SF1449 pg10.pdf

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

ADDITIONAL INFORMATION:

Please indicate your case size on items you are bidding on. No glass containers accepted. If your products differs from the description indicated, you must write in your specification.

Vendors must be registered at www.ccr.gov and https://orca.bpn.gov prior to receiving an award.

Please provide the following:

Tax ID Number:______________________

DUNS Number:______________________

The following sections of this form must be completed:

Block 12 Discount Terms Block 17A Contractor/Offeror Block 30A Signature Block 30B Name & Title Block 30C Date Signed

The Humane Slaughter Act, found in the provisions, must be returned with bids by ALL vendors bidding on any meat products.

CONTRACT NO.: REQUISITION NUMBER

Meat/Sub 3rd

AWARD/EFF. DATE

PAGE OF PAGES

10 10

32a. QUANTITY IN COLUMN 21 HAS BEEN

ACCEPTED AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVT. REPRESENTATIVE 32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

FINALPARTIAL

36. PAYMENT 37. CHECK NUMBER

COMPLETE PARTIAL FINAL

39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41c. DATE 42b. RECEIVED AT (Location)

STANDARD FORM 1449 (REV. 3/2005) BACK

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)