70Z08524FLREP0079 FY24 POLAR SEA DD task order.pdf

ORDER FOR SUPPLIES OR SERVICES PAGE OF PAGES

IMPORTANT: Mark all packages and papers with contract and/or order numbers.

1. DATE OF ORDER 2. CONTRACT NO. (If any)

3. ORDER NO. 4. REQUISITION/REFERENCE NO.

5. ISSUING OFFICE (Address correspondence to)

6. SHIP TO:

a. NAME OF CONSIGNEE

b. STREET ADDRESS

c. CITY d. STATE e. ZIP CODE

f. SHIP VIA

8. TYPE OF ORDER

a. PURCHASE

REFERENCE YOUR:

7. TO:

a. NAME OF CONTRACTOR

b. COMPANY NAME

c. STREET ADDRESS

d. CITY e. STATE f. ZIP CODE

b. DELIVERY -- Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of this form and is issued subject to the terms and conditions of the above-numbered contract.

17. SCHEDULE (See reverse for Rejections)

22.UNITED STATES OF

AMERICA BY (Signature)

23. NAME (Typed)

TITLE: CONTRACTING/ORDERING OFFICER

SEE BILLING

INSTRUCTIONS

ON

REVERSE

18. SHIPPING POINT 19. GROSS SHIPPING WEIGHT 20. INVOICE NO.

21. MAIL INVOICE TO:

a. NAME

b. STREET ADDRESS (or P.O. Box)

c. CITY d. STATE e. ZIP CODE

17(h) TOT.

(Cont.

pages)

17(i)

GRAND

TOTAL

OPTIONAL FORM 347 (REV. 2/2012)

Prescribed by GSA/FAR 48 CFR 53.213(f)

9. ACCOUNTING AND APPROPRIATION DATA 10. REQUISITIONING OFFICE

11. BUSINESS CLASSIFICATION (Check appropriate box(es))

a. SMALL

Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION NOT USABLE

d. WOMEN-OWNED

h. EDWOSB

12. F.O.B. POINT

13. PLACE OF

a. INSPECTION b. ACCEPTANCE

14. GOVERNMENT B/L NO. 15. DELIVER TO F.O.B. POINT ON

OR BEFORE (Date)

16. DISCOUNT TERMS

b. OTHER THAN SMALL c. DISADVANTAGED

g. WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOSB PROGRAM

e. HUBZone

f. SERVICE-DISABLED

VETERAN-OWNED

ITEM NO.

(a)

SUPPLIES OR SERVICES

(b)

QUANTITY

ORDERED

(c)

UNIT

(d)

UNIT

PRICE

(e)

AMOUNT

(f)

QUANTITY

ACCEPTED

(g)

SUPPLEMENTAL INVOICING INFORMATION

If desired, this order (or a copy thereof) may be used by the Contractor as the Contractor's invoice, instead of a separate invoice, provided the following statement, (signed and dated) is on (or attached to) the order: "Payment is requested in the amount of $ . No other invoice will be submitted."

However, if the Contractor wishes to submit an invoice, the following information must be provided: contract number (if any), order number, item number(s), description of supplies or service, sizes, quantities, unit prices, and extended totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs exceed $10 (except for parcel post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an ordering activity during the same billing period, consolidated periodic billings are encouraged.

RECEIVING REPORT

SHIPMENT

NUMBER

PARTIAL

FINAL

DATE RECEIVED SIGNATURE OF AUTHORIZED U.S. GOV'T REP. DATE

TOTAL CONTAINERS GROSS WEIGHT RECEIVED AT TITLE

REPORT OF REJECTIONS

ITEM NO. SUPPLIES OR SERVICES UNIT

QUANTITY

REJECTED REASON FOR REJECTION

OPTIONAL FORM 347 (REV. 2/2012) BACK

Quantity in the "Quantity Accepted" column on the face of this order has been:

and conforms to contract. Items listed below have been rejected for the reasons indicated.

inspected, accepted, received by me

70Z08524FLREP0079

TABLE OF CONTENTS:

Section II: Continuation of OF347 Section III: Contract Clauses Section IV: Any documents, exhibits, and other attachments

Section II: Continuation of OF347

Item Number Base Item Number

Supplies/Services Quantity Unit

0001 POLAR SEA - Extra Funds to cover The Cost

84208.98 Dollars, U.S.

Contract Type:Firm Fixed Price Unit Price $1.00

Extended Price $84,208.98

Description:

Purchase Requisitions 52000PR240001067 Referenced IDV Line

ACRN

Funded Amount $84,208.98

IDC Type: Not Applicable Period Of Performance Start Date

Period Of Performance End Date Period Of Performance Address

8/21/24 10/30/24 USCG Headquarters 2703 Martin Luther King Junior Ave SE Washington

DC US 20032

Supplies/Services Quantity Unit

0002 POLAR SEA - Original Cost 1833061.02 Dollars, U.S.

Contract Type:Firm Fixed Price

Unit Price $1.00 Extended Price $1,833,061.02

Description:

Purchase Requisitions 52000PR240001067 Referenced IDV Line

ACRN

Funded Amount $1,833,061.02

IDC Type: Not Applicable Period Of Performance Start Date

Period Of Performance End Date Period Of Performance Address

8/21/24 10/30/24 USCG Headquarters 2703 Martin Luther King Junior Ave SE

Supplies/Services Quantity Unit

0003 POLAR SEA - Additional Cost 1100000 Dollars, U.S.

Contract Type:Firm Fixed Price

Unit Price $1.00 Extended Price $1,100,000.00

Description:

Purchase Requisitions 52000PR240001067 Referenced IDV Line

ACRN

Funded Amount $1,100,000.00

IDC Type: Not Applicable Period Of Performance Start Date

Period Of Performance End Date Period Of Performance Address

8/21/24 10/30/24 USCG Headquarters 2703 Martin Luther King Junior Ave SE

Total Award Amount: $3,017,270.00 The Total Obligated Amount: $3,017,270.00

The Obligated Amount is broken down by line of accounting as follows:

Contract ACRN: LOA:

2024|0613000B012125DD|G165G000G000|52000PLLRE|UCGC4P1527|257034|61000000|70098438

XX|2435D122|000000|000000|000000|000000|0|0|0|0

Amount:$84,208.98 Clin 0001:$84,208.98

Contract ACRN: LOA:

2024|0613000B012125DD|G165G000G000|52000PLLRE|UCGC4P1527|257034|61000000|70098438

XX|2435D123|000000|000000|000000|000000|0|0|0|0

Amount:$1,833,061.02 Clin 0002:$1,833,061.02

Contract ACRN: LOA:

2024|0613000B012428DD|G160G020G000|52000PLLRE|UCGC4P1527|257034|61000000|70098438

XX|2438D103|000000|000000|000000|000000|0|0|0|0

Amount:$1,100,000.00 Clin 0003:$1,100,000.00

Section III: Contract Clauses

Clauses incorporated by reference

None

Clauses incorporated by full text

Section IV: Any Documents, Exhibits, and other Attachments

SURFACE FORCES LOGISTICS CENTER USCG

BALTIMORE, MD, 21226-5000, US

Commander Norfolk, VA, 23510, US