formVA134a.pdf
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- 36C24920Q0263
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| 36C24920Q0263.docx | DOCX document |
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REQUEST FOR FREIGHT TRANSPORTATION AND LOGISTICS SERVICES Page No. ______ of ______
EMAIL COMPLETED FOR TO VATLC@VA.GOV OR FAX IT TO (202) 495-5496
PICKUP POINT ADDRESS (Show your facility ID)
FROM STATION #:
SHIP-TO ADDRESS (Show Destination Facility ID)
B/L NUMBER: VAA-0,0 SHIP DATE SHIPPING VOUCHER NUMBER
LINE
ITEM
STOCK NO.
NOMENCLATURE (Describe what you are shipping)
TYPE
UNIT
UNITS
SHIPPED
UNIT
WEIGHT
UNIT
CUBE LINE CUBE VALUE
ITEM WEIGHTS
VALUATION TOTAL
QTY PALLETS EMPTY PALLET WT TOTAL
TOTAL SHIPMENT WEIGHT
BOX CUBE CALCULATOR - (Enter dimentional values in INCHES that are greater than 0.
You may use decimals or whole numbers. Do not use letters or other symbols.)
LENGTH WIDTH HEIGHT
ENTER NUMBERS ONLY
BOX CUBE TOTAL SHIPMENT CUBIC VOLUME
VALUE OF PROPERTY IN THIS SHIPMENT DISTANCE TO DESTINATION
CONTACT PERSON AT THE PICKUP/SHIPPING FACILITY COMMERCIAL PHONE NO. (Area Code)
EXT.
E-MAIL ADDRESS
CONTACT PERSON AT THE DESTINATION/RECEIVING FACILITY COMMERCIAL PHONE NO. (Area Code)
EXT.
E-MAIL ADDRESS
SEND VCBL COPY TO THIS PERSON COMMERCIAL PHONE NO. (Area Code)
EXT.
E-MAIL ADDRESS
CREDIT CARD HOLDER'S NAME COMMERCIAL PHONE NO. (Area Code)
EXT.
E-MAIL ADDRESS
OBLIGATION NUMBER APPROPRIATION NUMBER
ACCESSION NUMBERS (i.e., VHA-19-0078)
SPECIAL HANDLING (i.e., Lift Gate, Blanket-Wrap, Hazardous, Inside Delivery/Pickup, Temperature Control, etc.)
RETURN AUTHORIZATION NUMBER VA REQUISITION NUMBER/PURCHASE ORDER NUMBER VENDOR'S ORDER NUMBER REQUISITION DATE
CERTIFICATION: The undersigned certifies that funds are available and have been allocated and that the requested freight services are authorized and necessary to conduct the business of VA.
APPROVING OFFICIAL'S NAME AND TITLE DATE RECEIVING OFFICIAL'S NAME, SIGNATURE AND TITLE DATE RECEIVED
Posted Items recorded in inventory accounts.
SIGNATURE OF ACCOUNTABLE OFFICER DATE VOUCHER DATE VA STATION VOUCHER NUMBER
VA FORM
MAY 2019(RS) 134a SUPERSEDES VA FORM 134a, JUL 2016, WHICH WILL NOT BE USED mailto:VATLC@VA.GOV VHATVHHertsS Highlight
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INSTRUCTIONS
B/L NUMBER: VAA-0,0: Enter the last five digits of the VCBL number(s) after the shipment has been completed.
STOCK NO. NOMENCLATURE (Describe what you are shipping): Describe the item(s) being shipped. If furniture, then indicate if it is in boxes or requires blanket wrapping. Pallets should be shrink wrapped, banded and labeled.
∙ Less-than-truckload (LTL) carriers will not accept unpackaged items for transport.
∙ Hazardous materials must have an MSDS.
TYPE UNIT: Enter the shipping units description.
BX = BOX; BW = Blanket Wrap; CRT = Crate; CS = Case; CTN = Carton; CYL = Cylinder; DRM = Drum; EA = Each; SET; KIT;
ROL = ROLL
UNITS SHIPPED: Enter whole numbers. No decimals allowed. This is the number of pieces (each, boxes, cartons, rolls, crates, drums, etc.) to ship.
UNIT WEIGHT: A Shipping unit may have a weight from 0.1 pounds up to 45,000 pounds. Whole numbers or numbers with a decimal are permitted.
UNIT (BOX) CUBE: Enter the cube volume of one piece. Use the Box Cube calculator below. The program will compute the total cube for the shipment.
TOTAL VALUE: This is the total value of all items on this line.
QUANTITY PALLETS: Enter a whole number. Decimals are not allowed.
EMPTY PALLET WEIGHT: Enter a pallet weight from 10 to 65 pounds. 40 pounds is about average for GMA pallets.
