36C24920Q0137-001.pdf

REQUEST FOR FREIGHT TRANSPORTATION AND LOGISTICS SERVICES Page No. ______ of ______

EMAIL COMPLETED FOR TO VATLC@VA.GOV OR FAX IT TO (202) 495-5496

PICKUP POINT ADDRESS (Show your facility ID)

FROM STATION #:

SHIP-TO ADDRESS (Show Destination Facility ID)

B/L NUMBER: VAA-0,0 SHIP DATE SHIPPING VOUCHER NUMBER

LINE

ITEM

STOCK NO.

NOMENCLATURE (Describe what you are shipping)

TYPE

UNIT

UNITS

SHIPPED

UNIT

WEIGHT

UNIT

CUBE LINE CUBE VALUE

ITEM WEIGHTS

VALUATION TOTAL

QTY PALLETS EMPTY PALLET WT TOTAL

TOTAL SHIPMENT WEIGHT

BOX CUBE CALCULATOR - (Enter dimentional values in INCHES that are greater than 0.

You may use decimals or whole numbers. Do not use letters or other symbols.)

LENGTH WIDTH HEIGHT

ENTER NUMBERS ONLY

BOX CUBE TOTAL SHIPMENT CUBIC VOLUME

VALUE OF PROPERTY IN THIS SHIPMENT DISTANCE TO DESTINATION

CONTACT PERSON AT THE PICKUP/SHIPPING FACILITY COMMERCIAL PHONE NO. (Area Code)

EXT.

E-MAIL ADDRESS

CONTACT PERSON AT THE DESTINATION/RECEIVING FACILITY COMMERCIAL PHONE NO. (Area Code)

EXT.

E-MAIL ADDRESS

SEND VCBL COPY TO THIS PERSON COMMERCIAL PHONE NO. (Area Code)

EXT.

E-MAIL ADDRESS

CREDIT CARD HOLDER'S NAME COMMERCIAL PHONE NO. (Area Code)

EXT.

E-MAIL ADDRESS

OBLIGATION NUMBER APPROPRIATION NUMBER

ACCESSION NUMBERS (i.e., VHA-19-0078)

SPECIAL HANDLING (i.e., Lift Gate, Blanket-Wrap, Hazardous, Inside Delivery/Pickup, Temperature Control, etc.)

RETURN AUTHORIZATION NUMBER VA REQUISITION NUMBER/PURCHASE ORDER NUMBER VENDOR'S ORDER NUMBER REQUISITION DATE

CERTIFICATION: The undersigned certifies that funds are available and have been allocated and that the requested freight services are authorized and necessary to conduct the business of VA.

APPROVING OFFICIAL'S NAME AND TITLE DATE RECEIVING OFFICIAL'S NAME, SIGNATURE AND TITLE DATE RECEIVED

Posted Items recorded in inventory accounts.

SIGNATURE OF ACCOUNTABLE OFFICER DATE VOUCHER DATE VA STATION VOUCHER NUMBER

VA FORM

MAY 2019(RS) 134a SUPERSEDES VA FORM 134a, JUL 2016, WHICH WILL NOT BE USED mailto:VATLC@VA.GOV VHATVHHertsS Highlight

VHATVHHertsS Highlight

VHATVHHertsS Highlight

VHATVHHertsS Highlight

VHATVHHertsS Highlight

VHATVHHertsS Highlight

VHATVHHertsS Highlight

VHATVHHertsS Highlight

VHATVHHertsS Highlight

VHATVHHertsS Highlight

VHATVHHertsS Highlight

INSTRUCTIONS

B/L NUMBER: VAA-0,0: Enter the last five digits of the VCBL number(s) after the shipment has been completed.

STOCK NO. NOMENCLATURE (Describe what you are shipping): Describe the item(s) being shipped. If furniture, then indicate if it is in boxes or requires blanket wrapping. Pallets should be shrink wrapped, banded and labeled.

∙ Less-than-truckload (LTL) carriers will not accept unpackaged items for transport.

∙ Hazardous materials must have an MSDS.

TYPE UNIT: Enter the shipping units description.

BX = BOX; BW = Blanket Wrap; CRT = Crate; CS = Case; CTN = Carton; CYL = Cylinder; DRM = Drum; EA = Each; SET; KIT;

ROL = ROLL

UNITS SHIPPED: Enter whole numbers. No decimals allowed. This is the number of pieces (each, boxes, cartons, rolls, crates, drums, etc.) to ship.

UNIT WEIGHT: A Shipping unit may have a weight from 0.1 pounds up to 45,000 pounds. Whole numbers or numbers with a decimal are permitted.

UNIT (BOX) CUBE: Enter the cube volume of one piece. Use the Box Cube calculator below. The program will compute the total cube for the shipment.

TOTAL VALUE: This is the total value of all items on this line.

QUANTITY PALLETS: Enter a whole number. Decimals are not allowed.

EMPTY PALLET WEIGHT: Enter a pallet weight from 10 to 65 pounds. 40 pounds is about average for GMA pallets.

VALUE OF PROPERTY: Value of property in this shipment should normally equal the depreciated value for used property or new value if new property.

