As prescribed in section 1616.7002 , the following clause shall be inserted in all FEHBP contracts based on cost analysis (experience rated).
Accounting and Allowable Cost (FEHBAR 1652.216-71) (JAN 2003)
Certification of Accounting Statement Accuracy
This is to certify that I have reviewed this accounting statement and to the best of my knowledge and belief:
Carrier Name: _______________________________
Name of Chief Executive Officer:
(Type or Print)
_______________________________
Name of Chief Financial Officer:
_______________________________
Signature of Chief Executive Officer:
_______________________________
Signature of Chief Financial Officer:
_______________________________
Date Signed: _______________________________
Date Signed: _______________________________
Underwriter: _______________________________
Name and Title of Responsible Corporate Official:
(Type or Print:)
_______________________________
Signature of Responsible Corporate Official:
_______________________________
Date Signed:_______________________________
(End of certificate)
(End of clause)
48 C.F.R. §§1652.216-71