CLAIM, PASS-THROUGH TO GOVERNMENT

(SUB-CONTRACTOR)

 Date

Mr. Prime Contractor

(Address)

Re: Claim for Equitable Adjustment

(Subject)

Contract number

Dear Sir:

Regarding my Request for Change Order dated , I consider this matter to be in dispute. I am claiming an increase in my sub-contract amount of $ , and a time extension of calendar days.

(Note: If you have any additional data to submit, include this sentence: Attached please find two copies of additional supporting data.)

I believe that the claim is self-explanatory regarding the damaging events and extra costs and time of performance which we have incurred under this contract. However, should you require additional information regarding this claim, please contact me at telephone number (000) 000-0000.

I request that you sponsor this claim to the Government, properly certified by you, and that you request a final written decision of the Contracting Officer within sixty (60) days, as provided for by the "Disputes" clause of the prime contract. I also ask that you send me a copy of your cover letter forwarding the claim to the Government.

Although I believe the Government to be responsible for this change, my contract is wit you, and I must reserve my rights to pursue this matter against you, should efforts to obtain fair compensation from the Government fail, or should you refuse to sponsor my claim to the Government.

I hereby certify that the claim is made in good faith; that the supporting data are accurate and complete to the best of my knowledge and belief; that the amount requested accurately reflects the contract adjustment for which the Contractor believes the Government is liable; and that I am duly authorized to certify the claim on behalf of the Contractor.

(Note: Last paragraph not required for a claim of less than $50,000.00)