TAB_11_-_Task_Order_-_EDA_93449.pdf

ORDER FOR SUPPLIES OR SERVICES

1. CONTRACT/PURCH ORDER/AGREEMENT NO.

FA865120D0001

2. DELIVERY ORDER/ CALL NO.

FA8651-20-F-0001

3. DATE OF ORDER/CALL

(YYYYMMMDD)

4. REQUISITION/PURCH REQUEST NO.

SEE SCHEDULE

5. PRIORITY

DO-A5

6. ISSUED BY AFRL/RWK

CODE FA8651 7. ADMINISTERED BY (If Other than 6) CODE 8. DELIVERY FOB

AIR FORCE RESEARCH LABORATORY

MUNITIONS RESEARCH LABORATORY

203 W EGLIN BLVD, BLDG 300

EGLIN AFB, FL 32542-6810

CATHERINE D. GRAY 8508823018

catherine.gray.2@us.af.mil

DESTINATION

X OTHER

(See Schedule if other)

SCD: A PAS: (NONE)

9. CONTRACTOR CODE FACILITY 10. DELIVER TO FOB POINT BY (Date) 11. X IFBUSINESS IS

(YYYYMMMDD) SEE SCHEDULE

SMALL

NAME

AND

12. DISCOUNT ITEMS

SMALL DISAD-

VANTAGED

ADDRESS N

WOMEN-

OWNED

13. MAIL INVOICES TO ADDRESS IN BLOCK

SEE BLOCK 15 (PAYMENT OFFICE)

14. SHIP TO CODE 15. PAYMENT WILL BE MADE BY CODE

SEE SCHEDULE MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATION

NUMBERS IN

BLOCKS 1 AND 2.

EFT:T

16.

DELIVERY/

X

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

TYPE CALL

OF

PURCHASE

Reference your furnish the following on items specified herein.

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)

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

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

$0.00

29.

DIFFERENCES

CATHERINE D. GRAY

BY:

CONTRACTING/ORDERING OFFICER

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

INSPECTED RECEIVED 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

AT

38. RECEIVED BY (Print) 39. DATE RECEIVED

(YYYYMMMDD)

40. TOTAL CON-

TAINERS

41. S/R ACCOUNT NO. 42. S/R VOUCHER NO.

DD FORM 1155, JAN 1998 (EG) ConWrite Version 7.2.2.0 PREVIOUS EDITION MAY BE USED Created 31 Oct 2019 11:09 AM

DRAFT

LIST OF ATTACHMENTS

Qty Unit Price ITEM SUPPLIES OR SERVICES Purch Unit Total Item Amount

0001 0 $0.00 $0.00 Noun: TECHNOLOGY MATURATION

PSC: AC52

NSN: N - Not Applicable DD1423 is Exhibit: A Contract type: U - COST PLUS FIXED FEE Inspection: SOURCE Acceptance: SOURCE

FOB: SOURCE

Descriptive Data:

The contractor shall perform research and development in accordance with Basic Contract, Description/Specifications, Section J, Exhibit A and Attachment 1 Statement of Work dated ___________.

Performance Period of this CLIN is 39 months (approximately 36 months for the technical and an additional 3 months for the completion of the Final Report).

Deliver data in accordance with Exhibit A, Contract Data Requirements List (CDRL), and DD Forms 1423. See DD Form 1423 and CDRL Interpretation Instructions for data distribution mailing addresses.

WAWF Ship to BPN is F1TBPV. Contractor is required to submit a DD250Z via WAWF as a Stand-Alone Receiving Report at $0 in order to confirm Program Manager's receipt and acceptance of the final report and deliverables. Inspection and acceptance point should be marked as "D" for destination.

GUARANTEED FINAL REPORT: The contractor is required to provide a final report in accordance with Exhibit A, CDRL A014. During the life of the contract, the contractor shall continuously reserve sufficient funds from the amount allotted to guarantee the preparation and delivery of the final report.

NOTE: International Traffic in Arms Regulation (ITAR) Restricted. Export control applicable.

Estimated Cost $_____________

FCCM $_____________

Fixed Fee $_____________ Total Price $_____________

THIS CLIN IS INCREMENTALLY FUNDED AS FOLLOWS:

Total Price $ Funded Amount $ Total to Full Funding $

Qty Unit Price ITEM SUPPLIES OR SERVICES Purch Unit Total Item Amount

0002 0 $0.00 $0.00 Noun: SUBSYSTEM INTEGRATION & S&T CRITICAL DESIGN

REVIEW

PSC: AC53

NSN: N - Not Applicable DD1423 is Exhibit: A Contract type: U - COST PLUS FIXED FEE Inspection: DESTINATION Acceptance: DESTINATION

FOB: DESTINATION

Descriptive Data:

The contractor shall perform research and development in accordance with Basic Contract, Description/Specifications, Section J, Exhibit A and Attachment 1 Statement of Work dated ___________.

Performance Period of this CLIN is 39 months (approximately 36 months for the technical and an additional 3 months for the completion of the Final Report).

Deliver data in accordance with Exhibit A, Contract Data Requirements List (CDRL), and DD Forms 1423. See DD Form 1423 and CDRL Interpretation Instructions for data distribution mailing addresses.

WAWF Ship to BPN is F1TBPV. Contractor is required to submit a DD250Z via WAWF as a Stand-Alone Receiving Report at $0 in order to confirm Program Manager's receipt and acceptance of the final report and deliverables. Inspection and acceptance point should be marked as "D" for destination.

GUARANTEED FINAL REPORT: The contractor is required to provide a final report in accordance with Exhibit A, CDRL A014. During the life of the contract, the contractor shall continuously reserve sufficient funds from the amount allotted to guarantee the preparation and delivery of the final report.

NOTE: International Traffic in Arms Regulation (ITAR) Restricted. Export control applicable.

Estimated Cost $_____________

FCCM $_____________

Fixed Fee $_____________ Total Price $_____________

THIS CLIN IS INCREMENTALLY FUNDED AS FOLLOWS:

Total Price $

Qty Unit Price ITEM SUPPLIES OR SERVICES Purch Unit Total Item Amount

0003 OPTION CLIN

Noun: OPTION - SYSTEM GROUND DEMONSTRATIONS

PSC:

NSN: N - Not Applicable DD1423 is Exhibit: A Contract type: U - COST PLUS FIXED FEE Inspection: DESTINATION Acceptance: DESTINATION

FOB: DESTINATION

Descriptive Data:

The contractor shall perform research and development in accordance with Basic Contract, Description/Specifications, Section J, Exhibit A and Attachment 1 Statement of Work dated ___________.

Performance Period of this CLIN is 39 months (approximately 36 months for the technical and an additional 3 months for the completion of the Final Report).

Deliver data in accordance with Exhibit A, Contract Data Requirements List (CDRL), and DD Forms 1423. See DD Form 1423 and CDRL Interpretation Instructions for data distribution mailing addresses.

WAWF Ship to BPN is F1TBPV. Contractor is required to submit a DD250Z via WAWF as a Stand-Alone Receiving Report at $0 in order to confirm Program Manager's receipt and acceptance of the final report and deliverables. Inspection and acceptance point should be marked as "D" for destination.

GUARANTEED FINAL REPORT: The contractor is required to provide a final report in accordance with Exhibit A, CDRL A014. During the life of the contract, the contractor shall continuously reserve sufficient funds from the amount allotted to guarantee the preparation and delivery of the final report.

NOTE: International Traffic in Arms Regulation (ITAR) Restricted. Export control applicable.

Estimated Cost $_____________

FCCM $_____________

Fixed Fee $_____________ Total Price $_____________

THIS CLIN IS INCREMENTALLY FUNDED AS FOLLOWS:

Total Price $

SECTION F PERFORMANCE OR DELIVERY SHIP MARK TRANS

ITEM SUPPLIES SCHEDULE DATA QTY TO FOR PRI DATE

0001 0 U ASREQ

Noun: TECHNOLOGY MATURATION

ACRN: 9

0002 0 U ASREQ

Noun: SUBSYSTEM INTEGRATION & S&T CRITICAL

DESIGN REVIEW

ACRN: 9

SECTION G - CONTRACT ADMINISTRATION/PAYMENT DATA:

https://www.acq.osd.mil/dpap/dars/pgi/pgi_htm/PGI204_71.htm#payment_instructions

SECTION I - CONTRACT CLAUSES

52.217-9 -- Option to Extend the Term of the Contract (Mar 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor NLT _____________ provided that the Government gives the Contractor a preliminary written notice of its intent to extend NLT _________. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed ____ months.

SECTION J - LIST OF ATTACHMENTS:

DOCUMENT PGS DATE TITLE

ATTACHMENT 1 0 PLACEHOLDER FOR STATEMENT OF WORK

Attachment 1 – Statement of Objectives will be provided under separate cover.