Attachment 1 - Work Order Request.docx

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Class IX Repair Parts
Solicitation number
W91247-21-Q-CW02
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Attachment 6 Parts Listings.xlsx XLSX spreadsheet
Combined Synopsis Solicitation_RFQ and Attachment (Final).pdf PDF

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+W91247-21-Q-CW02

ATTACHMENT 1 – Work Order Request

SUPPLY REQUEST FORM

DMO/Work Order #: 100001234567
Shop: 1127
PO #:
Priority (circle
one):3
Bldg. #:
Floor #:
Room #: 2
PR #: 2000222222

POC

Name: JOHN DOE Phone #: 910-111-

Date:

Supervisor

Name: JANE DOE Phone #: 910-333-

Signature:

Manufacturer:

Model #:

Serial #:

Circle One: System Component or End Item

Brand Name or Equivalent (Equivalent items must perform as well and be equally Acceptable)

NSN/Part #
Detailed Description (Be

Specific)

Qty
Unit of

Issue Unit Price Total Quoted Price

12583471

012583471 - SWITCH.LOCK.IGNITION (Parts listing COMPACTOR – CAT-SLEP-LIN 61618)
1

EA

15847830

015847830 - FLOODLIGHT.ELECTRIC (Parts Listing EXCAVATOR – John Deer LIN E27792-E27860)
1
EA

123454919 123454919 – SPEEDOMETER (Parts Listing HUSKY – AFRICA- LIN V05001)

16502911 016502911 - CYLINDER ASSEMBLY.ACTUATING.LINEAR (Parts Listing IHMEE-JCB LIN H53576)

Parts/Serial Numbers Must Match Description of Item Estimated S/H Charge

Estimated Delivery Date:
Lead Time:
Total Price

Invoices Must Accompany Delivery *** Delivery Times Between 0800-1500 Only

Buyer’s Name: PURCHASING AGENT
Order Date:
Received Date:
Issue Date:
Property Book: Yes or No
LPA:BPA AR 420-1
Approving Official’s Signature:
Date:

Remarks:

Transaction Date:

Vendor:
Transaction Price:

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