Source: https://www.cao.gov/dlad/dlad-part-53-%E2%80%93-forms
Timestamp: 2019-11-20 16:49:26
Document Index: 377422358

Matched Legal Cases: ['art 53', 'art 53', 'ART 53', 'art 8', 'art 8', 'art 14', 'art 15', 'art 15', 'art 4']

DLAD Part 53 – Forms | Acquisition.GOV
HomeDLAD Part 53 – Forms
DLAD PART 53 – FORMS
(Revised March 9, 2018 through PROCLTR 2018-02)
(Revised April 18, 2014 through PROCLTR 2014-64)
DLA forms are electronically maintained at
https://www2.dla.mil/officialforms/pages/DLAformsinventory.html
☐ Construction ☐ Service ☐ Supply ☐ Research and development (R&D)
☐ Full and open competition
☐ Other than full and open competition* *
FAR 6.3 authority (Specify):
☐ Full and open after exclusion of sources
☐ Competitive non-DoD
☐ Mandatory use policy, including waivers (e.g., under Part 8)
☐ Limited sources (e.g. under Part 8.405-6):
☐ Competitive small business set-aside (SBSA)
☐ Competitive 8a ☐ Sole source 8a
☐ Service Disabled Veteran Owned Small Business (SDVOSB) Set-Aside
☐ SDVOSB sole source
☐ Historically underutilized business zone (HubZone) Sole Source
☐ HubZone set-aside
☐ Small disadvantaged women owned business (SDWOB)
☐ Economically disadvantaged women owned small business (EDWOSB)
☐ Historically Black colleges and universities / minority institutions (HBCU/MI)
☐ Not applicable (NA) (If acquisition is unrestricted)
☐Other (Specify):
☐ FAR 8.404 (GSA/Non-DoD Competitive) ☐ FAR 12 Commercial Items
☐ FAR 13 Simplified Acquisition Procedures ☐ FAR 14 Sealed Bidding
☐ FAR 15 Negotiation ☐ FAR 36 Construction and Architect and Engineer (A&E) and design build
☐ Invitation for bid (IFB)
☐ Competitive request for proposal (RFP)
☐ Sole source RFP
☐ Other (fill-in)
☐ Sealed bid – Part 14
☐ Negotiation – Part 15
☐ Lowest price technically acceptable
☐ Performance price trade-off without technical factors/proposal
☐ Performance price trade-off with technical factors/proposal
☐ Full trade off source selection (an acquisition plan is highly recommended)
☐ General Services Administration (GSA)/non-DoD competitive
☐ Other (explain):
☐ Fixed-price ☐ Time and material/labor hour agreements ☐ Economic price adjustment ☐ Incentive ☐ Award fee ☐ Cost-reimbursement ☐ Redetermination
☐ Indefinite delivery contract (IDC) ☐ Multiply Award
☐ Single Award (Provide rationale why single award)
☐ Contains sustainability requirements.
☐ Sustainability exception applies: (Specify)
☐ Sustainability requirements waived, approved by: (Specify)
☐ Progress payment ☐ Warranty ☐ First article test (FAT)
☐ Government furnished property(GFP) / Government furnished material (GFM) / Government furnished equipment (GFE) involved
☐ Other (specify). Other items/considerations may include, Non-Economy Act or Economy Act assisted acquisitions and use of reverse auction)
☐ Streamlined acquisition plan (SAP) approved as submitted
☐ SAP conditionally approved subject to comments below
☐ SAP disapproved (reviewers are required to include comments below)
☐ Requirement has been reviewed and validated by (specify):
☐ Small business specialist coordination _____________________________
☐ Competition Advocate coordination _____________________________
Simplified Acquisition Award Documentation
(FOR OFFICIAL USE ONLY - SOURCE SELECTION INFORMATION – SEE FAR 2.101 AND 3.104)
Acquisition Specialist: PR#: ________________________
PRC Code__________________________ NSN: __________________________
Basis for Award – Price Reasonableness Determination – FAR 13.106-3(a): (Check as applicable and explain*)
[ ] Fair and Reasonable – Adequate Price Competition – Manufacturer Competition
[ ] Fair and Reasonable – Adequate Price Competition Among Providers of Services
[ ] Fair and Reasonable – Adequate Price Competition – Dealer/OEM Competition
[ ] Fair and Reasonable – No Competition (single quote or noncompetitive price range)
[ ] Commercial Item $ per unit
[ ] Market Research
[ ] Federal Supply Schedule (FSS) Number: ________________ FSS Price: $ ________________
[ ] Independent Government Estimate
[ ] Comparison of the proposed price with prices found reasonable on previous purchases
Contract:_________________________ Unit Price: $____________ Quantity:_____________
Price Reasonableness Code (PRC) – DLAD 15.406-3(a)(11):____________
[ ] Comparison of similar items: NSN: ________________ Unit Price: $________________
Contract:_________________________ Quantity:____________ PRC:_____________
[ ] Contracting Officer’s knowledge of the item
[ ] Any other reasonableness basis (i.e. Informal Cost Breakdown, Set by law or regulation, or other FAR Part 15 procedures)
DFARS 217.7505 Sole Source Price Increase Certification:
Price has increased 25% or more within the past 12 months. [ ] Yes [ ] No. If “Yes”, the price has been evaluated and justified. Required notification prior to award completed.
