Berks OS-501 confirmation of service.pdf

361 KB Posted

Attached to
BUILDING MAINTENANCE
Solicitation number
6100029026
Issued by
Berks County, Troxelville CDP, Pennsylvania

About this file

Written by GovTribe AI ·

This document is a Confirmation of Service form for the Pennsylvania Department of Transportation (PennDOT) contract OS-501. The form is used to confirm the satisfactory completion of services performed by a contractor for PennDOT. The form includes the contractor's information such as name, address, and phone number, as well as the purchase order number and the specific items and quantities of services provided. The form requires the signature of the contractor and the PennDOT project manager to approve payment for the services rendered.

The pricing and payment terms are not included in this document. However, the form indicates that the contractor must have a valid SAP vendor number, which suggests that the contractor has an established relationship with PennDOT and has been approved to perform services under this contract. The form also references a goods receipt process in SAP, which is likely the system used by PennDOT to track and process payments for the services provided.

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Date Service Rendered: _______________________________ SAP Vendor Number: ________________________________ Contractor Name: ____________________________________ Address (1): ________________________________________ Phone: ____________________________________________ Address (2): ________________________________________ PURCHASE ORDER # ________________________________ State:______________ Zip Code: ____________________

(Reference line items on purchase order that match the services that were performed.)

Item # Description / Product ID Quantity U.O.M. Unit Price Item Total

Total:

Contractor Signature: ________________________________ Date: _____________

CONFIRMATION OF SERVICE

OS-501 (11-12)

www.dot.state.pa.us

PENNDOT USE ONLY

I certify the services represented by the confirmation of service form above were received satisfactorily. Therefore, I approve payment be made.

I certify that I have entered a Goods Receipt in SAP for this service. (Goods Receipts should be entered within 48 hours per Management Directive 310.31)

Project Manager Signature Date (mm/dd/yyyy)

SRM/R3 Receiver Signature Date (mm/dd/yyyy) SRM Confirmation # / R3 Material Document #

Date Service Rendered:
SAP Vendor Number:
Contractor Name:
Address 1:
Phone:
Address 2:
PURCHASE ORDER:
State:
Zip Code:
Date:
Date mmddyyyy:
Item #, Row 1:
Item #, Row2:
Item #, Row4:
Item #, Row5:
Item #, Row3:
Item #, Row6:
Description Product ID, Row 1:
Description Product ID, Row 2:
Description Product ID, Row 3:
Description Product ID, Row 4:
Description Product ID, Row 5:
Description Product ID, Row 6:
UOM, Row 1:
UOM, Row 2:
UOM, Row 3:
UOM, Row 4:
Quantity 1:
Quantity 2:
Quantity 3:
Quantity 4:
Unit Price 1:
ItemTotal1: 0
Unit Price 2:
Unit Price 3:
Unit Price 4:
ItemTotal2: 0
ItemTotal3: 0
ItemTotal4: 0
TOTAL: 0
Quantity 5:
UOM, Row 5:
Unit Price 5:
ItemTotal5: 0
ItemTotal6: 0
Unit Price 6:
UOM, Row 6:
Quantity 6:
Date mmddyyyy_2:
Confirmation Number:

File details come from the government source that posted it. Updated .