PROGRAM 2595-S (R-1) Term: May 2, 2019 through February 29, 2020

TITLE VAPHC Newsletter and Annual Report BASIS OF

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

I. COMPLETE PRODUCT:

1. Veterans Connect Newsletter:

(a) Printing 12 self-cover pages in 4-color process...each issue:

(1) Makeready and/or Setup 3 $85.00 $255.00 $1,800.00 $5,400.00 $1,506.50 $4,519.50 $1,725.00 $5,175.00

(2) Running Per 1,000 Copies 240 $260.00 $62,400.00 $210.00 $50,400.00 $457.80 $109,872.00 $184.20 $44,208.00

2. VA Pittsburgh Healthcare System Annual Report:

(a) Printing text pages in 4-color process...each text page:

(1) Makeready and/or Setup 12 $100.00 $1,200.00 $65.00 $780.00 $97.21 $1,166.52 $73.00 $876.00

(2) Running Per 1,000 Copies 36 $20.00 $720.00 $19.25 $693.00 $68.68 $2,472.48 $50.15 $1,805.40

(b) Printing covers 1 through 4 in 4-color process (including 

satin aqueous coating)...each complete cover:

(1) Makeready and/or Setup 1 $500.00 $500.00 $900.00 $900.00 $269.82 $269.82 $436.00 $436.00

(2) Running Per 1,000 Copies 3 $85.00 $255.00 $170.00 $510.00 $334.33 $1,002.99 $280.65 $841.95

$65,330.00 $58,683.00 $119,303.31 $53,342.35

2.00% $1,306.60 1.00% $586.83 0.25% $298.26 0.50% $266.71

20 Days $64,023.40 20 Days $58,096.17 20 Days $119,005.05 20 Days $53,075.64

Abstracted by: Teri Shoffstall

Verified by: Mike Sommer

NPC, INC.

Claysburg, PA

SCHMITZ PRESS

Sparks, MD

AWARDED

Capitol Heights, MD

MCDONALD & EUDY PRINTERS

Temple Hills, MD

GRAY GRAPHICS

CONTRACTOR SUBTOTAL

PROMPT PAYMENT DISCOUNT

DISCOUNTED TOTALS

Page 1 of 1
Program 2595-S (R-1) Page 1 of 20 

Specifications by LLP 

Reviewed by 

THIS IS A RE-SOLICITATION WITH REVISED SPECIFICATIONS 

This procurement is being solicited as a small purchase Request For Quotation (RFQ). The sealed bidding terminology as 

used throughout these specifications is synonymous with their negotiated procurement counterpart unless specifically stated 

otherwise. Negotiated pursuant to 41 U.S.C. 5(1). 

U.S. GOVERNMENT PUBLISHING OFFICE 

Columbus, Ohio 

GENERAL TERMS, CONDITIONS, AND SPECIFICATIONS 

For the Procurement of 

VAPHC Newsletter and Annual Report 

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

Veterans Healthcare System Pittsburgh 

Single Award 

TERM OF CONTRACT 

The term of this contract is for the period beginning Date of Award and ending February 29, 2020, plus up to four optional 

12-month extension period(s) (March 1, 2020 through February 28, 2021, March 1, 2021 through February 28, 2022, 

March 1, 2022 through February 28, 2023, and March 1, 2023 through February 29, 2024 that may be added in accordance 

with the “Option to Extend the Term of Contract” clause in Section 1 of this contract. Special attention is directed to the 

“Economic Price Adjustment” clause in Section 1 of this contract. 

SUBMIT QUOTE TO 

U.S. Government Publishing Office, Columbus Regional Office, 1335 Dublin Road, Suite 112-B, Columbus, OH 43215. 

Quote must be clearly marked on the outermost envelope/package with company name and address of the bidder, program 

number, and quote date. Bidder’s option to telefax quote to Columbus RO, (614) 488-4577. Telegraphic and e-mail quotes 

transmitted to GPO offices WILL NOT be considered. Quotes must be received by below date and time, late quotes 

will not be considered.

QUOTES ARE REQUESTED BY: 2:00 p.m., prevailing Columbus, Ohio time March 8, 2019 

BIDDERS PELASE NOTE 

 This is a new contract resolicited with revised specifications. Bidders are cautioned to familiarize themselves with 

all provisions of this contract before bidding. 

 The GPO 910 “BID” Form is no longer required. Bidders are to fill out, sign/initial, as applicable, all pages of 

SECTION 4. – SCHEDULE OF PRICES. 

