS Tax Forms 1099G and 1099C

 (a) White Uncoated Text, (60-lb)......................... 10 1.15 $11.50 2.34 $23.40 2.60 $26.00

 (b) Colored Uncoated Text, (60-lb.)..................... 5 ------------------- ------------------- 2.60 $13.00 5.00 $25.00

 4. No.9 Return envelope (3-7/8 x 8-7/8") with window....................

 (a) White Writing Envelope (24-lb.)........................................... 8,008 ------------------- ------------------- $3.39 $27,147.12 $1.50 $12,012.00

 5. No. 10 Mail-out Envelope (4-1/8 x 9-1/2") with window.....................

 (a) White Writing Envelope (24-lb.)........................................... 9,141 ------------------- ------------------- $3.63 $33,181.83 $2.30 $21,024.30

IV. ASSEMBLY, PACKAGING, AND DISTRIBUTION:

 (a) Form 6084 SAP.............................................per 100 mailers............ 8008 $2.82 $22,582.56 $3.50 $28,028.00 $5.00 $40,040.00

 (b) Form 6084 SC..............................................per 100 mailers.............. 1,074 $2.82 $3,028.68 $7.00 $7,518.00 $5.00 $5,370.00

 (c) ACE Dunning Letters...................................per 100 mailers................ 43 $35.00 $1,505.00 $10.00 $430.00 $10.00 $430.00

 (d) 612 Surety Report.......................................per 100 mailers................. 11 $42.00 $462.00 $10.00 $110.00 $400.00 $4,400.00

 (e) IRS Tax Forms 1099G and 1099C.............per 100 mailers................... 15 ------------------- ------------------- $3.50 $52.50 $50.00 $750.00

CONTRACTOR TOTALS ------------------- ------------------- $261,944.20 $0.00

DISCOUNT 0.00% ------------------- 0.00% ------------------- 0.00% $0.00 0.00% $0.00

DISCOUNTED TOTALS ------------------- ------------------- $261,944.20 $0.00

AWARDED

Page 2 of 2
Program 268-S Page 1 of 28

Specifications by DLL

Reviewed by MRN 

U.S. GOVERNMENT PUBLISHING OFFICE

Washington DC

GENERAL TERMS, CONDITIONS, AND SPECIFICATIONS

For the Procurement of

Forms 6084 SAP, ACE Dunning Letters, Form 6084 SC, 

612 Surety Report and IRS Forms 1099G and 1099C

as requisitioned from the U.S. Government Publishing Office (GPO) by the

U.S. Department of Homeland Security (DHS)

U.S. Customs and Border Protection (CBP)

Single Award

TERM OF CONTRACT: The term of this contract is for the period beginning Date of Award and ending 

July 31, 2023, plus up to four optional 12-month extension periods that may be added in accordance with the 

"Option to Extend the Term of the Contract" clause in Section 1 of this contract. 

Required post award implementation and certification of DHS security requirements will take place from 

Date of Award through August 31, 2022 or later. Actual production begins upon completion of the 

certification, no earlier than September 1, 2022. 

BID OPENING: Bids shall be opened at 11:00 a.m., prevailing Eastern Standard Time (EST), on 

August 18, 2022 at the U.S. Government Publishing Office, APSDC. Due to the COVID-19 pandemic, this will 

NOT be a public bid opening. 

BID SUBMISSION: Due to the COVID-19 pandemic, the physical office will NOT be open. Based on this, bidders 

MUST submit email bids to Bidsapsdc@gpo.gov for this solicitation. No other method of bid submission will be 

accepted at this time.

The Program 268-S and the bid opening date must be specified in the subject line of the emailed bid submission.

Bids received after 11:00 a.m. on the bid opening date specified above will not be considered for award.

BIDDERS, PLEASE NOTE: This program was formerly Program 756-S. Specifications have been extensively 

revised; therefore, all bidders are cautioned to familiarize themselves with all provisions of these specifications 

before bidding. 

Abstracts of contract prices are available at http://www.gpo.gov/gpo/abstracts/abstract.action?region=DC

For information of a technical nature call David Love (202) 512-0307 or e-mail dlove@gpo.gov.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 2 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

SECTION 1. - GENERAL TERMS AND CONDITIONS

GPO CONTRACT TERMS: Any contract which results from this Invitation for Bid will be subject to the 

applicable provisions, clauses, and supplemental specifications of GPO Contract Terms (GPO Publication 310.2, 

effective December 1, 1987 (Rev. 1-18)) and GPO Contract Terms, Quality Assurance Through Attributes Program 

for Printing and Binding (GPO Publication 310.1, effective May 1979 (revised 9-19)). 

GPO Contract Terms (GPO Publication 310.2) – 

https://www.gpo.gov/docs/default-source/forms-and-standards-files-for-vendors/contractterms2018.pdf

GPO QATAP (GPO Publication 310.1) – 

https://www.gpo.gov/docs/default-source/forms-and-standards-files-for-vendors/qatap-rev-09-19.pdf

SUBCONTRACTING: Subcontracting is allowed for manufacturing of the envelopes only. 

QUALITY ASSURANCE LEVELS AND STANDARDS: The following levels and standards shall apply to 

these specifications:

NOTE: Prior to award, contractor may be required to provide information related to specific equipment that will 

be used for production.

Product Quality Levels:

(a) Printing (page related) Attributes – Level III. 

(b) Finishing (item related) Attributes – Level III. 

NOTE: The forms produced under these specifications must be guaranteed to function properly when processed 

through High Speed Scanners. Forms require precision spacing, printing/imaging, trimming, and folding.

Inspection Levels (from ANSI/ASQC Z1.4):

(a) Non-destructive Tests - General Inspection Level I.

(b) Destructive Tests - Special Inspection Level S-2.

Specified Standards: The specified standards for the attributes requiring them shall be:

Attribute Specified Standard

P-7. Type Quality and Uniformity O.K. Press Sheets

P-9. Solid and Screen Tint Color Match O.K. Press Sheets

Special Instructions: In the event that inspection of press sheets is waived by the Government, the following listed 

alternate standards (in order of precedence) shall become the Specified Standards:

P-7. Type Quality and Uniformity O.K. Prior to production samples / O.K. Proofs / 

 average type dimension in publication; electronic media.

P-9. Solid and Screen Tint Color Match Pantone Matching System

NOTE: Prior to award, contractor may be required to provide information related to specific digital equipment that 

will be used for production.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 3 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

OPTION TO EXTEND THE TERM OF THE CONTRACT: The Government has the option to extend the 

term of this contract for a period of 12 months by written notice to the contractor not later than 30 days before the 

contract expires. If the Government exercises this option, the extended contract shall be considered to include this 

clause except, the total duration of this contract may not exceed five (5) years as a result of, and including, any 

extensions added under this clause. Further extension may be negotiated under the “EXTENSION OF CONTRACT 

TERM” clause. See also “ECONOMIC PRICE ADJUSTMENT” for authorized pricing adjustments.

EXTENSION OF CONTRACT TERM: At the request of the Government, the term of any contract resulting 

from this solicitation may be extended for such period of time as may be mutually agreeable to the GPO and the 

contractor. 

ECONOMIC PRICE ADJUSTMENT: The pricing under this contract shall be adjusted in accordance with this 

clause, provided that in no event will any pricing adjustment be made that would exceed the maximum permissible 

under any law in effect at the time of the adjustment. There will be no adjustment for orders placed during the first 

period specified below. Pricing will thereafter be eligible for adjustment during the second and any succeeding 

performance period(s). For each performance period after the first, a percentage figure will be calculated as 

described below and that figure will be the economic price adjustment for that entire next period. Pricing 

adjustments under this clause are not applicable to reimbursable postage or transportation costs, or to paper, if paper 

prices are subject to adjustment by separate clause elsewhere in this contract.

For the purpose of this clause, performance under this contract will be divided into successive periods. The first 

period will extend from Date of Award through July 31, 2023, and the second and any succeeding period(s) will 

extend for 12 months from the end of the last preceding period, except that the length of the final period may vary. 

The first day of the second and any succeeding period(s) will be the effective date of the economic price adjustment 

for that period.

Pricing adjustments in accordance with this clause will be based on changes in the seasonally adjusted “Consumer 

Price Index For All Urban Consumers - Commodities Less Food” (Index) published monthly in the CPI Detailed 

Report by the U.S. Department of Labor, Bureau of Labor Statistics. 

The economic price adjustment will be the percentage difference between Index averages as specified in this 

paragraph. An index called the variable index will be calculated by averaging the monthly Indexes from the 12-

month interval ending three (3) months prior to the beginning of the period being considered for adjustment. This 

average is then compared to the average of the monthly Indexes for the 12-month interval ending April 30, 2022, 

called the base index. The percentage change (plus or minus) of the variable index from the base index will be the 

economic price adjustment for the period being considered for adjustment.

The Government will notify the contractor by contract modification specifying the percentage increase or decrease 

to be applied to invoices for orders placed during the period indicated. The contractor shall apply the percentage 

increase or decrease against the total price of the invoice less reimbursable postage or transportation costs and 

separately adjusted paper prices. Payment discounts shall be applied after the invoice price is adjusted.

If the Government exercises an option, the extended contract shall be considered to include this economic price 

adjustment clause.

NOTE: Economic price adjustments are not cumulative and are to be applied to original bid prices only.

SECURITY REQUIREMENTS: Sensitive But Unclassified (SBU), For Official Use Only (FOUO), and 

Personally Identifiable Information (PII). 

NOTE: The sensitivity level of data being transmitted to the contractor’s site has been categorized under FIPS 

Publication 199 as “moderate”. The minimum required security controls that must be in place and show a 

demonstrated use are outlined in NIST Special Publication 800-53 for each of the security categorizations and are 

required for this contract. 
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 4 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

All information furnished to the contractor/subcontractor(s) will be considered Sensitive But Unclassified (SBU), 

For Official Use Only (FOUO), Personally Identifiable Information (PII): and disclosure or use of that information 

shall be treated as follows – 

(a) The contractor shall restrict access to all Sensitive But Unclassified (SBU), For Official Use Only (FOUO), 

Personally Identifiable Information (PII) information obtained from the CBP in the performance of this 

contract to those employees and officials who need that information to perform the requirements of this 

contract. Employees and officials who need access to this information for performance of the contract will 

be determined at the postaward conference between the Government and the contractor.

 (b) The contractor shall process all Sensitive But Unclassified (SBU), For Official Use Only (FOUO), Personally 

Identifiable Information (PII) information obtained from CBP in the performance of this contract under the 

immediate supervision and control of authorized personnel, and in a manner that will protect the 

confidentiality of the records in such a way that unauthorized persons cannot retrieve any such records. (c)

The contractor shall inform all personnel with access to the information obtained from CBP in the 

performance of this contract of the nature of the information and the safeguards required to protect this 

information from improper disclosure.

(d) For knowingly disclosing information in violation of the Privacy Act, the contractor and the contractor 

employees may be subject to the criminal penalties as set forth in 5 U.S.C Section 552a (i)(1), which is made 

applicable to contractors by 5 U.S.C. 552a (m)(1) to the same extent as employees of the CBP. For knowingly 

disclosing this information, the contractor and contractor’s employees may also be subject to criminal 

penalties.

(e) The contractor shall assure that each contractor employee with access to CBP information knows the 

prescribed rules of conduct, and that each contractor employee is aware that he/she may be subject to criminal 

penalties for violations of the Privacy Act.

(f) All information obtained from CBP for use in the performance of this contract shall, at all times, be stored in 

an area that is physically safe from unauthorized access. 

(g) The CBP reserves the right to conduct on-site visits to review the contractor’s documentation and in-house 

for procedures for the protection of confidential and official use only information.

(h) The contractor agrees to comply with the Privacy Act of 1974 and the rules and regulations issued pursuant 

to the Act in design, development, or operation of any system of records on individuals in order to accomplish 

an agency function when the contract specifically identifies the system or system of records and the work to 

be performed by the contractor in terms of any one or combination of design, development, or operation.

SECURITY WARNING: It is the contractor’s responsibility to properly safeguard personally identifiable 

information (PII) from loss, theft, or inadvertent disclosure and to immediately notify the Government of any loss 

of personally identifiable information. Personally identifiable information includes, but is not limited to, a person’s 

name, date of birth, Social Security Number, and/or address. 

The contractor must review and accept the Interconnection Security Agreement (ISA). See Exhibit A provided 

upon request.