VALUE OF PROPERTY: Value of property in this shipment should normally equal the depreciated value for used property or new value if new property.
∙ Enter the current dollar value of your property. This amount will appear on the VCBL for full value liability protection.
∙ Standard liability is actual value up $250,000. Special arrangements are necessary for up to $5 million liability protection.
DISTANCE TO DESTINATION: Enter the distance from the origin to the destination if you know it.
CONTACT PERSON (E-mail/Fax): Please add your e-mail address and fax number to receive a copy of the completed VCBL.
PAYMENT OFFICE REPRESENTATIVE'S EMAIL: Please add a Payment Office Representative's e-mail address who should received a copy of the complete VCBL. Confirm that the obligation has been funded.
ACCOUNTS PAYABLE PHONE NUMBER: When an obligation has not been funded, we need to call the responsible fiscal official to request they provide funds.
OBLIGATION NUMBER: Required Field. Please confirm with your payment official that this obligation has been funded.
APPROPRIATION NUMBER: Required Field. An Appropriation Number is required. You must enter your appropriation number before you can release this form. If requesting an estimate, send the completed document. To request a Bill of Lading, replace the word "Estimate" with an obligation and appropriation number.
∙ An Obligation Number is required for all requests except for shipments of salvage X-ray film to the Services and Distribution Center (SDC) at Hines, Illinois.
VA REQUISITION/PURCHASE ORDER NUMBER: Enter the VA Requisition Number/ Purchase Order Number.
VENDOR'S ORDER NUMBER: Enter the Vendor's Order Number.
Department of Veterans Affairs logo
REQUEST FOR FREIGHT TRANSPORTATION AND LOGISTICS SERVICES
REQUEST FOR FREIGHT TRANSPORTATION AND LOGISTICS SERVICES (See instructions on page 2) Page No. ______ of ______ Page No. ______ of ______
EMAIL COMPLETED FOR TO VATLC@VA.GOV OR FAX IT TO (202) 495-5496
PICKUP POINT ADDRESS
(Show your facility ID)
FROM STATION #:
SHIP-TO ADDRESS
(Show Destination Facility ID)
B/L NUMBER: VAA-0,0
B/L NUMBER: V A A-0,0 2
SHIP DATE
SHIPPING VOUCHER NUMBER
LINE
ITEM
STOCK NO.
NOMENCLATURE (Describe what you are shipping)
TYPE
UNIT
UNITS
SHIPPED
UNIT
WEIGHT
UNIT
CUBE
LINE CUBE
VALUE
ITEM WEIGHTS
VALUATION TOTAL
QTY PALLETS
EMPTY PALLET WT
TOTAL
TOTAL SHIPMENT WEIGHT
BOX CUBE CALCULATOR - (Enter dimentional values in INCHES that are greater than 0.
You may use decimals or whole numbers. Do not use letters or other symbols.)
BOX CUBE CALCULATOR - (Enter dimentional values in INCHES that are greater than 0.
You may use decimals or whole numbers. Do not use letters or other symbols.) (Length multiplied by Width multiplied by Height, divided by 17 28)
LENGTH
WIDTH
HEIGHT
ENTER NUMBERS ONLY
BOX CUBE
TOTAL SHIPMENT CUBIC VOLUME
VALUE OF PROPERTY IN THIS SHIPMENT
DISTANCE TO DESTINATION
CONTACT PERSON AT THE PICKUP/SHIPPING FACILITY
COMMERCIAL PHONE NO. (Area Code)
EXT.
E-MAIL ADDRESS
CONTACT PERSON AT THE DESTINATION/RECEIVING FACILITY
COMMERCIAL PHONE NO. (Area Code)
EXT.
E-MAIL ADDRESS
SEND VCBL COPY TO THIS PERSON
COMMERCIAL PHONE NO. (Area Code)
EXT.
E-MAIL ADDRESS
CREDIT CARD HOLDER'S NAME
COMMERCIAL PHONE NO. (Area Code)
EXT.
E-MAIL ADDRESS
OBLIGATION NUMBER
APPROPRIATION NUMBER
ACCESSION NUMBERS (i.e., VHA-19-0078) SPECIAL HANDLING (i.e., Lift Gate, Blanket-Wrap, Hazardous, Inside Delivery/Pickup, Temperature Control, etc.)
RETURN AUTHORIZATION NUMBER
VA REQUISITION NUMBER/PURCHASE ORDER NUMBER
VENDOR'S ORDER NUMBER
REQUISITION DATE
CERTIFICATION: The undersigned certifies that funds are available and have been allocated and that the requested freight services are authorized and necessary to conduct the business of VA.
APPROVING OFFICIAL'S NAME AND TITLE
DATE
RECEIVING OFFICIAL'S NAME, SIGNATURE AND TITLE
DATE RECEIVED
Posted Items recorded in inventory accounts.
