EFTA00032652.pdf

Type: pdf
Source set: data-set-8
Extracted text

UNITED STATES ATTORNEYS 
Request, Authorization, and Order for Services of 
Expert Witness, Litigative Consultant, or ADR Neutral 
Contract/Purchase Order No.: 
Date: 
Part I - Re uest for Services 
1. Requesting Official (Name & Title) 
2. Signature of Requesting Official 
3. Point of Contact (Name and Tel.) 
Telephone: 
4. Date of Request 
5. Proparer (Name & Tel.) 
6. Originating Office (Name & Address) 
7. Case Name. Court 8 Ct. Docket No. 8. DJ File No./USAO No. 
9. Contractor (Namo and Tel.) 
Telephone: 
10. Contractor Mailing Address 
11. Contractor TIN or SSN (Individual) 
12. Contractor Specialty 
13. Reason for Request (Place an "X" in the applicable Box in the Left Column) 
13.a. Expert Testimony on Behalf of U.S. 
13.b. Deposition Conducted by DOJ Attorney 
13.c. Medical Examination of Plaintiff/Witness/Defendant in Contemplation of Testimony on Behalf of U.S. 
13.d. Examination Under 18 USC 4241. Mental Competency to Stand Trial Only 
13.e. Dual Purpose Psychiatric Examination (Time of Offense and Competency to Stand Trial) on the motion of: 
13J. ADR Neutral Services 
13.g. Litigative Consultant Services 
13.h. Other (explain below): 
Attach the Statement of Work to this Form 
14. Negotiated Contractor Rates. Estimated Expenses. and Performance Dates (Note: Expenses incurred n ust be supported by receipts) 
Service/Expanse 
Performance Dates (From-To) 
Hour/Day 
Quantity 
Pato 
Total 
14.a. Examine Case 
- 
Hour 
$ 0.00 
14.b. Prepare Testimony 
- 
Hour 
$ 0.00 
14.c. Court Testimony 
- 
Hour 
$ 0.00 
14.d. Deposition 
- 
Hour 
$ 0.00 
14.e. Litigative ConsultanUNeutral 
- 
Hour 
$ 0.00 
14.f. Per Diem (if not part of fee) 
Day 
$ 0.00 
14o. Privately Owned Vehicle (NTE coach rate) 
Mile 
$ 0.00 
14.h. Common Carder Transportation Via GTA 
14.1. Common Carrier Transportation Reimbursed 
14.J. Miscellaneous 
14.k. Total Estimated Expenses 
I 
$ 0.00 
15. Submit Invoices & EFT Information to: 
U.S. Attorney's Office. SDNY 
Bud. et 8 Fiscal Unit 
or email…
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