Attachment B.1. Delivery Acceptance Document.docx

DOCX document 25 KB Posted

Attached to
6710--VRE Small Business - Surveillance Resources
Solicitation number
36C10D26Q0114
Issued by

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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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 .