DARPA-BAA-16-22_Attachment_6_Proposal_Template_-_Purchase_Order.pdf

DARPA‐BAA‐16‐22

DARPA‐BAA‐16‐22 Improv BAA

Attachment 6

Purchase Order Template

Do not enter or change information in any field other than those referenced in these instructions.

Do not include any classified information in the Purchase Order.

Page 1 (DD Form 1155): Provide the information requested in the yellow highlighted fields:

Field 9: Enter your organization and mailing address.

Field 11: If your organization is considered any of the following 3 business types, check the appropriate box: Small, Small Disadvantaged, Women‐owned. If none are applicable, leave this field blank.

Page 2 (Additions to DD Form 1155): In the yellow highlighted fields, enter your proposed cost for the Phase 1‐Feasibility Study. The same amount should be entered in each field and should not exceed $40,000. Do not include your proposed costs for Phase 2‐Prototype Construction or Phase 3‐Prototype

Evaluation.

Line Item No. 0001:

o Unit Price o Amount o Net Amt

Line Item No. 000101:

o Amount o Net Amt

Pages 3 ‐ 4 (Additions to DD Form 1155): Do not enter or change any information.

14. SHIP TO

ORDER FOR SUPPLIES OR SERVICES

PAGE 1 OF

1. CONTRACT/PURCH ORDER/AGREEMENT NO. 2. DELIVERY ORDER/CALL NO. 3. DATE OF ORDER/CALL

(YYYYMMMDD)

4. REQUISITION/PURCH REQUEST NO. 5. PRIORITY

CODE 7. ADMINISTERED BY (If other than 6) CODE 8. DELIVERY FOB

DESTINATION

OTHER

(See Schedule if other)

10. DELIVER TO FOB POINT BY (Date)

(YYYYMMMDD)

12. DISCOUNT TERMS

11. X IF BUSINESS IS

SMALL

SMALL DISAD-

VANTAGED

WOMEN-OWNED

CODE 15. PAYMENT WILL BE MADE BY CODE MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATION

NUMBERS IN

BLOCKS 1 AND 2.

16.

TYPE

OF

ORDER

DELIVERY/

CALL

PURCHASE

This delivery order/call is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contract.

Reference your furnish the following on terms specified herein.

ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME.

If this box is marked, supplier must sign Acceptance and return the following number of copies:

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED

(YYYYMMMDD)

17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE

18. ITEM NO. 19. SCHEDULE OF SUPPLIES/SERVICES

20. QUANTITY

ORDERED/

ACCEPTED*

21.

UNIT

22. UNIT PRICE 23. AMOUNT

*If quantity accepted by the Government is same as quantity ordered, indicate by X.

If different, enter actual quantity accepted below quantity ordered and encircle.

24. UNITED STATES OF AMERICA 25. TOTAL

26.

DIFFERENCES

30. INITIALS

27a. QUANTITY IN COLUMN 20 HAS BEEN

INSPECTED RECEIVED ACCEPTED, AND CONFORMS TO

THE CONTRACT EXCEPT AS NOTED:

c. DATE

(YYYYMMMDD)

b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

28. SHIP. NO.

PARTIAL

FINAL

31. PAYMENT

COMPLETE

PARTIAL

FINAL

29. D.O. VOUCHER NO.

32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR

34. CHECK NUMBER

35. BILL OF LADING NO.

42. S/R VOUCHER NO.

36. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT.

a. DATE

(YYYYMMMDD)

b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

37. RECEIVED

AT

38. RECEIVED BY (Print) 39. DATE RECEIVED

(YYYYMMMDD)

40. TOTAL CON-

TAINERS

41. S/R ACCOUNT NUMBER

DD FORM 1155, DEC 2001 PREVIOUS EDITION IS OBSOLETE.