 GPO has issued a new GPO Publication 310.2, GPO Contract Terms – Solicitations Provisions, Supplemental 

Specifications, and Contract Clause (Rev. 1-18). Prospective bidders should carefully read this publication as the 

applicable terms within become an integral part of this contract. The document is posted at 

https://www.gpo.gov/how-to-work-with-us/vendors/forms-and-standards along with a list of major revisions. 

 This is a new contract. No previous abstract of contract prices is available. 

 For information of a technical nature call Linda Price at (614) 488-4616, ext. 7 (No collect calls). 
VAPHC Newsletter and Annual Report Page 2 of 20 

2595-S (R-1) (02/20) 

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 Pub. 310.2, effective December 1, 1987 (Rev. 1-18)) and GPO 

Contract Terms, Quality Assurance Through Attributes Program for Printing and Binding (GPO Pub. 310.1, effective May 

1979 (Rev. 08/02)). 

 GPO Contract Terms (GPO Publication 310.2): 

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

 GPO QATAP (GPO Publication 310.1): 

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

REGULATIONS GOVERNING PROCUREMENT 

The U.S. Government Publishing Office (GPO) is an office in the legislative branch of the United States Government. 

Accordingly, the Federal Acquisition Regulation is inapplicable to this, and all GPO procurements. However, the text of 

certain provisions of the Federal Acquisition Regulation as contained in the Code of Federal Regulations (CFR), are 

referenced in this solicitation. The offeror should note that only those provisions of the Federal Acquisition Regulation 

which are specifically incorporated by reference into this solicitation are applicable. 

SECURITY PROVISIONS 

The Veterans Connect Newsletter contains information that is considered to be Personally Identifiable Information (PII). 

The following provisions apply to each print order issued for Veterans Connect. 

SECURITY WARNING: 

It is the contractor’s responsibility to properly safeguard PII from loss, theft, or inadvertent disclosure and to immediately 

notify the Government of any loss of PII. PII is “information which can be used to distinguish or trace an individual’s 

identity, such as their name, social security number, biometric records, etc., alone, or when combined with other personal 

or identifying information which is linked or linkable to a specific individual, such as date and place of birth, mother’s 

maiden name, etc.” Ref.: OMB Memorandum 07-16. Other specific examples of PII include, but are not limited to: 

a) Personal identification number, such as passport number, driver’s license number, taxpayer identification number, 

or financial account or credit card number; 

b) Address information, such as street address or personal email address; 

c) Personal characteristics, including photographic image (especially of face or other distinguishing characteristic), 

fingerprints, handwriting, or other biometric image or template data (e.g., retina scans, voice signature, facial 

geometry). 

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 nongovernment 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 the term of the contract. 

 
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2595-S (R-1) (02/20) 

The plan shall contain at a minimum: 

 How Government files (data) will be secured to prevent disclosure to a third party prior to and after termination of 

contract; 

 Explain how all accountable materials will be handled throughout all phases of production. 

 How the disposal of waste materials will be handled. 

 How all applicable Government-mandated security/privacy/rules and regulations as cited in this contract shall be 

adhered to by the contractor and/or subcontractor(s). 

This proposed plan is subject to review and approval by the government and award will not be made prior to approval of 

same. 

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 as stated in 5 U.S.C. 552a (i) (1) CRIMINAL PENALTIES. It is incumbent upon the 

contractor to inform its officers and employees of the penalties for improper disclosure imposed by the Privacy Act of 

1974, 5 U.S.C. 552a, specifically, 5 U.S.C. 552a (i) (1) CRIMINAL PENALTIES and m (1) GOVERNMENT 

CONTRACTORS. 

PRIVACY ACT 

(a) The contractor agrees: 

(1) to comply with the Privacy Act of l974 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; 

(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. 

 
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2595-S (R-1) (02/20) 

(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. 

VA INFORMATION CUSTODIAL LANGUAGE 

(a) Information made available to the contractor or subcontractor by VA for the performance or administration of this 

contract or information developed by the contractor/subcontractor in performance or administration of the 

contract shall be used only for those purposes and shall not be used in any other way without the prior written 

agreement of the Government. This clause expressly limits the contractor/subcontractor’s rights to use data as 

described in Rights in Data – General, FAR 52.227-14(d) (1). 

(b) VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor’s 

information systems or media storage systems in order to ensure VA requirements related to data protection and 

media sanitization can be met. If co- mingling must be allowed to meet the requirements of the business need, the 

contractor must ensure that VA’s information is returned to the VA or destroyed in accordance with IAW VA 

directive 6371 and VA Handbook 6500. The Government reserves the right to conduct on-site inspections of 

contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and 

destruction/media sanitization procedures are in compliance with IAW VA directive 6371 and VA Handbook 

6500. 

