Attachment 15 - TE 15 - Blank DD250.pdf

DD FORM 250, AUG 2000

MATERIAL INSPECTION AND RECEIVING REPORT

PREVIOUS EDITION IS OBSOLETE.

Form Approved OMB No. 0704-0248

The public reporting burden for this collection of information is estimated to average 30 minutes 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0248). 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.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.

SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.

1. PROCUREMENT INSTRUMENT IDENTIFICATION

(CONTRACT) NO.

ORDER NO.

2. SHIPMENT NO. 3. DATE SHIPPED 4. B/L

TCN

5. DISCOUNT TERMS

6. INVOICE NO./DATE 7. PAGE OF 8. ACCEPTANCE POINT

9. PRIME CONTRACTOR CODE 10. ADMINISTERED BY CODE

11. SHIPPED FROM (If other than 9) CODE FOB: 12. PAYMENT WILL BE MADE BY CODE

13. SHIPPED TO CODE 14. MARKED FOR CODE

15.

ITEM NO.

16. STOCK/PART NO. DESCRIPTION

(Indicate number of shipping containers - type of container - container number.)

17. QUANTITY

SHIP/REC'D*

* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark;

if different, enter actual quantity received below quantity shipped and encircle.

18.

UNIT

19.

UNIT PRICE

20.

AMOUNT

21. CONTRACT QUALITY ASSURANCE

a. ORIGIN

CQA ACCEPTANCE of listed items has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.

DATE SIGNATURE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

TYPED NAME:

TITLE:

MAILING ADDRESS:

COMMERCIAL TELEPHONE

NUMBER:

b. DESTINATION

CQA ACCEPTANCE of listed items has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.

DATE SIGNATURE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

TYPED NAME:

TITLE:

MAILING ADDRESS:

COMMERCIAL TELEPHONE

NUMBER:

22. RECEIVER'S USE

Quantities shown in column 17 were received in apparent good condition except as noted.

DATE RECEIVED SIGNATURE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

TYPED NAME:

TITLE:

MAILING ADDRESS:

COMMERCIAL TELEPHONE

NUMBER:

23. CONTRACTOR USE ONLY

DD Form 250, Material Inspection and Receiving Report, August 2000 D:20040302211848Z D:20061108084032- 05'00'

WHS/ESD/IMD

DD FORM 250, AUG 2000

MATERIAL INSPECTION AND RECEIVING REPORT

PREVIOUS EDITION IS OBSOLETE.

Form Approved OMB No. 0704-0248 The public reporting burden for this collection of information is estimated to average 30 minutes 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0248). 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.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.

SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.

1. PROCUREMENT INSTRUMENT IDENTIFICATION

(CONTRACT) NO.

ORDER NO.

2. SHIPMENT NO.

3. DATE SHIPPED

4. B/L

TCN

5. DISCOUNT TERMS

6. INVOICE NO./DATE

7. PAGE

OF

8. ACCEPTANCE POINT

9. PRIME CONTRACTOR

CODE

10. ADMINISTERED BY

CODE

11. SHIPPED FROM (If other than 9)

CODE

FOB:

12. PAYMENT WILL BE MADE BY

CODE

13. SHIPPED TO

CODE

14. MARKED FOR

CODE

15.

ITEM NO.

16. STOCK/PART NO.

DESCRIPTION

(Indicate number of shipping containers - type of container - container number.)

17. QUANTITY

SHIP/REC'D*

* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark;

if different, enter actual quantity received below quantity shipped and encircle.

18.

UNIT

19.

UNIT PRICE

20.

AMOUNT

21. CONTRACT QUALITY ASSURANCE

a. ORIGIN

CQA

ACCEPTANCE of listed items has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.

DATE

SIGNATURE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

TYPED NAME:

TITLE:

MAILING ADDRESS:

COMMERCIAL TELEPHONE

NUMBER:

b. DESTINATION

CQA

ACCEPTANCE of listed items has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.

DATE

SIGNATURE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

TYPED NAME:

TITLE:

MAILING ADDRESS:

COMMERCIAL TELEPHONE

NUMBER:

22. RECEIVER'S USE

Quantities shown in column 17 were received in apparent good condition except as noted.

DATE RECEIVED

SIGNATURE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

TYPED NAME:

TITLE:

MAILING ADDRESS:

COMMERCIAL TELEPHONE

NUMBER:

23. CONTRACTOR USE ONLY