Form St-4 Not Domestically Manufactured: Prime Contractor Page 2

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ST-4 FORM: FOR DGS USE ONLY.
CONTRACTORS - DO NOT WRITE ON THIS SIDE OF ST-4 FORM
A.
Field Personnel
CIS: __________________________________________
1. Date ST-4 submitted by Prime Contractor:
______/_____/_____
2. Date ST-4 forwarded to Regional Director:
______/_____/_____
B.
Regional Director
1. Date ST-4 forwarded to Harrisburg E/A: _____/_____/______
C.
Bureau of Engineering/Architecture
1. Date received from the Region: ______/______/______
2. Referred to for review:
________________________________________
3. Additional Suppliers/Manufacturers Contacted to verify domestic availability:
a.
Firm Name: ____________________________________________________
Phone :_____________
Address: ________________________________________________________________________________
Person Contacted:______________________________________________
Date Contacted:____/_____/____
b.
Firm Name:_____________________________________________________Phone :_____________
Address:_________________________________________________________________________________
Person Contacted: ______________________________________________
Date Contacted: ____/_____/_____
c.
Firm Name:_____________________________________________________Phone :____________
Address:_________________________________________________________________________________
Person Contacted: ______________________________________________ Date Contacted: ____/_____/_______
D.
Office of Chief Counsel Date received: ______/______/______
Action: ________________________________________
E.
Deputy Secretary
Date received: ______/______/______
Action: ________________________________________

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