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653.303-DS-1771 DEPARTMENT OF STATE FORM (DS) 1771,






NOTE: The information contained on this form is for the internal use of the Department of State and shall not be

disclosed outside the Department excepe as authorized by the Assistant Secretary of State for Administracion


1. EVALUATION OF CONTRACTOR'S PERFORMANCE 1. Explain the contractor's performance as compared to the requirements of the statement of work and its proposal,

including quantity, quality, and timeliness of work done.

2. Explain relationship of contractor's personnel to the Department and other parties involved in the performance of the

contract. (Did contractor's personnel conduct themselves in a professional and businesslike manner? Did they respond in a constructive way for problems and difficulties as they wose? Was there stability in the leadership and personnel assigned to the contractor or were there numerous changes?)

3. Did contractor report on progress in a timely and thorough manner as called for by the contract?

Yes No (Explain)

4. Did contractor perform within the cost structure of the contract?

D Yes

No (Explain)

S. To what extent was the final product of the contractor, including data and conclusions, responsive to the stated

purpose of the contract?

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Coniractor's invoice shall be submitted in an original and ono copy 10: cost and total amount. Contractor must furnish signed recoipt from
Office of Finance General Claims

transportation carrier as proof that shipment has been forwarded.
P.O. Box 9487
Rosslyn Station

whon Contractor is requested to prepay transportation charges against Arlington, VA 22209

an F.0.8. ordor, such charges are to be added as a separatı hem to the Invoicos must show the Dopartment's 10 digit ordor number. time pay. invoice and must be supported by a paid transportation receipt. shipmont discount loven it 1101). description of each item. quantity, unit mont via APO, furnish postal rocoipts.


Signature FORM DST. 1099-4-81



Note: If a contract number is shown, Terms and Conditions of the applicable contract shall apply to this Delivery Order which is issued pursuant thereto.

this provision shall not be construed to extend to this contract if made with a corporation for its general benefit.

1. INSPECTION AND MCCEPTANCE - Inspection and acceptance will be at destination, unless otherwise provided. Until delivery and acceptance, and after any rejection, risk of loss will be on the Contractor unless loss results irom negligence of the Government.

2 VARIATION IN QUANTITY - No variation in the quantity of any item called for by this contract will be accepted unless such variation has been caused by conditions of loading, shipping, or packing, or allowances in manufacturing processes, and then only to the extent, if any, specified elsewhere in this contract.

8. COVENANT AGAINST CONTINGENT FEES . The Contractor warrants that no person or selling agency has been employed or retained to solicit or secure this contract upon any agreement or understanding for a commission, percentage, brokerage, or contingent fees, excepting bona fide employees or bona fide established commercial or selling agencies maintained by the Contractor for the purpose of securing business. For breach or violation of this warranty the Government shall have the right to annul this contract without liability or in its discretion to deduct from the contract price or consideration, or otherwise recover, the full amount of such commission, percentage, brokerage, or contingent fee.

3. DISCOUNTS - (a) Time discounts will be computed from: (1) date of delivery of the supplies to carrier when delivery and acceptance are at the point of origin, (2) date of delivery at destination or port of embarkation, when delivery and acceptance are at either of those points, or (3) date a proper invoice or voucher is received in the office specified by the Government, if the latter date later than the date of delivery. (b) Payment will be deemed to have been made on the date which appears on payment checks.

4. DISPUTES - (This contract is governed by the Contract Disputes Act of 1978 (Public Law 95-563 "the Act')). The Act provides administrative procedures for the submittal, analysis, negotiation, and if necessary, litigation of claims relating to this contract. The parties to this contract must comply with certain time restriclions on rendering of contracting officer decisions on claims, and on the appeal of those decisions. Further details on the rights and remedies under the Act may be found in the Federal Procurement Regulations at 1-1.318.4.

9. FEDERAL, STATE, AND LOCAL TAXES · Except as may be otherwise provided in this contract, the contract price includes all applicable Federal, State, and local taxes and duties in effect on the date of this contract but does not include any taxes from which the Government, the contractor or this transaction is exempt. Upon request of the Contractor, the Government shall furnish a tax exemption certificate or similar evidence of exemption with respect to any such tax not included in the contract price pursuant to this clause. For the purpose of this clause, the term "date of this contract" means the date of the contractor's quotation or, if no quotation, the date of this purchase Order.

5. FOREIGN SUPPLIES . This contract is subject to the Buy American Act (41 U.S.C. 10 a-d) as implemented by Executive Order 10582 of December 17, 1954, and any restrictions in appropriation acts on the procurement of foreign supplies.

10. SERVICE CONTRACT ACT OF 1965, As Amended (Service contracts not exceeding $2,500) - Except to ihe extent that an exemption, variation, or tolerance would apply pursuant to 29 CFR 4.6 if this were a contract in excess of $2,500, the Contractor and any sub-contractor hereunder shall pay all of his employees engaged in performing work on the contract not less than the minimum wage specified under section 6(a)(1) of the Fair Labor Standards Act of 1938, as amended. All regulations and interpretations of the Service Contract Act of 1965 expressed by 29 CFR Part 4 are hereby incorporated by reference in this contract.

6. CONVICT LABOR - In connection with the performance of work under this contract, the Contractor agrees not to employ any person undergoing sentence or imprisonment except as provided by Public Law 89-176, September 10, 1965 (18 U.S.C. 4082(c) (2) and Executive Order 11775, December 29, 1973.

11. The following terms and conditions are applicable to purchases in excess of $2,500: (a) Employment of the Handicapped . Federal Procurement Regulation, Temporary Regulation 38, dated May 26, 1976. (b) Contract Work hours and Safety Standards Act . Overtime Compensation Section - Federal Procurement Regulation 1-12.303. (c) Service Contract Act of 1965 - (Services contracts in excess of $2,500) Federal Procurement Regulation 1-12.904-1.

7. OFFICIALS NOT TO BENEFIT - No member of or Delegate to Congress or resident commissioner, shall be admitted to any share or part of this contract, or to any benefit that may arise therefrom; but

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A list of CFR titles, subtitles, chapters, subchapters and parts and an alphabetical list of agencies publishing in the CFR are included in the CFR Index and Finding Aids volume to the Code of Federal Regulations which is published separately and revised annually.

Table of CFR Titles and Chapters
Alphabetical List of Agencies Appearing in the CFR
List of CFR Sections Affected

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