Exhibit A.pdf

PDF 63 KB Posted

Attached to
Federal Flexible Spending Account (FSAFEDS) Program Services
Solicitation number
24361820R0002
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Text version

INVOICE

Payable to OPM

INVOICE:

INVOICE Date: XX/XX/XXXX

Customer No: XXXXXXXXXXX

Payment Terms: NET30

Due Date: XX/XX/XXXX

Bill To:

Office of Personnel Management 1900 E St Nw Washington, DC 20415-0001

For invoice and banking information inquiries, please contact XXXXXXXXXXXXX or by email XXXXXX@XXXXXX.com

PAY AMOUNT DUE TO OPM: $3,527.75

Description Qty UofM Amount Charged Total Amount

Risk Reserve 11 Mos @ $0.25 1 PRT 2.75 $2.75

Risk Reserve 12 Mos @ $0.25 1,175 PRT 3.00 $3,525.00

PAY AMOUNT DUE TO OPM: $3,527.75

INFORMATION NEEDED TO IPAC:

Use the following IPAC parameters to pay this invoice to OPM:

Office of Personnel Management Agency Location Code: (ALC) 24-00-0002 Treasury Account Symbol: (TAS) 024X0800 Standard General Ledger: (SGL) Debit 1010 and Credit 5400

Business Event Type Code: COLL Federal Account: (F)

Description: Invoice Number XXXXXXXXXXXXXXX

Contract #: OPMXXXXXXXXX Point of Contact: Include the name and address of person who's familar with paying the FSAFEDS fees.

If you are unable to use the IPAC system, you must email OPM at Finance@opm.gov and request OPM's banking information to remit the funds via Electronic Funds Transfer (EFT). The EFT system of payment can only be used to pay this portion of your invoice if you are unable to process an IPAC.

XXXXXXXX

File details come from the government source that posted it. Updated .