Attachment 11 - DLA Form 2539.pdf

kthzchn-ian+ 11.

Prescribed by:

CUSTOMER’S VERIFICATION OF SERVICES 50P4160,OI-04I

Sponsor: Disposition Services

THIS FORM IS FOR USE BY THE CUSTOMER WHEN THE DLA DISPOSITION SERVICES CONTRACTING OFFICERS REPRESENTATIVE (COR) IS NOT PRESENT AT THE TIME OF SERVICE. IT IS NOT INTENDED TO REPRESENT A FORMAL ACCEPTANCE OF SERVICES PROVIDED UNDER THE REFERENCED CONTRACT. ITS ONLY PURPOSE IS TO PROVIDE A RECORD THAT THE SPECIFIC ITEMS INDICATED ON THE TASK ORDER (DD FORM 1155) WERE COMPLETED BY THE CONTRACTOR ON THE DATE INDICATED.

SECTION 1 - DLA INFORMATION

TO BE COMPLETED BY THE COR BEFORE BEING GIVEN TO THE CUSTOMER

1. COR NAME 2. TELEPHONE NUMBER(S)

3. ALTERNATE POINT OF CONTACT 4. TELEPHONE NUMBER(S)

6. CONTRACTING OFFICER (KO) NAME 6. TELEPHONE NUMBER

7. CONTRACT NUMBER 8. TASK ORDER NUMBER

9. LINE ITEM NUMBERS (IF PARTIAL REMOVAL, DELIVERY, AND/OR SERVICE ONLY)

SECTION 2 - CUSTOMER VERIFICATION

TO BE COMPLETED BY THE CUSTOMER VERIFYING THE SERVICE

10. ACTUAL LOCATION OF SERVICE (ADDRESS) 11. CUSTOMER’S PRINTED NAME

12. CUSTOMER’S TELEPHONE#

13. SHIPPING PAPERWORK NUMBER(S) OR MANIFEST NUMBER(S):

NOTE TO CUSTOMER: NEITHER YOU, NOR THE COR, ARE AUTHORIZED TO DIRECT OR ALLOW THE CONTRACTOR TO PERFORM ANY WORK WHICH IS NOT SPECIFICALLY IDENTIFIED IN THE TASK ORDER. ONLY THE KO HAS THAT AUTHORITY. ANY REQUESTS FOR CHANGES TO WHAT IS ORDERED ON THE TASK ORDER MUST BE APPROVED BY THE KO BEFORE REMOVAL OR OTHER WORK TAKES PLACE. IF CHANGES ARE NEEDED. CONTACT YOUR COR BEFORE PROCEEDING AND EXPLAIN ANY CHANGES IN “REMARKS”.

ANSWER QUESTIONS 14-16 IF YOU ANSWER “NO” TO ANY OF THE QUESTIONS CONTACT THE COR IMMEDIATELY FOR INSTRUCTIONS.

IF THE COR RESOLVES THE ISSUE(S), AND ALL PARTIES AGREE TO CONTINUE WITH THE SERVICE, THEN EXPLAIN FURTHER IN THE

REMARKS SECTION ON THE NEXT PAGE.

14. BEFORE ALLOWING ANY WORK TO BEGIN: YES NO N/A SEE REMARKS

A. Did the contractor arrive on the pre-arranged date & time? U U U U B. Does the contractor have sufficient equipment & personnel and act in a professional manner? U U U U C. Is the carrier’s vehicle suitable for hauling hazardous material and in good condition? U U U U D. If applicable, is the Driver in possession of all necessary hauling permits and a commercial driver’s license with a HAZMAT endorsement, which has been previously verified by a DLA Disposition U U U U Services COR?

15. DELIVERED SUPPLIES OR SERVICES: YES NO N/A SEE REMARKS

A. For supplies - Did Contractor deliver the correct quantity and types? U U U U B. For container swap out (roll offs, mud tanks, etc.) — Is replacement container in good condition and meet order requirements? (cover, right size, etc.).

C. For any other special service — Did contractor perform as required per Contract? U U U U D. Describe the special service:

16. PRIOR TO FINAL RELEASE OF THE SERVICE PROVIDED (IF APPLICABLE): YES NO N/A SEE REMARKS

A. Has the COPfContractor annotated the Task Order and Shipping paper(s) to reflect what was actually shipped?

B. Did you sign the Shipping Papers and receive a recei pt copy from the carrier? U U U U C. Did the contractor provide you with copies of all other pertinent documents? U U U U D. Were you satisfied with how the service went? U U U U

OLA FORM 2539, NOV 2024 PAGE 1 OF 2 PDF (DLA)

Prescribed by:

CUSTOMER’S VERIFICATION OF SERVICES SOP 4160.01-041

Sponsor: Disposition Senices

SECTION 3 - CUSTOMER’S VERIFICATION STATEMENT

17. CUSTOMERS SIGNATURE

I hereby attest that the line item(s) on the Task Order listed above, which are described and listed on the shipping paperwork number(s) listed above (if applicable) were removed and/or other services were completed by the contractor on this date. 18. DATE

PROVIDE A COPY OF THIS FORM, A COPY OF THE COMPLETED TASK ORDER AND ASSOCIATED HW MANIFESTS! SHIPPING PAPERS, AND ANY

OTHER PERTINENT DOCUMENTS TO YOUR COR AS SOON AS POSSIBLE.

RE MA R KS

Example Ordered supplies did not match what was requested. Ordered 5 gallon buckets with lids, but Contractor did not Remark: supply the lids. Took pictures and contacted COR for resolution. COR communicated discrepancy to Contractor Question ISA with disagreement arising. COR elevated to KO. KO instructed Contractor to deliver lids. Lids were received 2 weeks after initial receipt of 5 gallon buckets.

Example Upon re-weighing Line Item 3 of the Task Order, it was discovered to weigh 10 pounds more than first described. I Remark: contacted the COR, who then contacted the KO for a modification adding the weight. Upon discussion with the Question l6A Contractor, the KO modified Line Item 3 to reflect the extra 10 pounds, and it was removed as requested.

19. ADDITIONAL COMMENTS

DLA FORM 2539, NOV 2024 PAGE 2 OF 2 PDF (OLA)