Berks OS-501 confirmation of service.pdf

361 KB Posted

Attached to
Electrical service
Solicitation number
6100025468
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). The form is used to verify the receipt of services performed under a purchase order. The form includes details such as the vendor name, purchase order number, items or services provided, quantities, unit prices, and total amounts. It requires signatures from the contractor and PennDOT project manager to approve payment for the services rendered.

The document does not contain any information about a state or local contract opportunity. It appears to be a standard administrative form used by PennDOT to process payments for goods or services delivered under a purchase order.

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Other files

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GSPUR95.doc DOC document
OS-52.pdf PDF
Berks County Electrical Spec Revised 4-2013.doc DOC document

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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 .