(c) The contractor/subcontractor shall not make copies of VA information except as authorized and necessary to 

perform the terms of the agreement or to preserve electronic information stored on contractor/subcontractor 

electronic storage media for restoration in case any electronic equipment or data used by the 

contractor/subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, 

after the restoration is complete, the copies must be appropriately destroyed. 

(d) If Government determines that the contractor has violated any of the information confidentiality, privacy, and 

security provisions of the contract, it shall be sufficient grounds for VA to withhold payment to the contractor or 

third party or terminate the contract for default. 

(e) The contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, 

using VA-approved encryption tools (including Safe Access File Exchange and Symantic Endpoint Encryption) 

that are, at a minimum, FIPS 140-2 validated. 

(f) The contractor/subcontractor’s firewall and Web services security controls, if applicable, shall meet or exceed 

VA’s minimum requirements. VA Configuration Guidelines are available upon request. 

(g) Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the 

contractor/subcontractor may use and disclose VA information only in two other situations: (i) in response to a 

qualifying order of a court of competent jurisdiction, or (ii) with VA’s prior written approval. The 

contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA 

information and information systems to the VA through the GPO Contracting Officer for response. 

 
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2595-S (R-1) (02/20) 

SECURITY INCIDENT INVESTIGATION

(a) The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or 

damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The 

contractor/subcontractor shall immediately notify the GPO Contracting Officer and simultaneously, the 

designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any 

unauthorized disclosure of sensitive information, including that contained in system(s) to which the 

contractor/subcontractor has access. 

(b) To the extent known by the contractor/subcontractor, the contractor/subcontractor’s notice to GPO and VA shall 

identify the information involved, the circumstances surrounding the incident (including to whom, how, when, 

and where the VA information or assets were placed at risk or compromised), and any other information that the 

contractor/subcontractor considers relevant. 

LIQUIDATED DAMAGES FOR DATA BREACH

(a) Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal 

information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy 

incident involving any Sensitive Personal Information (SPI) the contractor/subcontractor processes or maintains 

under this contract. 

Sensitive personal information (SPI), with respect to an individual, means any information about the 

individual maintained by an agency, including the following: (1) education, financial transactions, medical 

history, and criminal or employment history; and (2) information that can be used to distinguish or trace the 

individual’s identity, including name, social security number, date and place of birth, mother’s maiden name, 

or biometric records. SPI is a subset of VA Sensitive Information/Data. See 38 U.S.C. 5727. NOTE: The term 

“Sensitive Personal Information” is synonymous and interchangeable with “Personally Identifiable 

Information.” 

(b) The contractor/subcontractor shall provide notice to GPO and VA of a “security incident” as set forth in the 

Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department 

entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level 

of risk associated with the data breach for the potential misuse of any sensitive personal information involved in 

the data breach. The term “data breach” means the loss, theft, or other unauthorized access, or any access other 

than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or 

printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor 

shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material 

breach and grounds for contract termination. 

(c) Each risk analysis shall address all relevant information concerning the data breach, including the following: 

(1) Nature of the event (loss, theft, unauthorized access); 

(2) Description of the event, including: 

(a) date of occurrence; 

(b) data elements involved, including any PII, such as full name, social security number, date of birth, 

home address, account number, disability code; 

(3) Number of individuals affected or potentially affected; 

(4) Names of individuals or groups affected or potentially affected; 

(5) Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of 

protection for the data, e.g., unencrypted, plain text; 

(6) Amount of time the data has been out of VA control; 

(7) The likelihood that the sensitive personal information will or has been compromised (made accessible to 

and usable by unauthorized persons); 

 
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2595-S (R-1) (02/20) 

(8) Known misuses of data containing sensitive personal information, if any; 

(9) Assessment of the potential harm to the affected individuals; 

(10) Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as 

appropriate; and 

(11) Whether credit protection services may assist record subjects in avoiding or mitigating the results of 

identity theft based on the sensitive personal information that may have been compromised. 

(d) Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the 

VA liquidated damages in the amount of up to $37.50 per affected individual to cover the cost of providing 

credit protection services to affected individuals consisting of the following: 

(1) Notification; 

(2) One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant 

credit bureau reports; 

(3) Data breach analysis; 

(4) Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to 

assist affected individuals to bring matters to resolution; 

(5) One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and necessary legal 

expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs. 

QUALITY ASSURANCE LEVELS AND STANDARDS 

The following levels and standards shall apply to these specifications: 

Product Quality Levels: 

(a) Printing Attributes -- Level II. 

(b) Finishing Attributes -- Level II. 

Inspection Levels (from ANSI/ASQC Z 1.4): 

(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 Approved Proofs 

 P-8. Halftone Match (Single and Double Impression) Approved Proofs 

 P-10. Process Color Match Approved Proofs 

EXTENSION OF TERM OF CONTRACT 

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. 

OPTION TO EXTEND TERM OF 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 the contract may not exceed 5 years 

(February 29, 2024) as a result of, and including, any extension(s) added under this clause. Further extension may be 

negotiated under the “Extension of Term of Contract” clause. See also “Economic Price Adjustment” clause for 

authorized pricing adjustment(s). 

 
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2595-S (R-1) (02/20) 

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 February 29, 2020, 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 November 30, 2018, 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: This contract does not have a Paper Price Adjustment clause. 

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. 

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. 

 
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2595-S (R-1) (02/20) 

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 February 29, 2020 plus for such additional period(s) as the 

contract is extended. 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(s) 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(s), 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(s) within the time specified in the order, and the rights and obligations of the contractor(s) 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(s) 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. 

DELIVERY/SHIPPING STATUS INFORMATION 

Contractors are to report information regarding each order for compliance reporting purposes and include date of delivery 

(and/or shipment as applicable) for proofs and delivery schedules in accordance with the contract requirements by 

contacting Columbus RPPO via e-mail to trackcolumbus@gpo.gov or by calling (614) 488-4616, ext. 6, or by faxing to 

(614) 488-4577. Personnel receiving e-mail, phone call, or fax, will be unable to respond to questions of a technical 

nature or transfer any inquiries. 

PAYMENT 

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

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. 

 
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2595-S (R-1) (02/20) 

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 https://www.gpo.gov/how-to-work-with-us/vendors/how-to-get-paid. 

NOTE: Contractor’s billing invoice must be itemized in accordance with the line items in the “SECTION 4. -

SCHEDULE OF PRICES.” 

At time of invoicing, the contractor shall submit a copy of the print order, contractor’s invoice, and all USPS postal 

reports for mailing and all delivery receipts via e-mail to infocolumbus@gpo.gov. 
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2595-S (R-1) (02/20) 

SECTION 2. – SPECIFICATIONS 

SCOPE 

These specifications cover the production of a newsletter and an annual report requiring such operations as proofs, 

reproducibles, printing pamphlets in 4-color process, binding, packing, mailing, and delivery. 

TITLE 

VAPHC Newsletter and Annual Report. 

 Veterans Connect Newsletter 

 VA Pittsburgh Healthcare System Annual Report 

NUMBER AND FREQUENCY OF ORDERS 

Approximately 4 orders per year. 

 Veterans Connect Newsletter: Approximately 3 orders per year 

 VA Pittsburgh Healthcare System Annual Report: Approximately 1 order per year 

QUANTITY 

 Veterans Connect Newsletter: 80,000 to 100,000 copies per order, usually 80,000 

 VA Pittsburgh Healthcare System Annual Report: 3,000 to 4,000 copies per order, usually 3,000 

NUMBER OF PAGES 

 Veterans Connect Newsletter: 12 self-cover pages 

 VA Pittsburgh Healthcare System Annual Report: 8 to 12 pages plus separate cover 

TRIM SIZE 

 Veterans Connect Newsletter: 8-1/2 x 11” 

 VA Pittsburgh Healthcare System Annual Report: 8-1/2 x 11” 

GOVERNMENT TO FURNISH 

Platform: Windows PC 

Storage Media: Electronic file to be transmitted via contractor maintained secure FTP site. Electronic data files 

must be stored using FIPS 140-2 encryption. 

Software: Newsletter and annual report in Adobe InDesign CS4 or higher native format. Distribution list for 

newsletter in MS Excel. The contractor must support all software upgrades, which may occur during the term of 

the contract. All graphics are linked. Changes were not made to the files after visuals were made. Color i.d. 

system is CMYK. Color separations have been made. Files provide for bleeds. 

Fonts: All screen and printer fonts will be furnished. The contractor is cautioned that these fonts are the property 

of the Government and must be returned with furnished material. All furnished fonts are to be eliminated from 

the contractor’s archive immediately after completion of the contract. 

Delivery/Shipping Status Report Form. 

