Attachment 4 - DHS_Form_700-21.pdf

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Coated Steel Pipe Piles
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70Z08426QWOPL0004
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This document is a Department of Homeland Security (DHS) Material Inspection Acceptance and Receiving Report (Form 700-21), which serves as a standard form for documenting the inspection and acceptance of materials or services under a contract. The two-page form provides a template for recording key details about contract deliverables, including contract number, order number, contractor information, inspection dates, quantities received, accepted, and rejected, and space for remarks and signatures of the inspecting official.

The form is designed to formally document the inspection process, allowing government personnel to verify that materials or services conform to contract requirements. Specific sections include spaces to record inspection dates (received, ready, started, completed), quantity details (on order, accepted to date, balance remaining), and provide a formal certification that inspected items meet contractual specifications. While this particular document is an empty template, it represents a critical administrative tool in federal contract management for tracking and validating contractor performance and deliverable quality.

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Other files

File Type Posted
70Z08426QWOPL0004 Amendment 0001.pdf PDF
Attachment 1-rev - Schedule of Supplies (Amendment 0001).xlsx XLSX spreadsheet
Attachment 5 - PPQ.docx DOCX document
Attachment 3 - Specifications Coated Steel Pipe Piles.pdf PDF
Attachment 6 - Clauses and Provisions.docx DOCX document
70Z08426QWOPL0004 Combined Sol-Synopsis.docx DOCX document
Attachment 1 - Schedule of Supplies.xlsx XLSX spreadsheet
Attachment 2 - Delivery Locations.pdf PDF

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DATE

1. CONTRACT NO. AND LATEST

MODIFICATION NO.

2. ORDER NO. 3. REPORT NO.

4. MATERIAL AND/OR SERVICES INSPECTED

5. CONTRACTOR

7. MANUFACTURER

8. PLACE OF INSPECTION

DHS Form 700-21 (10/14) Page 1 of 2

PREVIOUS

REPORTS

16. SUBMITTED

17. REJECTED

18. ACCEPTED

19. QUANTITY ON

ORDER

22. REMARKS (Use Continuation Sheet for Additional Entries)

23. INSPECTED BY 24. TITLE AND TELEPHONE NUMBER

The materials and/or services listed herein have been inspected or certified test data has been examined, by me or under my supervision.

The materials and/or services listed above as accepted conform to contract requirements. Those listed as rejected do not conform and may not be delivered, except as authorized under "Remarks."

25. SIGNATURE AND PRINTED NAME 26. TITLE AND TELEPHONE NUMBER 27. DATE

DEPARTMENT OF HOMELAND SECURITY

MATERIAL INSPECTION ACCEPTANCE AND RECEIVING REPORT

CONTRACT LINE

ITEM NO(S)

(If applicable)

9.

15. ACCEPTED14. REJECTED

QUANTITY

13. COMPLETED12. STARTED11. READY10. RECEIVED

INSPECTION DATES

20. ACCEPTED TO

DATE

21. BALANCE

REMAINING

THIS

REPORT

TOTAL

TO DATE

6. LOCATION WHERE ITEMS WERE DELIVERED OR

CONTRACTOR PERFORMED

3. REPORT NO.

DEPARTMENT OF HOMELAND SECURITY

MATERIAL INSPECTION ACCEPTANCE AND RECEIVING REPORT (Continued)

CONTRACT LINE

ITEM NO(S)

(If applicable)

9.

15. ACCEPTED14. REJECTED

QUANTITY

13. COMPLETED12. STARTED11. READY10. RECEIVED

INSPECTION DATES

Page 2 of 2DHS Form 700-21 (10/14)

Material Inspection Acceptance and Receiving Report, December 2003 U.S. Department of Homeland Security, Acquisition Policy and Legislation D:20040317145138- 05'00' D:20051012110539- 04'00'

DATE

1. CONTRACT NO. AND LATEST

MODIFICATION NO.

