Activity Name:

Activity Address:

Ratification Amount:

$

Ratification Contract/Order Number (include modification number if applicable)

Name of Contracting Officer Recommending Ratification:

Name of Ratifying Official:

Date of Ratification approval:

Description of Supplies/Services bought and from whom:

Brief description of the circumstances of the purchase, i.e. why normal procurement procedures were not followed:

Additional Relevant Information:

Name of Head of the Contracting Activity (HCA):

Phone Number(s):

Comm:

DSN:

( ) -

-

HCA Address:

Email Address: