SF1449.pdf

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Attached to
Forest Engineer and Road Maintenance (FERM) Stream Restoration Federal contract opportunity
Solicitation number
AG-04P5-S-16-0004
Issued by
Department of Agriculture Forest Service R6-Pacific Northwest Region

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Other files attached to Forest Engineer and Road Maintenance (FERM) Stream Restoration, newest first.
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Amend.pdf PDF
Amendment.pdf PDF
ReturnPackage.pdf PDF
FIRE_SPECSAttach567.pdf PDF
MapArea__6_Bly_Lakeview 1 .pdf PDF
Solicitation.pdf PDF
77-0079.txt TXT text file
Solicitation.pdf PDF
Example_Drawing_Log_Jam.pdf PDF
Example_Streambank_Reshaping_Stabilization.pdf PDF
77-0079.txt TXT text file
Example_Point_Bar_Gravel_Enhancement.pdf PDF
ReturnPackage.pdf PDF
MapArea__3_Chemult_Crescent 1 .pdf PDF
SF1449.pdf PDF
Example_Floodplain_Grade_Control.pdf PDF
Example_Point_Bar_Gravel_Enhancement_2.pdf PDF
MapArea__4_Paisley_Silverlake 1 .pdf PDF
MapArea__5_Chiloquin_Klamath 1 .pdf PDF
Upper_Sycan_River_Restoration_Map.pdf PDF
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SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

1. REQUISITION NUMBER PAGE 1 OF

2. CONTRACT NO. 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY

13b. RATING

14. METHOD OF SOLICITATION

CODE

15. DELIVER TO 16. ADMINISTERED BY CODE

18a. PAYMENT WILL BE MADE BY CODE17a. CONTRACTOR/

OFFEROR

CODE

FACILITY

CODE

CODE

TELEPHONE NO.

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

BELOW IS CHECKED

RFQ IFB RFP

SEE ADDENDUM

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

29. AWARD OF CONTRACT: REF. OFFER

DATED . . YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR

30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

31b. NAME OF CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

10. THIS ACQUISITION IS UNRESTRICTED OR

NAICS:

SIZE STANDARD:

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

SET ASIDE: % FOR:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

ARE ARE NOT ATTACHED

ARE ARE NOT ATTACHED

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

8 (A)

EDWOSB

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SMALL BUSINESS

STANDARD FORM 1449 (REV. 2/2012) BACK

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

40. PAID BY

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

PARTIAL FINAL

37. CHECK NUMBER

38. S/R ACCOUNT NO. 39. S/R VOUCHER NUMBER

36. PAYMENT

COMPLETE PARTIAL FINAL

Printing C:\FORMFLOW\FORMS\SF\S1449_3.FRP BarbMWilliams SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

1. REQUISITION NUMBER

PAGE 1 OF

2. CONTRACT NO.

3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

b. TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY

13b. RATING

14. METHOD OF SOLICITATION

CODE

15. DELIVER TO

16. ADMINISTERED BY

CODE

18a. PAYMENT WILL BE MADE BY

CODE

17a. CONTRACTOR/

OFFEROR

CODE

FACILITY

CODE

CODE

TELEPHONE NO.

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

BELOW IS CHECKED

RFQ

IFB

RFP

SEE ADDENDUM

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

29. AWARD OF CONTRACT: REF. OFFER

DATED . . YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 31b. NAME OF CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

10. THIS ACQUISITION IS

UNRESTRICTED OR

NAICS:

SIZE STANDARD:

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

SET ASIDE:

% FOR:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

ARE

ARE NOT ATTACHED

ARE

ARE NOT ATTACHED

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA 27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA \\iaimain\apps1\Pam_Ward\Logos\Pointer.jpg Right Arrow Pointing to Call the Contact Point for this Solicitation/Contract/Order 8 (A)

EDWOSB

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

SMALL BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SMALL BUSINESS

SMALL BUSINESS

STANDARD FORM 1449 (REV. 2/2012)

BACK

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED

INSPECTED

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE 42a. RECEIVED BY (Print) 42b. RECEIVED AT (Location) 42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

