J10 - Sample Delivery Certificate.doc
DOC document 32 KB Posted
- Attached to
- Nuclear Ship SAVANNAH Technical Support for Integrated Management of Licensed Activities
- Solicitation number
- DTMA-91-R-2012-0016
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Sample Delivery Certificate
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Text version
VESSEL DELIVERY CERTIFICATE
THIS IS TO CERTIFY that on the _____ day of __________ 20___, at ______ hours Eastern Standard Time, the N.S. Savannah (Official Number), a vessel owned by the United States of America, represented by the Department of Transportation, acting by and through the Maritime Administration, and in the custody of Keystone Shipping Company of Bala Cynwyd, Pennsylvania under General Agency Agreement DTMA insert number, was physically redelivered by Keystone Shipping Company to the Department of Transportation, Maritime Administration. Simultaneously, the said vessel was physically delivered by the Department of Transportation, Maritime Administration into the custody of (Contractor Name) under Contract Number DTMA insert number.
The said vessel will be husbanded by (Contractor Name) in accordance with the terms of the above contract. The vessel has been surveyed and is found to be in good, sound, seaworthy condition, and has onboard fixtures, tackle, apparel, furnishings, artifacts, equipment, and consumable/expendable stores as listed in inventories taken and agreed to, or reserved for completion by set date, by the Maritime Administration, Keystone Shipping Company, and (Contractor Name) on this date.
| United States of America |
| Keystone Shipping Company |
| Contractor |
Department of Transportation
Maritime Administration
| By: |
| _____________________ |
| By: |
| _________________________ |
| By: |
| _______________________ |
Typed name
Typed name
Title:
Title:
Title:
| Date: |
| ______________________ |
| Date: |
| _________________________ |
| Date: |
| _______________________ |
Attachments:
(1) Tank Sounding Report
First Original Counterpart to be retained by the United States of America
Second Original Counterpart to be retained by Keystone Shipping Company Third Original Counterpart to be retained by (Contractor Name) Original # 1 of 3
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