A0008100_Addendum.pdf

For the best experience, open this PDF portfolio in

Acrobat X or Adobe Reader X, or later.

Get Adobe Reader Now!

http://www.adobe.com/go/reader

SALE OF GOVERNMENT PROPERTY - ITEM BID PAGE -

SEALED BID

IFB NUMBER PAGE NO.

Enter a price per unit in the "Unit Price Bid" column and extend the total to the "Total Price Bid" column when bids are solicited in units of each, foot/centimeter, pound/kilogram, etc. Enter only a total price for the lot in the "Total Price Bid" column when bids are solicited by the lot.

ITEM NO. UNIT PRICE BID TOTAL PRICE BID ITEM NO. UNIT PRICE BID TOTAL PRICE BID ITEM NO. UNIT PRICE BID TOTAL PRICE BID

BID NUMBER TO

BE FILLED IN BY

SALES OFFICE

NAME OF BIDDER AND IDENTIFICATION NUMBER, IF APPLICABLE (Type or print)

STANDARD FORM 114A (REV. 11/2002)

Prescribed by GSA FPMR (41 CFR) 101-45.3

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable

C:\PERFORM\FORMS\S114A.FRP

Barbara Williams

\\iaimain\apps1\Pam_Ward\Logos\Pointer.jpg

SALE OF GOVERNMENT PROPERTY - ITEM BID PAGE -

SEALED BID

IFB NUMBER

PAGE NO.

Enter a price per unit in the "Unit Price Bid" column and extend the total to the "Total Price Bid" column when bids are solicited in units of each, foot/centimeter, pound/kilogram, etc. Enter only a total price for the lot in the "Total Price Bid" column when bids are solicited by the lot.

ITEM NO.

UNIT PRICE BID

TOTAL PRICE BID

ITEM NO.

UNIT PRICE BID

TOTAL PRICE BID

ITEM NO.

UNIT PRICE BID

TOTAL PRICE BID

BID NUMBER TO

BE FILLED IN BY

SALES OFFICE

NAME OF BIDDER AND IDENTIFICATION NUMBER, IF APPLICABLE (Type or print)

STANDARD FORM 114A (REV. 11/2002)

Prescribed by GSA FPMR (41 CFR) 101-45.3

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable

ITEM NUMBER:

UNIT PRICE BID:

TOTAL PRICE BID:

ITEM NUMBER:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

TOTAL PRICE BID:

UNIT PRICE BID:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

TOTAL PRICE BID:

UNIT PRICE BID:

ITEM NUMBER:

BID NUMBER TO BE FILLED IN BY SALES OFFICE:

NAME OF BIDDER AND IDENTIFICATION NUMBER, IF APPLICABLE (Type or print) :

IFB NUMBER:

PAGE NUMBER:

LETTER OF AUTHORIZATION

(Prescribing Authority: DRMS-I 4160.14, Sec. 2, Ch. 6)

SIGNATURE OF PURCHASER

TO:

(PRINT NAME) (PRINT NAME)

DATE

DRMS FORM 1646, APR 2002 (EF) (Previous Edition May Be Used Until Exhausted)

I, the undersigned, hereby authorize to act as my agent on

Contract

EXTENT OF AUTHORITY LIST ITEM(S)

with respect to the items listed below and for the purpose indicated by check mark in the boxes provided under "Extent of Authority".

Make payment.

Make payment and remove property.

Remove property.

Perform work required under the contract.

Accept and sign for deliveries above or below the quantity variations allowed under the contract.

Sign certifications required prior to Government's permitting release of property.

Other (specify):

R:\\DRMS\\DRMS1646.FRP Printing lsc1872

D:20030806180550Z

D:20080506131535- 04'00'

LETTER OF AUTHORIZATION

(Prescribing Authority: DRMS-I 4160.14, Sec. 2, Ch. 6)

SIGNATURE OF PURCHASER

TO:

(PRINT NAME)

(PRINT NAME)

DATE

DRMS FORM 1646, APR 2002 (EF)

(Previous Edition May Be Used Until Exhausted)

I, the undersigned, hereby authorize to act as my agent on

Contract

EXTENT OF AUTHORITY

LIST ITEM(S)

with respect to the items listed below and for the purpose indicated by check mark in the boxes provided under "Extent of Authority".

Other (specify):

TO:

NAME:

NAME2:

CONTRACT:

LIST:

SIGNATURE:

DATE:

SPECIFY:

PrintButton1:

ResetButton1:

CheckBox1: 0

CheckBox1: 0

CheckBox1: 0

CheckBox1: 0

CheckBox1: 0

CheckBox1: 0

REPORT OF DISCREPANCY (ROD)

SHIPPING PACKAGING

1. DATE OF PREPARATION 2. REPORT NUMBER

3. TO (Name and address, include ZIP Code) 4. FROM (Name and address, include ZIP Code)

5a. SHIPPER'S NAME 5b. NUMBER AND DATE OF

INVOICE

6. TRANSPORTATION DOCUMENT

NUMBER (GBL, Waybill; TCN, etc.)

7a. SHIPPER'S NUMBER (Purchase order/Shipment, Contract, etc.)

7b. OFFICE ADMINISTRATION CONTRACT 8. REQUISTIONER'S NUMBER (Requi-sition, Purchase Request, etc)

9. SHIPMENT, BILLING, AND RECEIPT DATA 10. DISCREPANCY DATA 11.

AC-2

TION

CODENSN/PART NUMBER AND

NOMENCLATURE

(a)

UNIT

OF ISSUE

(b)

QUANTITY

SHIPPED/

BILLED

(c)

QUANTITY

RECEIVED

(d)

QUAN-

TITY

(a)

UNIT

PRICE

(b)

TOTAL

COST

CODE1

12. REMARKS (Continue on separate sheet of paper if necessary)

1DISCREPANCY CODES 2 ACTION CODES

CONDITION OF MATERIAL

C1 — In condition other than that indicated on release/ receipt document C2 — Expired shelf life C3 — Damaged parcel post shipment

SUPPLY DOCUMENTATION

D1 — Not received D2 — Illegible or mutilated D3 — Incomplete improper or without authority (Only when receipt cannot be properly process)

MISDIRECTED MATERIAL

M1 — Addressed to wrong activity

OVERAGE/ DUPLICATE SHIPMENTS

O1 — Quantity in excess of that on receipt docu-ment O2 — Quantity in excess of that requested (Other than unit of issue pack) O3— Quantity duplicates shipment

PACKING DISCREPANCY

P1 — Improper preservation P2 — Improper packing P3 — Improper marking P4 — Improper unitization

PRODUCT QUALITY DEFICIENCIES

Q1 — Deficient material (Applicable to Grant Aid and FMS shipments only)

SHORTAGE OF MATERIAL

S1 — Quantity less than that on receipt document S2 — Quantity less than that requested (Other than unit of issue pack) S3 — Non-receipt of parcel post shipments ITEMS TECHNICAL DATA MARKINGS (i.e, Name Plates, Log Books, Opening Handbooks, Special Instructions, etc.)