Interconnection Security Agreement - An agreement established between the organizations that own and operate 

connected IT systems to document the technical requirements of the interconnection. The ISA also supports a 

Memorandum of Understanding or Agreement (MOU/A) between the organizations. SOURCE: SP 800-47. 

The ISA is vital in protection of the confidentiality, integrity, and availability of data processed between 

interconnected IT systems. Electronic connections between IT systems must be established in accordance 

with National Institute of Standards and Technology (NIST) Special Publication (SP) 800-47, "Security Guide for 

Interconnecting Information Technology Systems." 
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 5 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

An ISA is required whenever the security policies of interconnected systems are not identical and the systems are 

not administered by the same Authorizing Official (AO). The ISA documents the security protections that must 

operate on interconnected systems to ensure that transmission between systems permits only acceptable 

transactions.

The ISA addresses the interconnection between CBP and Non-DHS Entity by way of the HSEN extranet 

infrastructure. The connection is established through a secure VPN/MPLS connection. Additionally, the ISA covers 

application and/or control data traversing the networks.

An ISA is required by Federal and Department of Homeland Security (DHS) policy and establishes individual and 

organizational security responsibilities for the protection and handling of unclassified information between the U.S. 

Customs and Border Protection (CBP) and a Non-DHS Entity through the Homeland Security Enterprise Network 

(HSEN). 

System interconnections may be characterized as either direct or networked. Direct connections are single purpose 

point-to-point connections that support only the two connected systems. Directly connected systems do not rely on 

another network for their connectivity or security and are physically and electronically isolated from other networks 

and systems. Networked systems connect via an intervening network that exists as a general support system, not a 

single-purpose connection. Systems that are connected via an encrypted tunnel, whether on HSDN (Homeland 

Security Data Network) or any other network, are considered networked systems.

PREAWARD SURVEY: In order to determine the responsibility of the prime contractor or any subcontractor, the 

Government reserves the right to conduct an on-site preaward survey at the contractor’s/subcontractor’s facility or 

to require other evidence of technical, production, managerial, financial, and similar abilities to perform, prior to 

the award of a contract. As part of the financial determination, the contractor in line for award may be required to 

provide one or more of the following financial documents: 

1) Most recent profit and loss statement 

2) Most recent balance sheet 

3) Statement of cash flows 

4) Current official bank statement 

5) Current lines of credit (with amounts available) 

6) Letter of commitment from paper supplier(s) 

7) Letter of commitment from any subcontractor 

The documents will be reviewed to validate that adequate financial resources are available to perform the contract 

requirements. Documents submitted will be kept confidential and used only for the determination of responsibility 

by the Government. Failure to provide the requested information in the time specified by the Government may 

result in the Contracting Officer not having adequate information to reach an affirmative determination of 

responsibility.

The pre-award survey will include a review of all subcontractors involved, along with their specific functions; and, 

the contractor’s backup facility, quality control, computer systems, mail, material, personnel, production, and 

security plans, as required by this specification.

PREAWARD PRODUCTION PLANS: As part of the preaward survey, the contractor shall present, in writing, 

to the Contracting Officer within five (5) workdays of being notified to do so by the Contracting Officer or his/her 

representative, detailed plans for each of the following activities. The workday after notification to submit will be 

the first day of the schedule. If the Government requests additional information after review of plans, the contractor 

must submit updated plans within two (2) workdays of request.

The Contractor shall not change, enhance, or modify any of the approved plans, products, raw materials, 

manufacturing processes (including equipment) without written approval of the Government. 
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 6 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

Five (5) additional workdays will be permitted to review and agree to the supplied ISA, as required above. The 

contractor, at the Government’s discretion, may be granted five (5) additional workdays if additional information 

is required. The workday after notification to submit will be the first day of the schedule. 

Option Years - For each option year that may be exercised, the contractor will be required to review their production 

plans and re-submit in writing the above plans detailing any changes and/or revisions that may have occurred. The 

revised plans are subject to Government approval. The revised plans must be submitted to the Contracting Officer 

or his/her representative within ten (10) workdays of notification of the option year being exercised.

NOTE: If there are no changes/revisions, the contractor will be required to submit to the Contracting Officer or

his/her representative a statement confirming that the current plans are still in effect.

Failure to maintain all requirements in accordance with the plans submitted and approved by the Government may 

result in the Government terminating the contract for default. 

The Government retains the right to conduct on-site security reviews at any time during the term of the contract.

These proposed plans are subject to review and approval by the Government, and award will not be made 

prior to approval of same. The Government reserves the right to waive some or all of these plans.

Backup Facility - The failure to deliver these forms in a timely manner would have an impact on the daily operations 

of CBP. Therefore, if for any reason(s) (act of God, labor disagreements, etc.) the contractor is unable to perform 

at said location for a period longer five workdays, the contractor must have a backup facility with the capability of 

producing the forms. The backup facility must be operated by the contractor.

Plans for their contingency production must be prepared and submitted to the Contracting Officer as part of the 

preaward survey. 

These plans must include the location of the facility to be used, equipment available at the facility, security plans at 

the facility, and a timetable for the start of production at that facility. Part of the plans must also include the 

transportation of Government materials from one facility to another. The contractor must produce items from a test 

file at the new facility for verification of software prior to producing notices at this facility. 

NOTE: All terms and conditions of this contract will apply to the backup facility.

Quality Control Plan - The contractor shall provide and maintain, within their own organization, an independent 

quality assurance organization of sufficient size and expertise to monitor the operations performed, and inspect the 

products of each operation to a degree and extent that will ensure the Government’s quality assurance, inspection 

and acceptance provisions herein are met. The contractor shall perform, or have performed, the process controls, 

inspections and tests required to substantiate that the products provided under this contract conform to the 

specifications and contract requirements. The contractor shall describe in detail their quality control/quality 

assurance and recovery plans describing how, when and by whom the plans will be performed.

The plan must provide for periodic samplings to be taken during the production run, a control system that will detect 

defective, missing, or mutilated pieces, and the actions to be taken by the contractor when 

defective/missing/mutilated pieces are discovered. These actions must be consistent with the requirements found in 

GPO Contract Terms (GPO Publication 310.2, effective December 1, 1987 (Rev. 1-18)). A recovery system is 

required to replace all defective, missing, or mutilated pieces. This control system must use a unique sequential 

number to aid in the recovery program which has to be maintained in order to recover any missing or damaged 

pieces. These pieces must be reprinted and 100% accountability must be maintained throughout the run. The 

contractor must ensure that there are no missing or duplicated pieces.

The quality control plan must also include examples and a detailed description of all quality control samples and 

their corresponding inspection reports or logs the contractor will keep to document the quality control inspections 

performed on each run. Furthermore, the plan must include the names of all quality assurance officials and describe 

their duties in relationship to the quality control plan.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 7 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

The quality control system must include all aspects of the job including mail-flow and materials handling. The plan 

must also allow for a complete audit trail (e.g., it must be possible to locate any piece of mail at any time from the 

point it leaves the press up to and including the point at which the mail is off-loaded at the USPS facility. CBP will 

not, as a matter of routine, request the contractor produce pieces in transit within the contractor’s plant.) 

The quality control plan must account for the number of pieces mailed weekly for all daily, weekly, monthly and 

annual mailers. 

Quality Control Sample Plan - The plan must provide a description of how the contractor will create quality control 

samples for periodic samplings to be taken during the production run and provide for backup and rerunning in the 

event of an unsatisfactory sample. The plan shall contain control systems that will detect defective, missing, or 

mutilated pieces.

The plan should include the sampling interval the contractor intends to utilize. The contractor will be required to 

create two quality control samples to be drawn from the production stream at the same time. One sample will be 

drawn, inspected and retained as part of the contractor’s quality assurance records. The second sample drawn for 

the CBP will be packed with the remaining samples associated with each print order and shipped to CBP (address 

to be supplied at the post-award conference). 

For smaller quantities, the sampling rate must be adjusted as necessary to generate samples in the middle of each 

version run, or at the contractor’s option, the entire version may be produced a second time.

The plan shall detail the actions to be taken by the contractor when either defective, missing, or mutilated pieces

are discovered. These actions must be consistent with the requirements found in GPO Contract Terms (GPO 

Publication 310.2, effective December 1, 1987, Rev. 6-01).

The plan shall monitor all aspects of the job including material handling and mail flow to assure that the production 

and delivery of these forms meet specifications and Government requirements. This includes maintaining 100% 

accountability in the accuracy of imaging, packaging, and mailing of all pieces throughout each run. The contractor 

must ensure there are no missing or duplicate pieces.

The contractor must maintain quality control samples, inspection reports and records for a period of no less than 

30 calendar days. The Government will periodically verify that the contractor is complying with the approved 

quality control plan through on-site examinations and/or requesting copies of the contractor’s quality assurance 

records and quality assurance random copies.

Verification of Production and Mailing Plan - Contractor will be responsible for validating the integrity of every 

form produced in all phases of printing, imaging, packaging, and mailing and to ensure all forms received from 

CBP were correctly entered into the United States postal system.

Form integrity shall be defined as follows: Each mailer shall include only the form intended for the designated 

recipient as contained in the print files received from CBP. 

The contractor is responsible for providing the automated print form integrity control systems and processes 

required to prevent the commingling of forms intended for different recipients into a completed package. The 

contractor’s printing process must have automated systems that include form coding and scanning technology 

capable of:

• Validating the count of forms in a data transmission. 

• Validating the sequence of forms in a production batch. 

• Interrupting production if variances are detected.

Mailing integrity shall be defined as follows: All forms received from CBP for each print order were printed, 

imaged, packaged, and entered correctly into the United States postal system.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 8 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

The contractor is responsible for providing the automated inserted form tracking/reporting systems and processes 

required to validate that 100% of all notices received from CBP were printed, imaged, packaged, and mailed 

correctly. The contractor’s inserting equipment must have automated systems that include form coding and scanning 

technology capable of:

• Reconciling form counts from CBP provided print files to print order control totals provided by CBP; 

reporting variances.

• Uniquely identifying each form within a print order.

• Scanning the unique identifier after insertion to ensure all forms are present and accounted for.

• Tracking and reporting all forms produced and mailed within a print order at the form level.

• Identifying and reporting all missing notices that were lost or spoiled during production within a print order. 

• Generating a new production file for all missing forms. 

• Reconciling the total of all forms produced and mailed within a print order to the control totals provided by 

CBP; reporting all variances.

• Reconciling the total of all forms mailed to mailing totals contained on Postal Entry Forms within a print

order; reporting all variances.

• Generating a final automated summary report which provides information that all mail pieces have been 

scanned, after insertion, verifying that all pieces for each mail package and file date are accounted for after 

contents are inserted, and event information on any spoiled or missing pieces verifying that they were scanned 

and accounted for. A copy of the summary report must be submitted with the matching GPO 712 form(s) to: 

U.S. Customs and Border Protection, 1300 Pennsylvania Avenue, Room 3.2C-64, Mail Stop 1017, 

Washington, DC 20229-1017. Attn: Dewey Hicks (Email: dewey.hicks@cbp.dhs.gov) 

Contractor must generate an automated audit report when necessary showing the tracking of all forms throughout 

all phases of production for each mail piece. This audit report will contain all information outlined above for each 

phase of printing, imaging, inserting, and mailing.

All form tracking/reporting data must be retained in electronic form for one (1) year after mailing, and must be 

made available to CBP for auditing of contractor performance upon request.

Unique Identification Number Plan - Unique identifying numbers will be used to track each individual notice, 

thereby providing 100% accountability. This enables the contractor to track each notice through completion of the 

project. The contractor may create their own sequence number and run date to facilitate their presorting and 

inserting process. 

Recovery System – A recovery system will be required to ensure all defective, missing, or mutilated pieces detected 

are identified, reprinted, and replaced. The contractor’s recovery system must use unique sequential alpha/numeric 

identifiers assigned to each piece (including quality control samples) to aid in the recovery and replacement of any 

defective/missing/mutilated pieces, and must be capable of tracking and/or locating any individual piece of mail 

from the time it leaves the press, up to and including when it is off-loaded at the USPS facility. 

An explanation of the contractor’s sequential numbering system is required to understand the audit trail required 

for each piece. The sequential numbers will be used to track each individual form, thereby providing 100% 

accountability.

The contractor’s sequential number must include the contractor’s name (a 4-character field) plus the production 

date (an 8-character date (MMDDCCYY)). OCR-A 10-point typeface should be utilized to image the sequential 

number.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 9 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

NOTE: The sequential number should be placed in a position that does not restrict the CBP form function or will 

cause confusion by the form recipient.

