Order 4400.4 - Attachment A

FHWA CONTRACTING OFFICER WARRANT APPLICATION FORM

1. Applicant Information:

2. Type of Request

a. Initial Request. Check box to identify the authority requested:

Warrant Level I (SAP)
(Up to $100,000 under FAR Part 8) (desired dollar limit) $
(Up to $25,000 under FAR Part 13) (desired dollar limit) $

Warrant Level I
(Up to $100,000) (desired dollar limit) $
(Up to $25,000 under FAR Part 13) (desired dollar limit) $

Warrant Level II (SAP)
(Up to $500,000 under FAR Part 8) (desired dollar limit) $
(Up to $100,000 under FAR Part 13) (desired dollar limit) $

Warrant Level II
(Up to $500,000) (desired dollar limit) $

Warrant Level II (a)
(Up to $50,000,000 under FAR Part 36) (desired dollar limit) $

Warrant Level III
(Unlimited) (desired dollar limit) $

Providing additional authority to approve and execute Grants, Cooperative Agreements and Other Transactions within designated warrant level above.

Other Authority/Limitations:

b.	Change in Warrant Level and/or Dollar Limit:
	From Level		$ To Level		$

c. Contracting Officer Primary Warrant Type:

Procuring Contracting Officer (PCO)

Administrative Contracting Officer (ACO).

Warrant Authority covers PCO and ACO functions

d.	Termination of Warrant, effective date (dd-mmm-yyyy):
Reason for termination:

3. Provide a brief explanation why a warrant is required for the applicant:

4. Applicant's qualifications to be a Contracting Officer:

a. Meet educational and experience qualification requirements for current grade (check all that apply):

Successfully completed all mandatory contracting courses or equivalents for current grade,

Has the required experience for a contracting position,

Have received a Baccalaureate degree from an accredited educational institution,

and/or

Completed at least 24 semester credit hours, or equivalent study from an accredited educational institution in any of the following disciplines: accounting, business finance, law, contracts, purchasing, economics, industrial management, marketing, quantitative methods, and organization and management; and

Held a civilian position in the GS-1102 occupational series on January 1, 2000.

b. Meet Federal Acquisition Certification in Contracting (FAC-C) requirements

Certified at an appropriate level to support warrant obligations Highest Achieved Certification Level (i.e., Level II)

c. Waiver

The Senior Procurement Executive approved the Contracting Officer Warrant Waiver Request dated on .

5. Prior Warrant(s) Held

None

Yes. Check appropriate boxes and include obligation limit.

	Obligation Limit:	Date:	Agency
Procuring Contracting Officer	$
Administrative Contracting Officer	$
Terminating Contracting Officer	$
Grants Officer	$
Warrant other than those above	$

SIGNATURES

Supervisor Endorsement: I recommend the above named individual be appointed as a Contracting Officer to enter into, administer and/or terminate contracts, and to make related determinations and findings. I certify the above named individual posses the qualifications as cited in FAR 1.603-2 and TAM 1201.603-2 as supported by attached documentation.