T1 — Missing T2 — Illegible or mutilated T3 — Precautionary operational markings missing T4 — Inspection data missing or incomplete T5 — Serviceability operating data missing or incomplete T6 — Warranty data missing WRONG ITEM (Identify requested item as a separate copy in item 9 above) W1 — Incorrect item received W2 — Unacceptable substitute

OTHER DISCREPANCIES

Z1 — See remarks

1A— Disposition instructions re-quested (Reply on reverse) 1B— Material being retained (See remarks) 1C— Supporting supply documenta-tion requested 1D— Material still required expedite shipment (Not applicable to

FMS)

1E— Local purchase material to be returned at supplier's expense unless disposition instructions to the contrary are received within 15 days (Reply on re-verse) (Not applicable to FMS) 1F— Replacement shipment requested (Not applicable to FMS) 1G— Reshipment not required. Item to be re-requisitioned.

1H— No action required. Information only 1Z— Other action requested (See remarks)

13. FUNDING AND ACCOUNTING DATA

14a. TYPED OR PRINTED NAME, TITLE, AND PHONE NUMBER OF PRE-

PARING OFFICAL

14b. SIGNATURE

15. DISTRIBUTION ADDRESSEES FOR COPIES

STANDARD FORM 364 (REV. 2-80)

16. FROM: 17. DISTRIBUTION ADDRESSEES FOR COPIES

18. TO:

Use window envelope to mail this document. Insert name, and address, including ZIP Code, starting one typing space below the left dot.

Each address line must NOT extent beyond right dot.

Address must not exceed four singles space typing lines.

19. IN ACCORDANCE WITH NOTICE OF DISCREPANCY ON FACE OF THIS FORM:

a. MATERIAL

HAS

BEEN

WILL

BE

SHIPPED

DOCUMENT NUMBER

NO RECORD OF SHIPMENT. RESUBMIT REPORT TO

b. PROPER OFFICE UNDER APPROPRIATE REGULATION.

AN ADJUSTMENT IN BILL-

ING HAS BEEN / WILL BE

c. PROCESSED AS A: CREDIT DEBIT

INVOICE/BILL

d. ATTACHED

PROOF OF DELIVERY (Parcel Post Shipments) OR EVIDENCE OF

e. SHIPMENTS ENCLOSED.

AN ADJUSTMENT IN BILLING FOR THE REPORTED DISCREPANCY WILL NOT BE PROCESSED FOR THE FOLLOWING REASON

f. WHICH IS CITED IN THE INDICATED REGULATION.

(1) REASON FOR NOT PROCESSING (2) PRESCRIBING REGULATION

(a) DISCREPANCY WAS NOT REPORTED WITHIN THE TIME

FRAMES ALLOWED AND/OR

(b) DOLLAR VALUE DOES NOT MEET THE CRITERIA PRE-

SCRIBED IN THE REGULATION OR AGREEMENT INDI-

CATED IN 19f(2)

(a) CHAPTER 5 OF THE GSA HANDBOOK. DISCREPANCIES OR

DEFICIENCIES IN GSA OR DOD SHIPMENTS, MATERIAL,

OR BILLINGS (FPMR 101-26.8)

(b) CHAP.2 AND/OR 7 OF DOD 4000.25-7-M, MILITARY STAND-

ARD BILLING SYSTEM (MILSBILLS) AND/OR DD 1513, U.S.

DOD OFFER AND ACCEPTANCE, AS APPLICABLE.

20. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL:

PROCESS FOR DISPOSAL IN ACCORDANCE

a. WITH SERVICE/AGENCY DIRECTIVES.

c. RETAIN MATERIAL AT NO CHARGE.

REPRESENTATIVE WILL CALL FOR DISCUS-

b. SION CONCERNING DISPOSITION IN:

d. MATERIAL WILL BE PICKED UP IN:

DAYS

DAYS

e. SHIP MATERIAL (Specify location):

(1) GBL APPROPRIATIONS CHARGEABLE:

(2) CHARGES COLLECT-VIA: FREIGHT EXPRESS PARCEL POST ($ postage advanced herewith.

NOTE: Please enclose postage. Material cannot to returned Parcel Post collect.)(3) PARCEL POST LABEL ATTACHED (4) FREIGHT PREPAID

f. OTHER (Specify)

IF MATERIAL IS STILL REQUIRED,

21. SUBMIT NEW REQUISITION

REPLACEMENT WITH SATISFACTORY

22. MATERIAL WILL BE MADE ON OR BEFORE:

DATE

23. REMARKS (Continue on separate sheet of paper if necessary)

24a. TYPED OR PRINTED NAME AND PHONE NUM-

BER OF PREPARING OFFICAL

24b. SIGNATURE 24c. DATE

STANDARD FORM 364 BACK (REV. 2-80)

REPORT OF DISCREPANCY (ROD)

SHIPPING

PACKAGING

1. DATE OF PREPARATION

2. REPORT NUMBER

3. TO (Name and address, include ZIP Code)

4. FROM (Name and address, include ZIP Code)

5a. SHIPPER'S NAME

5b. NUMBER AND DATE OF

INVOICE

6. TRANSPORTATION DOCUMENT

NUMBER (GBL, Waybill; TCN, etc.)

7a. SHIPPER'S NUMBER (Purchase order/Shipment, Contract, etc.)

7b. OFFICE ADMINISTRATION CONTRACT

8. REQUISTIONER'S NUMBER (Requi-sition, Purchase Request, etc)

9. SHIPMENT, BILLING, AND RECEIPT DATA

10. DISCREPANCY DATA

11.

AC-2

TION

CODE

NSN/PART NUMBER AND

NOMENCLATURE

(a)

UNIT

OF ISSUE

(b)

QUANTITY

SHIPPED/

BILLED

(c)

QUANTITY

RECEIVED

(d)

QUAN-

TITY

(a)

UNIT

PRICE

(b)

TOTAL

COST

CODE1

12. REMARKS (Continue on separate sheet of paper if necessary)

1DISCREPANCY CODES

2 ACTION CODES

CONDITION OF MATERIAL

C1 — In condition other than that indicated on release/ receipt document

C2 — Expired shelf life

C3 — Damaged parcel post shipment

SUPPLY DOCUMENTATION

D1 — Not received

D2 — Illegible or mutilated

D3 — Incomplete improper or without authority

(Only when receipt cannot be properly process)

MISDIRECTED MATERIAL

M1 — Addressed to wrong activity

OVERAGE/ DUPLICATE SHIPMENTS

O1 — Quantity in excess of that on receipt docu-ment

O2 — Quantity in excess of that requested (Other than unit of issue pack)

O3— Quantity duplicates shipment

PACKING DISCREPANCY

P1 — Improper preservation

P2 — Improper packing

P3 — Improper marking

P4 — Improper unitization

PRODUCT QUALITY DEFICIENCIES

Q1 — Deficient material (Applicable to Grant Aid and FMS shipments only)

SHORTAGE OF MATERIAL

S1 — Quantity less than that on receipt document

S2 — Quantity less than that requested (Other than unit of issue pack)

S3 — Non-receipt of parcel post shipments

ITEMS TECHNICAL DATA MARKINGS (i.e, Name

Plates, Log Books, Opening Handbooks, Special

Instructions, etc.)