40. PAID BY

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE 32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER

34. VOUCHER NUMBER

35. AMOUNT VERIFIED

CORRECT FOR

PARTIAL

FINAL

37. CHECK NUMBER

38. S/R ACCOUNT NO.

39. S/R VOUCHER NUMBER

36. PAYMENT

COMPLETE

PARTIAL

FINAL

1. REQUISITION NUMBER:
PAGE 1 OF:
2. CONTRACT NUMBER:
4. ORDER NUMBER:
5. SOLICITATION NUMBER: AG-04P5-S-16-0004
7. FOR SOLICITATION INFORMATION CALL: a. NAME: Deanna Vest / Rich Pyzik
7. FOR SOLICITATION INFORMATION CALL: b. TELEPHONE NUMBER (No collect calls): 541-883-6737 / 943-4440
9. ISSUED BY CODE:
% For :
12. DISCOUNT TERMS:
13b. RATING:
15. DELIVER TO:
16. ADMINISTERED BY CODE:
16. ADMINISTERED BY:
17a. CONTRACTOR/ OFFEROR CODE:
17a. CONTRACTOR/ OFFEROR:

DUNS #_______________________

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER:
18a. PAYMENT WILL BE MADE BY: Invoice Processing Platform - IPP

via WWW.IPP.GOV

19. ITEM NUMBER. Line 1 of 8.:
20. SCHEDULE OF SUPPLIES/ SERVICES: CENTRAL OREGON
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 2 of 8.:
20. SCHEDULE OF SUPPLIES/ SERVICES: Forest Engineering & Road Maintenance
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 3 of 8.:
20. SCHEDULE OF SUPPLIES/ SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 4 of 8.:
20. SCHEDULE OF SUPPLIES/ SERVICES: Awards under this solicitation will be made through
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 5 of 8.:
20. SCHEDULE OF SUPPLIES/ SERVICES: issuance of a Blanket Purchase Agreement. See the
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 6 of 8.:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 7 of 8.:
20. SCHEDULE OF SUPPLIES/ SERVICES: following pages. The quantities represent estimated work
20. SCHEDULE OF SUPPLIES/ SERVICES: with an annual $1M Ceiling.
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 8 of 8.:
20. SCHEDULE OF SUPPLIES/ SERVICES: Continued on following page...
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
25. ACCOUNTING AND APPROPRIATION DATA:
28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED. INITIALS :

29. AWARD OF CONTRACT: REFERENCE OFFER:
DATE. YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS.:

30b. NAME OF SIGNER (Type or print):
30b. TITLE OF SIGNER (Type or print):
31b. NAME OF CONTRACTING OFFICER (Type or print):
10. THIS ACQUISITION IS UNRESTRICTED: 1
10. THIS ACQUISITION IS SET ASIDE:: 0
11. DELIVERY FOR FOB DESTINATION UNLESS BLOCK IS MARKED SEE SCHEDULE: 0
13a. THIS CONTRACT IS A RATED ORDER UNDER DPAS (15 CFR 700): 0
14. METHOD OF SOLICITATION RFQ: 0
10. THIS ACQUISITION IS NAICS:: 115310
10. THIS ACQUISITION IS SIZE STANDARD:: $7.5 m
14. METHOD OF SOLICITATION IFB: 0
14. METHOD OF SOLICITATION RFP: 0
18a. PAYMENT WILL BE MADE BY CODE: email:___________________
18a. PAYMENT WILL BE MADE BY CODE: 8 A.M. PST
18a. PAYMENT WILL BE MADE BY CODE: Western Oregon Acquisition Management Area

Klamath Ranger District 2819 Dahlia St., Suite A Klamath Falls, OR 97601 dvest@fs.fed.us