∙ Enter the current dollar value of your property. This amount will appear on the VCBL for full value liability protection.

∙ Standard liability is actual value up $250,000. Special arrangements are necessary for up to $5 million liability protection.

DISTANCE TO DESTINATION: Enter the distance from the origin to the destination if you know it.

CONTACT PERSON (E-mail/Fax): Please add your e-mail address and fax number to receive a copy of the completed VCBL.

PAYMENT OFFICE REPRESENTATIVE'S EMAIL: Please add a Payment Office Representative's e-mail address who should received a copy of the complete VCBL. Confirm that the obligation has been funded.

ACCOUNTS PAYABLE PHONE NUMBER: When an obligation has not been funded, we need to call the responsible fiscal official to request they provide funds.

OBLIGATION NUMBER: Required Field. Please confirm with your payment official that this obligation has been funded.

APPROPRIATION NUMBER: Required Field. An Appropriation Number is required. You must enter your appropriation number before you can release this form. If requesting an estimate, send the completed document. To request a Bill of Lading, replace the word "Estimate" with an obligation and appropriation number.

∙ An Obligation Number is required for all requests except for shipments of salvage X-ray film to the Services and Distribution Center (SDC) at Hines, Illinois.

VA REQUISITION/PURCHASE ORDER NUMBER: Enter the VA Requisition Number/ Purchase Order Number.

VENDOR'S ORDER NUMBER: Enter the Vendor's Order Number.

Department of Veterans Affairs logo

REQUEST FOR FREIGHT TRANSPORTATION AND LOGISTICS SERVICES

REQUEST FOR FREIGHT TRANSPORTATION AND LOGISTICS SERVICES (See instructions on page 2) Page No. ______ of ______ Page No. ______ of ______

EMAIL COMPLETED FOR TO VATLC@VA.GOV OR FAX IT TO (202) 495-5496

PICKUP POINT ADDRESS

(Show your facility ID)

FROM STATION #:

SHIP-TO ADDRESS

(Show Destination Facility ID)

B/L NUMBER: VAA-0,0

B/L NUMBER: V A A-0,0 2

SHIP DATE

SHIPPING VOUCHER NUMBER

LINE

ITEM

STOCK NO.

NOMENCLATURE (Describe what you are shipping)

TYPE

UNIT

UNITS

SHIPPED

UNIT

WEIGHT

UNIT

CUBE

LINE CUBE

VALUE

ITEM WEIGHTS

VALUATION TOTAL

QTY PALLETS

EMPTY PALLET WT

TOTAL

TOTAL SHIPMENT WEIGHT

BOX CUBE CALCULATOR - (Enter dimentional values in INCHES that are greater than 0.

You may use decimals or whole numbers. Do not use letters or other symbols.)

BOX CUBE CALCULATOR - (Enter dimentional values in INCHES that are greater than 0.

You may use decimals or whole numbers. Do not use letters or other symbols.) (Length multiplied by Width multiplied by Height, divided by 17 28)

LENGTH

WIDTH

HEIGHT

ENTER NUMBERS ONLY

BOX CUBE

TOTAL SHIPMENT CUBIC VOLUME

VALUE OF PROPERTY IN THIS SHIPMENT

DISTANCE TO DESTINATION

CONTACT PERSON AT THE PICKUP/SHIPPING FACILITY

COMMERCIAL PHONE NO. (Area Code)

EXT.

E-MAIL ADDRESS

CONTACT PERSON AT THE DESTINATION/RECEIVING FACILITY

COMMERCIAL PHONE NO. (Area Code)

EXT.

E-MAIL ADDRESS

SEND VCBL COPY TO THIS PERSON

COMMERCIAL PHONE NO. (Area Code)

EXT.

E-MAIL ADDRESS

CREDIT CARD HOLDER'S NAME

COMMERCIAL PHONE NO. (Area Code)

EXT.

E-MAIL ADDRESS

OBLIGATION NUMBER

APPROPRIATION NUMBER

ACCESSION NUMBERS (i.e., VHA-19-0078) SPECIAL HANDLING (i.e., Lift Gate, Blanket-Wrap, Hazardous, Inside Delivery/Pickup, Temperature Control, etc.)

RETURN AUTHORIZATION NUMBER

VA REQUISITION NUMBER/PURCHASE ORDER NUMBER

VENDOR'S ORDER NUMBER

REQUISITION DATE

CERTIFICATION: The undersigned certifies that funds are available and have been allocated and that the requested freight services are authorized and necessary to conduct the business of VA.

APPROVING OFFICIAL'S NAME AND TITLE

DATE

RECEIVING OFFICIAL'S NAME, SIGNATURE AND TITLE

DATE RECEIVED

Posted Items recorded in inventory accounts.

Posted Items recorded in inventory accounts.

SIGNATURE OF ACCOUNTABLE OFFICER

DATE

VOUCHER DATE

VA STATION VOUCHER NUMBER

VA FORM

MAY 2019(RS)

V A Form 1 34 A, MAY 2019.