Computer System Plan - This plan must include a detailed listing of the contractor’s operating software platform 

and file transfer system necessary for electronic transmission of files from CBP. The Computer System Plan shall 

demonstrate the contractor’s ability to provide complete hardware and software compatibility in accordance with 

the specifications.

Included with the Computer System Plan shall be a resume for each employee responsible for the monitoring and 

the programming of the contractor’s computer system and file transmissions. 

Mail Plan - This plan must include sufficient detail as to how the contractor will comply with all applicable U.S. 

Postal Service (USPS) mailing requirements as listed in the USPS Domestic and International Mail Manuals in 

effect at the time of the mailing and other USPS instructional material such as the Postal Bulletin. 

Material Handling and Inventory Control Plan - This plan must explain in detail how the following materials will 

be handled: incoming raw materials; work-in-progress materials; quality control inspection materials; USPS 

inspection materials; and all outgoing materials cleared for USPS pick-up/delivery.

Personnel Plan - This plan must include a listing of all personnel who will be involved with this contract. For any 

new employees, the plan should include the source of these employees, and a description of the training programs 

the employees will be given to familiarize them with the requirements of this program.

Production Plan - This plan must include items such as a detailed listing of all production equipment and equipment 

capacities to be utilized on this contract. If new equipment is to be utilized, documentation of the source, delivery 

schedule, and installation dates are required.

Security Control Plan - The contractor shall maintain in operation, an effective security system where items by 

these specifications are manufactured and/or stored (awaiting distribution or disposal) to assure against theft and/or 

the product ordered falling into unauthorized hands. 

Contractor is cautioned that no Government provided information shall be used for non-government business. 

Specifically, no Government information shall be used for the benefit of a third party. 

The Government retains the right to conduct on-site security reviews at any time during this contract. 

The plan must address, at a minimum, the following:

Materials - The contractor is required to explain how all accountable materials will be handled throughout all 

phases of production. 

Production Area - The contractor must provide a secure area(s) dedicated to the processing and storage of data 

(either a separate facility dedicated to this product or a walled-in limited access area within the contractor’s 

existing facility). Access to the area(s) shall be limited to security-trained employees involved in the production 

of CBP forms.

Part of the Security Control Plan shall include a floor plan detailing the area(s) to be used, showing existing 

walls equipment to be used, and the printing and finishing locations.

Disposal of Waste Materials - The contractor is required to demonstrate how all waste materials used in the 

production of sensitive CBP records will be definitely destroyed (e.g.., burning, pulping, shredding, macerating, 

or other suitable similar means). Electronic records must be definitely destroyed in a manner that prevents 

reconstruction. Definitely destroying the records means the material cannot be reassembled and used in an 

inappropriate manner in violation of law and regulations. Sensitive records are records that are national security 

classified or exempted from disclosure by statute, including the Privacy Act or regulation.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 10 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

The contractor, at a minimum, must crosscut shred all documents into squares not to exceed 1/4”. All 

documents to be destroyed cannot leave the security of the building and must be destroyed at contractor’s 

printing site. The contractor must specify the method planned to dispose of the material. Subcontracting is not 

allowed.

POSTAWARD CONFERENCE: Unless waived by the Contracting Officer, the total requirements of the job as 

indicated in these specifications will be reviewed by Government representatives with the contractor’s 

representatives at the U.S. Government Publishing Office, Washington, DC, immediately after award. At the 

Government’s option, the postaward conference may be held via teleconference.

Person(s) that the contractor deems necessary for the successful implementation of the contract must be in 

attendance.

ASSIGNMENT OF JACKETS, PURCHASE AND PRINT ORDERS: A GPO jacket number will be assigned 

and a purchase order issued to the contractor to cover work performed. The purchase order will be supplemented 

by an individual print order for each job placed with the contractor. The print order, when issued, will indicate the 

quantity to be produced and any other information pertinent to the particular order.

ORDERING: Items to be furnished under the contract shall be ordered by the issuance of print orders by the 

Government. Orders may be issued under the contract from Date of Award through July 31, 2023. All print 

orders issued hereunder are subject to the terms and conditions of the contract. The contract shall control in the 

event of conflict with any print order. A print order shall be "issued" upon notification by the Government for 

purposes of the contract when it is electronically transmitted or otherwise physically furnished to the contractor in 

conformance with the schedule.

REQUIREMENTS: This is a requirements contract for the items and for the period specified herein. 

Shipment/delivery of items or performance of work shall be made only as authorized by orders issued in accordance 

with the clause entitled "Ordering". The quantities of items specified herein are estimates only, and are not 

purchased hereby. Except as may be otherwise provided in this contract, if the Government's requirements for the 

items set forth herein do not result in orders in the amounts or quantities described as "estimated", it shall not 

constitute the basis for an equitable price adjustment under this contract.

Except as otherwise provided in this contract, the Government shall order from the contractor all the items set forth 

which are required to be purchased by the Government activity identified on page 1.

The Government shall not be required to purchase from the contractor, requirements in excess of the limit on total 

orders under this contract, if any.

Orders issued during the effective period of this contract and not completed within that time shall be completed by 

the contractor within the time specified in the order, and the rights and obligations of the contractor and the 

Government respecting those orders shall be governed by the terms of this contract to the same extent as if

completed during the effective period of this contract.

If shipment/delivery of any quantity of an item covered by the contract is required by reason of urgency prior to the 

earliest date that shipment/delivery may be specified under this contract, and if the contractor will not accept an 

order providing for the accelerated shipment/delivery, the Government may procure this requirement from another 

source.

The Government may issue orders which provide for shipment/delivery to or performance at multiple destinations.

Subject to any limitations elsewhere in this contract, the contractor shall furnish to the Government all items set 

forth herein which are called for by print orders issued in accordance with the "Ordering" clause of this contract.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 11 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

ADDITIONAL EMAILED BID SUBMISSION PROVISIONS: The Government will not be responsible for any 

failure attributable to the transmission or receipt of the emailed bid including, but not limited to, the following:

1. Illegibility of bid.

2. Emails over 75 MB may not be received by GPO due to size limitations for receiving emails.

3. The bidder’s email provider may have different size limitations for sending email; however, bidders are 

advised not to exceed GPO’s stated limit.

4. When the email bid is received by GPO, it will remain unopened until the specified bid opening time. 

Government personnel will not validate receipt of the emailed bid prior to bid opening. GPO will use the 

prevailing time (specified as the local time zone) and the exact time that the email is received by GPO’s 

email server as the official time stamp for bid receipt at the specified location.

PAYMENT: Prior to submitting billing invoice to GPO for payment, the contractor shall submit an itemized 

statement for billing to the ordering agency for examination and certification as to the correctness of the billing. 

Submit billing to: U.S. Customs and Border Protection, 1300 Pennsylvania Avenue, Room 3.2C-64 Mail Stop 

1017, Washington, DC 20229-1017. Attn: Dewey Hicks

After agency verification, contractor must submit the signed, verified billing invoice to the U.S. Government 

Publishing Office for payment. 

Submitting invoices for payment via the GPO fax gateway (if no samples are required) utilizing the GPO bar code 

coversheet program application is the most efficient method of invoicing. Instruction for using this method can be 

found at the following web address: 

http://winapps.access.gpo.gov/fms/vouchers/barcode/instructions.html. 

Invoices may also be mailed to: U.S. Government Publishing Office, Office of Financial Management, Attn: 

Comptroller, Stop: FMCE, Washington, DC 20401. 

For more information about the billing process, refer to the General Information of the Office of Finance web page 

located at: http://www.gpo.gov/finance/index.htm. 

Contractor’s billing invoice must be itemized in accordance with the line items in the “SCHEDULE OF PRICES.”

PRIVACY ACT NOTIFICATION: This procurement action requires the contractor to do one or more of the 

following: design, develop, or operate a system of records on individuals to accomplish an agency function in 

accordance with the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable 

agency regulations. Violation of the Act may involve the imposition of criminal penalties.

PRIVACY ACT

(a) The contractor agrees:

(1) To comply with the Privacy Act of 1974 and the rules and regulations issued pursuant to the Act in the 

design, development, or operation of any system of records on individuals in order to accomplish an 

agency function when the contract specifically identifies (i) the system or systems of records and (ii) 

the work to be performed by the contractor in terms of any one or combination of the following: (A) 

design, (B) development, or (C) operation;
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 12 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

(2) To include the solicitation notification contained in this contract in every solicitation and resulting 

subcontract and in every subcontract awarded without a solicitation when the statement of work in the 

proposed subcontract requires the design, development, or operation of a system of records on 

individuals to accomplish an agency function; and

(3) To include this clause, including this paragraph (3), in all subcontracts awarded pursuant to this contract 

which require the design, development, or operation of such a system of records.

(b) In the event of violations of the Act, a civil action may be brought against the agency involved where the 

violation concerns the design, development, or operation of a system of records on individuals to 

accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of 

the agency where the violation concerns the operation of a system of records on individuals to accomplish 

an agency function. For purposes of the Act when the contract is for the operation of a system of records 

on individuals to accomplish an agency function, the contractor and any employee of the contractor is 

considered to be an employee of the agency.

(c) The terms used in this clause have the following meanings:

(1) “Operation of a system of records” means performance of any of the activities associated with 

maintaining the system of records including the collection, use, and dissemination of records.

(2) “Record” means any item, collection or grouping of information about an individual that is maintained 

by an agency, including, but not limited to, his education, financial transactions, medical history, and 

criminal or employment history and that contains his name, or the identifying number, symbol, or other 

identifying particular assigned to the individual, such as a finger or voice print or a photograph.

(3) “System of records” on individuals means a group of any records under the control of any agency from 

which information is retrieved by the name of the individual or by some identifying number, symbol, 

or other identifying particular assigned to the individual.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 13 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

SECTION 2. - SPECIFICATIONS

SCOPE: These specifications cover the production of mailers consisting of a personalized form, Business Reply 

Mail (BRM) return envelope, letter, report, and/or a mail-out envelope requiring such operations as receipt and 

processing of transmitted data; electronic prepress; printing; imaging (computerized printing) of changeable form 

data; binding; construction; assembling; packaging; and, distribution.

TITLE: Form 6084 SAP, Form 6084 SC, ACE Dunning Letter, 612 Surety Report, IRS Forms 1099G and 

1099C

FREQUENCY OF ORDERS, and QUANTITY: 

The first print order placed will be for the proofs and prior to production samples only. The balance of the print 

orders will be for the production and distribution of the mailers.

Daily

Form 6084 SAP– Approximately 800 to 4,000 copies. 

Weekly

Form 6084 SC - Approximately 1,000 to 3,000 copies.

NOTE: For SeaCats only, contractor has to create ship to port documents. This requires a 2nd set of all printed

copies of SeaCats bills, which is to be mailed USPS 1st Class to the port(s), when the original bill is mailed to the 

importer or agent.

ACE Dunning Letters – Approximately 60 to 100 copies. 

Monthly

612 Surety Report – Approximately 50 to 100 copies. 

Yearly

IRS Form 1099G - Approximately 1,000 copies. 

IRS Form 1099C - Approximately 500 copies. 

NUMBER OF PAGES: 

Daily

Form 6084 SAP – one (1) page 

Weekly

Form 6084 SC – one (1) page

ACE Dunning Letters – Up to six (6) pages 

Monthly

612 Surety Report –one (1) to 100 pages

Yearly

IRS Form 1099G - one (1) page 

IRS Form 1099C - one (1) page 
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 14 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

TRIM SIZES: 

Form 6084 SAP: 8-1/2 x 11”

Form 6084 SC: 8-1/2 x 11”

ACE Dunning Letters: 8-1/2 x 11”

612 Surety Report: 8-1/2x 14”

IRS Form 1099G: 8-1/2 x 11”

IRS Form 1099C: 8-1/2 x 11”

Return Envelope: 3-7/8 x 8-7/8” (No. 9) plus flap.

Mail-out Envelope: 4-1/8 x 9-1/2” (No. 10) plus flap.

