Blank_Delivery_Order.pdf

Delivery Order Number: Date Issued:

Contract Number: Skilled Hrs Clin: Skilled Hrs:

Contractor: Skilled Hrs Cost:

Vessel: Materials Clin: Materials Cost:

The following work is authorized upon execution of this delivery order pursuant to the supplemental growth item of the subject contract.

Related Original Item: Condition Report Number: Extension Required:

Description: Expected Completion Date:

Statement of Work:

Delivery Order Price Presented:

Contractor Representative: Date:

Agreed Delivery Order Price *: Agreed Delivery Date:

Receipt of the foregoing is hereby acknowledged. The agreed price stated, dates for commencement and/or completion of the work and other terms and conditions are accepted by this means.

The contract completion date remains:

The contract completion date is: pending completion of contract modification.

COTR: Date:

* All delivery orders over $10,000.00 require approval of the Contracting Officer.

Contractor Representative: Contracting Officer: Date:

Determined Delivery Order Price:

Date withdrawn: DOT – MARAD Contracting Officer: Date: