Fillable Form Gsa 2957 - Reimbursable Work Authorization

15A.

Funding Agency Code (FPDS) - Enter a valid 4-digit code from the FPDS-NG Agency Code Table for the agency that is

providing the majority of funds to be obligated by this transaction. Contact your Agency's FPDS Administrator and/or your agency

Acquisition Community for assistance with identifying your agency specific code.

15B.

Funding Office Code (FPDS) - Enter a valid alphanumeric code from the FPDS-NG Funding Office Code Table (maximum of 6

characters). This code identifies the office (or other organization entity) that provided the majority of funds. If the Funding Agency is a

non-DoD agency, the code is the DoD Activity Address Code (DODAAC). Contact your Agency's FPDS Administrator and/or your

agency Acquisition Community for assistance with identifying your agency specific code.

GSA Internal Customer or Interfund Customer

16.

Enter the 2-character Fedcode.

17.

Mandatory for all General Services Administration internal customers. Enter the 8-position Pegasys Document number.

18.

Enter the Pegasys accounting line number. This field is optional and is limited to 2 positions.

19.

Enter the 4-position fund code.

20.

Enter the 1-position interfund year. This is the last position of the fund code entered in Block 20.

21A.

Enter the signature of authorized Agency representative who is certifying the validity of the order form and the availability of fund.

Further written assurances may be required - see the certification paragraph preceding Block 21A.

21B.

Enter date the RWA form was signed.

21C-E.

Enter the name, e-mail address, and phone number of the Agency certifying official who has signed the form.

General Services Administration/Public Buildings Service

22.

Enter Project Control Number.

23A.

Enter summary-level GSA organization code.

23B.

Enter the lease number (if applicable).

23C.

Check the appropriate budget activity code.

23D.

Enter the 4-character work item number used to track repair and alteration tasks.

23E.

Enter the 6-character Billed Office Address Code (BOAC).

23F.

Enter the correspondence symbol.

23G.

Enter the 4-character Agency Bureau Code.

24A.

Enter the initial contract award date agreed upon by GSA-PBS and the RA. Per GSA acquisition policy, GSA-PBS has a "reasonable

time, based on the complexities of the requirement," to obligate contractually funds accepted from an RA.

24B.

Enter the estimated completion date agreed upon by GSA-PBS and the RA.

25.

Enter a brief project description (limited to 25 characters).

26.

Check the appropriate action block.

27.

Check as appropriate.

28A-F.

If multiple buildings or multiple functions are cited, enter organization code, building number, function code, object class and total

amount for each building or function. The form limit is 15 lines. If additional lines are needed, please attach a spreadsheet providing

the information requested in Blocks 28A-F.

29A-C.

Enter the name, telephone number, and e-mail address of a project contact who can answer questions regarding all work planned or

performed under this RWA.

30A.

Enter the signature of the GSA approving official. GSA's signature indicates GSA's acceptance of the terms and conditions set forth on

page 3 of the RWA.

30B.

Enter the date of signature.

30C-E.

Enter the name, telephone number, and e-mail address of the GSA approving official.

31.

Enter the seller/GSA Business Partner Network/Data Universal Numbering System Number (BPN/DUNS).

32A-C.

Enter the certification of completion signature, certifying name, and completion date.

GSA 2957 (REV. 2/2011) PAGE 5

Form Gsa 2957 - Reimbursable Work Authorization - 2011 Page 5

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