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