T1 — Missing

T2 — Illegible or mutilated

T3 — Precautionary operational markings missing

T4 — Inspection data missing or incomplete

T5 — Serviceability operating data missing or incomplete

T6 — Warranty data missing

WRONG ITEM (Identify requested item as a separate copy in item 9 above)

W1 — Incorrect item received

W2 — Unacceptable substitute

OTHER DISCREPANCIES

Z1 — See remarks

1A— Disposition instructions re-quested (Reply on reverse)

1B— Material being retained (See remarks)

1C— Supporting supply documenta-tion requested

1D— Material still required expedite shipment (Not applicable to

FMS)

1E— Local purchase material to be returned at supplier's expense unless disposition instructions to the contrary are received within 15 days (Reply on re-verse) (Not applicable to FMS)

1F— Replacement shipment requested

(Not applicable to FMS)

1G— Reshipment not required. Item to be re-requisitioned.

1H— No action required. Information only

1Z— Other action requested (See remarks)

13. FUNDING AND ACCOUNTING DATA

14a. TYPED OR PRINTED NAME, TITLE, AND PHONE NUMBER OF PRE-

PARING OFFICAL

14b. SIGNATURE

15. DISTRIBUTION ADDRESSEES FOR COPIES

STANDARD FORM 364 (REV. 2-80)

16. FROM:

17. DISTRIBUTION ADDRESSEES FOR COPIES

18. TO:

Use window envelope to mail this document. Insert name, and address, including ZIP Code, starting one typing space below the left dot. Each address line must NOT extent beyond right dot. Address must not exceed four singles space typing lines.

19. IN ACCORDANCE WITH NOTICE OF DISCREPANCY ON FACE OF THIS FORM:

a. MATERIAL

HAS

BEEN

WILL

BE

SHIPPED

DOCUMENT NUMBER

NO RECORD OF SHIPMENT. RESUBMIT REPORT TO

b. PROPER OFFICE UNDER APPROPRIATE REGULATION.

AN ADJUSTMENT IN BILL-

ING HAS BEEN / WILL BE

c. PROCESSED AS A:

CREDIT

DEBIT

INVOICE/BILL

d. ATTACHED

PROOF OF DELIVERY (Parcel Post

Shipments) OR EVIDENCE OF

e. SHIPMENTS ENCLOSED.

AN ADJUSTMENT IN BILLING FOR THE REPORTED DISCREPANCY WILL NOT BE PROCESSED FOR THE FOLLOWING REASON

f. WHICH IS CITED IN THE INDICATED REGULATION.

(1) REASON FOR NOT PROCESSING

(2) PRESCRIBING REGULATION

(a) DISCREPANCY WAS NOT REPORTED WITHIN THE TIME

FRAMES ALLOWED AND/OR

(b) DOLLAR VALUE DOES NOT MEET THE CRITERIA PRE-

SCRIBED IN THE REGULATION OR AGREEMENT INDI-

CATED IN 19f(2)

(a) CHAPTER 5 OF THE GSA HANDBOOK. DISCREPANCIES OR

DEFICIENCIES IN GSA OR DOD SHIPMENTS, MATERIAL,

OR BILLINGS (FPMR 101-26.8)

(b) CHAP.2 AND/OR 7 OF DOD 4000.25-7-M, MILITARY STAND-

ARD BILLING SYSTEM (MILSBILLS) AND/OR DD 1513, U.S.

DOD OFFER AND ACCEPTANCE, AS APPLICABLE.

20. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL:

PROCESS FOR DISPOSAL IN ACCORDANCE

a. WITH SERVICE/AGENCY DIRECTIVES.

c. RETAIN MATERIAL AT NO CHARGE.

REPRESENTATIVE WILL CALL FOR DISCUS-

b. SION CONCERNING DISPOSITION IN:

d. MATERIAL WILL BE PICKED UP IN:

DAYS

DAYS

e. SHIP MATERIAL (Specify location):

(1) GBL APPROPRIATIONS CHARGEABLE:

(2) CHARGES COLLECT-VIA:

FREIGHT

EXPRESS

PARCEL POST

($ postage advanced herewith.

NOTE: Please enclose postage. Material cannot to returned Parcel Post collect.)

(3) PARCEL POST LABEL ATTACHED

(4) FREIGHT PREPAID

f. OTHER (Specify)

IF MATERIAL IS STILL REQUIRED,

21. SUBMIT NEW REQUISITION

REPLACEMENT WITH SATISFACTORY

22. MATERIAL WILL BE MADE ON OR BEFORE:

DATE

23. REMARKS (Continue on separate sheet of paper if necessary)

24a. TYPED OR PRINTED NAME AND PHONE NUM-

BER OF PREPARING OFFICAL

24b. SIGNATURE

24c. DATE

STANDARD FORM 364 BACK (REV. 2-80)

8.2.1.4029.1.523496.503679

REPORT OF DISCREPANCY (ROD). SHIPPING: 0

REPORT OF DISCREPANCY (ROD). PACKAGING: 0

1. DATE OF PREPARATION. Enter 2 digit month, 2 digit day and 4 digit year.:

2. REPORT NUMBER.:

3. TO (Name and address, include ZIP Code).:

4. FROM (Name and address, include ZIP Code).:

5a. SHIPPER'S NAME.:

5b. NUMBER OF INVOICE.:

24c. DATE. Enter 2 digit month, 2 digit day and 4 digit year.:

6. TRANSPORTATION DOCUMENT NUMBER (GBL, Waybill; TCN, etc.).:

7a. SHIPPER'S NUMBER (Purchase order/Shipment, Contract, etc.).:

7b. OFFICE ADMINISTRATION CONTRACT.:

8. REQUISTIONER'S NUMBER (Requisition, Purchase Request, etc).:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 1 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 7 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 6 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 5 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 4 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 3 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 2 of 7.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

10a. DISCREPANCY DATA. QUANTITY.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

10b. DISCREPANCY DATA. UNIT PRICE.:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

11. ACTION CODE. (See 2 below).:

12. REMARKS (Continue on separate sheet of paper if necessary):

13. FUNDING AND ACCOUNTING DATA:

14a. TYPED OR PRINTED NAME, TITLE, AND PHONE NUMBER OF PREPARING OFFICAL.:

14b. SIGNATURE.:

24b. SIGNATURE.:

15. DISTRIBUTION ADDRESSEES FOR COPIES.:

16. FROM::

17. DISTRIBUTION ADDRESSEES FOR COPIES.:

18. TO::

a. MATERIAL. HAS BEEN SHIPPED.: 0

a. MATERIAL. WILL BE SHIPPED.: 0

DOCUMENT NUMBER.:

b. NO RECORD OF SHIPMENT. RESUBMIT REPORT TO ROPER OFFICE UNDER APPROPRIATE REGULATION.: 0

c. AN ADJUSTMENT IN BILLING HAS BEEN / WILL BE PROCESSED AS A:: 0

c. AN ADJUSTMENT IN BILLING HAS BEEN / WILL BE PROCESSED AS A: CREDIT.: 0

c. AN ADJUSTMENT IN BILLING HAS BEEN / WILL BE PROCESSED AS A: DEBIT.: 0

d. INVOICE/BILL ATTACHED.: 0

e. PROOF OF DELIVERY (Parcel Post Shipments) OR EVIDENCE OF SHIPMENTS ENCLOSED.: 0

f. AN ADJUSTMENT IN BILLING FOR THE REPORTED DISCREPANCY WILL NOT BE PROCESSED FOR THE FOLLOWING REASON WHICH IS CITED IN THE INDICATED REGULATION.: 0