Best Value Determination: (Required if Awarding to Other Than Lowest Price Highest Scored):
Other Determinations: (Check as applicable and explain as needed*)
[ ] Procurement is a First Time Buy
[ ] SAM.gov checked; awardee not proposed for suspension/debarment or debarred IAW FAR 9.105-1.
Date SAM Checked: ___________
Contracting Officer’s signature on the award document constitutes concurrence with all determinations made above.
The following format shall be used to document market research for commercial items as prescribed in 13.501(b)(1).
SUBJECT: Market Research for Commercial Items (FAR 10.002, FAR 2.101, and FAR 13.5)
Solicitation # , NSN(s) , Item
In accordance with FAR 10.002(b) and FAR 2.101, Definitions, a review has been conducted of the item description(s) to determine if commercial items or non-developmental items are available to meet the Government’s needs or could be modified to meet the Government’s needs to determine the following:
• Whether items of a type are customarily available in the commercial marketplace; annotate evidence of actual sale, lease, or license to the general public:
• Whether items of a type are customarily available in the commercial marketplace with modifications; annotate evidence of actual sale, lease, or license to the general public and type of modification:
• Whether items are used exclusively for governmental purposes; annotate evidence that the items were (1) developed exclusively at private expense, and (2) sold competitively in substantial quantities to multiple state and local Governments:
• Customary practices regarding customizing, modifying or tailoring of items to meet customers’ needs and associated costs; annotate evidence of customary availability of the modification in the commercial marketplace or the technical relationship between the modified items:
• Customary practices, including warranty, buyer financing, discounts, contract type considering the nature and risk associated with the requirement, etc., under which commercial sales of the products or services are made:
• The applicability of any laws and/or regulations unique to the item being acquired:
• The availability of items that contain recovered materials and items that are energy efficient; the distribution and support capabilities of potential suppliers, including alternative arrangements and cost estimates; and the size and status of potential sources:
Please check the applicable block(s) for techniques utilized to conduct market research and determine commerciality:
( ) Commercial-Off-the-Shelf Field is coded
( ) If item has been coded in SAP as commercial, but non-commercial practices are required (e.g., QCCs, packaging, etc.) the justification for the use of these practices has been entered in SAP in the internal comments field.
( ) Contacted knowledgeable individuals in Government and industry regarding market capabilities to meet requirements;
( ) Reviewed the results of recent market research undertaken to meet similar or identical requirements;
( ) Published formal requests for information in appropriate technical or scientific journals or business publications;
( ) Queried the Government-wide database of contracts and other procurement instruments intended for use by multiple agencies available at
https://www.fpds.gov and other Government and commercial databases that provide information relevant to agency acquisitions;
( ) Participated in interactive, on-line communication among industry, acquisition personnel, and customers;
( ) Obtained source lists of similar items from other contracting activities, agencies, trade associations, or sources;
( ) Reviewed catalogs and other available product literature published, or on-line, by manufacturers, distributors, and dealers;
( ) Queried the Central Contractor Registration (CCR) via the System for Award Management (SAM) for small business sources, as applicable. (See FAR and DFARS Part 4 for information on SAM).
( ) Other (attach supporting documentation to include a review of the Material Master in SAP):
The Acquisition Specialist contacted the Product Specialist
Product Specialist Concurrence Received (Y/N): ________________________________
If “Yes,” has the Material Master been updated: ______________________________
If “No,” state reason for non-concurrence and how non-concurrence resolved: ___________________________
Based on the market research conducted, item(s) to be solicited against subject solicitation have been determined to be commercial.
( ) Commercial ( ) Non-Commercial
______________________ __________ ___________________________ ___________
Acquisition Specialist Date Contracting Officer Date
Approving Official (one level above KO – for > $1M only) Date
The following format shall be used to document evaluation and award information, and the determination of responsibility, as prescribed in 13.501(b)(1).
SUBJECT: COMMERCIAL ITEM AWARD DETERMINATION UNDER 13.5
Determination of Responsibility: The awardee [insert CAGE code] is hereby determined responsible.
The Price is determined fair and reasonable based on:
If only one response was received, the price is determined fair and reasonable based on:
Market Research: (insert narrative below);
Comparison of proposed price with prices found reasonable on previous purchases (insert narrative below);
Current price lists, catalogs, or advertisements. However, inclusion of a price in a price list, catalog, or advertisement does not, in and of itself, establish fairness and reasonableness of the price (insert narrative below);
Comparison with similar items in a related industry (insert narrative below);
The contracting officer’s personal knowledge of the item being purchased (insert narrative below);
Comparison to an independent Government estimate (insert narrative below); OR
Any other reasonable basis (insert narrative below) Additional Remarks:
Award Justification: (Insert narrative)
Contracting officers must use format in the following checklist as prescribed in 15.406-3.
“FOR OFFICIAL USE ONLY (FOUO)” at the top and bottom of first and last page, and bottom of each page containing FOUO (DOD Manual 5200.01, Vol 4)
c. Clearance authority
6. Advisory reports and key documents
Listing of Government advisory reports (pricing, technical, should cost, etc. Include title, report number and date.)
Signature block for contracting officer, and any other signatures required
e. Actions exceeding TINA threshold, the contracting officer must search the Contract Business Analysis Repository (CBAR) and document the results of CBAR search.
a. List government advisory reports (audit, pricing, technical, should cost, etc. Include title, report number and date.)
(1) Explain use of informal field support instead of formal report (s)
(2) Explain basis for any field reports required but not received
b. Give status, explanation, and disposition of deficiencies on the following contractor systems that affect negotiations