11._Contractor_Combined_Invoice.pdf

U.S. Marshals Service Asset Forfeiture Division

INVOICE COVER SHEET

12/13/2017

DISTRICT: CONTRACT #:

BILLING OFFICE: TASK ORDER #:

BILLING ADDRESS: INVOICE NUMBER:

INVOICE DATE:

INVOICE PERIOD OF PERFORMANCE:

OPTION YEAR:

Company Name: Telephone Number:

Point of Contact: Fax Number:

Address: Tax Identification Number:

E-Mail Addresses:

SOC 22012 -$

SOC 25715 -$

SOC 25226 -$

Remaining Balance -$

CONTRACTOR CERTIFICATION: I hereby certify to the best of my knowledge and belief that the charges for services shown on this invoice are being invoiced accurately per the Statement of Work.

Contractor Signature Date

COR CERTIFICATION: I hereby certify to the best of my knowledge and belief that the supplies and / or services shown on this invoice have been received and accepted.

COR Signature Date

Towing, Storage & Disposal Services - USMS Vehicle Invoice

OBLIGATION CERTIFICATION

I hereby certify that________________ is a small business concern as defined in Federal Acquisition Regulation (FAR) subpart 2.101.

Obligation Balance Additional Funds De-obligation of Funds

Current Obligation Balance:

Previous Balance Current Invoice Total Amount

Invoice Cover Sheet