134a SUPERSEDES VA FORM 134a, JUL 2016, WHICH WILL NOT BE USED

SUPERSEDES V A FORM 134 a, JUL 2016, WHICH WILL NOT BE USED

VA Form 134a, REQUEST FOR FREIGHT TRANSPORTATION AND LOGISTICS SERVICES 134a, Freight, Transportation, Logistics, Services Missie Vaccaro-Palomaki Paul Bunker Jan 2012 003A3B3

MAY 2019

INSTRUCTIONS

B/L NUMBER: VAA-0,0: Enter the last five digits of the VCBL number(s) after the shipment has been completed.

STOCK NO. NOMENCLATURE (Describe what you are shipping): Describe the item(s) being shipped. If furniture, then indicate if it is in boxes or requires blanket wrapping. Pallets should be shrink wrapped, banded and labeled.

∙ Less-than-truckload (LTL) carriers will not accept unpackaged items for transport.

∙ Hazardous materials must have an MSDS.

TYPE UNIT: Enter the shipping units description.

BX = BOX; BW = Blanket Wrap; CRT = Crate; CS = Case; CTN = Carton; CYL = Cylinder; DRM = Drum; EA = Each; SET; KIT;

ROL = ROLL

UNITS SHIPPED: Enter whole numbers. No decimals allowed. This is the number of pieces (each, boxes, cartons, rolls, crates, drums, etc.) to ship.

UNIT WEIGHT: A Shipping unit may have a weight from 0.1 pounds up to 45,000 pounds. Whole numbers or numbers with a decimal are permitted.

UNIT (BOX) CUBE: Enter the cube volume of one piece. Use the Box Cube calculator below. The program will compute the total cube for the shipment.

TOTAL VALUE: This is the total value of all items on this line.

QUANTITY PALLETS: Enter a whole number. Decimals are not allowed.

EMPTY PALLET WEIGHT: Enter a pallet weight from 10 to 65 pounds. 40 pounds is about average for GMA pallets.

VALUE OF PROPERTY: Value of property in this shipment should normally equal the depreciated value for used property or new value if new property.

∙ Enter the current dollar value of your property. This amount will appear on the VCBL for full value liability protection.

∙ Standard liability is actual value up $250,000. Special arrangements are necessary for up to $5 million liability protection.

DISTANCE TO DESTINATION: Enter the distance from the origin to the destination if you know it.

CONTACT PERSON (E-mail/Fax): Please add your e-mail address and fax number to receive a copy of the completed VCBL.

PAYMENT OFFICE REPRESENTATIVE'S EMAIL: Please add a Payment Office Representative's e-mail address who should received a copy of the complete VCBL. Confirm that the obligation has been funded.

ACCOUNTS PAYABLE PHONE NUMBER: When an obligation has not been funded, we need to call the responsible fiscal official to request they provide funds.

OBLIGATION NUMBER: Required Field. Please confirm with your payment official that this obligation has been funded.

APPROPRIATION NUMBER: Required Field. An Appropriation Number is required. You must enter your appropriation number before you can release this form. If requesting an estimate, send the completed document. To request a Bill of Lading, replace the word "Estimate" with an obligation and appropriation number.

∙ An Obligation Number is required for all requests except for shipments of salvage X-ray film to the Services and Distribution Center (SDC) at Hines, Illinois.

VA REQUISITION/PURCHASE ORDER NUMBER: Enter the VA Requisition Number/ Purchase Order Number.

VENDOR'S ORDER NUMBER: Enter the Vendor's Order Number.

Submit By Email:

Enter the last five digits of the V C B L number(s) after the shipment has been completed.:

Enter the shipping units description.

BX = BOX; BW = Blanket Wrap;

CRT = Crate; CS = Case; CTN = Carton;

CYL = Cylinder; DRM = Drum; EA = Each;

SET; KIT; ROL = ROLL:

Enter the shipping units description.

BX = BOX; BW = Blanket Wrap;

CRT = Crate; CS = Case; CTN = Carton;

CYL = Cylinder; DRM = Drum; EA = Each;

SET; KIT; ROL = ROLL:

Enter the shipping units description.

BX = BOX; BW = Blanket Wrap;

CRT = Crate; CS = Case; CTN = Carton;

CYL = Cylinder; DRM = Drum; EA = Each;

SET; KIT; ROL = ROLL:

Enter the shipping units description.

BX = BOX; BW = Blanket Wrap;

CRT = Crate; CS = Case; CTN = Carton;

CYL = Cylinder; DRM = Drum; EA = Each;

SET; KIT; ROL = ROLL:

Enter the shipping units description.

BX = BOX; BW = Blanket Wrap;

CRT = Crate; CS = Case; CTN = Carton;

CYL = Cylinder; DRM = Drum; EA = Each;

SET; KIT; ROL = ROLL:

You may use decimals or whole numbers. Do not use letters or other symbols.) (Length multiplied by Width multiplied by Height, divided by 17 28). Enter length (ENTER NUMBERS ONLY):

Enter the current dollar value of your property. This amount will appear on the V C B L for full value liability protection.

Standard liability is actual value up $250,000. Special arrangements are necessary for up to $5 million liability protection.: