FA8604-18-R-1004_AFLCMC_WL_Unique_IT_Task_Order.pdf

ORDER FOR SUPPLIES OR SERVICES

1. CONTRACT/PURCH ORDER/AGREEMENT NO.

2. DELIVERY ORDER/ CALL NO.

FA8604-18-F-1004F A8604-18-R-1001

6. ISSUED BY AFLCMC/PZITB CODE I FA8604

USAF/AFMC/AFLCMC

AF LIFE CYCLE MANAGEMENT CENTER

2275 D STREET, BLDG 16, RM 128

WRIGHT-PATTERSON AFB OH 45433-7228

ZACHARY S. KIMPEL 937-656-7399

zachary.kimpel@us.af.mil

9. CONTRACTOR CODE I

NAME

AND

ADDRESS

(YYYYMMMDD) 1

3. DATE OF ORDER/CALL

4. REQUISITION/PURCH REQUEST NO.

SEE SCHEDULE

7. ADMINISTERED BY (If Other than 6) CODE I FY1294

AFLCMC/PZI

BLDG 16 ROOM 128

2275 D STREET

WRIGHT-PATTERSON AFB OH 45433-7228

SCD: PAS: (NONE)

FACILITY I 10. DELIVER TO FOB POINT BY (Date)

(YYYYMMMDD) SEE SCHEDULE

12. DISCOUNT ITEMS

N

13. MAIL INVOICES TO ADDRESS IN BLOCK

5. PRIORITY

DO-A7

8. DELIVERY FOB

=8J DESTINATION

OTHER

(S96 Schedule if other')

11. X IFBUSINESS IS

SMALL

X SMALL DISAD-

VANTAGED

WOMEN-

OWNED

SEE BLOCK 15 (PAYMENT OFFICE)

14. SHIP TO

SEE SCHEDULE

16. DELIVERY/

TYPE CALL X

OF PURCHASE

CODE I 15. PAYMENT WILL BE MADE BY

ATTN: DFAS-JAIQBA/CO

P.O. BOX 182317

COLUMBUS OH 43218-2317

COM'L FAX#: 1-866-244-2894

EFT:T

CODE I F03000

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 items specified herein.

MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATION

NUMBERS IN

BLOCKS 1 AND 2.

ORDER 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.

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED(YYYYMMMDD)

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

17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE

18. ITEM NO. 19. SCHEDULE OF SUPPLIES/SERVICES 20. QUANTITY 21. 22. UNIT PRICE 23. AMOUNT

ORDERED/ UNIT

ACCEPTED*

24. UNITED STATES OF AMERICA 25. TOTAL

*If quantity accepted by the Government is same as quantity

29. ordered, indicate by X. If different, enter actual quantity accepted DIFFERENCES below quantity ordered and encircle.

STEPHEN L. WHARTON

BY: CONTRACTING/ORDERING OFFICER

26. QUANTITY IN COLUMN 20 HAS BEEN 27. SHIP NO. 28. D.O. VOUCHER NO. 30. INITIALS

� INSPECTED

D

RECEIVED

D

ACCEPTED, AND CONFORMS TO THE

CONTRACT EXCEPT AS NOTED

PARTIAL 32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR

FINAL

DATE SIGNATURE AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32. PAYMENT 34. CHECK NUMBER

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

PARTIAL 35. BILL OF LADING

DATE SIGNATURE AND TITLE OF CERTIFYING OFFICER FINAL

37. RECEIVED

38. RECEIVED BY (Print)

39. DATE RECEIVED 40. TOTAL CON- 41. S/R ACCOUNT NO. 42. S/R VOUCHER NO.

AT (YYYYMMMDD) TAINERS

DD FORM 1155, JAN 1998 (EG) ConWrite Version 6.15.2 PREVIOUS EDITION MAY BE USED Created 14 Nov 2017 2:57 PM