Attachment J-12 Acknowledgement of Receipt AOR Form.pdf
PDF 127 KB Posted
- Attached to
- U. S. Senate Information Technology Support Contract (ITSC) V Federal contract opportunity
- Solicitation number
- 2025-R-001
- Issued by
- United States Senate
About this file
This is an Acknowledgement of Receipt form from the United States Senate Sergeant at Arms documenting the delivery and installation of IT equipment under purchase order PSPA21800029. The form lists several hardware items including two HP 840 G5 laptops (one SIPP and one non-SIPP configuration), two Varidesk standing desk converters (models 49770 and 48504), HP Thunderbolt docks, and DDR4 memory modules. The form includes fields for asset tag numbers, serial numbers, office location information, and requires verification and signature from both the installation technician and office representative to confirm physical receipt of the items.
This form appears to be related to the broader U.S. Senate Information Technology Support Contract (ITSC) V solicitation, which involves comprehensive IT support services including hardware acquisition and maintenance. The form serves as documentation for tracking and confirming delivery of IT equipment to Senate offices.
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Text version
*302293* Office:
State:
PO Number: PSPA21800029 *PSPA21800029*
ID Item Qty Commodity Code Model Number Verified
002 4 425-49-00-020
003 2 204-35-99-353
004 2 204-35-99-353
005 2 204-35-99-354
001 1 425-49-00-018
Vendor Model Number Asset Tag # Verified
Varidesk 039599
*N/A* *399599* 006 1 204-54-10-418
Vendor Model Number Room Staffer Asset Tag # Verified
HPI 039927
*5CG8352F5T* *399627*
007 1 204-54-10-419
Vendor Model Number Room Staffer Asset Tag # Verified
HPI 039626
*5CG8351X0V* *399626*
Date:
Serial Number
5CG8351X0V
By signing this form, you acknowledge receipt of all listed items, including those on preceding pages.
Office Representative, Print Name:
HPI 840 G5 NON SIPP CTO (30011473)
Location:
Description
VARIDESK (49770)
HPI 3TR87AA THUNDERBOLT DOCK G2 W/ COMBO CABLE
HPI 3TK88AA 8GB DDR4-2666 SODIMM
HPI 3TK88AA 8GB DDR4-2666 SODIMM
VARIDESK PRO PLUS (48504) Room
Room StafferSerial Number
N/A
HPI 840 G5 SIPP CTO (30011303)
Serial Number
5CG8352F5T
123456 Tech Dev DC
DC
Rev 04-27-2004
Attachment J-12 Acknowledgement of Receipt AOR Form
UNITED STATES SENATE SERGEANT AT ARMS
ACKNOWLEDGEMENT OF RECEIPT
Page __ of __
SC Ticket:
*302293* Office:
State:
PO Number: PSPA21800029 *PSPA21800029*
Location:
123456 Tech Dev DC
DC
UNITED STATES SENATE SERGEANT AT ARMS
Rev 04-27-2004 ACKNOWLEDGEMENT OF RECEIPT Page __ of __
SC Ticket:
Date of Installation-DeliveryInstallation Technician
Office Representative, Signature:
I have physically verified and received all items listed above.
File details come from the government source that posted it. Updated .