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Contract Closeout Guide Attachment 4: Contracting Officer’s Contract Completion Statement and Certification – Template and Instructions

(The CO must complete the following information, as applicable, for contracts – including orders using simplified acquisition procedures, as well as task and delivery orders. The instructions for completing the form should not be part of the completed form. Do not include this introductory paragraph or the attachment designation and title in the statement.

______________________________

CONTRACTING OFFICER´S CONTRACT COMPLETION STATEMENT AND CERTIFICATION

Contract number: ________________

Total amount obligated: $______________

Period of performance (including all options):______________________

Contract type: ____________________________

I. COR Closeout Certification. The COR has provided a certification for contract closeout to the Contracting Officer indicating the following: (check the appropriate box)

(1) The contractor has completed the required deliveries and/or performed all services:

(1)The Government has inspected and accepted the supplies and/or services and found them to be fully satisfactory and in accordance with the contract´s terms and conditions:

II. Administrative Closeout Procedures. In accordance with the FAR, the Contracting Officer has completed the following administrative procedures, or they are not applicable, for closure of the subject contract: (check the appropriate box)

(1) Disposition of classified material is completed:

(2) Final patent report is cleared:

(3) Final royalty report is cleared:

(4) There is no outstanding value engineering change proposal or it has been resolved:

(5) Plant clearance report is received:

(6) Property clearance is received and reviewed:

(7) All interim or disallowed costs are settled:

(8) Price revision is completed:

(9) Subcontracts are settled by the prime contractor:

(10) Prior year indirect cost rates are settled:

(11) Termination docket is completed:

(12) Contract audit is completed:

(13) Contractor´s closing statement documents are completed:

 

Contractor´s Certification – General Provisions:

Contractor´s Release of Claims:

Contractor´s Assignment of Refunds, Rebates, Credits and Other Amounts:

(14) Contractor´s final invoice or completion voucher been submitted (and paid):

(15) Contract funds review is completed and excess have been deobligated:

(16) Contractor´s past performance assessment is completed and reported to PPIRS:

(17) Contractor´s individual and summary subcontracting compliance reports have been provided to eSRS:

III. Comments (specify, as appropriate):

______________________________
______________________________
______________________________
______________________________

IV. Contracting Officer Certification. (Complete the following information (see FAR 4.804-5(b)):

(1) Contract administration office, if different from the contracting office:

(specify "N/A" if the same as (2) immediately below)

(2) Contracting office name and address: 

__________________________

__________________________

(3) Contract number: __________

(4) Last modification number: __________

(specify "N/A" if no modifications were issued)

(5) Last task or delivery order number: _________

(specify "N/A" if no calls or orders were issued)

(6) Contractor name and address:

____________________________________
____________________________________
____________________________________
____________________________________

(7) Dollar amount of excess funds, if any: $_______________

(8) Final invoice/completion voucher number and date:

Invoice/Voucher Number: ______________

Date: ___________

(9) CO certification:

CERTIFICATION

Pursuant to FAR 4.804-5(b)(10), all required contract administration actions have been fully and satisfactorily accomplished.

CONTRACTING OFFICER NAMESIGNATUREDATE