 
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2595-S (R-1) (02/20) 

Print Orders (GPO Form 2511). 

Identification markings such as register marks, ring folios, rubber stamped jacket numbers, commercial 

identification marks of any kind, etc., except GPO imprint, form number, and revision date, carried on copy or 

film, must not print on finished product. 

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 Columbus GPO Contracting 

Officer prior to further performance. 

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. 

Upon completion of the 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. 

CONTRACTOR TO FURNISH 

All materials and operations, other than those listed under “Government to Furnish”, necessary to produce the 

product(s) in accordance with these specifications. 

REPRODUCIBLES 

The contractor must make all reproducibles required. The contractor is responsible for determining what type 

reproducibles will be used but must maintain the quality level specified in the contract. No separate charges will 

be allowed for the various types of reproducibles that may be used. 

Further, the contractor is responsible for outputting all images contained on furnished material, regardless of the 

production process, at the highest effective resolution possible. The contractor is responsible for determining the 

appropriate output resolution to achieve optimal results for such design elements as blends, gradients, halftones, 

type and other images. This determination should be made using factors such as stock, imaging device (or press) 

being used, and other factors unique to the contractors production environment. 

PROOFS 

All orders require the following proofs. 

CONTENT PROOFS 

Two set(s) of digital color content proofs for the complete publication. Direct to plate must be used to produce 

the final product with a minimum resolution 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. 

 
VAPHC Newsletter and Annual Report Page 12 of 20

2595-S (R-1) (02/20) 

COLOR PROOFS 

Two set(s) of digital one-piece composite laminated color proofs on the actual production stock (Kodak Approval, 

Screen TrueRite, Polaroid PolaProof, Latran Prediction, CreoSpectrum, or Fuji Final Proof) with a minimum 

resolution of 2400 x 2400 dpi. Proofs must show dot structure and be in press configuration. Direct to plate must 

be used to produce the final product. 

In lieu of digital one-piece laminated proofs, at contractor’s option two set(s) of inkjet proofs that are G7 profiled 

and use pigment-based inks may be submitted. A proofing RIP that provides option for high quality color 

matching such as Device Links Technology and/or ICC Profiles Technology, and meets or exceeds industry 

tolerance to ISO 12647-2 standard for Graphic Technology (as of 3/19/09 and future amendments) must be 

utilized. Output must be a minimum of 720 x 720 dpi on a GRACoL or SWOP certified proofing media. Proofs 

must contain one of the following color control strips to be evaluated for accuracy: IDEAlliance ISO 12647-7 

(2007 or later) Wedge or P2P25 Target. 

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

patches for process color (if applicable). These areas must be repeated consecutively across the sheet. The make 

and model number of the proofing system utilized shall be furnished with the proofs. These proofs must contain 

all elements and indicate margins. Proofs will be used for color match on press. 

ALL PROOFS 

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. 

The contractor is cautioned that these proofs must be made from the final digital files (used for this printing) that 

are to be delivered to the Government. 

In the event proofs are disapproved by the Government, or the contractor fails to submit proofs in a sufficient 

amount of time to meet the delivery schedule, the contractor may be deemed to have failed to make progress, and 

is subject to the termination for default clause. However, failure of the Government to terminate the contract for 

default in such event shall not relieve the contractor of the responsibility to deliver the contract quantities in 

accordance with the original production schedule allotted in the specifications. 

Submit proofs together with the furnished media (including visual when applicable) and a prepaid airbill to the 

address indicated under “Distribution” for Proofs. All packages containing proofs must be clearly marked on the 

outside as “PROOFS”, and contain the GPO Jacket Number, Requisition Number, Program Number, and Print 

Order Number, and publication title. 

PROOF DELIVERY NOTIFICATION 

The contractor must notify the GPO via facsimile or email when the proofs are shipped to the department and 

provide the name of the carrier service and tracking number. In addition, if the proofs are not returned by the 

department within the specified time the contractor must notify the GPO that the proofs have not been returned. 

Send proof delivery notification via facsimile to (614) 488-4577 or email trackcolumbus@gpo.gov. Include GPO 

Jacket Number, Program/Print Order Numbers with all correspondence. 

 
VAPHC Newsletter and Annual Report Page 13 of 20

2595-S (R-1) (02/20) 

The contractor must not print prior to receipt of an “OK to Print” or “OK to Print with Corrections”. 

STOCK/PAPER 

The specifications of all stock/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. 12” dated March 2011, 

available at https://www.gpo.gov/docs/default-source/forms-and-standards-files-for-vendors/vol_12.pdf?sfvrsn=2. 

