1.

Date:

_________________

2.

Closure Type:

DIRECT FINAL ____
INTERIM ____
INTERIM TO FINAL ____

3.

Country Code-Implementing Agency-Case:

_________________

4.

Net Case Value:

_________________

5.

Case Closed at Zero Value per FMS Purchaser's Request:

YES_____ NO______

6.

Final Delivered Articles/Services value (including CAS and LSC):

_________________

 

  1. ___ The net case value shown on line 4 agrees with Implementing Agency records and Obligational Authority released to this agency via DD Form 2060 or automated equivalent.

    AND

  2. ____ The contracts awarded in connection with the case are logistically complete with no associated unliquidated obligations

    OR

    ___ The contracts awarded in connection with the case are logistically complete; but, unliquidated obligations exists. Responsible officials have advised that no additional costs beyond the recorded unliquidated obligations in line 8 below can be identified.

    AND

  3. ____ All requisitions, reimbursable work orders, MIPRs and invitational travel orders that were processed pursuant to this case are accounted for and the costs thereof are included in line 6. Reimbursements from the DFAS/JAX/IN have been credited to the financing appropriation or Miscellaneous Receipt Account 3041, as applicable.

    AND

  4. ____ All estimated deliveries were converted to actual deliveries.

    AND

  5. Check one below that applies:

    ____ Constructive delivery transactions have been reported for all major end items.

    OR

    ____ Constructive delivery reporting does not apply to this case.

    AND

  6. ____ All outstanding discrepancy reports against the case were processed.

    AND

  7. ____ All Performance Reporting and Cash Disbursements were reconciled with Implementing Agency accounting records and are equal in value.

    AND

  8. ____ All accessorial charges have been validated.

7.

Above-the-line disbursements excluding CAS and LSC:

_________________

8.

Unliquidated obligation balance (to include ULO CAS):

_________________

 

ULO CAS:

_________________

9.

Unliquidated Obligation supporting documentation attached for Interim Closures:

YES _____ N/A _____

10.

Closure certificate point of contact:
(Name, email, phone number)

_________________

Unliquidated Obligation (ULO) Supporting Documentation 

LOA Line #

Funding
Document

Requisition
Number/ACRN

Articles/Services
Obligated Value

Articles/Services
Expended Value

ULO Value
(excluding CAS)

Reason for ULO

Latest Estimated
Completion Date
(MMM/YYYY)

 

 

 

 

 

Note: Sum of all entries in this column must equal ULO amount specified in item 7 of the certificate

Note: Identify ULO category as provided in A7.C3.13.1.

Also include future physical completion date, when available.

 

Example Follows (For Illustration Purposes Only):

007

N00024-02-C-0001

PBD044-2715-0001

$100,247.03

$95,868.92

$4,378.11

Open contract; estimated physical completion date is Jun 2007

Dec 2017

A copy of this page is appended to the interim case closure certificate sent via e-mail to DFAS Indianapolis.