Attachment B.1. Delivery Acceptance Document.docx
DOCX document 25 KB Posted
- Solicitation number
- 36C10D26Q0114
- Issued by
-
Department of Veterans Affairs
About this file
This is a Delivery Acceptance Document that serves as a receipt and verification form for delivered items under Department of Veterans Affairs Solicitation 36C10D26Q0114 for surveillance resources. The document is a template requiring vendors to document the acceptance of 17 contract line items (CLINs) across surveillance and related equipment categories.
The items specified include specialized surveillance equipment such as hidden cameras (Dissembler Pro Max, Dissembler PVC Pro, Dissembler Tan Rock), keychain and glasses-mounted cameras (Lawmate models), near-field detection receivers (Andre Deluxe), and stabilization equipment (Hohem iSteady MT2 Kit). Additional items include a 4K dash cam (VIOFO A229 Pro), cellular surveillance camera (HyperFire 4K), WiFi-enabled coffee cup DVR, computer equipment (14-inch MacBook Pro M4 Max), and consumables such as lithium batteries (6 packs), memory cards (SDHC and microSD). The document requires vendors to confirm the quantity delivered matches the quantity required, record the acceptance date, and obtain the signature of the government accepting representative. Upon completion, the form must be submitted with the invoice and bill of lading to fulfill contract delivery and acceptance requirements.
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| File | Type | Posted |
|---|---|---|
| 36C10D26Q0114.docx | DOCX document |
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Text version
Vendor shall edit Name of Item and Model Number as needed to reflect delivered/accepted item
| Status |
| Acceptance |
| CLIN # |
| Name of item and Model Number |
(same as or equal)
| Quantity Required |
| Quantity Delivered |
| Confirmed |
| Date |
| 0001 |
| Andre® Deluxe Near-field Detection receiver | M/N: REI-ANDRE-8-00103 |
| 1 |
| 0002 |
| Dissembler Pro Max Hidden Camera |
| 1 |
| 0003 |
| custom 50 mm Camera (Pairs w/ Dissembler Pro Max Hidden Camera) |
| 1 |
| 0004 |
| Dissembler PVC Pro Hidden Camera |
| 1 |
| 0005 |
| Dissembler Ground Pipe Mount (Pairs w/Dissembler PVC Pro Hidden Camera) |
| 1 |
| 0006 |
| Dissembler Tan Rock Hidden Camera |
| 1 |
| 0007 |
| Lawmate PV-RC400UW Keychain Fob Camera | M/N: PV-RC400UW |
| 1 |
| 0008 |
| Lawmate Hidden Camera Glasses | M/N: 5711 |
| 1 |
| 0009 |
| Hohem iSteady MT2 Kit with MIC-01 & Briefcase Handle | M/N: MT2-MIC01-BRIEF |
| 1 |
| 0010 |
| HyperFire 4K Surveillance LPC Cellular Camera External Antenna |
| 1 |
| 0011 |
| Lithium AA 12-Pack batteries |
| 6 |
| 0012 |
| 128GB SDHC Memory Card |
| 2 |
| 0013 |
| HyperFire 4K Surveillance LPC Cellular Camera |
| 1 |
| 0014 |
| 14-inch MacBook Pro - Space Blck M4 Max chip 14 CPU; 32GPU; 16 NE: 2TB SSD |
| 1 |
| 0015 |
| WiFi Coffee Cup Lid DVR |
| 1 |
| 0016 |
| VIOFO A229 Pro 4K HDR Dash Cam |
| 1 |
| 0017 |
| VIOFO 512GB Industrial Grade microSD Card |
| 1 |
Contract Number:
Bill of Laden or Invoice Number:
Signature of Accepting Representative (Gov't)
Contract: 36C10D26PXXX
Attachment B.1. Delivery Acceptance Document (submit completed form with invoice)
File details come from the government source that posted it. Updated .