Color of paper furnished shall be of a uniform shade and a close match by visual inspection of the JCP and/or 

attached color sample(s). The Contracting Officer reserves the right to reject shipments of any order printed on 

paper the color of which, in his opinion, materially differs from that of the color sample(s). All stock/paper used 

in each copy must be of a uniform shade and must have the grain parallel to the spine. 

VETERANS CONNECT NEWSLETTER 

Newsletter: White Dull Coated Offset Book, basis size 25 x 38”, 60 lbs. per 500 sheets, equal to JCP Code A260. 

ANNUAL REPORT 

Text: White No. 1 Coated Text, Dull-Finish, basis size 25 x 38”, 80 lbs. per 500 sheets, equal to JCP Code A261. 

NOTE: Exception to Paper Specification Standards (Mach 2011, No. 12), under “Testing” – The acceptance 

criteria in Part 4 SHALL apply for Opacity ONLY. 

Cover: White No. 1 Coated Cover, Dull-Finish, basis size 20 x 26”, 80 lbs. per 500 sheets, equal to JCP Code 

L61. 

POST-CONSUMER FIBER 

The requirement for post-consumer fiber (as specified in the Government Paper Specification Standards No. 12) 

for this contract is waived for JCP Codes A260, A261, and L61. However, the addition of post-consumer fiber is 

encouraged provided that the requirements of this standard are met. All other attributes remain the same. 

PRINTING 

Newsletter and annual report print head-to-head in 4-color process, heavy coverage. Printing may be boxed, 

bleed, align across bind, etc, as indicated on the files. Reverse printing may be required. After printing annual 

report, cover entire area of Covers 1 through 4 and all text pages with a satin aqueous coating. 

MARGINS 

Margins will be as indicated on the furnished material. Pages bleed all sides and to/across bind. Bleeds provided. 

BINDING 

Newsletter and annual report saddle-stitch: Fold, inset, saddle wire stitch with two wire stitches, and trim 3 sides. 

Covers trim flush. 

Contractor to address approximately 77,000 copies of the newsletter using mailing label or direct imaging address 

in black ink and in proper location on Cover 4. Individual print order and furnished distribution list will indicate 

the number of addresses required. These copies fold to 8-1/2 x 5-1/2” for mailing. Balance of copies ship flat. 

 
VAPHC Newsletter and Annual Report Page 14 of 20

2595-S (R-1) (02/20) 

PREPARATION FOR MAILING 

Prior to printing and addressing Veterans Connect Newsletter, contractor to perform CASS and NCOA 

certifications on the distribution list. Contractor to provide matching Zip + 4, all necessary barcodes, and 

presorting for maximum post automation discounts as applicable. No return service or undeliverable addresses 

are to be entered into the mail stream. Contractor to notify GPO of changes in quantity due to CASS and NCOA 

modifications prior to printing newsletter. 

Contractor to prepare Veterans Connect Newsletter for mailing. After printing and binding, contractor to fold 

approximately 77,000 newsletters to 8-1/2 x 5-1/2” with Cover 4 facing out with return address and mailing 

address appearing in proper location. Contractor to ensure address positioning is in accordance with current 

postal regulations. Balance of copies that are not on the distribution list are to bulk package as described below. 

Mailing addresses are anticipated to be within Pennsylvania, Ohio, and West Virginia; however, other domestic 

addresses may be included. 

NOTE: All addresses furnished on distribution list are considered PII. See “Security Provisions” in Section 1 for 

security requirements. 

BULK PACKAGING 

Veterans Connect Newsletter quantity not on distribution list shrink wraps in units of 50 and packs flat in suitable 

shipping cartons supplied by the contractor. Each shipping container must not exceed 45 pounds when fully 

packed. Do not fold bulk packed newsletters beyond 8-1/2 x 11”. 

VA Pittsburgh Healthcare System Annual Report shrink wraps in units of 25 and packs in suitable shipping 

cartons supplied by the contractor. Each shipping carton must not exceed 45 pounds when fully packed. Do not 

fold annual reports beyond 8-1/2 x 11”. 

LABELING AND MARKING 

Contractor to download the “Labeling and Marking Specifications” form (GPO Form 905, R. 7-15) from 

https://www.gpo.gov/how-to-work-with-us/vendors/forms-and-standards, fill in appropriate blanks, and attach to 

shipping cartons. 

DEPARTMENTAL RANDOM COPIES (BLUE LABEL) 

All orders must be divided into equal sublots in accordance with the chart below. A random copy must be 

selected from each sublot. Do not choose copies from the same general area in each sublot. The contractor will 

be required to certify that copies were selected as directed using GPO Form 917 – Certificate of Selection of 

Random Copies (located at https://www.gpo.gov/how-to-work-with-us/vendors/forms-and-standards). The 

random copies constitute a part of the total quantity ordered, and no additional charge will be allowed. 

 Quantity Number of 

 Ordered Sublots 

 500 to 3,200 50 

 3,201 to 10,000 80 

 10,001 to 35,000 125 

 35,001and over 200 

 
VAPHC Newsletter and Annual Report Page 15 of 20

2595-S (R-1) (02/20) 

These randomly selected copies must be packed separately and identified by a special label (GPO Form 2678-

Departmental Random Copies (Blue Label) that must be printed on blue paper and affixed to each affected 

container. This form can be downloaded from https://www.gpo.gov/how-to-work-with-us/vendors/forms-andstandards. The container and its contents shall be recorded separately on all shipping documents and sent in 

accordance with the “Distribution” hereafter. 

A copy of the print order/specification and a signed Certificate of Selection of Random Copies must be included. 

A copy of the signed Certificate of Selection of Random Copies must accompany the invoice sent to U.S. 

Government Publishing Office, Financial Management Services, for payment. Failure to furnish the certificate 

may result in delay in processing the invoice. 

INSPECTION SAMPLES 

Mail two samples of each order for inspection to the U.S. Government Publishing Office, Columbus Regional 

Office, 1335 Dublin Road, Suite 112-B, Columbus, Ohio 43215-7034, Attn: 2595-S Inspection Samples. 

These samples cannot be deducted from the total quantity ordered. The package or envelope containing the 

samples shall be identified by the GPO jacket number, program number, print order number, title, and include a 

facsimile of the print order on which they were ordered. The contractor will comply with the shipping schedule 

regardless of this requirement and will be notified of the test results only if there are deficiencies. 

DISTRIBUTION 

Deliver f.o.b destination and f.o.b. contractor’s city as indicated below. Actual quantities and distribution 

addresses will be indicated on the individual print orders. 

Inside delivery to room number specified is required for all f.o.b. destination delivery addresses. 

VETERANS CONNECT NEWSLETTER 

Furnished material transmitted via contractor maintained secure FTP site. Deliver f.o.b. destination as follows: 

 15 copies to: BAC (By-Law) 1525-01 

 Library of Congress 

 U.S. Serials and Government Documents Section 

 U.S./Anglo Division 

 101 Independence Avenue, SE, Stop 4276 

 Washington, D.C. 20540-4276 

 MARKED: Depository File Copies 

 1 copy to: BAC (C&I) 1523-01 

 U.S. Government Publishing Office 

 Federal Depository Library Program 

 Mail Stop: FDLP 

 44 H Street, NW, Loading Doc 

 Washington, D.C. 20401 

 MARKED: Item 0985 

 
VAPHC Newsletter and Annual Report Page 16 of 20

2595-S (R-1) (02/20) 

 Usually 3,000 copies (including Blue Label copies) and proofs deliver f.o.b. destination to and proofs 

pickup f.o.b. contractor’s city from: 

 VA Pittsburgh Healthcare System 

 ATTN: Kimberly Graham, (412) 822-3818 

 1010 Delafield Road, Building 32, Room 2A105 

 Pittsburgh, PA 15215 

 Mark cartons as indicated on the individual print order. 

 Usually 77,000 copies mail f.o.b. contractor’s city to domestic addresses on distribution list furnished 

with the individual print order. 

All mailing shall be made at the pre-sort standard rate and must conform to the appropriate 

regulations in the U.S. Postal Service manuals for “Domestic Mail” as applicable. Contractor will be 

required to pay postage at time of mailing and will be reimbursed by submitting properly completed 

USPS form(s) with invoice at time of billing. 

The contractor must immediately forward a copy of all USPS form(s) to the ordering agency and to 

GPO Columbus Regional Office identifying the Program Number, Print Order, Jacket Number as 

appropriate. 

VA PITTSBURGH HEALTHCARE SYSTEM ANNUAL REPORT 

Furnished material transmitted via contractor maintained secure FTP site. 