2. ORDER NO.

3. REPORT NO.

4. MATERIAL AND/OR SERVICES INSPECTED

5. CONTRACTOR

7. MANUFACTURER

8. PLACE OF INSPECTION

DHS Form 700-21 (10/14)

PREVIOUS REPORTS

16. SUBMITTED

17. REJECTED

18. ACCEPTED

19. QUANTITY ON ORDER

22. REMARKS (Use Continuation Sheet for Additional Entries)

23. INSPECTED BY

24. TITLE AND TELEPHONE NUMBER

The materials and/or services listed herein have been inspected or certified test data has been examined, by me or under my supervision. The materials and/or services listed above as accepted conform to contract requirements. Those listed as rejected do not conform and may not be delivered, except as authorized under "Remarks."

The materials and/or services listed herein have been inspected or certified test data has been examined, by me or under my supervision. The materials and/or services listed above as accepted conform to contract requirements. Those listed as rejected do not conform and may not be delivered, except as authorized under Remarks.

25. SIGNATURE AND PRINTED NAME

26. TITLE AND TELEPHONE NUMBER

27. DATE

DEPARTMENT OF HOMELAND SECURITY

MATERIAL INSPECTION ACCEPTANCE AND RECEIVING REPORT

CONTRACT LINE

ITEM NO(S)

(If applicable) 9.

15. ACCEPTED

14. REJECTED

QUANTITY

13. COMPLETED

12. STARTED

11. READY

10. RECEIVED

INSPECTION DATES

20. ACCEPTED TO DATE

21. BALANCE REMAINING

THIS

REPORT

TOTAL

TO DATE

6. LOCATION WHERE ITEMS WERE DELIVERED OR

CONTRACTOR PERFORMED

3. REPORT NO.

DEPARTMENT OF HOMELAND SECURITY

MATERIAL INSPECTION ACCEPTANCE AND RECEIVING REPORT (Continued)

CONTRACT LINE

ITEM NO(S)

(If applicable) 9.

15. ACCEPTED

14. REJECTED

QUANTITY

13. COMPLETED

12. STARTED

11. READY

10. RECEIVED

INSPECTION DATES

DHS Form 700-21 (10/14)

9. CONTRACT LINE ITEM NUMBER(S) (If applicable) Line 38 of 38.:
15. Quantity Accepted:
14. Quantity REJECTED:
Inspection Dates. 13. Completed Date. Enter 2-digit month, 2-digit day and 4-digit year.:
Inspection Dates. 12. Started Date. Enter 2-digit month, 2-digit day and 4-digit year.:
Inspection Dates. 11. Ready Date. Enter 2-digit month, 2-digit day and 4-digit year.:
Inspection Dates. 10. Received Date. Enter 2-digit month, 2-digit day and 4-digit year.:
Date. Enter 2-digit month, 2-digit day and 4-digit year.:
1. Contract Number and Latest Modification Number.:
2. ORDER NUMBER.:
4. MATERIAL AND/OR SERVICES INSPECTED.:
5. CONTRACTOR.:
7. MANUFACTURER:
8. PLACE OF INSPECTION:
16. SUBMITTED. PREVIOUS REPORTS:
16. SUBMITTED. THIS REPORT:
16. SUBMITTED. TOTAL TO DATE:
17. REJECTED. TOTAL TO DATE:
17. REJECTED. THIS REPORT:
17. REJECTED. PREVIOUS REPORTS:
18. ACCEPTED. TOTAL TO DATE:
18. ACCEPTED. THIS REPORT:
18. ACCEPTED. PREVIOUS REPORTS:
22. REMARKS (Use Continuation Sheet for Additional Entries). :
23. INSPECTED BY.:
24. TITLE.:
26. TITLE. :
27. DATE. Enter 2-digit month, 2-digit day and 4-digit year.:
19. QUANTITY ON ORDER:
20. ACCEPTED TO DATE:
21. BALANCE REMAINING:
25. PRINTED NAME.:
3. REPORT NUMBER. :
6. LOCATION WHERE ITEMS WERE DELIVERED OR CONTRACTOR PERFORMED.:
26. Telephone Number. Enter 10 digit telephone number including area code.:
25. SIGNATURE. Digital Signature.:

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