Emergency_Freight_Contract_Service_Request_Form.docx

DOCX document 21 KB Posted

Attached to
Region 6 Fire Cache Freight Services Federal contract opportunity
Solicitation number
1204H118Q0006
Issued by
Department of Agriculture Forest Service R6-Pacific Northwest Region

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Emergency Freight Service Request - SAMPLE

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Northwest Area Incident Support Cache Emergency Freight Contract Service Request Form

Ordering Office/Contact: Northwest Area Incident Support Cache Ryan Jackson 541-504-7237

Contractor: JOE SMITH TRUCKING Contract #: AG-04XX-C-10-9999 Equipment/Resources Requested: 1 TRACTOR Incident/Project Name: NORTHEST AREA INCIDENT SUPPORT (NEK) Incident Order Number: MN-NEK-002018 Charge Code: PWD1MB/1325 Incident Transportation Support Number: OR-NWK-00X

RAC E-#: E-1

Date and Time Ordered: October 31, 2010 @ 1620 Cache and Contractor Contact: Ryan to Joe Trailer Seal #: USFS PADLOCK

Deliver To: NORTHEAST AREA INCIDENT SUPPORT CACHE (NEK) 402 11th STREET SE

GRAND RAPIDS, MN 55744

Service Requested: 1 Tractor to haul 27’ trailer #634 to the NORTHEAST AREA INCIDENT SUPPORT CACHE (NEK) in Grand Rapids, MN at the above address. Unless otherwise instructed the driver will wait to be off loaded and return to the Redmond Fire Cache.

Estimated Time of Departure: October 31, 2010@ 1800 Estimated Time of Arrival: November 3, 2010 @ 1400 Estimated Round Trip Miles: 3375 miles Cost per mile: $ 4.10 Estimated Cost: $13,803.75 Estimated Weight: 5500

APPROVED BY: ______________________________Date: October 31, 2010

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