Deliver f.o.b. destination as follows: 

 15 copies to: BAC (By-Law) 1525-01 

 Library of Congress 

 U.S. Serials and Government Documents Section 

 U.S./Anglo Division 

 101 Independence Avenue, SE, Stop 4276 

 Washington, D.C. 20540-4276 

 MARKED: Depository File Copies 

 1 copy to: BAC (C&I) 1523-01 

 U.S. Government Publishing Office 

 Federal Depository Library Program 

 Mail Stop: FDLP 

 44 H Street, NW, Loading Doc 

 Washington, D.C. 20401 

 MARKED: Item 0985 

 Usually 3,000 copies (including Blue Label copies) and proofs deliver f.o.b. destination to and proofs 

pickup f.o.b. contractor’s city from: 

 
VAPHC Newsletter and Annual Report Page 17 of 20

2595-S (R-1) (02/20) 

 VA Pittsburgh Healthcare System 

 ATTN: Kimberly Graham, (412) 822-3818 

 1010 Delafield Road, Building 32, Room 2A105 

 Pittsburgh, PA 15215 

 Mark cartons as indicated on the individual print order. 

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 2511) to be 

mailed with the furnished material. 

Furnished material and print order will be transmitted via contractor maintained secure FTP site. 

The schedule will begin upon receipt of furnished materials and print order. 

Complete production and mailing/delivery must be made as follows: 

Proofs are to be received at Pennsylvania addresses indicated under “Distribution” within 3 workdays after receipt 

of furnished material. 

Proofs will be withheld not more than 2 workdays after receipt by department. 

Complete production and mailing/delivery must be made within 9 workdays after “O.K. to Print” or “O.K. to 

Print with Corrections”. 

When revised page proofs are ordered by the Government due to errors caused by the Government, additional 

workdays will be allowed in accordance with GPO Contract Terms, Article 12(c), Extension of Schedule. 

The ship/delivery date indicated on the print order is the date products must be received at destination and a mail 

date for all other consignments. 

RECEIPT FOR DELIVERY 

Contractor must furnish their own receipts for delivery. These receipts must include the GPO jacket, program, 

and print order numbers; total quantity delivered, number of cartons, and quantity per carton; date delivery made; 

and signature of the Government agent accepting delivery. The original copy of this receipt must accompany the 

contractor's voucher for payment. 

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. 

RETURN OF GOVERNMENT FURNISHED PROPERTY 

All expenses incidental to pickup/return of proofs and furnishing sample copies must be borne by the contractor. 
VAPHC Newsletter and Annual Report Page 18 of 20 

2595-S (R-1) (02/20) 

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 1 year’s production 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. (1) (2) 

 1. (a) 3 240 

 2. (a) 12 36 

 (b) 1 3 
VAPHC Newsletter and Annual Report Page 19 of 20 

2595-S (R-1) (02/20) 

SECTION 4. – SCHEDULE OF PRICES 

Bids offered are f.o.b. at destination to Pennsylvania and f.o.b. contractor’s city for mailings. 

Prices must be submitted for the entire term of the contract and bids qualified for a lesser period will not be 

considered. 

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 nonresponsive. 

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 vouchers submitted to the GPO shall be based on the most economical method of production. 

Fractional parts of 1,000 will be prorated at the per 1,000 rate. 

I. COMPLETE PRODUCT: Prices offered shall include the cost of all required materials and operations 

necessary for the complete production and delivery of the product listed in accordance with these specifications. 

Makeready Running Per 

and/or Setup 1,000 Copies 

(1) (2) 

 1. Veterans Connect Newsletter: 

 (a) Printing 12 self-cover pages in 

 4-color process .................................................. each issue ...................... $__________ $__________ 

 2. VA Pittsburgh Healthcare System Annual Report: 

 (a) Printing text pages in 4-color process ............... each text page ................ $__________ $__________ 

 (b) Printing Covers 1 through 4 in 4-color 

 process (including satin aqueous coating) ........ each complete cover ...... $__________ $__________ 

____________ 

(Initials) 

RETURN THIS PAGE TO GPO REGIONAL OFFICE, COLUMBUS, OH 

 
VAPHC Newsletter and Annual Report Page 20 of 20

2595-S (R-1) (02/20) 

SCHEDULE OF PRICES 

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 Solicitations 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 point(s), in exact accordance with specifications. 

NOTE: 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 fax or mail, fill out and return one 

copy of all pages in “SECTION 4. – SCHEDULE OF PRICES,” including initialing/signing where indicated. 

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) 

Contracting Officer Review ____________ Date ___________ Certifier ______________ Date ________ 

RETURN THIS PAGE TO GPO REGIONAL OFFICE, COLUMBUS, OH