UnitedStatesGovernment

InteragencyAgreement(IAA)–AgreementBetweenFederalAgenciesOrderRequirementsandFundingInformation(Order)Section

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ServicingAgency’sAgreement

GT&C#Order#Amendment/Mod#TrackingNumber(Optional)

PRIMARYORGANIZATION/OFFICEINFORMATION
24. / RequestingAgency / ServicingAgency
PrimaryOrganization/OfficeName / / U.S. Treasury, Fiscal Service
ResponsibleOrganization/OfficeAddress / / 401 14th Street, SW
Washington, DC 20227
ORDER/REQUIREMENTS INFORMATION
25.OrderAction(CheckOne)
New
Modification(Mod)–ListaffectedOrderblocksbeingchangedandexplainsthechangesbeingmade.ForExample:foraperformanceperiodmod,statenewperformanceperiodforthisOrderinBlock27.FillouttheFundingModificationSummarybyLine(Block26)ifthemodinvolvesadding,deletingorchangingFundingforanOrderLine.
Cancellation–ProvideabriefexplanationforOrdercancellationandfillinthePerformancePeriodEndDatefortheeffectivecancellationdate.
26.FundingModificationSummarybyLine / Line#_ / Line# / Line#_ / TotalofAllOtherLines(attachfundingdetails) / Total
OriginalLineFunding / $ / $ / $ / $ / $0.00
CumulativeFundingChangesFromPriorMods[addition(+)orreduction(-)] / $ / $ / $ / $ / $0.00
FundingChangeforThisMod / $ / $ / $ / $ / $0.00
TOTALModifiedObligation / $0.00 / $0.00 / $0.00 / $0.00 / $0.00
TotalAdvanceAmount(-) / $ / $ / $ / $ / $0.00
NetModifiedAmountDue / $0.00 / $0.00 / $0.00 / $0.00 / $0.00
27.PerformancePeriodStartDateEndDate

Foraperformanceperiodmod,insertMM-DD-YYYYMM-DD-YYYYthestartandenddatesthatreflectthe
newperformanceperiod.

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ServicingAgency’sAgreement

GT&C#Order#Amendment/Mod#TrackingNumber(Optional)

28.OrderLine/FundingInformation / LineNumber
RequestingAgencyFundingInformation / ServicingAgencyFundingInformation
ALC / 20180031
ComponentTASRequiredby10/1/2014 / SP / ATA / AID / BPOA / EPOA / A / MAIN / SUB / SP / ATA / AID / BPOA / EPOA / A / MAIN / SUB
020 / 3220 / 018
ORCurrentTASformat
BETC / COLUVRCT
ObjectClassCode(Optional)
BPN
BPN+4(Optional)
AdditionalAccountingClassification/Information(Optional) / DUNS 078859289
RequestingAgencyFundingExpirationDate

MM-DD-YYYY / RequestingAgencyFundingCancellationDate

MM-DD-YYYY
ProjectNumberTitle
DescriptionofProductsand/orServices,includingtheBonaFideNeedforthisOrder(Stateorattachadescriptionofproducts/services,includingthebonafideneedforthisOrder.)
NorthAmericanIndustryClassificationSystem(NAICS)Number(Optional)
BreakdownofReimbursableLineCostsORBreakdownofAssistedAcquisitionLineCost:
UnitofMeasure / ContractCost / $
Quantity / UnitPrice / Total / ServicingFees / $
$0.00 / TotalObligatedCost / $ 0.00
OverheadFeesCharges / $ / Advancefor
Line(-) / $
TotalLineAmountObligated / $0.00
NetTotalCost / $ 0.00
AssistedAcquisitionServicingFeesExplanation
AdvanceLineAmount(-) / $
NetLineAmountDue / $0.00
TypeofServiceRequirements
SeverableServiceNon-severableServiceNotApplicable

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ServicingAgency’sAgreement

GT&C#Order#Amendment/Mod#TrackingNumber(Optional)

29.AdvanceInformation(CompleteBlock29iftheAdvancePaymentforProducts/Serviceswaschecked“Yes”ontheGT&C.)
TotalAdvanceAmountfortheOrder$[AllOrder Lineadvanceamounts(Block28)mustsumtothistotal.]
RevenueRecognitionMethodology(accordingtoSFFAS7)(IdentifytheRevenueRecognitionMethodologythatwillbeusedtoaccountfortheRequestingAgency’sexpenseandtheServicingAgency’srevenue)
Straight-line–Provideamounttobeaccrued$andNumberofMonths AccrualPerWorkCompleted–Identifytheaccountingpostingperiod:
Monthlyperworkcompletedinvoiced
Other–Explainotherregularperiod(bimonthly,quarterly,etc.)forpostingaccrualsand howtheaccrual
amountswillbecommunicatedifotherthanbilled.
30. TotalNetOrderAmount: $
[AllOrderLineNetAmountsDueforreimbursableagreementsandNetTotalCostsforAssistedAcquisitionAgreements(Block28)mustsumtothistotal.]
31.Attachments(Stateorlistattachments.)
Keyprojectand/oracquisitionmilestones(OptionalexceptforAssistedAcquisitionAgreements)
OtherAttachments(Optional)
BILLINGPAYMENTINFORMATION
32.PaymentMethod(CheckOne)[Intra-governmentalPaymentandCollection(IPAC)isthePreferredMethod.]IfIPACisused,thepaymentmethod mustagreewiththeIPACTradingPartnerAgreement(TPA).
RequestingAgencyInitiatedIPACServicingAgencyInitiatedIPAC
CreditCardOther–Explainotherpaymentmethodandreasoning
33.BillingFrequency(CheckOne)
[AnInvoice mustbesubmittedbytheServicingAgencyandacceptedbytheRequestingAgencyBEFOREfundsarereimbursed(i.e.,viaIPACtransaction)]
MonthlyQuarterlyOtherBillingFrequency(includeexplanation)_
34.PaymentTerms(CheckOne)
7daysOtherPaymentTerms(includeexplanation):

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ServicingAgency’sAgreement

GT&C#Order#Amendment/Mod#TrackingNumber(Optional)

35.FundingClauses/Instructions(Optional)(Stateand/orlistfundingclauses/instructions.)
36.Delivery/ShippingInformationforProducts(Optional)
AgencyName
PointofContact(POC)NameTitle
POCEmailAddress
DeliveryAddress/RoomNumber
POCTelephoneNumber
SpecialShippingInformation
APPROVALSANDCONTACTINFORMATION
37.PROGRAMOFFICIALS
TheProgramOfficials,asidentifiedbytheRequestingAgencyandServicingAgency, mustensurethatthescopeofworkisproperlydefinedandcanbefulfilled forthisOrder.TheProgramOfficialmayormaynotbetheContractingOfficerdependingoneachagency’sIAAbusinessprocess.
RequestingAgency / ServicingAgency
Name / Reginald McKinney
Title / OTCnet Business Kead
TelephoneNumber / 202-874-6893
FaxNumber
EmailAddress /
SIGNATURE
DateSigned
38.FUNDINGOFFICIALS-TheFundsApprovingOfficials,asidentifiedbytheRequestingAgencyandServicingAgency,certifythatthefundsareaccuratelycitedandcanbeproperlyaccountedforperthepurposessetforthintheOrder.TheRequestingAgencyFundingOfficialsignstoobligatefunds.TheServicingAgencyFundingOfficialsignstostartthework,andtobill,collect,andproperlyaccountforfundsfromtheRequestingAgency,inaccordancewiththeagreement.
RequestingAgency / ServicingAgency
Name
Title
TelephoneNumber
FaxNumber
EmailAddress
SIGNATURE
DateSigned

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ServicingAgency’sAgreement

GT&C#Order#Amendment/Mod#TrackingNumber(Optional)

CONTACTINFORMATION
FINANCEOFFICEPointsofContact(POCs)
Thefinanceofficepointsofcontactmustensurethatthepayment(RequestingAgency),billing(ServicingAgency),andadvance/accountinginformationareaccurateandtimelyforthisOrder.
39. / RequestingAgency(PaymentOffice) / ServicingAgency(BillingOffice)
Name
Title
OfficeAddress
TelephoneNumber
FaxNumber
EmailAddress
SignatureDate(Optional)
40.ADDITIONALPointsofContacts(POCs)(asdeterminedbyeachAgency)ThismayincludeCONTRACTINGOfficePointsofContact(POCs).
RequestingAgency / ServicingAgency
Name
Title
OfficeAddress
TelephoneNumber
FaxNumber
EmailAddress
SignatureDate(Optional)
Name
Title
OfficeAddress
TelephoneNumber
FaxNumber
EmailAddress
SignatureDate(Optional)
Name
Title
OfficeAddress
TelephoneNumber
FaxNumber
EmailAddress
SignatureDate(Optional)