GSA/FAS Multiple Award Schedule Modification Checklist



Modification Request Checklist for Dealers with a DiscountCompany Name:Doing Business As (DBA):GSA Contract Number:Authorized Negotiator Name and Title:Signature of Authorized Negotiator:Date:Type of Modification Action(s) requested: FORMCHECKBOX Add # product(s)/service(s) under SIN(s):_______________________________ FORMCHECKBOX All products being added are in compliance with the Trade Agreements Act. FORMCHECKBOX All products contain no hazardous substances as defined by the Federal Hazardous Substances mercial Sales Practices: Please check the box which applies: FORMCHECKBOX If adding product to an existing manufacturer, the commercial sales practices information previously submitted with the initial award have not changed. FORMCHECKBOX If adding product to a new manufacturer, please include a Letter of Supply from the new manufacturer and a CSP-1 Form for the new manufacturer products. FORMCHECKBOX Modification Spreadsheet attached detailing items added. FORMCHECKBOX Commercial Price List with Effective Date is included. FORMCHECKBOX GSA Price List with Effective Date is included. FORMCHECKBOX Test Certificate and Technical Requirements Certification are included (applicable only to Schedules 71 and 72). FORMCHECKBOX Delete # product(s)/service(s) under SIN(s):_______________________________ FORMCHECKBOX This deletion request results in deleting the entire SIN from the contract. FORMCHECKBOX The reason for requesting the deletion/cancelation is ______________________________. FORMCHECKBOX A substantially equal item, to the item(s) being deleted/cancelled, has not and will not be added to the schedule contract at a higher price during the contract term. FORMCHECKBOX Modification Spreadsheet attached detailing deleted items. FORMCHECKBOX Commercial Price List with Effective Date is included. FORMCHECKBOX GSA Price List with Effective Date is included. FORMCHECKBOX Add SIN(s):_______________________________ FORMCHECKBOX All products being added are in compliance with the Trade Agreements Act. FORMCHECKBOX All products contain no hazardous substances as defined by the Federal Hazardous Substances Act. FORMCHECKBOX A separate CSP-1 form for each SIN or product line being added is included. FORMCHECKBOX Modification Spreadsheet attached detailing items added. FORMCHECKBOX Commercial Price List with Effective Date is included. FORMCHECKBOX GSA Price List with Effective Date is included. FORMCHECKBOX Price Reduction for # product(s)/service(s) under SIN(s):_______________________________ FORMCHECKBOX The proposed price reduction(s) are in full conformity with the Price Reduction Clause.Price Reduction Type: Please check the box which applies: FORMCHECKBOX Permanent Price Reduction. FORMCHECKBOX Temporary Price Reduction, which will run from _________ to __________.Indicate whether the price reduction(s) are the result of: FORMCHECKBOX A revision in the commercial catalog, pricelist, schedule, or other document upon which contract award was predicated, so as to reduce the price(s). FORMCHECKBOX The granting of more favorable discount(s) or terms and conditions than those contained in the commercial catalog, pricelist, schedule, or other document upon which contract award was predicated. FORMCHECKBOX The granting of special discount(s) to the customer (or category of customers) used as the basis of award, with the ultimate result of disturbing the price/discount relationship of the Government to the customer (or category of customers) used as the basis of award. FORMCHECKBOX Modification Spreadsheet attached detailing percentage of decrease. FORMCHECKBOX Commercial Price List with Effective Date is included. FORMCHECKBOX GSA Price List with Effective Date is included. FORMCHECKBOX Economic Price Adjustment (EPA) for # product(s)/service(s) under SIN(s):_______________________________ FORMCHECKBOX Document is attached explaining the reason for the price increase. FORMCHECKBOX Modification Spreadsheet attached detailing percentage of increase. FORMCHECKBOX Commercial Price List with Effective Date is included. FORMCHECKBOX GSA Price List with Effective Date is included. FORMCHECKBOX Novation (See FAR 42.1204 for required documentation) FORMCHECKBOX Company Name Change (See FAR 42.1205 for required documentation) FORMCHECKBOX Administrative FORMCHECKBOX Address Change FORMCHECKBOX Telephone Number Change FORMCHECKBOX Fax Number Change FORMCHECKBOX e-Mail Address Change FORMCHECKBOX Point of Contact ChangeFrom:To: FORMCHECKBOX Other (Specify) ________________________Upon approval of the modification we agree to submit an electronic catalog/price list within 15 days to update GSA Advantage! ................
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