Attachment 4 - DD Form 1155.pdf

PDF 174 KB Posted

Attached to
Turkey Electronic Hazardous Waste Federal contract opportunity
Solicitation number
SP4500-26-R-0006
Issued by
Defense Logistics Agency

About this file

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The document is a DD Form 1155, Order for Supplies or Services from December 2001. This is a standard federal procurement form designed to record the details of a government supply or service order, but the specific fields are left blank in this template. The form is prescribed by the Defense Federal Acquisition Regulation Supplement (DFARS) 253.213 and provides space for key contracting information such as contract/purchase order number, delivery details, contractor information, accounting data, item descriptions, quantities, pricing, and government authorization. The form includes sections for recording order acceptance, inspection, payment verification, and delivery confirmation, serving as a comprehensive document for tracking government procurement transactions.

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Attachment 12_Contractor Regist. Process _Turkey.pdf PDF
Attachment 15_PPI Questionnaire_02132025.pdf PDF
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Attachment 3 - DD Form 1348-1A.pdf PDF
Attachment 5_DLA Form 2503 Apply for QTL.pdf PDF
Attachment 6_DLA Form 2505 Invoice.pdf PDF
Attachment 10_ DLA Form 1367_Shipment Release.pdf PDF
Attachment 13_52.212-1_Instructions to Offerors.pdf PDF
Attachment 14_52.212‐2 Evaluation.pdf PDF
Attachment 7_DLA Form 2507 Apply for QFL.pdf PDF
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Attachment 16_Provisions_Clauses OCONUS.pdf PDF
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PREVIOUS EDITION IS OBSOLETE.DD FORM 1155, DEC 2001

Prescribed by: DFARS 253.213

ORDER FOR SUPPLIES OR SERVICES

PAGE 1 OF

1. CONTRACT/PURCH ORDER/AGREEMENT NO. 2. DELIVERY ORDER/CALL NO. 3. DATE OF ORDER/CALL

(YYYYMMMDD)

4. REQUISITION/PURCH REQUEST NO. 5. PRIORITY

6. ISSUED BY CODE 7. ADMINISTERED BY (If other than 6) CODE 8. DELIVERY FOB

DESTINATION

OTHER

(See Schedule if other)

9. CONTRACTOR CODE FACILITY

NAME

AND

ADDRESS

10. DELIVER TO FOB POINT BY (Date)

(YYYYMMMDD)

12. DISCOUNT TERMS

11. X IF BUSINESS IS

SMALL

SMALL DISAD-

VANTAGED

WOMEN-OWNED

13. MAIL INVOICES TO THE ADDRESS IN BLOCK

14. SHIP TO CODE 15. PAYMENT WILL BE MADE BY CODE MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATION

NUMBERS IN

BLOCKS 1 AND 2.

16.

TYPE

OF

ORDER

DELIVERY/

CALL This delivery order/call is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contract.

PURCHASE

Reference your furnish the following on terms specified herein.

ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME.

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED

(YYYYMMMDD)

If this box is marked, supplier must sign Acceptance and return the following number of copies:

17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE

18. ITEM NO. 19. SCHEDULE OF SUPPLIES/SERVICES

20. QUANTITY

ORDERED/

ACCEPTED*

21.

UNIT

22. UNIT PRICE

23. AMOUNT

*If quantity accepted by the Government is same as quantity ordered, indicate by X.

If different, enter actual quantity accepted below quantity ordered and encircle.

24. UNITED STATES OF AMERICA

BY: CONTRACTING/ORDERING OFFICER

25. TOTAL

26.

DIFFERENCES

27a. QUANTITY IN COLUMN 20 HAS BEEN

INSPECTED RECEIVED ACCEPTED, AND CONFORMS TO THE

CONTRACT EXCEPT AS NOTED:

b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE c. DATE

(YYYYMMMDD)

d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

f. TELEPHONE NUMBER g. E-MAIL ADDRESS

36. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT.

a. DATE

(YYYYMMMDD)

b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

37. RECEIVED

AT

38. RECEIVED BY (Print) 39. DATE RECEIVED

(YYYYMMMDD)

28. SHIP. NO.

PARTIAL

FINAL

31. PAYMENT

COMPLETE

PARTIAL

FINAL

29. D.O. VOUCHER NO. 30. INITIALS

32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR

34. CHECK NUMBER

35. BILL OF LADING NO.

40. TOTAL CON-

TAINERS

41. S/R ACCOUNT NUMBER 42. S/R VOUCHER NO.

DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

DD FORM 1155, DEC 2001

Prescribed by: DFARS 253.213

PREVIOUS EDITION IS OBSOLETE.

DD FORM XXXX (BACK), 20YYMMDD DRAFT

DRAFT

Page of

DRAFT

INSTRUCTIONS

NEEDS DD67

PREVIOUS EDITION IS OBSOLETE.

