B1(a)._Attachment_J.4_TSA_Form_DD-1149.doc
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- Attached to
- Boarding Pass Scanners Federal contract opportunity
- Solicitation number
- 70T04018R9DAP2042
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Attachment J.4
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SHIPPING CONTAINER TALLY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
| REQUISITION AND INVOICE/SHIPPING DOCUMENT |
| Form Approved |
OMB No. 0704-0246
Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302 and to the Office of Management and Budget. Paperwork Reduction Project (0704-0246). Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN COMPLETED FORM TO THE ADDRESS IN ITEM 2
1. FROM: (Include Zip Code)
Site Name and Site Code Full Shipping Address POC#1 (Full Name/Email Address, Telephone Number) POC#2 (Full Name/Email Address, Telephone Number)
| SHEET NO. |
| NO. OF SHEETS |
| 5. REQUISITION DATE |
6. REQUISITION NUMBER
Agency Internal Use Only
| 1 |
| 1 |
| Date Submitted |
7. DATE MATERIAL REQUIRED
Date/Time
8. PRIORITY
Standard or Expedite
2. TO: (Include ZIP Code) Site Name and Site Code Full Shipping Address POC#1 (Full Name/Email Address, Telephone Number) POC#2 (Full Name/Email Address, Telephone Number)
9. AUTHORITY OR PURPOSE
Contract Number: Task Order/Deliver Order Number:
10. SIGNATURE
ANNETTE CUYLER
TSA
11a VOUCHER NUMBER & DATE
3. SHIP TO: MARK FOR
12. DATE SHIPPED
(Date/Time Items Left Location)
b. WITNESS BY:
(POC First Initial, Last Name)
13. MODE OF SHIPMENT
(Air, Ground, and/or Water) Carrier Name:
Driver's Name:
Driver's Cell Number:
Truck Number:
Trailer Number:
14. BILL OF LADING NUMBER
(Shipper Bill of Lading Information)
15. AIR MOVEMENT DESIGNATOR OR PORT REFERENCE NO.
| 4. APPROPRIATIONS SYMBOL AND SUBHEAD |
| AMOUNT |
| ITEM NO. |
| FEDERAL STOCK NUMBER, DESCRIPTION AND CODING OF MATERIAL AND/SERVICES |
| UNIT OF ISSUE |
| QUANTITY REQUESTED |
| SUPPLY ACTION |
| TYPE |
CONTAINER
| CONTAINER NOS |
| UNIT PRICE |
| TOTAL COST |
| (a) |
| (b) |
| (c) |
| (d) |
| (e) |
| (f) |
| (g) |
| (h) |
| (i) |
| 1 |
| Description, Manufacturer, Make, Model, Serial Number, Full TSA Barcode, Condition Code (1 = New, 4 = Used, 7 = Used/Need Repair or X = Salvage) |
| EA |
| # |
| SKID |
| # |
EA
EA
| 16. TRANSPORTATION VIA MATS OR MSTS CHARGEABLE TO |
| 17. SPECIAL HANDLING- PLEASE CALL POC: 24 HRS PRIOR TO ARRIVAL @ SITE |
18.
RECAPIT-ULATION
ISSUED BY
TOTAL CON-TAINERS
| TYPE CON-TAINERS |
| DESCRIPTION |
| TOTAL WEIGHT |
| TOTAL CUBE |
| 19. |
RECEIPT
CONTAINERS RECEIVED EXCEPT AS
NOTED
| DATE |
| BY |
| SHEET TOTAL |
| OF SHIP-MENT |
| Name of Person |
| # |
| SKID |
| Description |
| LBS |
CHECKED BY
QUANTITIES RECEIVED EXCEPT AS
NOTED
| DATE |
| BY |
| GRAND TOTAL |
PACKED BY
| POSTED |
| DATE |
| BY |
| 20. RECEIVER’S |
VOUCHER NO.
FORM DD1149, APR 2000
51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
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