(1) REASON FOR NOT PROCESSING. (a) DISCREPANCY WAS NOT REPORTED WITHIN THE TIME FRAMES ALLOWED AND/OR.: 0

(b) DOLLAR VALUE DOES NOT MEET THE CRITERIA PRESCRIBED IN THE REGULATION OR AGREEMENT INDICATED IN 19f(2).: 0

(b) CHAPTER 2 AND/OR 7 OF DOD 4000.25-7-M, MILITARY STANDARD BILLING SYSTEM (MILSBILLS) AND/OR DD 1513, U.S. DOD OFFER AND ACCEPTANCE, AS APPLICABLE.: 0

(a) CHAPTER 5 OF THE GSA HANDBOOK. DISCREPANCIES OR DEFICIENCIES IN GSA OR DOD SHIPMENTS, MATERIAL, OR BILLINGS (FPMR 101-26.8).: 0

20a. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. PROCESS FOR DISPOSAL IN ACCORDANCE WITH SERVICE/AGENCY DIRECTIVES.: 0

20c. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. RETAIN MATERIAL AT NO CHARGE.: 0

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REDERENCED MATERIAL. SHIP MATERIAL (Specify location):: 0

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REDERENCED MATERIAL. OTHER.: 0

20b. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. REPRESENTATIVE WILL CALL FOR DISCUSSION CONCERNING DISPOSITION IN:: 0

20d. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. MATERIAL WILL BE PICKED UP IN:: 0

20. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. DAYS.:

20. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. DAYS.:

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. SHIP MATERIAL (Specify location): (1) GBL APPROPRIATIONS CHARGEABLE.: 0

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. SHIP MATERIAL (Specify location): (2) CHARGES COLLECT-VIA:: 0

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. SHIP MATERIAL (Specify location): (3) PARCEL POST LABEL ATTACHED.: 0

(2) CHARGES COLLECT-VIA: FREIGHT.: 0

(2) CHARGES COLLECT-VIA: EXPRESS.: 0

(2) CHARGES COLLECT-VIA: PARCEL POST.: 0

(Dollar amount) for postage advanced herewith. NOTE: Please enclose postage. Material cannot to returned Parcel Post collect.:

20f. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCE MATERIAL. OTHER (Specify).:

21. IF MATERIAL IS STILL REQUIRED, SUBMIT NEW REQUISITION.: 0

22. REPLACEMENT WITH SATISFACTORY MATERIAL WILL BE MADE ON OR BEFORE:: 0

22. DATE. Enter 2 digit month, 2 digit day and 4 digit year.:

23. REMARKS (Continue on separate sheet of paper if necessary).:

24a. TYPED OR PRINTED NAME OF PREPARING OFFICAL.:

24a. TYPED OR PRINTED PHONE NUMBER OF PREPARING OFFICAL.:

24b. SIGNATURE. THIS IS A PROTECTED FIELD.:

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. SHIP MATERIAL (Specify location): (4) FREIGHT PREPAID: 0

Title: Certification of Demilitarization or Mutilation

Description:

A certification statement as shown shall be signed and dated by a DoD contracted person or a Government employee who actually performed or witnessed the DEMIL.

The certificate shall be verified by a technically qualified DoD contracted person or a Government employee who witnessed the DEMIL of the material or inspected the residue.

The individual who verifies the DEMIL should generally be at least in the next higher management or technical level to the initial certifying individual and must be a U.S. citizen.

DLA Disposition Services, in compliance with their responsibilities outlined in the Defense Materiel Disposition Manual (DoD 4160.21-M), will at the time of receipt, place the DEMIL certificate in the applicable source document file for a period of 50 years, except small arms weapons DEMIL certificates. The DEMIL certificates for small arms weapons/ receivers, subject to the DoD Small Arms Serialization Program (SASP), will be retained indefinitely in a permanent record file by the responsible DoD Component.

Document Number: QTY:

NSN/LSN and Description:

Certification Statement:

[ ] DEMIL: I CERTIFY THAT THE ITEMS(S) LISTED HERE OR ATTACHED HAS/HAVE BEEN

DEMILITARIZED IN ACCORDANCE WITH DoD MANUAL 4160.28, VOLUME 3, “DEMILITARIZATION PROCEDURAL GUIDANCE,” CATEGORY _______, PARAGRAPH

______ AND/OR THE FOLLOWING APPLICABLE REGULATION:

Signature (Certifier):_____________________________________________Date____________

Printed Name/Grade/Rank: _______________________________________________________

Title: _________________________________________________________________________

Phone (COM/DSN/FAX): _________________________________________________________

Address: ______________________________________________________________________

Signature (Verifier):______________________________________________Date____________

Printed Name/Grade/Rank: _______________________________________________________

Title: _________________________________________________________________________

Phone (COM/DSN/FAX): _________________________________________________________

Address: ______________________________________________________________________

Reference:

DoD Manual 4160.28, Volume 3, "Defense Demilitarization:

Procedural Guidance," current edition

UI:

Disposal TurnIn Document:

QTY:

National Stock Number or Description:

PROCEDURAL GUIDANCE CATEGORY:

PARAGRAPH:

FOLLOWING APPLICABLE REGULATION:

Date:

Printed NameGradeRank:

Title:

Phone COMDSNFAX:

Address 1:

Address 2:

Date_2:

Printed NameGradeRank_2:

Title_2:

Phone COMDSNFAX_2:

Address 1_2:

Address 2_2:

MUTILATION ONLY: [ ] MUTILATION: Items have been mutilated to the point of scrap. No use/value beyond material content.

PDF (DLA)DLA FORM 2536, JAN 2019

STATEMENT OF INTENT Prescribed by: 41 CFR 102-40 Sponsor: Disposition Services

Form Approved OMB No. 0704-0534 Expires October 31, 2021

REPLACES DRMS FORM 1645, WHICH IS OBSOLETE

NOTE: The bidder has a duty to demonstrate responsibility and compliance with federal, state, county, city or local environmental/safety regulations or ordinances on the use and storage of Hazardous Property (HP) to qualify for an award. The Disposition Services Sales Contracting Officer may use the bidder's failure to provide complete or accurate information on this basis to deny the award.

SECTION I. BIDDER INFORMATION If bidder is agent, check here

a. NAME AND PHONE NUMBER OF PRINCIPAL:

b. PRINCIPAL'S ADDRESS:

c. PLEASE LIST OTHER BUSINESS OR NAMES USED BY THE PRINCIPAL BIDDER:

d. NATURE OF BUSINESS

(1) BROKER, MARKETER, RETAILER or WHOLESALER

(2) TREATMENT, STORAGE AND/OR DISPOSAL FACILITY

(3) OTHER (Specify)

e. INDICATE ALL RELEVANT TRAINING AND EXPERIENCE RELATED TO THE USE AND STORAGE OF HAZARDOUS PROPERTY.

BIDDER MUST INDICATE THE ITEM(S) FOR WHICH THE INFORMATION IN THIS SECTION APPLIES.

