PGI 13.106-3(b) File documentation and retention.

(90)(a)(i) Sample format.

SIMPLIFIED ACQUISITION PRICING MEMORANDUM

PURCHASE REQUEST OR CALL/ORDER NUMBER: ________________ PRC:________

ITEM NUMBER & NAME: ________________________________________________

PRICE REASONABLENESS BASED ON (Check one or more):

PRICE COMPARABILITY WITH PRIOR PURCHASE PRICES (Adjusted as appropriate):

Yes _____ No _____ NA _____

Explain: _____________________________________________________

__________________________________________________________________

_____ ADEQUATE PRICE COMPETITION (Attach quotes/abstract) INVOLVING:

_____ ONE MANUFACTURER'S PART or ____ PARTS OF VARIOUS MFRS

Identify type competition (mfgr(s)/dealer(s)/both), competitive range of offers, etc.:

_________________________________________________________________

_____ COMPARISON WITH PRIOR PURCHASE PRICE(s) OF SIMILAR ITEM NAME & NO.:

______________________________________________________

CONTRACT & CALL/ORDER NO.______________________________

VENDOR___________________________ AWARD DATE_________

UNIT OF ISSUE__________ UNIT PRICE_________ QTY__________

EXPLAIN ADJUSTMENTS AND BASIS FOR DETERMINING PRIOR PRICE

REASONABLE: _________________________________________________

_____________________________________________________________

_____ COMMERCIAL CATALOG/PRICE LIST FOR:

_____ SAME ITEM or _____ SIMILAR ITEM

NAME/NUMBER___________________________________________

DATE___________________ PAGE____________________

EXPLAIN DIFFERENCES:_____________________________________

____________________________________________________________

_____ ESTABLISHED MARKET PRICE:

MEANS OF VERIFICATION: _________________________________

_____ VALUE/VISUAL/COST ANALYSIS BY BUYER/USER/TECHNICAL PERSONNEL

(Attach or reference the review of technical data, examination of sample, etc.):

EXPLAIN:_________________________________________________

________________________________________________________________

_____ OTHER (Explain specific reason, e.g., valid purchase request estimate, minimum order quantity, high priority delivery, special packaging/marking, etc.):

__________________________________________________________________

SIGNATURE OF CONTRACTING OFFICER DATE

_________________________________________ ____________________