Attachment J-13 Record of Equipment Transfer.pdf
PDF 68 KB Posted
- Solicitation number
- 2025-R-001
- Issued by
-
United States Senate
About this file
This is a Record of Equipment Transfer form used by the United States Senate Office of the Sergeant at Arms to track and document equipment movements. The form is a template that captures details including the office name, service management number, date, and type of transfer (delivery/install, inheritable, office move, return to stock, or other).
The form contains a table to record equipment details including model, bar code, serial number, current/new locations, and current/new users. It requires three sets of signatures: one from the receiving office acknowledging receipt and responsibility for the equipment, one from the vendor technician, and one from ITSS (Information Technology Support Staff). The form includes a statement that equipment usage must comply with United States Senate rules and regulations.
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Text version
Office:
SM #:
Date:
United States Senate Page ___ of _
Office of the Sergeant at Arms Record of Equipment Transfer
Delivery/Install Inheritable Office Move Return to Stock Other
Model Bar Code Serial No Current Location New Location Current User New User
OFFICE:
Signature Printed Name Date
On behalf of the receiving office, I acknowledge receipt of and responsibility for the equipment listed above. Usage of this equipment will be in accordance with the rules and regulations of the United States Senate.
Vendor Tech:
Signature Printed Name Date
ITSS:
Signature Printed Name Date version 4
| Office: SM #: |
| Delivery/Install Inheritable Office Move Return to Stock Other |
| Vendor Tech: |
| Signature Printed Name Date |
| ITSS: |
Signature Printed Name Date
| Office: |
| SM: |
| Date: |
| DeliveryInstall: Off |
| Inheritable: Off |
| Office Move: Off |
| Return to Stock: Off |
| Other: |
| ModelRow1: |
| Bar CodeRow1: |
| Serial NoRow1: |
| Current LocationRow1: |
| New LocationRow1: |
| Current UserRow1: |
| New UserRow1: |
| ModelRow2: |
| Bar CodeRow2: |
| Serial NoRow2: |
| Current LocationRow2: |
| New LocationRow2: |
| Current UserRow2: |
| New UserRow2: |
| ModelRow3: |
| Bar CodeRow3: |
| Serial NoRow3: |
| Current LocationRow3: |
| New LocationRow3: |
| Current UserRow3: |
| New UserRow3: |
| ModelRow4: |
| Bar CodeRow4: |
| Serial NoRow4: |
| Current LocationRow4: |
| New LocationRow4: |
| Current UserRow4: |
| New UserRow4: |
| ModelRow5: |
| Bar CodeRow5: |
| Serial NoRow5: |
| Current LocationRow5: |
| New LocationRow5: |
| Current UserRow5: |
| New UserRow5: |
| ModelRow6: |
| Bar CodeRow6: |
| Serial NoRow6: |
| Current LocationRow6: |
| New LocationRow6: |
| Current UserRow6: |
| New UserRow6: |
| ModelRow7: |
| Bar CodeRow7: |
| Serial NoRow7: |
| Current LocationRow7: |
| New LocationRow7: |
| Current UserRow7: |
| New UserRow7: |
| ModelRow8: |
| Bar CodeRow8: |
| Serial NoRow8: |
| Current LocationRow8: |
| New LocationRow8: |
| Current UserRow8: |
| New UserRow8: |
| ModelRow9: |
| Bar CodeRow9: |
| Serial NoRow9: |
| Current LocationRow9: |
| New LocationRow9: |
| Current UserRow9: |
| New UserRow9: |
| ModelRow10: |
| Bar CodeRow10: |
| Serial NoRow10: |
| Current LocationRow10: |
| New LocationRow10: |
| Current UserRow10: |
| New UserRow10: |
| ModelRow11: |
| Bar CodeRow11: |
| Serial NoRow11: |
| Current LocationRow11: |
| New LocationRow11: |
| Current UserRow11: |
| New UserRow11: |
| ModelRow12: |
| Bar CodeRow12: |
| Serial NoRow12: |
| Current LocationRow12: |
| New LocationRow12: |
| Current UserRow12: |
| New UserRow12: |
| ModelRow13: |
| Bar CodeRow13: |
| Serial NoRow13: |
| Current LocationRow13: |
| New LocationRow13: |
| Current UserRow13: |
| New UserRow13: |
| Printed Name: |
| Date_2: |
| Printed Name_2: |
| Date_3: |
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