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, OMB 0704-0534, is estimated to average 1.5 hours 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.

mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

SECTION 2. DESTINATION OF PROPERTY

NOTE: LIST THE ACTUAL STREET ADDRESS WHERE THE PROPERTY IS TO BE DELIVERED. POST OFFICE BOXES ARE NOT

ACCEPTABLE.

a. 1. PRINCIPAL BIDDER(S)

NAME, ADDRESS AND PHONE NUMBER OF DESTINATION

EPA ID NO. AND/OR LICENSE/PERMIT(S) NO. (Mandatory if facility is regulated by federal/state or local authorities)

TYPE(S) OF ACTIVITY DESTINATION POINT IS LICENSED/PERMITTED FOR:

b. DOES THE PRINCIPAL OWN THE STORAGE FACILITY? YES NO

IF THE STORAGE FACILITY IS NOT OWNED BY THE PRINCIPAL, PROVIDE THE NAME AND PHONE NO. OF THE OWNER AND THE RELATIONSHIP BETWEEN THE PARTIES. IF THE STORAGE FACILITY IS RENTED, DOES THE LEASE SPECIFICALLY INCLUDE THE STORAGE OF HAZARDOUS PROPERTY? IF YES, ENCLOSE A COPY OF THE LEASE AGREEMENT.YES NO

c. PROVIDE THE NAME, ADDRESS AND PHONE NO. OF THE FEDERAL/STATE ENVIRONMENTAL REGULATORY AGENCIES AND/OR NON- EMERGENCY PHONE NO. FOR THE LOCAL, STATE, COUNTY, CITY OR OTHER AGENCY THAT HAS JURISDICTION FOR FIRE/SAFETY INSPECTIONS OR WOULD RESPOND TO EMERGENCIES WHERE THE PROPERTY WILL BE STORED. FAILURE TO ACCURATELY COMPLETE THIS BLOCK WITH REQUESTED INFORMATION MAY RESULT IN YOUR BID BEING NON-RESPONSIVE AND ULTIMATELY NO AWARD. (911 Is Not Acceptable)

d. LIST ALL FEDERAL/STATE/LOCAL ENVIRONMENTAL REGULATORY AGENCIES THAT HAVE INSPECTED THE FACILITY/BUSINESS OR THE DESTINATION SITE DURING THE PAST TWO (2) YEARS. INCLUDE THE NAME OF THE INSPECTORS, AND THE NAME, ADDRESS, AND PHONE NO. OF EACH AGENCY. FAILURE TO ACCUR.ATELY COMPLETE THIS BLOCK WITH REQUESTED INFORMATION MAY RESULT IN

YOUR BID BEING NON-RESPONSIVE AND ULTIMATELY NO AWARD.

2. OTHER (List )

SECTION 3. SPECIFIC USAGE (Insert Item Number(s) as Appropriate)

a. AS A PURCHASER, I WILL:

(1) RESELL ITEM(S):

SECTION 4. ACKNOWLEDGEMENTS

(2) USE ITEM AS INTENDED:

(3) SCRAP ITEM(S) FOR RECOVERY OF CONTENTS:

(4) RE-REFINE/REPROCESS ITEM(S):

(5) OTHER (Specify Item and Usage):

b. IF ITEM(S) ARE RESOLD, LIST ALL CUSTOMERS AND PROVIDE ALL APPLICABLE INFORMATION REQUESTED IN SECTION 2, PARAGRAPHS C & D OF ABOVE FOR EACH CUSTOMER. USE ADDITIONAL PAPER IF NECESSARY AND ATTACH TO THIS FORM.

a. Bidder acknowledges that sanctions may be imposed against any persons who knowingly/unknowingly violates any law relative to environmental protection, illegal transportation or storage/safety requirements/regulations or who knowingly falsifies or conceals information regarding the business, disposition, violation or use of the property and may include the denial of any future participation in the DoD Surplus Sales Program.

b. Bidder acknowledges that the information provided in this statement will be considered a part of the bid under the IFB, and a part of the contract of sale if the bid is accepted by the United States of America.

SECTION 5. CERTIFICATION

THE UNDERSIGNED BIDDER HEREBY CERTIFIES THAT IF AWARDED A CONTRACT UNDER THIS INVITATION FOR BIDS, THE BIDDER WILL COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, ORDINANCES, AND REGULATIONS WITH RESPECT TO THE CARE, HANDLING, STORAGE, SHIPMENT, RESALE, EXPORT, OR OTHER USE OF THE MATERIAL HEREBY PURCHASED. THE BIDDER WILL HOLD THE UNITED STATES HARMLESS FROM AND INDEMNIFY THE UNITED STATES AGAINST ANY OR ALL DEBTS, LIABILITIES, JUDGEMENTS, COSTS, DEMANDS, SUITS, ACTIONS, OR OTHER CLAIMS OF ANY NATURE ARISTNG FROM OR INCIDENT TO THE HANDLING, USE, STORAGE, SHIPMENT, RESALE, EXPORT, OR OTHER DISPOSITION OF THE ITEMS PURCHASED.

I CERTIFY THAT ALL OF THE INFORMATION GIVEN IN THIS STATEMENT IS TRUE AND CORRECT, AND THAT I HAVE NOT KNOWINGLY OMITTED ANY ADDITIONAL INFORMATION WHICH IS INCONSISTENT WITH THIS STATEMENT. I UNDERSTAND THAT THIS STATEMENT IS INCORPORATED BY REFERENCE INTO ANY RESULTING CONTRACT OF SALE WITH THE U.S. GOVERNMENT. PRIOR TO EFFECTING ANY CHANGE OF FACT OR INTENTION FROM THAT STATED HEREIN OR IN ANY PRIOR AMENDMENT, WHETHER OCURRING BEFORE OR AFTER THE RELEASE OF PROPERTY UNDER CONTRACT, I WILL SUBMIT A WRITTEN REQUEST FOR AMENDMENT OF THIS

STATEMENT TO THE DLA DISPOSITION SERVICES CONTRACTING OFFICER.

I AGREE THAT I WILL NOT EFFECT SUCH CHANGES WITHOUT FIRST RECEIVING THE WRITTEN APPROVAL OF THE DLA DISPOSITION

SERVICES CONTRACTING OFFICER.

DATE OF SIGNING SIGNATURE OF OFFICIAL BIDDER

PRINT OR TYPE NAME OF BIDDER

SECTION 6. SPECIFIC USAGE

As a purchaser, I will:

(a) Ensure that a minimum of 75% of the hazardous property purchased from DLA Disposition Services will be managed by one of the following methods within 12 months of the purchase date: (Specify Item)

(1) Resell Items:

(2) Use Item as Intended:

(3) Scrap Item(s) For Recovery of Contents:

(4) Re-Refine. Reprocess Item(s):

(5) Other (Specify Item and Use)

(b) Maintain accurate log(s) which records management of hazardous property by one of the following methods for purchases from DLA Disposition Services: (Specify Item)

(4) Re-Refine/Reprocess Items(s):

(5) Other (Specify Item and Use):

(c) Provide DLA Disposition Services Sales Office with a Semi-Annual Report (See section 7) June 1st and December 1st recording management of hazardous property received from DLA Disposition Services by one of the following methods: (Specify Item)

(4) Re-Refine/Reprocess Items(s):

(5) Other (Specify Item and Use):

NOTE: If the conditions of these requirements are not met, DLA Disposition Services will not consider releasing any further property to you until the requirements have been satisfied.