CONTRACTING/ORDERING

9. CONTRACTOR CODE FACILITY

NAME

AND

ADDRESS

BY:

d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

f. TELEPHONE NUMBER g. E-MAIL ADDRESS

HR0011-16-P-____

6. ISSUED BY

DARPA/CMO

ATTN: MICHAEL MUTTY

675 N. RANDOLPH STREET

ARLINGTON, VA 22203-2114

HR0011

SEE ITEM 6 X

SEE SCHEDULE

SEE SCHEDULE

13. MAIL INVOICES TO THE ADDRESS IN BLOCK

SEE ITEM 15

X DARPA-BAA-16-22 PROPOSAL

SEE SCHEDULE

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HR0011-16-P-____

Section 18-23 - ADDITIONS TO DD FORM 1155

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 EACH $______ $______

Basic

FFP

The Contractor shall perform in accordance with the Statement of Work (Attachment 1) FOB: Destination

NET AMT $______

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

000101 $______

Funding for CLIN 0001

FFP

FOB: Destination

NET AMT $______

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 N/A N/A N/A Government 000101 N/A N/A N/A Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

0001 N/A N/A N/A N/A

000101 N/A N/A N/A N/A

CLAUSES INCORPORATED BY REFERENCE

FAR 52.213-4 Terms and Conditions--Simplified Acquisitions (Other

Than Commercial Items)

MAR 2016

FAR 52.222-50 Combating Trafficking in Persons MAR 2015 FAR 52.222-54 Employment Eligibility Verification OCT 2015 DFARS 252.225-7048 Export-Controlled Items JUNE 2013

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

0001 30 Days After

Award

N/A DARPA

DR. JOHN MAIN

DEFENSE SCIENCES OFFICE

675 N. RANDOLPH STREET

ARLINGTON VA 22203-2114

703-526-2809

FOB: DESTINATION

HR0011

000101 N/A N/A N/A N/A

CLAUSES INCORPORATED BY FULL TEXT

G-1 Procuring Office Representative

(a) The Procuring Office Representative is Michael Mutty, DARPA/CMO, 675 North Randolph Street, Arlington, VA 22203-2114, telephone: 571-218-4588, e-mail: michael.mutty@darpa.mil.

(end of clause)

G-2 Delegation of Authority for Contract Administration

(a) DCMA __________________, is hereby designated as the Contracting Officer’s authorized representative for administering this contract in accordance with current directives.

(end of clause)

G-3 Purchase Order Administrative Data

(a) Invoices for goods received or services rendered under this purchase order shall be submitted electronically through Wide Area Work Flow – Receipt and Acceptance (WAWF):

(1) Vendors that have never used WAWF shall follow the directions in the WAWF Vendor Getting Started Guide available at the following website:

http://www.dfas.mil/contractorpay/electroniccommerce/wideareaworkflow.html. This website also contains links for Vendor training and practice. Additional support can be obtained by calling WAWF Customer Service at 866-618-5988.

(2) Back up documentation (such as timesheets, monthly status reports, etc.) can be included and attached to the invoice in WAWF. Attachments should be in PDF format, but Attachments created in any Microsoft Office product may be attached. Total limit for the size of files per invoice is 5 megabytes.

(b) The following information, regarding invoice routing DODAAC’s, must be entered for completion of the invoice in WAWF:

WAWF Invoice Type: 2-in-1 Issuing Office DoDAAC HR0011 Admin Office DoDAAC HR0011 Service Acceptor DoDAAC (for 2-in -1) Service Approver DoDAAC (Cost Voucher)

HR0011/004

DCAA Office DoDAAC (Used on Cost Vouchers only) Not Applicable Paying Office DoDAAC

(c) Cost Vouchers from Contractors approved by DCAA for direct billing will be directly routed to DFAS. Cost Vouchers from Contractors not approved for direct billing will be routed to DCAA for approval before the Cost Voucher is routed to DFAS. All Final Cost Voucher submissions will be routed to the Service Approver for approval. The DCAA office for this award is: Not Applicable

(d) For each invoice/cost voucher submitted for payment, the contractor shall also e-mail the WAWF automated invoice notice directly to the following points of contact:

Name E-mail Phone Role Ms. Karen McMullen karen.mcmullen@darpa.mil (703) 696-2344 ProgAnalyst

(e) Travel. All travel requests, other than local travel, shall be approved in advance by the Contracting Officer.

The contractor shall maintain a travel policy consistent with the federal cost principles for non-profit educational institutions, which are incorporated in FAR 31.3.

Attachment 1 Improv Statement of Work