DD FORM XXXX, 20YYMMDD DRAFT

Page of

ORDER FOR SUPPLIES OR SERVICES

6. ISSUED BY

CODE

7. ADMINISTERED BY (If other than 6)

CODE

8. DELIVERY FOB

9. CONTRACTOR

CODE

FACILITY

NAME AND ADDRESS

11. X IF BUSINESS IS

14. SHIP TO

CODE

15. PAYMENT WILL BE MADE BY

CODE

MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATION

NUMBERS IN

BLOCKS 1 AND 2.

16. TYPE OF ORDER

DELIVERY/CALL

This delivery order/call is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contract.

PURCHASE

Reference your furnish the following on terms specified herein.

ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME.

18. ITEM NO.

19. SCHEDULE OF SUPPLIES/SERVICES

20. QUANTITY ORDERED/ACCEPTED*

21. UNIT

23. AMOUNT

*If quantity accepted by the Government is same as quantity ordered, indicate by X.

If different, enter actual quantity accepted below quantity ordered and encircle.

24. UNITED STATES OF AMERICA

CONTRACTING/ORDERING OFFICER

25. TOTAL

26. DIFFERENCES

27a. QUANTITY IN COLUMN 20 HAS BEEN

36. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT.

31. PAYMENT

30. INITIALS

9.0.0.2.20120627.2.874785 DD Form 1155, "ORDER FOR SUPPLIES OR SERVICES"

Click this Reset button to erase data from all fields.:
Click this button to save this form.:
Click this button to print this form.:
CurrentPage:
PageCount:
ORDER FOR SUPPLIES OR SERVICES - PAGE 1 OF... - Enter total number of pages.:
42. S/R VOUCHER NUMBER:
DateField1:
31. PAYMENT - Select for "COMPLETE.": 0
31. PAYMENT - Select for "COMPLETE.": 0
31. PAYMENT - Select for "COMPLETE.": 0
31. PAYMENT - Select for "COMPLETE.": 0
31. PAYMENT - Select for "COMPLETE.": 0
31. PAYMENT - Select for "PARTIAL.": 0
31. PAYMENT - Select for "PARTIAL.": 0
31. PAYMENT - Select for "PARTIAL.": 0
31. PAYMENT - Select for "PARTIAL.": 0
31. PAYMENT - Select for "PARTIAL.": 0
DateField2:
31. PAYMENT - Select for "FINAL.": 0
31. PAYMENT - Select for "FINAL.": 0
16. TYPE OF ORDER - SIGNATURE:
16. TYPE OF ORDER - DATE SIGNED (YYYYMMMDD):
27a. QUANTITY IN COLUMN 20 HAS BEEN - Select for "ACCEPTED, AND CONFORMS TO THE CONTRACT EXCEPT AS NOTED:": 0
27a. QUANTITY IN COLUMN 20 HAS BEEN - Select for "ACCEPTED, AND CONFORMS TO THE CONTRACT EXCEPT AS NOTED:": 0
27a. QUANTITY IN COLUMN 20 HAS BEEN - Select for "ACCEPTED, AND CONFORMS TO THE CONTRACT EXCEPT AS NOTED:": 0
27a. QUANTITY IN COLUMN 20 HAS BEEN - Select for "ACCEPTED, AND CONFORMS TO THE CONTRACT EXCEPT AS NOTED:": 0
Enter number of copies.:
20. QUANTITY ORDERED/ACCEPTED (If quantity accepted by the Government is

same as quantity ordered, indicate by X.

If different, enter actual quantity accepted below quantity ordered and encircle.), line 1.:

22. UNIT PRICE, line 1.:
23. AMOUNT (automatically calculated), line 1.:
20. QUANTITY ORDERED/ACCEPTED (If quantity accepted by the Government is

same as quantity ordered, indicate by X.

If different, enter actual quantity accepted below quantity ordered and encircle.), line 2.:

22. UNIT PRICE, line 2.:
23. AMOUNT (automatically calculated), line 2.:
20. QUANTITY ORDERED/ACCEPTED (If quantity accepted by the Government is

same as quantity ordered, indicate by X.

If different, enter actual quantity accepted below quantity ordered and encircle.), line 3.:

22. UNIT PRICE, line 3.:
23. AMOUNT (automatically calculated), line 3.:
25. TOTAL (automatically calculated):
26. DIFFERENCES, line 1.:
26. DIFFERENCES, line 2.:
27b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE:
27c. DATE (YYYYMMMDD):
36. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT. - a. DATE (YYYYMMMDD):
36. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT. - b. SIGNATURE AND TITLE OF CERTIFYING OFFICER:
DateField6:
DecimalField15:

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