1-_GSA_300.pdf

PDF 514 KB Posted Aug 18, 2015

Attached to: Fire Safety Surveys
Solicitation number: EQ10PME-15-5002-5009
Issued by: General Services Administration Public Buildings Service Region 10

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GSA 300

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FOR

GOVERNMENT

USE

ONLY

5. ACCOUNTING AND APPROPRIATION DATA

FUND FUNCTION CODE B/A CODE CC-A

CC-B PROJ./PROS NO. O/C CODE ORG. CODE

7. TYPE OF ORDER

C/E CODE FY REGION

W/ITEM PRT./CRFT

Please furnish the following on the terms and conditions specified on the order and the attached sheets, if any, including delivery as indicated.

This delivery order is issued subject to the terms and conditions of the above numbered contract.

This task order is issued subject to the terms and conditions of the above numbered contract.

26A. UNITED STATES OF AMERICA (NAME OF CONTRACTING/ORDERING OFFICER)

25B. SIGNATURE

25A. NAME AND TITLE OF OFFEROR/CONTRACTOR

26B. SIGNATURE

21. MAIL INVOICE TO: (Electronic Invoice Preferred)

GENERAL SERVICES ADMINISTRATION

GENERAL SERVICES ADMINISTRATION GSA 300 (REV. 5/2010)

ORDER FOR SUPPLIES AND SERVICES

REQUISITION/REFERENCE NUMBER PAGE OF

PAGES

1. DATE OF ORDER 2. ORDER NUMBER 3. CONTRACT NUMBER 4. PDN NUMBER

ITEM NUMBER

(A)

SUPPLIES OR SERVICES

(B)

QUANTITY

ORDERED

(C)

UNIT

(D)

UNIT PRICE

(E)

AMOUNT

(F)

6. TO: CONTRACTOR (Name, address and zip code)

D. MODIFICATION NUMBER AUTHORITY FOR ISSUING

8A. Data Universal Numbering System (DUNS) Number 8B. Taxpayer Identification Number (TIN)

Except as provided herein, all terms and conditions of the original order, as heretofore mentioned, remain unchanged.

9A. BUSINESS CLASSIFICATION

9B. START DATE:

9C. COMPLETION DATE:

13. PLACE OF INSPECTION AND ACCEPTANCE 14. REQUISITION OFFICE (Name, Symbol and Telephone Number)

15. F.O.B. POINT 16. GOVERNMENT B/L NUMBER 17. DELIVERY F.O.B. POINT 18. PAYMENT/DISCOUNT TERMS

19. SCHEDULE

20. RECEIVING OFFICE (Name, Symbol and Telephone Number)

23. SHIPPING POINT

22. GROSS SHIP WEIGHT

TOTAL

FROM

300-A(s)

GRAND

TOTAL

24A. FOR INQUIRIES REGARDING PAYMENT CONTACT: 24B. TELEPHONE NUMBER

25C. DATE SIGNED 26C. DATE SIGNED

11. REMITTANCE ADDRESS (MANDATORY) 12. SHIP TO (Consignee Address, Zip Code and Telephone Number)10. ISSUING OFFICE (Address, Zip Code, and Telephone Number)

PURCHASE

DELIVERY (For Supplies)

TASK ORDER (For Services)

b. OTHER THAN SMALLa. SMALL c. SMALL DISADVANTAGED

d. WOMAN-OWNED e. HUBZone f. EMERGING SMALL

h. SERVICE DISABLED VETERANg. VETERAN

FOR

GOVERNMENT

USE

ONLY

5. ACCOUNTING AND APPROPRIATION DATA

FUND

FUNCTION CODE

B/A CODE

CC-A

CC-B

PROJ./PROS NO.

O/C CODE

ORG. CODE

7. TYPE OF ORDER

C/E CODE

REGION

W/ITEM

PRT./CRFT

Please furnish the following on the terms and conditions specified on the order and the attached sheets, if any, including delivery as indicated.

This delivery order is issued subject to the terms and conditions of the above numbered contract.

This task order is issued subject to the terms and conditions of the above numbered contract.

26A. UNITED STATES OF AMERICA (NAME OF CONTRACTING/ORDERING OFFICER)

25B. SIGNATURE

25A. NAME AND TITLE OF OFFEROR/CONTRACTOR

26B. SIGNATURE

21. MAIL INVOICE TO: (Electronic Invoice Preferred)

GENERAL SERVICES ADMINISTRATION

GSA 300 (REV. 5/2010)

ORDER FOR SUPPLIES AND SERVICES

REQUISITION/REFERENCE NUMBER

PAGE

PAGES

1. DATE OF ORDER

2. ORDER NUMBER

3. CONTRACT NUMBER

4. PDN NUMBER

ITEM NUMBER

(A)

SUPPLIES OR SERVICES

(B)

QUANTITY

ORDERED

(C)

UNIT

(D)

UNIT PRICE

(E)

AMOUNT

(F)

6. TO: CONTRACTOR (Name, address and zip code)

D. MODIFICATION NUMBER

AUTHORITY FOR ISSUING

8A. Data Universal Numbering System (DUNS) Number 8B. Taxpayer Identification Number (TIN) Except as provided herein, all terms and conditions of the original order, as heretofore mentioned, remain unchanged.

9A. BUSINESS CLASSIFICATION

9B. START DATE:

9C. COMPLETION DATE:

13. PLACE OF INSPECTION AND ACCEPTANCE

14. REQUISITION OFFICE (Name, Symbol and Telephone Number)

15. F.O.B. POINT

16. GOVERNMENT B/L NUMBER

17. DELIVERY F.O.B. POINT

18. PAYMENT/DISCOUNT TERMS

19. SCHEDULE

20. RECEIVING OFFICE (Name, Symbol and Telephone Number)

23. SHIPPING POINT

22. GROSS SHIP WEIGHT

TOTAL

FROM

300-A(s)

GRAND

TOTAL

24A. FOR INQUIRIES REGARDING PAYMENT CONTACT:

24B. TELEPHONE NUMBER

25C. DATE SIGNED

26C. DATE SIGNED

11. REMITTANCE ADDRESS (MANDATORY)

12. SHIP TO (Consignee Address, Zip Code and Telephone Number)

10. ISSUING OFFICE (Address, Zip Code, and Telephone Number) Type of Order, Select from the Following: Purchase, Delivery (For Supplies), Task Order (For Services) Business Classification: Select from the following, Small, Other than Small, Small Disadvantaged, Woman-Owned, HUBZone , Emerging Small, Veteran, Service Disabled Veteran

Contracting/Ordering Officer's Signature Date: Please excel bid schedule for CLINS

Contracting/Ordering Officer's Signature Date: PBS Payments Branch

P.O. Box 17181 Fort Worth, TX 76102-0181 Contracting/Ordering Officer's Signature Date: General Services Administration Acquisition Solutions Branch (10PQC) 400 15th Street SW Auburn, WA 98001-6599 Contracting/Ordering Officer's Signature Date: General Services Administration Acquisition Solutions Branch (10PQC) 400 15th Street SW Auburn, WA 98001-6599

Contracting/Ordering Officer's Signature Date: 10PME-15-5002~5009

Row 3 Quantity Ordered:

Row 3 Unit Price:

Row 3 Amount:

Row 1 Amount:

Row 1 Unit Price:

Row 1 Quantity Ordered:

Row 2 Quantity Ordered:

Row 2 Unit Price:

Row 2 Amount:

Row 12 Amount:

Total From 300-A's:

Grand Total:

Row 11 Amount:

Row 10 Amount:

Row 9 Amount:

Row 8 Amount:

Row 7 Amount:

Row 6 Amount:

Row 5 Amount:

Row 4 Amount:

Row 12 Unit Price:

Row 11 Unit Price:

Row 10 Unit Price:

Row 9 Unit Price:

Row 8 Unit Price:

Row 7 Unit Price:

Row 6 Unit Price:

Row 5 Unit Price:

Row 4 Unit Price:

Row 12 Quantity Ordered:

Row 11 Quantity Ordered:

Row 10 Quantity Ordered:

Row 9 Quantity Ordered:

Row 8 Quantity Ordered:

Row 7 Quantity Ordered:

Row 6 Quantity Ordered:

Row 5 Quantity Ordered:

Row 4 Quantity Ordered:

Enter the name of an additional data element, if applicable:

SignatureField1:

File details come from the government source that posted it. Updated Nov 14, 2017.