29. AWARD OF CONTRACT : 1
29. AWARD OF CONTRACT : 1
29. AWARD OF CONTRACT : 0
29. AWARD OF CONTRACT : 0
27a. ARE ATTACHED: 1
27a. ARE NOT ATTACHED: 0
27b. ARE ATTACHED: 1
27b. ARE NOT ATTACHED: 0
42c. DATE RECEIVED. Enter 2 digit month, 2 digit day and 4 digit year.: 2016-05-10
42c. DATE RECEIVED. Enter 2 digit month, 2 digit day and 4 digit year.: 2016-05-31
3. AWARD/ EFFECTIVE DATE. Enter 2 digit month, 2 digit day and 4 digit year.:
32B SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE. THIS IS A PRTECTED FIELD.:
18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK IS CHECKED SEE ADDENDUM: 0
26. TOTAL AWARD AMOUNT (FOR GOVT. USE ONLY):
17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER : 0

41b. SIGNATURE OF CERTIFYING OFFICER. :
10. THIS ACQUISITION IS 8 (A): 0
10. THIS ACQUISITION IS SMALL BUSINESS: 0
10. THIS ACQUISITION IS SMALL BUSINESS: 0
10. THIS ACQUISITION IS SMALL BUSINESS: 0
10. THIS ACQUISITION IS SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS: 0
10. THIS ACQUISITION IS HUBZONE SMALL BUSINESS: 0
19. ITEM NUMBER. Line 1 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 2 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: A quoter is only required to price work activities of
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 3 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: stream restoration.
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 4 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: As specified herein, utilization of Service
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 5 of 28.:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 6 f 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: Contract Act and Davis Bacon wage rates shall be used
20. SCHEDULE OF SUPPLIES/SERVICES: in response to this solicitation. However, ALL pay items
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 7 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: must be priced within each work activity in order to be
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
20. SCHEDULE OF SUPPLIES/SERVICES: responsive to this RFQ.
21. QUANTITY:
22. UNIT:
24. AMOUNT:
19. ITEM NUMBER. Line 8 of 28.:
19. ITEM NUMBER. Line 9 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 10 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: In addition to this Blanket Purchase Agreement
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 11 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: solicitation is a solicitation for Upper Sycan Aquatic
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 12 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: Habitat for the Paisley Ranger District of the
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 13 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: Fremont-Winema National Forest. You may also
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line14 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: submit an offer for this project at this time.
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 15 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 16 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 17 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: Must be registered in SAM.gov to be considered for
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 18 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: award.
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 19 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 20 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: DUNS # ________________________
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 21 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 22 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: Phone #________________________
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 23 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 24 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES: Email Address __________________________
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 25 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 26 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 27 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
19. ITEM NUMBER. Line 28 of 28.:
20. SCHEDULE OF SUPPLIES/SERVICES:
21. QUANTITY:
22. UNIT:
23. UNIT PRICE:
24. AMOUNT:
32a. QUANTITY IN COLUMN 21 HAS BEEN ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:
32d. PRINTED NAME OF AUTHORIZED GOVERNMENT REPRESENTATIVE:
32d. PRINTED TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE.:
32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE:
32F. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE:
32G. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE:
33. SHIP NUMBER:
34. VOUCHER NUMBER:
35. AMOUNT VERIFIED CORRECT FOR:
37. CHECK NUMBER:
38. S/R ACCOUNT NUMBER:
39. S/R VOUCHER NUMBER:
40. PAID BY:
41b. TITLE OF CERTIFYING OFFICER:
42a. RECEIVED BY (Print):
42b. RECEIVED AT (Location):
42d. TOTAL CONTAINERS:
32a. QUANTITY IN COLUMN 21 HAS BEEN RECEIVED: 0
32a. QUANTITY IN COLUMN 21 HAS BEEN INSPECTED : 0
32a. QUANTITY IN COLUMN 21 HAS BEEN ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: 0
41c. DATE. Enter 2 digit month, 2 digit day and 4 digit year.:
33. SHIP NUMBER PARTIAL: 0
33. SHIP NUMBER FINAL: 0
32c. DATE. Enter 2 digit month, 2 digit day and 4 digit year.:
36. PAYMENT COMPLETE: 0
36. PAYMENT PARTIAL: 0
36. PAYMENT FINAL: 0
41b. SIGNATURE OF CERTIFYING OFFICER. THIS IS A PROTECTED FIELD.:

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