Printed Name of Buyer(s)

Signature of Buyer(s) Date Signed

h. IF PROPERTY IS RESOLD BUYER(s):

DLA DISPOSITION SERVICES SALES CONTRACTOR SIGNATURE:

SECTION 7. SEMI-ANNUAL REPORT

a. NAME OF ITEM:

b. UNIT OF ISSUE:

c. QUANTITY:

d. CONTRACT NUMBER(s) (where the material came from #):

e. STORAGE LOCATION:

f. DATE OF REMOVAL (n/a if item stored in original location):

g. POINT OF CONTACT (POC) IF DIFFERENT FROM ORIGINAL DESTINATION:

PRINTED NAME:

ADDRESS:

TELEPHONE NUMBER:

SIGNATURE:

PRINTED NAME:

ADDRESS:

TELEPHONE NUMBER:

PDF (DLA)

DLA FORM 2536, JAN 2019

STATEMENT OF INTENT

Prescribed by: 41 CFR 102-40

Sponsor: Disposition Services

Page of

Form Approved

OMB No. 0704-0534

Expires October 31, 2021

REPLACES DRMS FORM 1645, WHICH IS OBSOLETE

R:\\DRMS\\DRMS1645.FRP Printing lsc1872

D:20030806163903Z

D:20080409104528- 04'00'

NOTE: The bidder has a duty to demonstrate responsibility and compliance with federal, state, county, city or local environmental/safety regulations or ordinances on the use and storage of Hazardous Property (HP) to qualify for an award. The Disposition Services Sales Contracting Officer may use the bidder's failure to provide complete or accurate information on this basis to deny the award.

SECTION I. BIDDER INFORMATION If bidder is agent, check here

d. NATURE OF BUSINESS

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, OMB 0704-0534, is estimated to average 1.5 hours 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

SECTION 2. DESTINATION OF PROPERTY

NOTE: LIST THE ACTUAL STREET ADDRESS WHERE THE PROPERTY IS TO BE DELIVERED. POST OFFICE BOXES ARE NOT ACCEPTABLE.

a.

b. DOES THE PRINCIPAL OWN THE STORAGE FACILITY?

IF THE STORAGE FACILITY IS NOT OWNED BY THE PRINCIPAL, PROVIDE THE NAME AND PHONE NO. OF THE OWNER AND THE RELATIONSHIP BETWEEN THE PARTIES. IF THE STORAGE FACILITY IS RENTED, DOES THE LEASE SPECIFICALLY INCLUDE THE STORAGE OF HAZARDOUS PROPERTY? IF YES, ENCLOSE A COPY OF THE LEASE AGREEMENT.

c. PROVIDE THE NAME, ADDRESS AND PHONE NO. OF THE FEDERAL/STATE ENVIRONMENTAL REGULATORY AGENCIES AND/OR NON-EMERGENCY PHONE NO. FOR THE LOCAL, STATE, COUNTY, CITY OR OTHER AGENCY THAT HAS JURISDICTION FOR FIRE/SAFETY INSPECTIONS OR WOULD RESPOND TO EMERGENCIES WHERE THE PROPERTY WILL BE STORED. FAILURE TO ACCURATELY COMPLETE THIS BLOCK WITH REQUESTED INFORMATION MAY RESULT IN YOUR BID BEING NON-RESPONSIVE AND ULTIMATELY NO AWARD. (911 Is Not Acceptable)

d. LIST ALL FEDERAL/STATE/LOCAL ENVIRONMENTAL REGULATORY AGENCIES THAT HAVE INSPECTED THE FACILITY/BUSINESS OR THE DESTINATION SITE DURING THE PAST TWO (2) YEARS. INCLUDE THE NAME OF THE INSPECTORS, AND THE NAME, ADDRESS, AND PHONE NO. OF EACH AGENCY. FAILURE TO ACCUR.ATELY COMPLETE THIS BLOCK WITH REQUESTED INFORMATION MAY RESULT IN YOUR BID BEING NON-RESPONSIVE AND ULTIMATELY NO AWARD.

SECTION 3. SPECIFIC USAGE (Insert Item Number(s) as Appropriate)

a. AS A PURCHASER, I WILL:

SECTION 4. ACKNOWLEDGEMENTS

a. Bidder acknowledges that sanctions may be imposed against any persons who knowingly/unknowingly violates anylaw relative to environmental protection, illegal transportation or storage/safety requirements/regulations or who knowingly falsifies or conceals information regarding the business, disposition, violation or use of the property and mayinclude the denial of any future participation in the DoD Surplus Sales Program.

b. Bidder acknowledges that the information provided in this statement will be considered a part of the bid under theIFB, and a part of the contract of sale if the bid is accepted by the United States of America.

SECTION 5. CERTIFICATION

THE UNDERSIGNED BIDDER HEREBY CERTIFIES THAT IF AWARDED A CONTRACT UNDER THIS INVITATION FOR BIDS, THE BIDDER WILL COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, ORDINANCES, AND REGULATIONS WITH RESPECT TO THE CARE, HANDLING, STORAGE, SHIPMENT, RESALE, EXPORT, OR OTHER USE OF THE MATERIAL HEREBY PURCHASED. THE BIDDER WILL HOLD THE UNITED STATES HARMLESS FROM AND INDEMNIFY THE UNITED STATES AGAINST ANY OR ALL DEBTS, LIABILITIES, JUDGEMENTS, COSTS, DEMANDS, SUITS, ACTIONS, OR OTHER CLAIMS OF ANY NATURE ARISTNG FROM OR INCIDENT TO THE HANDLING, USE, STORAGE, SHIPMENT, RESALE, EXPORT, OR OTHER DISPOSITION OF THE ITEMS PURCHASED.

I CERTIFY THAT ALL OF THE INFORMATION GIVEN IN THIS STATEMENT IS TRUE AND CORRECT, AND THAT I HAVE NOT KNOWINGLY OMITTED ANY ADDITIONAL INFORMATION WHICH IS INCONSISTENT WITH THIS STATEMENT. I UNDERSTAND THAT THIS STATEMENT IS INCORPORATED BY REFERENCE INTO ANY RESULTING CONTRACT OF SALE WITH THE U.S. GOVERNMENT. PRIOR TO EFFECTING ANY CHANGE OF FACT OR INTENTION FROM THAT STATED HEREIN OR IN ANY PRIOR AMENDMENT, WHETHER OCURRING BEFORE OR AFTER THE RELEASE OF PROPERTY UNDER CONTRACT, I WILL SUBMIT A WRITTEN REQUEST FOR AMENDMENT OF THIS STATEMENT TO THE DLA DISPOSITION SERVICES CONTRACTING OFFICER.

I AGREE THAT I WILL NOT EFFECT SUCH CHANGES WITHOUT FIRST RECEIVING THE WRITTEN APPROVAL OF THE DLA DISPOSITION SERVICES CONTRACTING OFFICER.