GOVERNMENT TO FURNISH: 

Form 6084 SAP, and Form 6084 SC – The Government will furnish either fully composed print ready PDF files

with all static and variable data in position for each recipient * OR Static print file with variable data files to be 

merged into it for each recipient. **

ACE Dunning Letter – The Government will furnish multi-page, fully composed print ready PDF files with all 

static and variable data in position for each recipient. * 

612 Surety Report - The Government will furnish multi-page, fully composed print ready PDF files with all static 

and variable data in position for each recipient. * 

IRS Forms 1099G and 1099C – Files will be furnished a static print file with variable data files to be merged into 

it for each recipient. **

* All the PDF files require the contractor to isolate address element, CASS certify files, add IMB barcode , 2D 

barcodes, Presort First Class, and replace the updated data elements into the PDF files. 

** Data Files require contractor to CASS certify files, add IMB barcode, 2D barcodes, and Presort First Class.

Folded samples, to be used as a guide, will be provided after award. 

“Postage and Fees Paid” mailing indicia.

USPS Form 3602-G for mailing.

Exhibit A: Interconnection Security Agreement (ISA) - Available by e-mail upon request of GPO

Exhibit B: Sample Form 6084 SAP

Exhibit C: Sample Form 6084 SC

Exhibit D: ACE Dunning Letter 

Exhibit E: 612 Surety Report 

Exhibit F: IRS Form 1099G

Exhibit G: IRS Form 1099C

Identification markings such as register marks, commercial identification marks of any kind, etc., except GPO 

imprint, form number, and revision date, carried in the electronic files, must not print on the finished product.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 15 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

CONTRACTOR TO FURNISH: All materials and operations, other than those listed under “GOVERNMENT 

TO FURNISH,” necessary to produce the products in accordance with these specifications.

Contractor must have their own dedicated server which would be connected to CBP Cloud server to access files. 

Minimum requirements for the server based on current equipment: BTO PE R430 E5-2623 2.6GHZ 16GB DELL 

SERVER. 

After award, the Government will provide connectivity specifications and will reimburse the contractor for all costs 

necessary to address connectivity requirements between servers 

The Contractor must be able to share files and soft proofs electronically via a contractor-hosted Secure File Transfer 

Protocol (SFTP) server. Appropriate log-on instructions and protocol must be provided at time of award. The 

contractor must provide necessary security for the SFTP, which at a minimum, must have a unique user ID and 

password.

The contractor will be expected to work closely with the ordering agency, if required, to re-design and test existing

print templates (for the form) capable of supporting the complex scripting and variable data that is furnished on this 

contract. 

ELECTRONIC PREPRESS: Prior to image processing, the contractor shall perform a basic check (preflight) of 

the furnished media and publishing files to assure correct output of the required reproduction image. Any errors, 

media damage, or data corruption that might interfere with proper file image processing must be reported to the 

agency contact specified on the print order.

The contractor shall create or alter any necessary trapping, set proper screen angles and screen frequency, and define 

file output selection for the imaging device being utilized. Furnished files must be imaged as necessary to meet the 

assigned quality level. When required by the Government, the contractor shall make minor revisions to the 

electronic files. It is anticipated that the Government will make all major revisions. Prior to making revisions, 

contractor shall copy the furnished files and make all changes to the copy.

Upon completion of each order, the contractor must furnish final production native application files (digital

deliverables) with the furnished material. The digital deliverables must be an exact representation of the final 

printed product and shall be returned on the same type of storage media as was originally furnished. The 

Government will not accept, as digital deliverables, PostScript files, Adobe Acrobat Portable Document Format 

(PDF) files, or any proprietary file formats other than those supplied, unless specified by the Government. (The 

Government will accept PDF files as digital deliverables when furnished by the Government.)

PROOFS: Required on the first order issued for each mailer type and as a result of any required copy change. 

If produced via conventional offset printing: 

One (1) set of digital color content proofs. Direct to plate must be used to produce the final product with a minimum 

of 2400 x 2400 dpi. Proofs must be created using the same Raster Image Processor (RIP) that will be used to 

produce the product. Proofs shall be collated with all elements in proper position (not pasted up), imaged face and 

back, trimmed, and folded to the finished size of the product, as applicable. 

NOTE: For Form 6084 SAP, proofs must show perforation placement. For the envelopes, proofs show all margins 

and dimensions, indicate trim marks, show flap, and show window size and placement. 

If produced via digital printing: 

One (1) set of digital color one-off proofs created using the same output device that will be used to produce the final 

printed product on the actual production stock. Proofs shall be collated with all elements in proper position (not 

pasted up), imaged face and back, trimmed, and folded to the finished size/format of the product, as applicable. 

Proof will be used for color match on the press on the production run. 
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 16 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

NOTE: For Form 6084 SAP, proofs must show perforation placement. For the envelopes, proofs show all margins 

and dimensions, indicate trim marks, show flap, and show window size and placement.

If any contractor’s errors are serious enough in the opinion of the GPO to require revised proofs, the revised proofs 

are to be provided at no expense to the Government. No extra time can be allowed for this reproofing; such 

operations must be accomplished within the original production schedule allotted in the specifications.

PDF soft proofs

A PDF soft production proof must be submitted as a single file for the first five names in the furnished file and must 

include all the variable data for those five names. Proof will be transferred to the agency via SFTP site. 

If any contractor’s errors are serious enough in the opinion of the GPO to require revised proofs, the revised proofs 

are to be provided at no expense to the Government. No extra time can be allowed for this reproofing; such 

operations must be accomplished within the original production schedule allotted in the specifications.

CONTRACTOR MUST NOT PRINT PRIOR TO THE RECEIPT OF AN “O.K. TO PRINT.”

STOCK/PAPER: The specifications of all paper furnished must be in accordance with those listed herein or listed 

for the corresponding JCP Code numbers in the “Government Paper Specification Standards No. 13” dated 

September 2019. Government Paper Specification Standards No. 13 – 

https://www.gpo.gov/docs/default-source/forms-and-standards-files-for-vendors/vol_13.pdf. 

All paper used in each order must be of a uniform shade. 

Form 6084 SAP, Form 6084 SC, ACE Dunning Letters – White Optical Character Recognition (OCR) Bond, basis 

weight: 24 lbs. per 500 sheets, 17 x 22”, equal to JCP Code O-25.

612 Surety Report – White Optical Character Recognition (OCR) Bond, basis weight: 24 lbs. per 500 sheets, 

17 x 22”, equal to JCP Code O-25. 

IRS Forms 1099G and 1099C – 

White Uncoated Text, basis weight: 60 lbs. per 500 sheets, 25 x 38”, equal to JCP Code A60.

Uncoated Colored Text, basis weight: 60 lbs. per 500 sheets, 25 x 38”, equal to JCP Code A63.

Return and Mail-out Envelopes – White Writing, basis weight: 24 lbs. per 500 sheets, 17 x 22”, equal to 

JCP Code V20.

PRINTING/IMAGING: 

NOTE: U.S. Customs and Border Protection reserves the right to make changes to the format/text on the form or 

changes to the envelopes at any time during the term of the contract. Therefore, the contractor shall not pre-print 

or maintain more than a three month’s supply of any of the mailer components required under this contract. CBP 

will not be required to purchase from the contractor the inventory of any component remaining on hand in excess 

of what was authorized when a format/text change to the form or envelope change is implemented. 

At contractor’s option, the products may be produced via conventional offset or digital printing provided that 

Quality Level 3 standards are maintained. Final output must be a minimum of 150 line screen and at a minimum 

resolution of 1200 x 1200 x 1 dpi or 600 x 600 x 4 bit depth technology. 

The contractor must manipulate the text from furnished electronic files, which is a flat file. All variable imaging 

required in the performance of this contract is direct image. The form templates will be the same for each record. 

Since the image/data on each form is for a different CBP account, each record will be separate data. 
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 17 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

The recommended displacement is no more than 0.014” between characters. The scan line must have a clear band 

at least 3/8” in width, from the top of the scan line to the bottom of the line above. The scan line and additional 

record specific information must also be printed in a 417 bar code.

Form 6084 SAP – Prints one side only in black with variable data printing in Pantone 187 Red. Imaging consists 

of text matter (importer address) and a bar code (which captures the importer number, importer name, bill date, 

“amount due after” date, and the bill number).

Most of the information that will be imaged on the voucher portion of the form is the same information that is 

imaged on the rest of the form; the bar code should capture the importer number, importer name, bill date, “amount 

due after” date, and the bill number. 

On the payment voucher portion of the form (i.e., the portion below the perforation – see “BINDING”), the voucher 

scan line must be vertically positioned 1/2” from the bottom edge of the voucher to the bottom of the scan line. The 

right most character of the scan line must be placed 3-1/2” from the right (leading) edge of the form. 

Printed form is perforated for easy removal preaddressed return payment stub. See BINDING 

Form 6084 SC – Prints one side only in black with variable data printing in Pantone 187 Red. No perforations 

are required.

ACE Dunning Letters – Prints face and back, head to head in black.

612 Surety Reports – Prints face and back, head to head in black.

IRS Forms 1099G & 1099C - Prints one side only in black. No perforation required. 

Return Envelope – Prints face and back (before construction) in black ink. Printing on the face consists of the CBP 

return address and a postage block. Printing on the back consists of text matter.

NOTE: Return envelope is only required for Form 6084 SAP. The face of the return envelopes is to be in 

BUSINESS REPLY FORMAT

Mail-out Envelope – Prints face and back (before construction) in black ink. Printing consists of the CBP return 

address and the CBP mailing indicia. 

NOTE: See “ASSEMBLY” for additional specific printing requirements on the mail-out envelopes for 

Form 6084 SAP, Form 6084 SC, and IRS Forms 1099G & 1099C

Return and Mail-out Envelopes require a security tint printed on the inside (back - before construction) in black ink. 

Contractor may use his own design but must guarantee that the product will ensure complete opacity and prevent 

show through of any material contained therein.

Printing of return and mail-out envelopes shall be in accordance with the requirements for the style envelope 

ordered. All printing shall comply with all applicable U.S. Postal Service regulations. The envelope shall accept 

printing without feathering or penetrating to the reverse side.

SHEET INSPECTION: 

Final make-ready press sheets will be inspected and approved at the contractor’s plant for the purpose of establishing 

specified standards for use during the actual press run. Upon approval of the sheets, contractor is charged with 

maintaining those standards throughout the press run (within QATAP tolerances when applicable) and with 

discarding all make-ready sheets that preceded approval. When a press sheet inspection is required, it will be 

specified on the individual print order. See GPO Publication 315.3 (Guidelines for Contractors Holding Press Sheet 

Inspections) dated January 2015.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 18 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

A press sheet inspection is for the purpose of setting specific standards that are to be maintained throughout the 

entire run. It does not constitute a prior approval of the entire run.

Press sheets must contain control bars for each color of ink on the sheet. Control bars must be placed parallel to the 

press’s ink rollers. The control bars (such as, BRUNNER, GATF, GRETAG, or RIT) must show areas consisting 

of 1/8 x 1/8” minimum solid color patches; tint patches of 25, 50, and 75%; dot gain scale; gray balance patches, 

and trap targets for process color (if applicable). These areas must be repeated consecutively across the entire press 

sheet.

NOTE: The agency will notify the contractor a week in advance (of an order being placed) of a press sheet 

inspection on that order. The agency will provide the contractor with the print order number that will require the 

inspection.

MARGINS: Maintain all margins as indicted in the furnished electronic files. All forms and envelopes print to 

precise margins as indicated in each file. All margins for the return envelopes (business reply envelopes) must 

comply with the USPS publication 25.

BINDING: 

Form 6084 SAP – Trim four sides. The form contains one horizontal perforation 7-3/8” from the top edge of form 

to create a payment voucher that is 8-1/2 x 3-5/8” in size. All perforations must be slit or slot (pinholes not 

acceptable) and provide a clean edge. Perforations must be of such strength as to prevent separation during normal 

mailing and handling. 

Form 6084 SC – Trim four sides then fold form down to 8-1/2 x 3-5/8” with mailing address on form facing out.

ACE Dunning Letters – All leaves trim four sides. 

612 Surety Report – Trim four sides, and gather together loose-leaf. 

IRS Forms 1099G & 1099C – Trim four sides. 

CONSTRUCTION (Envelopes):

Return and Mail-out Envelopes – Envelope must be open side, high-cut diagonal or side seams, with gummed 

fold-over flap for sealing. Flap depth must be a minimum of 2-3/8” and must be coated with remoistenable glue 

that will securely seal without adhering to the contents. The sealed seams shall not adhere to the inside of the 

envelope.

Face of return envelope to contain one die-cut window (1-1/8 x 3-3/8”) with slightly rounded corners. Window is 

to be located 4-5/8” from the left edge of the envelope and 1/2” from the bottom edge of the envelope.

Face of mail-out envelope to contain one die-cut window (1-3/8 x 4-1/2”) with slightly rounded corners. Window 

is to be located 7/8” from left edge of the envelope and 1/2” from bottom edge of envelope.

Windows are to be covered with a suitable poly-type transparent, low-gloss material that must be clear of smudges,

lines, and distortions. Poly-type material must be securely affixed to the inside of the envelope so as not to interfere

with insertion of contents. Window material must meet the current U.S. Postal Service’s (USPS) readability

standard/requirements.

ASSEMBLY AND PACKAGING: 

Form 6084 SAP - Fold form from 8-1/2 x 11” down to 8-1/2 x 3-5/8” with mailing address on form facing out. 

(Follow furnished sample). Insert one folded form with one flat return envelope (behind the folded form) into a 

mail-out envelope with mailing address on the form facing out for visibility through mail-out envelope window. 

NOTE: Mail-out envelopes must include the text “INVOICE ENCLOSED.”
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 19 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

It is the contractor’s responsibility to assure that only the recipient’s address and bar code is visible through the 

envelope window and that only one form and one return envelope is inserted into each mail-out envelope. Seal mailout envelopes.

Form 6084 SC – Fold form from 8-1/2 x 11” down to 8-1/2 x 3-5/8” with mailing address on form facing out. 

Insert one folded form into a mail-out envelope with mailing address on the form facing out for visibility through

mail-out envelope window. Seal mail-out envelopes.

NOTE: Mail-out envelopes must include the text “INVOICE ENCLOSED.”

ACE Dunning Letter – Gather all required leaves in proper sequence. Leaves are to be nested together will all 

faces forward. Fold letter from 8-1/2 x 11” down to 8-1/2 x 3-5/8” with mailing address on letter facing out. Insert 

folded letter into a mail-out envelope with mailing address on the letter facing out for visibility through the mailout envelope window. Seal mail-out envelopes.

612 Surety Reports – At Contractor’s option insert all flat copies into either 10 x 13” side flap, 28-lb. Kraft mailout envelope(s), or equivalent, OR 14 x 12 x 3” Standard shipping container(s), or equivalent.

Apply 2 x 4” Avery Standard white (printable, permanent adhesive back mailing address label, or equivalent, to 

each envelope or container.

IRS Forms 1099G and 1099C – Fold form from 8-1/2 x 11” down to 8-1/2 x 3-5/8” with mailing address on form 

facing out. Insert one folded IRS form into a mail-out envelope with mailing address on the form facing out for 

visibility through mail-out envelope window. Seal mail-out envelopes.

NOTE: Mail-out envelopes must include the text “TAX DOCUMENT ENCLOSED”

PRODUCTION INSPECTIONS: 

Production inspection(s) may be required at the contractor’s/subcontractor’s plant to ensure that operations of

receipt and processing of wire transmitted data; electronic prepress; printing; imaging (computerized printing) of 

changeable form data; binding, construction; assembling; and packaging, distribution are being accomplished in 

accordance with contract quality attributes and requirements. 

NOTE: A production inspection is for the purpose of setting specific standards that are to be maintained throughout 

the entire run. It does not constitute a prior approval of the entire run.

The agency will notify the contractor a week in advance (of an order being placed) of a production inspection 

on that order. The agency will provide the contractor with the print order number that will require the inspection.

DISTRIBUTION: 

Mail f.o.b. contractor’s city to domestic (nationwide) and foreign addresses. 

The prime contractor’s facility must be a United States Postal Service Detached Mailing Unit or Postal Substation 

to provide assurance of the contractor’s expertise in mailing high volumes of critical documents and to expedite 

secure delivery of the forms via the USPS mail stream. Coding Accuracy Support System (CASS) certifications 

shall be present within the facility of manufacture. Production (imaging, packaging, and mailing) of the personalized 

form must begin and end within the same facility to enhance production efficiency, security, and control.

Domestic addresses include the American Territories. Complete addresses and quantities will be furnished with the 

print orders.

All mailing shall be made at the lowest possible First-Class rate using the latest mailing software to realize the best 

cost rates.

NOTE: Greater than 40% of the mailings will be foreign addresses.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 20 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

The contractor is cautioned that the “Postage and Fees Paid” indicia may be used only for the purpose of mailing 

material produced under this contract.

Orders which result in mailings of less than 200 pieces or less than 50 pounds will require the contractor to apply 

the appropriate postage to each mailing. Contractor will be reimbursed for postage by submitting a properly 

completed Postal Service Certificate of Mailing with the contractor’s invoice for billing.

Contractor must utilize USPS approved commercial software to provide Coding Accuracy Support system (CASS) 

address hygiene and standardization, as well as to analyze and re-sequence the data to obtain maximum presort 

postage discounts. The contractor’s software must also be presort Accuracy Validation and Evaluation (PAVE) 

certified.

Contractor must be an approved Full-Service USPS Intelligent Mail Bar Code provider and must supply an 

approved copy of their IMB Mailer ID application to verify status. 

The contractor must meet all Full Service IMB preparation and postage documentation requirements, as required in 

the Domestic Mail Manual. All mail shall be presented under the contractor-obtained Mailer ID. The contractor 

must establish customer reference ID (CRID) for CBP as the mail owner. 

The contractor must provide all requested postage statements and reports along with the following mail data: date 

of mailing; USPS acceptance data; number of pieces; postage amount; and, weight. The contractor will provide 

access and password to Postal One for use by CBP upon request.

Certificate of Conformance: When using Permit Imprint Mail the contractor must complete GPO Form 712 - 

Certificate of Conformance (Rev. 2-91), supplied by GPO and the appropriate mailing statement or statements, 

supplied by USPS.

The contractor is required to fill in all applicable items on USPS form(s) and submit in duplicate to the entry post 

office. The post office will return a verified copy of USPS form(s) to the contractor. The contractor must 

immediately forward a copy to the ordering agency identifying the Program Number, Print Order, and Jacket

Number as appropriate.

All copies mailed must conform to the appropriate regulations in the U.S. Postal Service manuals for “Domestic 

Mail” or “International Mail”, as applicable.

Each week, the contractor is to furnish the weekly list of the merged data with the date mailed. This list must be 

signed by an authorized representative of the contractor. The contractor is to email the list to: U.S. Customs and 

Border Protection, Attn: Dewey Hicks at dewey.hicks@cbp.dhs.gov. 

Upon completion of each order, the contractor must complete the following:

• The contractor must notify the ordering agency on the same day that the product mails via email to the 

email address specified on the print order. The subject line of the email shall be “Distribution Notice for 

Program 268-S, P.O. XXXXX, Jacket XXX-XXX, Print Order XXXXX.” The notice must provide all 

applicable tracking numbers and mailing method. Contractor must be able to provide copies of all mailing 

receipts upon agency request.

• At the request of the Government and to be determined post award. The contractor will send back to 

DHS/CBP, via secured electronic system, a PDF copy of each Form 6084 SAP bill, Form 6084 SC bill, and 

IRS Forms 1099C notice, and 1099G notice that has been mailed. Additional instructions to follow post 

award

• All electronic files received must be destroyed within 30 days after mailing.

• All Government furnished material for the static information on the forms, envelopes, and digital 

deliverables must be returned to: U.S. Customs and Border Protection, 1300 Pennsylvania Avenue, NW, 

Room 3.2C, Mailstop: 1017, Washington, DC 20229-1017.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 21 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

Within five workdays of completion of each mailing, the contractor must return a completed USPS 3602-G mail 

form to: U.S. Customs and Border Protection, National Mail Management Program Office, Attn: Lewis Walters, 

Room 3.2C, Mailstop 1017, 1300 Pennsylvania Avenue, NW, Washington, DC 20229-1017. (Telephone: (202) 

344-2482; email: lewis.a.walter@dhs.gov) 

All expenses incidental to picking up/receiving and returning materials, submitting proofs and prior to production 

samples, and furnishing sample copies must be borne by the contractor. 

SCHEDULE: Adherence to this schedule must be maintained. 

Contractor must not start production of any job prior to receipt of the individual print order (GPO Form 2511).

At the Government’s option, the print order may be faxed or emailed to the contractor.

When ordered, hard Proofs must be delivered to: U.S. Customs and Border Protection, 1300 Pennsylvania Avenue, 

NW, Room 3.2C, Mailstop: 1017, Washington, DC 20229-1017.

When ordered, contractor to email PDF soft proof as instructed by CBP. 

Workday for transmission of files – For the purpose of this contract, the term “workday” is defined as Sunday 

through Friday each week, exclusive of the days on which Federal Government holidays are observed. 

Workday for production and distribution – For the purpose of this contract, the term “workday” is defined as 

Monday through Friday each week, exclusive of the days on which Federal Government holidays are observed. 

Federal Government Holidays are as follows: New Year’s Day, Martin Luther King’s Birthday, President’s Day, 

Memorial Day, Juneteenth Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, 

and Christmas Day.

Form 6084 SAP - Live production files will be transmitted on a daily basis (each Sunday through Friday), except 

for the Federal Holidays listed above.

Form 6084 SC and ACE Dunning Letters – Live production files will be transmitted on a weekly basis (each 

Sunday), except for the Federal Holidays listed above.

612 Surety Report – Live production files will be transmitted on a monthly basis (1st Sunday of the month), 

except for the Federal Holidays listed above.

IRS Forms 1099G & 1099C - Live production files will be transmitted annually in (1st Sunday of January except 

for the Federal Holidays listed above.

Proofing Schedule: All expenses incidental to submitting proofs must be borne by the contractor.

The following schedule begins the workday after notification of the availability of print order and furnished 

material; the workday after notification will be the first workday of the schedule.

When required, the contractor must submit hard proofs (digital color content or digital color one-off proofs) within 

three (3) workdays of notification of the availability of print order and furnished material.

Proofs will be withheld no more than two (2) workdays from their receipt at the ordering agency until they are made 

available for pickup. (The first workday after receipt of proofs at the ordering agency is day one (1) of the hold 

time.)

When required, the contractor must submit soft copy PDF production proofs for the first five names in the furnished 

data files or fully composed files. PDF must be submitted within two (2) work days after approval of hard proofs
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 22 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

Soft copy PDF production proofs will be withheld no more than two (2) work days from their receipt at the ordering 

agency until they are made available for pickup or the corrections / changes/“O.K. to print” are provided to the 

contractor (via email), as applicable. The first workday after receipt of proofs at the ordering agency is day one of 

the hold time.

Schedule for Production and Distribution of Mailers 

The following schedule begins the workday after notification of the availability of print order and furnished 

material; the workday after notification will be the first workday of the schedule.

Contractor must complete production and distribution of all mailers for all files transmitted within three (3)

workdays of receipt of print order and furnished material.

Press Sheet Inspection or Product Inspection 

The agency will notify the contractor a week in advance (of an order being placed) of a press sheet inspection and/or 

production inspection on that order. The contractor must notify the U.S. GPO of the date and time the inspection(s) 

can be performed the Friday before the Sunday files are transmitted for that order. 

Notify the U.S. Government Publishing Office, Quality Control for Published Products,, Washington, DC 20401 at 

(202) 512-0542. Telephone calls will only be accepted between the hours of 8:00 a.m. and 2:00 p.m., prevailing 

Eastern Time, Monday through Friday. 

NOTE: See contract clauses, paragraph 14(e)(1), Inspections and Tests of GPO Contract Terms (GPO Publication 

310.2, effective December 1, 1987 (Rev. 01-18)). When supplies are not ready at the time specified by the 

contractor for inspection, the Contracting Officer may charge to the contractor the additional cost of the inspection.

The ship/deliver date indicated on the print order is the date products ordered for mailing f.o.b. contractor’s city 

must be delivered to the U.S. Postal Service. 

Unscheduled material such as shipping documents, receipts or instructions, delivery lists, labels, etc., will be 

furnished with each order or shortly thereafter. In the event such information is not received in due time, the 

contractor will not be relieved of any responsibility in meeting the shipping schedule because of failure to request 

such information.

For compliance reporting purposes, contractors are to report information regarding each order with date of shipment 

or delivery, as applicable, in accordance with the contract requirements by contacting the Shared Support Services 

Compliance Section via email at compliance@gpo.gov or via telephone at (202) 512-0520. Personnel receiving the 

email or call will be unable to respond to questions of a technical nature or to transfer any inquiries.
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 23 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

SECTION 3. - DETERMINATION OF AWARD

The Government will determine the lowest bid by applying the prices offered in the “SCHEDULE OF PRICES” to 

the following units of production which are the estimated requirements to produce one (1) year’s production 

requirements under this contract. These units do not constitute, nor are they to be construed as, a guarantee of the 

volume of work which may be ordered for a like period of time.

The following item designations correspond to those listed in the “SCHEDULE OF PRICES.”

I. (a) 94

(b) 6

(c) 6

(1) (2)

II. (a) 657 8,008

(b) 55 1,074

(c) 206 166

(d) 608 508

(e) 2 15

(f) 12 8,008

(g) 38 9,141

III. 1. (a) 9,198

2. (a) 254

3. (a) 10

(b) 5

4. (a) 8,008

5. (a) 9,141

IV. (a) 8,008

(b) 1,074

(c) 43

(d) 11

(e) 15
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 24 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

THIS PAGE IS INTENTIONALLY BLANK
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 25 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

SECTION 4. - SCHEDULE OF PRICES

Bids offered are f.o.b. contractor’s city. 

Prices must include the cost of all required materials and operations for each item listed in accordance with these 

specifications.

Bidder must make an entry in each of the spaces provided. Bids submitted with any obliteration, revision, or 

alteration of the order and manner of submitting bids may be declared non-responsive.

An entry of NC (No Charge) shall be entered if bidder intends to furnish individual items at no charge to the 

Government. Bids submitted with NB (No Bid), NA (Not Applicable), or blank spaces for an item may be declared 

nonresponsive.

The Contracting Officer reserves the right to reject any offer that contains prices for individual items of production 

(whether or not such items are included in the DETERMINATION OF AWARD) that are inconsistent or unrealistic 

in regard to other prices in the same offer or to GPO prices for the same operation if such action would be in the 

best interest of the Government.

All invoices submitted to the GPO shall be based on the most economical method of production. Fractional parts 

of 100 will be prorated at the per-100 rate.

Contractor’s billing invoice must be itemized in accordance with the line items in the “SCHEDULE OF PRICES.”

I. ELECTRONIC PREPRESS: Prices offered must be all inclusive.

(a) Digital color content proofs or One-off 

color proofs (forms and envelopes) .....................................per trim/page size unit ............$___________

NOTE: Each side of an envelope will count as one page. 

(b) Adobe Acrobat PDF soft proof (5 names).................................................... per file ............$___________

(c) System Timework....................................................................................... per hour ............ $ ___________ 

Electronic prepress operations which cannot be properly classified under any other item shall be charged 

as "System Timework". Any charge made under "System Timework" must be supported by a statement 

outlining in detail the operation for which payment is claimed. In case of dispute, the Contracting Officer 

reserves the right to be the final judge as to the operations and/or number of hours chargeable under 

item I(c).

II. PRINTING, IMAGING, BINDING, AND CONSTRUCTION: Prices offered shall include the cost of all 

required materials and operations necessary (excluding paper) for the printing, imaging, binding, and 

construction of the products listed in accordance with these specifications.

Makeready Running Per

and/or Setup 100 Copies

(1) (2) 

(a) Form 6084 SAP................................................... per form .................. $ ___________ $ ___________ 

(b) Form 6084 SC ..................................................... per form .................. $ ___________ $ ___________ 

____________ 

(Initials)
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 26 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

Makeready Running Per

and/or Setup 100 Copies

(1) (2) 

(c) ACE Dunning Letters.......................................... per page .................. $ ___________ $ ___________ 

(d) 612 Surety Report................................................ per page .................. $ ___________ $ ___________ 

(e) IRS Tax Forms 1099G and 1099C...................... per form .................. $ ___________ $ ___________ 

(f) No. 9 Return Envelope

(3-7/8 x 8-7/8”) with window.............................. per envelope ........... $ ___________ $ ___________ 

(g) No. 10 Mail-out Envelope

(4-1/8 x 9-1/2”) with window.............................. per envelope .......... $ ___________ $ ___________ 

III. PAPER: Payment for all paper supplied by the contractor under the terms of these specifications, as ordered 

on the individual Print Orders, will be based on the net number of leaves furnished for the products ordered in 

the applicable trim size. The cost of any paper required for makeready or running spoilage must be included 

in the prices offered. 

Computation of the net number of leaves will be based on the following:

Forms: One basic charge will be allowed for each page-size leaf. 

Envelopes: One flat envelope (before construction) 

Per 100 leaves

1. Form 6084 SAP, and Form 6084 SC, ACE Dunning Letters,

(a) White Optical Character Recognition (OCR) Bond (24-lb.) .......................................... $ ___________ 

2. 612 Surety Report

(a) White Optical Character Recognition (OCR) Bond (24-lb.) .......................................... $ ___________ 

3. IRS Tax Forms 1099G and 1099C

(a) White Uncoated Text (60-lb.)......................................................................................... $ ___________ 

(b) Colored Uncoated Text (60-lb.)...................................................................................... $ ___________ 

4. No. 9 Return envelope (3-7/8 x 8-7/8”) with window 

(a) White Writing Envelope (24-lb). .................................................................................... $ ___________ 

5. No. 10 Mail-out Envelope (4-1/8 x 9-1/2”) with window 

(a) White Writing Envelope (24-lb). .................................................................................... $ ___________ 

 

____________ 

(Initials)
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 27 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

IV. ASSEMBLY, PACKAGING, AND DISTRIBUTION: The prices offered must be all-inclusive and shall 

include the cost of all required materials operations necessary for the assembly, packaging, and distribution of 

the products listed in accordance with these specifications

 Per 100 mailers

(a) Form 6084 SAP..................................................................................................................... $ ___________ 

(b) Form 6084 SC ....................................................................................................................... $ ___________ 

(c) ACE Dunning Letters............................................................................................................ $ ___________ 

(d) 612 Surety Report.................................................................................................................. $ ___________ 

(e) IRS Tax Forms 1099G and 1099C........................................................................................ $ ___________ 

LOCATION OF POST OFFICE: All mailing will be made from the __________________________________

Post Office located at Street Address _____________________________________________________________,

City_____________________________, State___________________________, Zip Code __________________

____________ 

(Initials)
Form 6084 SAP, ACE Dunning Letter, Form 6084 SC, Page 28 of 28

612 Surety Report, and IRS Forms 1099G and 1099C

268-S (7/23)

SHIPMENT(S): Shipments will be made from: City __________________________, State ________________

The city(ies) indicated above will be used for evaluation of transportation charges when shipment f.o.b. contractor’s 

city is specified. If no shipping point is indicated above, it will be deemed that the bidder has selected the city and 

state shown below in the address block, and the bid will be evaluated and the contract awarded on that basis. If 

shipment is not made from evaluation point, the contractor will be responsible for any additional shipping costs 

incurred.

DISCOUNTS: Discounts are offered for payment as follows: __________ Percent, _________calendar days. See 

Article 12 “Discounts” of Solicitation Provisions in GPO Contract Terms (Publication 310.2).

AMENDMENT(S): Bidder hereby acknowledges amendment(s) number(ed) ____________________________

BID ACCEPTANCE PERIOD: In compliance with the above, the undersigned agree, if this bid is accepted 

within____________ calendar days (60 calendar days unless a different period is inserted by the bidder) from the 

date for receipt of bids, to furnish the specified items at the price set opposite each item, delivered at the designated 

points(s), in exact accordance with specifications.

Failure to provide a 60-day bid acceptance period may result in expiration of the bid prior to award.

BIDDER’S NAME AND SIGNATURE: Unless specific written exception is taken, the bidder, by signing and 

submitting a bid, agrees with and accepts responsibility for all certifications and representations as required by the 

solicitation and GPO Contract Terms – Publication 310.2. When responding by email, fill out and return one copy 

of all pages in “SECTION 4. – SCHEDULE OF PRICES,” including initialing/signing where indicated. Valid 

electronic signatures will be accepted in accordance with the Uniform Electronic Transactions Act, § 2. Electronic 

signatures must be verifiable of the person authorized by the company to sign bids.

Failure to sign the signature block below may result in the bid being declared non-responsive.

Bidder ___________________________________________________________________________________

(Contractor Name) (GPO Contractor’s Code)

___________________________________________________________________________________________

(Street Address)

___________________________________________________________________________________________

(City – State – Zip Code)

By _________________________________________________________________________________________

(Printed Name, Signature, and Title of Person Authorized to Sign this Bid) (Date)

___________________________________________________________________________________________

(Person to be Contacted) (Telephone Number) (Email)

******************************************************************************************* 

THIS SECTION FOR GPO USE ONLY

Certified by: __________ Date: __________ Contracting Officer: __________ Date: __________

Initials Initials

*******************************************************************************************
EXHIBIT B

EXHIBIT C

EXHIBIT D
The U.S Postal Service can deliver overnight express mail to a P.O. Box. All checks must be 

drawn on a U.S. bank and in U.S. dollars. For further details on acceptable manners of payment, 

please refer to 19 CFR 24.1. Questions concerning this matter may be directed to 

(317) 614-4811 or by email to billinginquiry@cbp.dhs.gov.

Sincerely,

Kim Caudill

Chief, Debt Management Section

Revenue Protection Branch

Revenue Division

U.S. Customs and Border Protection

Enclosure

U.S Customs and Border Protection

P.O. Box 979126

St. Louis, MO 63197-9000

, 

Dear Sir/Madam:

This is to notify you that the enclosed listing of delinquent bill(s) totaling 

which are owed to U.S. Customs and Border Protection (CBP), are past due. If the delinquent 

bill(s) are not paid or protested within 180 days from the date of the bill per 19 U.S.C. § 1514, 

the bill is subject to being setoff by a diverted refund, if available, per 19 C.F.R § 24.72, and/or 

CBP will sanction you because of that bill, per 19 C.F.R § 142.14. If the protest is denied and 

the delinquent bill(s) is past 180 days old, you will be immediately placed on national sanction.

The bill number(s) listed are for a supplemental charge of duties, taxes and fees due to the 

liquidation or re-liquidation of an entry. Payment should be made immediately. Submit your 

check payable to U.S. Customs and Border Protection and a copy of this letter and attachment

to the following address:

07/09/2022 BOB M. PORTER POTST1 1801 N BEAUREGARD ST ALEXANDRIA VA 22311-1701 9791 $30,964,757.32
UNPAID (OPEN) BILL IMPORTER LIST

Importer No. Importer Name Entry Number Bill No. Bill Date Amount

23-589645800 BOB M. PORTER POTST1 REX11811751 60080285 03/04/2022 $155.68

23-589645800 BOB M. PORTER POTST1 REX11254570 60080286 03/04/2022 $156.24

23-589645800 BOB M. PORTER POTST1 REX10241686 60080287 03/04/2022 $86.15

23-589645800 BOB M. PORTER POTST1 REX11836123 60080288 03/04/2022 $155.68

23-589645800 BOB M. PORTER POTST1 REX11252699 60080289 03/04/2022 $6,687.86

23-589645800 BOB M. PORTER POTST1 REX11241200 60080290 03/04/2022 $84.12

23-589645800 BOB M. PORTER POTST1 REX09627941 60080291 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX09549319 60080292 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX10580646 60080293 03/04/2022 $805.36

23-589645800 BOB M. PORTER POTST1 REX09560860 60080294 03/04/2022 $6,687.86

23-589645800 BOB M. PORTER POTST1 REX10481409 60080297 03/04/2022 $1,083.77

23-589645800 BOB M. PORTER POTST1 REC08000196 60080298 03/04/2022 $29.15

23-589645800 BOB M. PORTER POTST1 REX09576085 60080300 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX00416795 60080301 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX10420042 60080302 03/04/2022 $156.24

23-589645800 BOB M. PORTER POTST1 REX09940965 60080303 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX09955717 60080304 03/04/2022 $155.68

23-589645800 BOB M. PORTER POTST1 REC08000204 60080305 03/04/2022 $29.15

23-589645800 BOB M. PORTER POTST1 REC08000218 60080306 03/04/2022 $29.15

23-589645800 BOB M. PORTER POTST1 REX09964230 60080307 03/04/2022 $86.15

TOTAL: $30,964,757.32 Bill Count: 9791 07/09/2022

2
Importer No. Importer Name Entry Number Bill No. Bill Date Amount

23-589645800 BOB M. PORTER POTST1 REX00236586 60080308 03/04/2022 $84.12

23-589645800 BOB M. PORTER POTST1 REX10667964 60080310 03/04/2022 $156.24

23-589645800 BOB M. PORTER POTST1 REX10663597 60080318 03/04/2022 $1,083.20

23-589645800 BOB M. PORTER POTST1 REX10633327 60080327 03/04/2022 $84.12

23-589645800 BOB M. PORTER POTST1 REX10976271 60080338 03/04/2022 $155.68

23-589645800 BOB M. PORTER POTST1 REX10807662 60080349 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX10830575 60080358 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX10819498 60080366 03/04/2022 $155.68

23-589645800 BOB M. PORTER POTST1 REX10716030 60080378 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX10938067 60080387 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REC08000221 60080311 03/04/2022 $473.64

23-589645800 BOB M. PORTER POTST1 REX09988296 60080312 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX11014247 60080322 03/04/2022 $802.92

23-589645800 BOB M. PORTER POTST1 REX01399688 60080313 03/04/2022 $84.12

23-589645800 BOB M. PORTER POTST1 REX01257081 60080323 03/04/2022 $10,560.42

23-589645800 BOB M. PORTER POTST1 REX10600634 60080314 03/04/2022 $27.17

23-589645800 BOB M. PORTER POTST1 REX11025638 60080315 03/04/2022 $156.24

23-589645800 BOB M. PORTER POTST1 REX01309487 60080316 03/04/2022 $5,891.78

23-589645800 BOB M. PORTER POTST1 REX02341799 60080326 03/04/2022 $155.68

23-589645800 BOB M. PORTER POTST1 REX01847645 60080317 03/04/2022 $5,883.83

TOTAL: $30,964,757.32 Bill Count: 9791 07/09/2022

3
EXHIBIT E
REV – 612 Surety Report

FOR OFFICIAL USE ONLY

Report Parameters:

Reporting Period: May, 2022 Run Datetime: 06/17/2022 11:03:45 Page Number: 1

Surety Header Surety Header

Test Surety 891

1801 N Beauregard St, Alexandria, VA,

22311-1701, US

WASHINGTON INTERNATIONAL INS CO

475 N Martingale Rd, Ste 850,

Schaumburg, IL, 60173-2276, US

US Customs and Border Protection

Automated Commercial Environment

Formal Demand On Surety For Payment of Delinquent Amounts Due

All Bills Other Than Fine, Penalty and Liquidated Damage Bills

Surety Surety Code

Test Surety 891

1801 N Beauregard St, Alexandria,

VA, 22311-1701, US

891

WASHINGTON INTERNATIONAL

INS CO

475 N Martingale Rd, Ste 850,

Schaumburg, IL, 60173-2276, US

891

Dear Sir/Madam,

This is a formal demand upon you for payment of the amount(s) noted on the enclosure(s) hereto. Enclosed herewith is a listing of 102,031 bills(s) totaling $9,001,248,897,554.37 ($ 9,001,241,027,944.47 principal and $

7,869,609.9 interest) due to the U.S. Customs & Border Protection principal(s) for whom you are surety and which were due and payable on the dates indicated in the enclosure(s). Formal demands were made on the

principal(s) involved but the bill(s) remain unpaid as of May 31, 2022. Under the terms of your bond you are an original promisor and debtor with each of your principals. 

The amount(s) identified on the enclosure(s) are summarized by age category as follows:

35,392 Bill(s) totaling $ 39,890,376.21 ($ 39,624,359.87 principal and $ 266,016.34 interest) are 60 or more days old.

9,523 Bill(s) totaling $ 61,446,882.04 ($ 60,935,367.63 principal and $ 511,514.41 interest) are 90 or more days old.

3,314 Bill(s) totaling $ 28,562,899.28 ($ 28,283,919.2 principal and $ 278,980.08 interest) are 120 or more days old and appear in this category for the first time.

56,986 Bill(s) totaling $ 9,001,122,783,108.05 ($ 9,001,115,951,387.05 principal and $ 6,831,721 interest) are 120 or more days old and have appeared in this category on previous reports.

If any claim to which this letter relates has been paid in full since May 31, 2022, no further action with respect to that claim is required of you.

We wish to call your attention to the fact that the claims to which this letter relates are not necessarily the only outstanding claims against your company.

 

 Sincerely Yours,

Director, Revenue Division
REV – 612 Surety Report

FOR OFFICIAL USE ONLY

Report Parameters:

Reporting Period: May, 2022 Run Datetime: 06/17/2022 11:03:45 Page Number: 2

Director, Revenue Division

Please direct your replies to the Director, Revenue Division, U.S. Customs & Border Protection,

6650 Telecom Drive, Ste 100, Indianapolis, IN 46268

US Customs and Border Protection

Automated Commercial Environment

Formal Demand On Surety For Payment of Delinquent Amounts Due

All Bills Other Than Fine, Penalty and Liquidated Damage Bills

Surety Surety

Code

Test Surety 891

1801 N Beauregard St, Alexandria, VA,

22311-1701, US 891

WASHINGTON INTERNATIONAL INS CO

475 N Martingale Rd, Ste 850,

Schaumburg, IL, 60173-2276, US 891

Delinquent Debtor Debtor

Number

Bankruptcy

Type

Bankruptcy

Date

Number Of

Bills Total Amount Due Total Principal Amount Total Interest Amount

98-007312800

 , , , 98-007312800 1 $3,425.23 $3,400.00 $25.23

Bill

Number

Bill

Ver. #

Bond

Number

Billing

Location

Center

ID Code

Transaction

Date

Transaction

Number

Bill

Date

612 Added

Date

Amount

Due

Principal

Amount

Interest

Amount

Days

Delinquent

Protest

Number

Protest

Status

Protest

Create

Date

Protest

Status Date

60088463 4 15C0002PU 1182 10/5/20 ABU12130747 1/7/22 3/1/22 $6,850.46 $6,800.00 $50.46 144

60088463 4 16C0000AO 1182 10/5/20 ABU12130747 1/7/22 3/1/22 $6,850.46 $6,800.00 $50.46 144
REV – 612 Surety Report

FOR OFFICIAL USE ONLY

Report Parameters:

Reporting Period: May, 2022 Run Datetime: 06/17/2022 11:03:45 Page Number: 3

US Customs and Border Protection

Automated Commercial Environment

Formal Demand On Surety For Payment of Delinquent Amounts Due

All Bills Other Than Fine, Penalty and Liquidated Damage Bills

Surety Surety

Code

Test Surety 891

1801 N Beauregard St, Alexandria, VA,

22311-1701, US 891

WASHINGTON INTERNATIONAL INS CO

475 N Martingale Rd, Ste 850,

Schaumburg, IL, 60173-2276, US 891

Delinquent Debtor Debtor

Number

Bankruptcy

Type

Bankruptcy

Date

Number Of

Bills Total Amount Due Total Principal Amount Total Interest Amount

AMERICAN PRESIDENT LINES INC.

 1800 HARRISON ST , SPRINGFIELD, VA

22150, US 94-043490000 79 $90,979.62 $87,424.69 $1,397.76

Bill

Number

Bill

Ver. #

Bond

Number

Billing

Location

Center

ID Code

Transaction

Date

Transaction

Number

Bill

Date

612 Added

Date

Amount

Due

Principal

Amount

Interest

Amount

Days

Delinquent

Protest

Number

Protest

Status

Protest

Create

Date

Protest

Status Date

60004376 9 14C0000AG 2907 CEE007 7/3/19 STA01000044 9/27/21 3/1/22 $44.32 $43.52 $0.80 246

60005279 9 14C0000AG 1101 CEE007 10/2/20 S0210027437 10/1/21 3/1/22 $1,626.90 $1,595.14 $31.76 242

60005280 9 14C0000AG 1101 CEE007 10/7/20 S0219110132 10/1/21 3/1/22 $2,794.72 $2,740.14 $54.58 242

60012239 8 14C0000AG CEE007 10/11/21 5769001 10/11/21 3/1/22 $12,208.92 $12,000.00 $208.92 232

60012470 9 14C0000AG 2907 CEE007 7/10/19 TER01000080 10/12/21 3/1/22 $1,972.92 $1,934.38 $38.54 231

60012477 9 14C0000AG 2907 CEE007 7/10/19 TER01000082 10/12/21 3/1/22 $4,895.04 $4,799.44 $95.60 231

60012485 9 14C0000AG 2907 CEE007 7/10/19 TER06000113 10/12/21 3/1/22 $1,722.06 $1,688.44 $33.62 231

60012489 8 14C0000AG 2907 CEE007 7/10/19 TER01000079 10/12/21 3/1/22 $8,941.88 $8,788.86 $153.02 231

60012494 8 14C0000AG 2907 CEE007 7/10/19 TER06000114 10/12/21 3/1/22 $1,717.82 $1,688.44 $29.38 231

60012496 9 14C0000AG 2907 CEE007 7/10/19 TER01000083 10/12/21 3/1/22 $861.14 $844.32 $16.82 231

60012503 9 14C0000AG 2907 CEE007 7/10/19 TER06000135 10/12/21 3/1/22 $58.24 $57.12 $1.12 231

60012511 9 14C0000AG 2907 CEE007 7/9/19 TER01000071 10/12/21 3/1/22 $1,973.18 $1,934.64 $38.54 231

60012515 8 14C0000AG 2907 CEE007 7/9/19 TER06000089 10/12/21 3/1/22 $1,718.06 $1,688.66 $29.40 231

60012521 8 14C0000AG 2907 CEE007 7/9/19 TER06000088 10/12/21 3/1/22 $1,718.06 $1,688.66 $29.40 231

60012522 8 14C0000AG 2907 CEE007 7/9/19 TER01000069 10/12/21 3/1/22 $7,397.12 $7,270.54 $126.58 231

60012530 9 14C0000AG 2907 CEE007 7/9/19 TER01000070 10/12/21 3/1/22 $8,965.14 $8,790.04 $175.10 231

60012534 9 14C0000AG 2907 CEE007 7/9/19 TER01000073 10/12/21 3/1/22 $4,895.70 $4,800.10 $95.60 231

60012535 9 14C0000AG 2907 CEE007 7/9/19 TER06000110 10/12/21 3/1/22 $58.24 $57.12 $1.12 231

60012536 9 14C0000AG 2907 CEE007 7/8/19 TER01000059 10/12/21 3/1/22 $7,416.38 $7,271.52 $144.86 231
REV – 612 Surety Report

FOR OFFICIAL USE ONLY

Report Parameters:

Reporting Period: May, 2022 Run Datetime: 06/17/2022 11:03:45 Page Number: 4

Bill

Number

Bill

Ver. #

Bond

Number

Billing

Location

Center

ID Code

Transaction

Date

Transaction

Number

Bill

Date

612 Added

Date

Amount

Due

Principal

Amount

Interest

Amount

Days

Delinquent

Protest

Number

Protest

Status

Protest

Create

Date

Protest

Status Date

60012544 8 14C0000AG 2907 CEE007 7/8/19 TER01000060 10/12/21 3/1/22 $8,944.32 $8,791.26 $153.06 231

60012545 8 14C0000AG 2907 CEE007 7/5/19 TER06000061 10/12/21 3/1/22 $1,719.04 $1,689.60 $29.44 231

60012547 8 14C0000AG 2907 CEE007 7/8/19 TER01000064 10/12/21 3/1/22 $859.28 $844.56 $14.72 231

60012548 8 14C0000AG 2907 CEE007 7/8/19 TER01000063 10/12/21 3/1/22 $4,884.28 $4,800.72 $83.56 231

60012551 9 14C0000AG 2907 CEE007 7/8/19 TER01000061 10/12/21 3/1/22 $1,973.44 $1,934.90 $38.54 231

60012555 9 14C0000AG 2907 CEE007 7/5/19 TER01000051 10/12/21 3/1/22 $1,974.26 $1,935.70 $38.56 231

60012556 9 14C0000AG 2907 CEE007 7/5/19 TER01000050 10/12/21 3/1/22 $8,970.06 $8,794.86 $175.20 231

60012560 9 14C0000AG 2907 CEE007 7/5/19 TER06000062 10/12/21 3/1/22 $1,723.28 $1,689.60 $33.68 231

60012566 9 14C0000AG 2907 CEE007 7/5/19 TER01000053 10/12/21 3/1/22 $4,898.40 $4,802.72 $95.68 231

60012570 8 14C0000AG 2907 CEE007 7/5/19 TER06000084 10/12/21 3/1/22 $58.14 $57.16 $0.98 231

60012574 8 14C0000AG 2907 CEE007 7/3/19 TER06000060 10/12/21 3/1/22 $1,719.26 $1,689.82 $29.44 231

60012581 9 14C0000AG 2907 CEE007 7/3/19 TER06000059 10/12/21 3/1/22 $1,723.50 $1,689.82 $33.68 231

60012584 9 14C0000AG 2907 CEE007 7/3/19 TER01000030 10/12/21 3/1/22 $8,971.30 $8,796.08 $175.22 231

60012593 9 14C0000AG 2907 CEE007 7/3/19 TER06000081 10/12/21 3/1/22 $58.28 $57.16 $1.12 231

60012781 1 14C0000AG 2907 CEE007 7/12/19 TS106000185 11/10/21 3/1/22 $57.10 $57.10 $0.00 202

60012789 1 14C0000AG 2907 CEE007 7/12/19 TS106000163 11/10/21 3/1/22 $1,687.98 $1,687.98 $0.00 202

60012794 1 14C0000AG 2907 CEE007 7/11/19 TS106000160 11/10/21 3/1/22 $57.10 $57.10 $0.00 202

60012796 1 14C0000AG 2907 CEE007 7/12/19 TS111000018 11/10/21 3/1/22 $61.78 $61.78 $0.00 202

60012815 1 14C0000AG 2907 CEE007 7/11/19 TS106000139 11/10/21 3/1/22 $1,688.20 $1,688.20 $0.00 202

60012818 1 14C0000AG 2907 CEE007 7/11/19 TS106000138 11/10/21 3/1/22 $1,688.20 $1,688.20 $0.00 202

60012822 1 14C0000AG 2907 CEE007 7/10/19 TS106000135 11/10/21 3/1/22 $57.12 $57.12 $0.00 202

60012824 1 14C0000AG 2907 CEE007 7/10/19 TS106000113 11/10/21 3/1/22 $1,688.44 $1,688.44 $0.00 202

60012830 1 14C0000AG 2907 CEE007 7/10/19 TS106000114 11/10/21 3/1/22 $1,688.44 $1,688.44 $0.00 202

60012850 9 14C0000AG 2907 CEE007 7/9/19 TS106000110 11/10/21 3/1/22 $58.24 $57.12 $1.12 202

60012855 8 14C0000AG 2907 CEE007 7/9/19 TS106000088 11/10/21 3/1/22 $1,718.06 $1,688.66 $29.40 202

60012858 8 14C0000AG 2907 CEE007 7/9/19 TS106000089 11/10/21 3/1/22 $1,718.06 $1,688.66 $29.40 202

60012884 8 14C0000AG 2907 CEE007 7/8/19 TS106000085 11/10/21 3/1/22 $58.12 $57.14 $0.98 202

60012892 9 14C0000AG 2907 CEE007 7/8/19 TS106000063 11/10/21 3/1/22 $1,722.54 $1,688.90 $33.64 202

60012896 9 14C0000AG 2907 CEE007 7/5/19 TS106000061 11/10/21 3/1/22 $1,723.28 $1,689.60 $33.68 202
EXHIBIT F
 

Form 1099-G

(Rev. January 2022)

Certain 

Government 

Payments

Copy B

For Recipient

Department of the Treasury Internal Revenue Service

This is important tax 

information and is 

being furnished to the 

IRS. If you are required 

to file a return, a 

negligence penalty or 

other sanction may be 

imposed on you if this 

income is taxable and 

the IRS determines that 

it has not been 

reported.

OMB No. 1545 0120

For calendar year 

20

CORRECTED (if checked)

PAYER'S name, street address, city or town, state or province, country, ZIP 

or foreign postal code, and telephone no.

PAYER'S TIN RECIPIENT'S TIN

RECIPIENT'S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 Unemployment compensation

$

2 State or local income tax 

refunds, credits, or offsets

$

3 Box 2 amount is for tax year 4 Federal income tax withheld

$

5 RTAA payments

$

6 Taxable grants

$

7 Agriculture payments

$

8 If checked, box 2 is 

trade or business 

income ▶

9 Market gain

$

10a State 10b State identification no. 11 State income tax withheld

$

$

Form 1099-G (Rev. 1 2022) (keep for your records) www.irs.gov/Form1099G

42950 1 1 1 1 SP 0.530 ***

53-0257415

U.S. CUSTOMS AND BORDER PROTECTION

6650 TELECOM DRIVE

INDIANAPOLIS, IN 46278



Instructions for Recipient

Recipient's taxpayer identification number (TIN). For your protection, this 

form may show only the last four digits of your TIN (SSN, ITIN, ATIN, or EIN). 

However, the issuer has reported your complete TIN to the IRS.

Account number. May show an account or other unique number the payer has 

assigned to distinguish your account.

Caution: Identity Theft (IDT). If you suspect that you are a victim of IDT, do not 

report the incorrect amount shown in box 1 of Form(s) 1099 G on your tax 

return. Go to www.irs.gov/idtheftunemployment for more information.

Box 1. Shows the total unemployment compensation (UC) paid to you in the 

calendar year reported. Combine the box 1 amounts from all Forms 1099 G and 

report the total as income on the UC line of your tax return. Except as explained 

below, this is your taxable amount. If you made contributions to a governmental

UC program or to a governmental paid family leave program and received a 

payment from that program, the payer must issue a separate Form 1099 G to 

report this amount to you. If you itemize deductions, you may deduct your 

contributions on Schedule A (Form 1040) as taxes paid. If you do not itemize, 

only include in income the amount that is in excess of your contributions.

Box 2. Shows refunds, credits, or offsets of state or local income tax you

received. It may be taxable to you if you deducted the state or local income tax 

paid on Schedule A (Form 1040). Even if you did not receive the amount shown, 

for example, because (a) it was credited to your state or local estimated tax, (b) 

it was offset against federal or state debts, (c) it was offset against other offsets, 

or (d) you made a charitable contribution from your refund, it is still taxable if it 

was deducted. If you received interest on this amount, you may receive Form 

1099 INT for the interest. However, the payer may include interest of less than 

$600 in the blank box next to box 9 on Form 1099 G. Regardless of whether the 

interest is reported to you, report it as interest income on your tax return. See 

your tax return instructions. 

Box 3. Identifies the tax year for which the box 2 refunds, credits, or offsets

shown were made. 

Box 4. Shows backup withholding or withholding you requested on

unemployment compensation, Commodity Credit Corporation (CCC) loans, or

certain crop disaster payments. Generally, a payer must backup withhold on

certain payments if you did not give your TIN to the payer. See Form W 9 for 

information on backup withholding. Include this amount on your income tax 

return as tax withheld.

Box 5. Shows reemployment trade adjustment assistance (RTAA) payments you 

received. Include on the “Other income” line of Schedule 1 (Form 1040).

Box 6. Shows taxable grants you received from a federal, state, or local

government.

Box 7. Shows your taxable Department of Agriculture payments. If the payer

shown is anyone other than the Department of Agriculture, it means the payer

has received a payment, as a nominee, that is taxable to you. This may

represent the entire agricultural subsidy payment received on your behalf by the 

nominee, or it may be your pro rata share of the original payment. See Pub. 225 

and the Schedule F (Form 1040) instructions for information about where to 

report this income. Partnerships, see Form 8825 for how to report.

Box 8. If this box is checked, the amount in box 2 is attributable to an income

tax that applies exclusively to income from a trade or business and is not a tax

of general application. If taxable, report the amount in box 2 on Schedule C or F 

(Form 1040), as appropriate.

Box 9. Shows market gain on CCC loans whether repaid using cash or CCC

certificates. See the Schedule F (Form 1040) instructions.

Boxes 10a–11. State income tax withheld reporting boxes.

Future developments. For the latest information about developments related to 

Form 1099 G and its instructions, such as legislation enacted after they were 

published, go to www.irs.gov/Form1099G.

Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no cost 

online federal tax preparation, e filing, and direct deposit or payment options.

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2021
EXHIBIT G
 

Form 1099-C

(Rev. January 2022)

Cancellation 

of Debt

Copy B

For Debtor

Department of the Treasury Internal Revenue Service

This is important tax 

information and is being 

furnished to the IRS. If 

you are required to file a 

return, a negligence 

penalty or other 

sanction may be 

imposed on you if 

taxable income results 

from this transaction 

and the IRS determines 

that it has not been 

reported.

OMB No. 1545 2281

For calendar year 

20

CORRECTED (if checked)

CREDITOR'S name, street address, city or town, state or province, country, 

ZIP or foreign postal code, and telephone no.

CREDITOR'S TIN DEBTOR'S TIN

DEBTOR'S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Account number (see instructions)

1 Date of identifiable event

2 Amount of debt discharged

$

3 Interest, if included in box 2

$

4 Debt description

5 If checked, the debtor was personally liable for 

repayment of the debt . . . . . . . . ▶

6 Identifiable event code 7 Fair market value of property

$

Form 1099-C (Rev. 1 2022) (keep for your records) www.irs.gov/Form1099C

Instructions for Debtor

You received this form because a federal government agency or an applicable 

financial entity (a creditor) has discharged (canceled or forgiven) a debt you 

owed, or because an identifiable event has occurred that either is or is deemed 

to be a discharge of a debt of $600 or more. If a creditor has discharged a debt 

you owed, you are required to include the discharged amount in your income, 

even if it is less than $600, on the “Other income” line of your Form 1040 or 

1040 SR. However, you may not have to include all of the canceled debt in your 

income. There are exceptions and exclusions, such as bankruptcy and 

insolvency. See Pub. 4681, available at www.irs.gov/Pub4681, for more details. 

If an identifiable event has occurred but the debt has not actually been 

discharged, then include any discharged debt in your income in the year that it 

is actually discharged, unless an exception or exclusion applies to you in that 

year. 

Debtor's taxpayer identification number (TIN). For your protection, this form 

may show only the last four digits of your TIN (social security number (SSN), 

individual taxpayer identification number (ITIN), adoption taxpayer identification 

number (ATIN), or employer identification number (EIN)). However, the creditor 

has reported your complete TIN to the IRS.

Account number. May show an account or other unique number the creditor 

assigned to distinguish your account. 

Box 1. Shows the date the earliest identifiable event occurred or, at the 

creditor's discretion, the date of an actual discharge that occurred before an 

identifiable event. See the code in box 6. 

Box 2. Shows the amount of debt either actually or deemed discharged. Note: If 

you don't agree with the amount, contact your creditor. 

Box 3. Shows interest if included in the debt reported in box 2. See Pub. 4681 to

see if you must include the interest in gross income.

Box 4. Shows a description of the debt. If box 7 is completed, box 4 also shows 

a description of the property. 

Box 5. Shows whether you were personally liable for repayment of the debt 

when the debt was created or, if modified, at the time of the last modification. 

See Pub. 4681 for reporting instructions. 

Box 6. Shows the reason your creditor has filed this form. The codes in this box 

are described in more detail in Pub. 4681. A Bankruptcy; B Other judicial 

debt relief; C Statute of limitations or expiration of deficiency period; D

Foreclosure election; E Debt relief from probate or similar proceeding; F By 

agreement; G Decision or policy to discontinue collection; or H Other actual 

discharge before identifiable event. 

Box 7. If, in the same calendar year, a foreclosure or abandonment of property 

occurred in connection with the cancellation of the debt, the fair market value 

(FMV) of the property will be shown, or you will receive a separate Form 1099 A. 

Generally, the gross foreclosure bid price is considered to be the FMV. For an 

abandonment or voluntary conveyance in lieu of foreclosure, the FMV is 

generally the appraised value of the property. You may have income or loss 

because of the acquisition or abandonment. See Pub. 4681 for information 

about foreclosures and abandonments. If the property was your main home, see 

Pub. 523 to figure any taxable gain or ordinary income.

Future developments. For the latest information about developments related to 

Form 1099 C and its instructions, such as legislation enacted after they were 

published, go to www.irs.gov/Form1099C.

Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no cost 

online federal tax preparation, e filing, and direct deposit or payment options.

43950 1 1 1 1 SP 0.530 ***

53-0257415

U.S. CUSTOMS AND BORDER PROTECTION

6650 TELECOM DRIVE

INDIANAPOLIS, IN 46278

(317) 298-1200 ext. 4872

07/11/21

AMOUNTS COLLECTIBLE

PURSUANT TO 19 CFR

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