JULY 05
SOLICITATION FOR OFFERS
OUTPATIENT CLINIC
SFO NO. V101-183R-xxx-xxx-xx
[INSERT LOCATION OF FACILITY]
CERTIFICATE OF CURRENT COST OR PRICING DATA
This is to certify that, to the best of my knowledge and belief, the cost or pricing data (as
defined in section 2.101 of the Federal Acquisition Regulation (FAR) and required under
FAR subsection 15.403-4) submitted, either actually or by specific identification in
writing, to the Contracting Officer or to the Contracting Officer's representative in support
of ________* are accurate, complete, and current as of ________**. This certification
includes the cost or pricing data supporting any advance agreements and forward pricing
rate agreements between the offeror and the Government that are part of the proposal.
Firm ________________________________________
Signature ____________________________________
Name _______________________________________
Title ________________________________________
Date of execution*** ___________________________
* Identify the proposal, request for price adjustment, or other submission involved, giving
the appropriate identifying number (e.g., RFP No.).
**Insert the day, month, and year when price negotiations were concluded and price
agreement was reached or, if applicable, an earlier date agreed upon between the
parties that is as close as practicable to the date of agreement on price.
*** Insert the day, month, and year of signing, which should be as close as practicable to
the date when the price negotiations were concluded and the contract price was agreed
to.
Part IX Forms
Lessor __________ Gov't. __________
__________ of __________ Pages
CERTIFICATE OF CURRENT COST OR PRICING DATA
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