SECTION 6. SPECIFIC USAGE

As a purchaser, I will:

(a) Ensure that a minimum of 75% of the hazardous property purchased from DLA Disposition Services will be managed by one of the following methods within 12 months of the purchase date: (Specify Item)

(b) Maintain accurate log(s) which records management of hazardous property by one of the following methods for purchases from DLA Disposition Services: (Specify Item)

(c) Provide DLA Disposition Services Sales Office with a Semi-Annual Report (See section 7) June 1st and December 1st recording management of hazardous property received from DLA Disposition Services by one of the following methods: (Specify Item)

NOTE: If the conditions of these requirements are not met, DLA Disposition Services will not consider releasing any further property to you until the requirements have been satisfied.

h. IF PROPERTY IS RESOLD BUYER(s):

SECTION 7. SEMI-ANNUAL REPORT

g. POINT OF CONTACT (POC) IF DIFFERENT FROM ORIGINAL DESTINATION:

CurrentPage:

PageCount:

CHK1:

ITEM NAME:

ADDRESS:

LIST:

Chk 1d1:

Chk 1d2:

Chk 1d3:

OTHER:

TRNG:

ITEMS:

PrintButton1:

ResetButton1:

Chk 2.1:

LIST2:

ADDRESS2:

EPA_ID:

TYPES:

2B:

2C:

2D:

Chk 2.2:

Check 3a1:

RESELL:

Check 3a2:

USE:

Check 3a3:

SCRAP:

Check 3a4:

REFINE:

Check 3a5:

SPEC:

LIST3:

DATE:

SIGNATURE:

PRINT:

CHK 6A1:

LIST A1:

CHK 6A2:

LIST A2:

CHK 6A3:

LIST A3:

CHK 6A4:

LIST A4:

CHK 6A5:

OTHER:

CHK 6B1:

LIST B1:

CHK 6B2:

LIST B2:

CHK 6B3:

LIST B3:

CHK 6B4:

LIST B4:

CHK 6B5:

OTHER:

CHK 6B1:

LIST C1:

CHK 6B2:

LIST C2:

CHK 6B3:

LIST C3:

CHK 6B4:

LIST C4:

CHK 6B5:

OTHER:

T116:

T117:

T118:

T76:

UNIT OF ISSUE:

QTY:

CONTRACT NO.:

LOCATION:

REMOVAL DATE:

NAME:

ADDRESS:

TEL. NO.:

T69:

NAME:

ADDRESS:

TEL. NO.:

DATE OF ACCEPTANCE JOB TITLE OF CONTRACTING OFFICER (Type or print)

AUTHORIZED FOR LOCAL REPRODUCTION

previous edition is usable

STANDARD FORM 114 (REV. 5/2003)

Prescribed by GSAFPMR (41 CFR) 101-45.3

RETURN WITH BID

SALE OF GOVERNMENT PROPERTY- BID AND AWARD

(See SF 114C for Privacy Act Statement)

INVITATION FOR BIDS NO. PAGE NO.

ISSUED BY ADDRESS YOUR BID TO:

AGENCY'S NAME

FOR INFORMATION CONTACT:

BUREAU/SERVICE/OFFICE

ACCEPTANCE BY THE GOVERNMENT (This section for Government Use Only)

ACCEPTED AS TO ITEM(S) NUMBERED AMOUNT($) CONTRACT NUMBER(S)

BY - UNITED STATES OF AMERICA (Contracting Officer) NAME OF CONTRACTING OFFICER (Type or print)

NAME

STREET

CITY STATE ZIP CODE

TELEPHONE

AREA CODE PHONE EXTENSION

BIDDER ID NUMBER BIDDER'S TIN/SOCIAL SECURITY NO.

SIGNATURE OF PERSON AUTHORIZED TO SIGN THIS BID DATE OF BID

NAME OF SIGNER (Type or print) JOB TITLE OF SIGNER (Type or print)

ZIP CODE

NAME

TELEPHONE

AREA CODE NUMBER EXTENSION

E-MAIL ADDRESS

BIDS WILL BE

OPENED AT

PLACE

DATE TIME

SEALED BIDS

Sealed bids for purchasing any or all items listed on the accompanying schedule, will be received at the place designated above until the date and time specified above and at that time publicly opened. (Copies of the below mentioned forms, if not attached, are on file at the issuing office and are available upon request). Bidder is required to pay for any or all of the items listed on the Item Bid page(s) as part of this Bid, at the price sent opposite each.

NO. OF COPIES

SUBJECT TO

SF 114C, General Sale Terms and Conditions Other Special Terms and Conditions Attached Incorporated by reference:

IF 'YES", PERCENTAGE OF TOTAL

BID

DEPOSIT MADE PAYABLE TO PAYMENT DUE

(Calendar Days)

REMOVAL OF PROPERTY

(Calendar Days)

BID (Completed by Bidder)

In compliance with the above, the undersigned offers and agrees, if this Bid is accepted (60 calendar days if no period is specified by the Government or the Bidder, but not less than 10 calendar days in any case) after date of Bid opening, to pay for and remove the property.

BID ACCEPTANCE (Calendar Days) TOTAL AMOUNT

BID DEPOSIT REQUIRED

YES NO

DEPOSIT ATTACHED

YES NO

DEPOSIT FORM(S) AMOUNT OF DEPOSIT

BIDDER REPRESENTS THAT:

(Check appropriate boxes)

BIDDER REPRESENTS THAT: (Check appropriate boxes) (Complete if the total amount of the bid(s) exceeds $25,000.)

YES YESNOACTION NOACTION

Property was inspected Bidder is an individual Bidder is a small business. (See CFR, title 13, Chapter 1, Part 121, Sec. 121.3-9, for the definition of small business.)

Bidder employed or retained any company or person (other than a full-time, bona fide employee working solely for the Bidder) to solicit or secure this contract.

Bidder paid or agreed to pay any company or person (other than a full-time, bona fide employee working solely for the Bidder) any fee, commission, percentage or brokerage fee, contingent upon or resulting from the award of this contract.

Bidder agreed to furnish information relating to use of a company or person in securing or soliciting contract as requested by the Contracting Officer.

B

ID

D E

R 'S

IN

FO

R

M A

TI

O

N

STREET ADDRESS

CITY STATE

\\iaimain\apps1\Pam_Ward\Logos\Pointer.jpg

\\iaimain\apps1\Pam_Ward\Logos\Pointer.jpg

DATE OF ACCEPTANCE

JOB TITLE OF CONTRACTING OFFICER (Type or print)

AUTHORIZED FOR LOCAL REPRODUCTION

previous edition is usable

STANDARD FORM 114 (REV. 5/2003) Prescribed by GSAFPMR (41 CFR) 101-45.3

RETURN WITH BID

SALE OF GOVERNMENT PROPERTY- BID AND AWARD

(See SF 114C for Privacy Act Statement)

INVITATION FOR BIDS NO.

PAGE NO.

ISSUED BY

ADDRESS YOUR BID TO:

AGENCY'S NAME

FOR INFORMATION CONTACT:

BUREAU/SERVICE/OFFICE

ACCEPTANCE BY THE GOVERNMENT (This section for Government Use Only)

ACCEPTED AS TO ITEM(S) NUMBERED

AMOUNT($)

CONTRACT NUMBER(S)

BY - UNITED STATES OF AMERICA (Contracting Officer)

NAME OF CONTRACTING OFFICER (Type or print)

NAME

STREET

CITY

STATE

ZIP CODE

TELEPHONE

AREA CODE

PHONE

EXTENSION

BIDDER ID NUMBER

BIDDER'S TIN/SOCIAL SECURITY NO.

SIGNATURE OF PERSON AUTHORIZED TO SIGN THIS BID

DATE OF BID

NAME OF SIGNER (Type or print)

JOB TITLE OF SIGNER (Type or print)

ZIP CODE

NAME

TELEPHONE

AREA CODE

NUMBER

EXTENSION

E-MAIL ADDRESS

BIDS WILL BE OPENED AT

PLACE

DATE

TIME

SEALED BIDS

Sealed bids for purchasing any or all items listed on the accompanying schedule, will be received at the place designated above until the date and time specified above and at that time publicly opened. (Copies of the below mentioned forms, if not attached, are on file at the issuing office and are available upon request). Bidder is required to pay for any or all of the items listed on the Item Bid page(s) as part of this Bid, at the price sent opposite each.

NO. OF COPIES

SUBJECT TO

SF 114C, General Sale Terms and Conditions

Other Special Terms and Conditions Attached

Incorporated by reference:

IF 'YES", PERCENTAGE OF TOTAL BID

DEPOSIT MADE PAYABLE TO

PAYMENT DUE (Calendar Days)

REMOVAL OF PROPERTY (Calendar Days)

BID (Completed by Bidder)

In compliance with the above, the undersigned offers and agrees, if this Bid is accepted (60 calendar days if no period is specified by the Government or the Bidder, but not less than 10 calendar days in any case) after date of Bid opening, to pay for and remove the property.

BID ACCEPTANCE (Calendar Days)

TOTAL AMOUNT

BID DEPOSIT REQUIRED

YES

NO

DEPOSIT ATTACHED

YES

NO

DEPOSIT FORM(S)

AMOUNT OF DEPOSIT

BIDDER REPRESENTS THAT:

(Check appropriate boxes)

BIDDER REPRESENTS THAT: (Check appropriate boxes) (Complete if the total amount of the bid(s) exceeds $25,000.)

YES

YES

NO

ACTION

NO

ACTION

Property was inspected

Bidder is an individual

Bidder is a small business. (See CFR, title 13, Chapter 1, Part 121, Sec. 121.3-9, for the definition of small business.)

Bidder employed or retained any company or person (other than a full-time, bona fide employee working solely for the Bidder) to solicit or secure this contract.

Bidder paid or agreed to pay any company or person (other than a full-time, bona fide employee working solely for the Bidder) any fee, commission, percentage or brokerage fee, contingent upon or resulting from the award of this contract.

Bidder agreed to furnish information relating to use of a company or person in securing or soliciting contract as requested by the Contracting Officer.

BIDDER'S INFORMATION

STREET ADDRESS

CITY

STATE

8.2.1.4029.1.523496.503679

INVITATION FOR BIDS NUMBER:

ADDRESS YOUR BID TO: ZIP CODE: 49037-3092

BIDS WILL BE OPENED AT. PLACE: Room 2-6-C17

BIDS WILL BE OPENED AT. TIME:

PAYMENT DUE (Calendar Days): 10

DEPOSIT FORM(S):

BID (Completed by Bidder). BID ACCEPTANCE (Calendar Days): 180

DEPOSIT MADE PAYABLE TO: U.S. Treasury

IF 'YES", PERCENTAGE OF TOTAL BID: 20%

BIDDER'S INFORMATION. NAME:

BIDDER'S INFORMATION. STREET:

BIDDER'S INFORMATION. CITY:

BIDDER'S INFORMATION. TELEPHONE. AREA CODE:

ACCEPTANCE BY THE GOVERNMENT (This section for Government Use Only). ACCEPTED AS TO ITEM(S) NUMBERED:

ACCEPTANCE BY THE GOVERNMENT (This section for Government Use Only). BY - UNITED STATES OF AMERICA (Contracting Officer):

BIDDER'S INFORMATION. TELEPHONE. PHONE NUMBER:

BIDDER'S INFORMATION. TELEPHONE. EXTENSION:

BIDDER ID NUMBER:

BIDDER'S TIN/SOCIAL SECURITY NUMBER:

NAME OF SIGNER (Type or print):

ACCEPTANCE BY THE GOVERNMENT (This section for Government Use Only). CONTRACT NUMBER(S):

ACCEPTANCE BY THE GOVERNMENT (This section for Government Use Only). NAME OF CONTRACTING OFFICER (Type or print):

ACCEPTANCE BY THE GOVERNMENT (This section for Government Use Only). JOB TITLE OF CONTRACTING OFFICER (Type or print):

JOB TITLE OF SIGNER (Type or print):

BIDDER'S INFORMATION. ZIP CODE:

BIDDER'S INFORMATION. STATE:

REMOVAL OF PROPERTY (Calendar Days): Per IFB Terms

SUBJECT TO. Incorporated by reference::

ADDRESS YOUR BID TO: STATE: MI

ADDRESS YOUR BID TO: AGENCY NAME: DLA Disposition Services

ISSUED BY: DLA Disposition Services

ADDRESS YOUR BID TO: STREET ADDRESS: 74 N. Washington Ave.

ADDRESS YOUR BID TO: CITY: Battle Creek

FOR INFORMATION CONTACT: NAME: Todd Koleski

FOR INFORMATION CONTACT: TELEPHONE. AREA CODE:

FOR INFORMATION CONTACT: E-MAIL ADDRESS: todd.koleski@dla.mil

FOR INFORMATION CONTACT: TELEPHONE. NUMBER: No Calls Accepted

FOR INFORMATION CONTACT: TELEPHONE. EXTENSION:

ADDRESS YOUR BID TO: BUREAU/SERVICE/OFFICE: Sales

PAGE NUMBER:

BIDS WILL BE OPENED AT. DATE. Enter 2 digit month, 2 digit day and 4 digit year.:

SEALED BIDS. NUMBER OF COPIES: 1.00000000

SUBJECT TO. SF 114C, General Sale Terms and Conditions: 0

SUBJECT TO. Other Special Terms and Conditions Attached: 0

BID DEPOSIT REQUIRED. YES: 1

DEPOSIT ATTACHED. YES: 1

BIDDER REPRESENTS THAT: (Check appropriate boxes). ACTION. Property was inspected. YES: 0

BIDDER REPRESENTS THAT: (Check appropriate boxes). ACTION. Property was inspected. NO: 0

BIDDER REPRESENTS THAT: (Check appropriate boxes). ACTION. Bidder is an individual. YES: 0

BIDDER REPRESENTS THAT: (Check appropriate boxes). ACTION. Bidder is an individual. NO: 0

BIDDER REPRESENTS THAT: (Check appropriate boxes). ACTION. Bidder is a small business. (See CFR, title 13, Chapter 1, Part 121, Sec. 121.3-9, for the definition of small business.). YES: 0

BIDDER REPRESENTS THAT: (Check appropriate boxes). ACTION. Bidder is a small business. (See CFR, title 13, Chapter 1, Part 121, Sec. 121.3-9, for the definition of small business.). NO: 0

BIDDER REPRESENTS THAT: (Check…