Posted Items recorded in inventory accounts.
SIGNATURE OF ACCOUNTABLE OFFICER
DATE
VOUCHER DATE
VA STATION VOUCHER NUMBER
VA FORM
MAY 2019(RS)
V A Form 1 34 A, MAY 2019.
134a SUPERSEDES VA FORM 134a, JUL 2016, WHICH WILL NOT BE USED
SUPERSEDES V A FORM 134 a, JUL 2016, WHICH WILL NOT BE USED
VA Form 134a, REQUEST FOR FREIGHT TRANSPORTATION AND LOGISTICS SERVICES 134a, Freight, Transportation, Logistics, Services Missie Vaccaro-Palomaki Paul Bunker Jan 2012 003A3B3
MAY 2019
INSTRUCTIONS
B/L NUMBER: VAA-0,0: Enter the last five digits of the VCBL number(s) after the shipment has been completed.
STOCK NO. NOMENCLATURE (Describe what you are shipping): Describe the item(s) being shipped. If furniture, then indicate if it is in boxes or requires blanket wrapping. Pallets should be shrink wrapped, banded and labeled.
∙ Less-than-truckload (LTL) carriers will not accept unpackaged items for transport.
∙ Hazardous materials must have an MSDS.
TYPE UNIT: Enter the shipping units description.
BX = BOX; BW = Blanket Wrap; CRT = Crate; CS = Case; CTN = Carton; CYL = Cylinder; DRM = Drum; EA = Each; SET; KIT;
ROL = ROLL
UNITS SHIPPED: Enter whole numbers. No decimals allowed. This is the number of pieces (each, boxes, cartons, rolls, crates, drums, etc.) to ship.
UNIT WEIGHT: A Shipping unit may have a weight from 0.1 pounds up to 45,000 pounds. Whole numbers or numbers with a decimal are permitted.
UNIT (BOX) CUBE: Enter the cube volume of one piece. Use the Box Cube calculator below. The program will compute the total cube for the shipment.
TOTAL VALUE: This is the total value of all items on this line.
QUANTITY PALLETS: Enter a whole number. Decimals are not allowed.
EMPTY PALLET WEIGHT: Enter a pallet weight from 10 to 65 pounds. 40 pounds is about average for GMA pallets.
VALUE OF PROPERTY: Value of property in this shipment should normally equal the depreciated value for used property or new value if new property.
∙ Enter the current dollar value of your property. This amount will appear on the VCBL for full value liability protection.
∙ Standard liability is actual value up $250,000. Special arrangements are necessary for up to $5 million liability protection.
DISTANCE TO DESTINATION: Enter the distance from the origin to the destination if you know it.
CONTACT PERSON (E-mail/Fax): Please add your e-mail address and fax number to receive a copy of the completed VCBL.
PAYMENT OFFICE REPRESENTATIVE'S EMAIL: Please add a Payment Office Representative's e-mail address who should received a copy of the complete VCBL. Confirm that the obligation has been funded.
ACCOUNTS PAYABLE PHONE NUMBER: When an obligation has not been funded, we need to call the responsible fiscal official to request they provide funds.
OBLIGATION NUMBER: Required Field. Please confirm with your payment official that this obligation has been funded.
APPROPRIATION NUMBER: Required Field. An Appropriation Number is required. You must enter your appropriation number before you can release this form. If requesting an estimate, send the completed document. To request a Bill of Lading, replace the word "Estimate" with an obligation and appropriation number.
∙ An Obligation Number is required for all requests except for shipments of salvage X-ray film to the Services and Distribution Center (SDC) at Hines, Illinois.
VA REQUISITION/PURCHASE ORDER NUMBER: Enter the VA Requisition Number/ Purchase Order Number.
VENDOR'S ORDER NUMBER: Enter the Vendor's Order Number.
| Page No. ______ of ______: |
| Page No. ______ of ______: |
| Click to Attach Form and |
Submit By Email:
| Ship To Address: |
| (Show your facility ID) FROM STATION #:: |
| (Show Destination Facility I D): |
| B/L NUMBER: V A A-0,0 |
Enter the last five digits of the V C B L number(s) after the shipment has been completed.:
| Ship Date. Enter 2-digit month, 2-digit day and 4-digit year.: |
| SHIPPING VOUCHER NUMBER: |
| Stock No. Nomenclature (Describe what you are shipping) line 1 of 5: |
| TYPE UNIT: LINE 1 of 5 |
Enter the shipping units description.
BX = BOX; BW = Blanket Wrap;
CRT = Crate; CS = Case; CTN = Carton;
CYL = Cylinder; DRM = Drum; EA = Each;
SET; KIT; ROL = ROLL:
| UNITS Shipped. line 1 of 5: |
| UNIT WEIGHT LINE 1 of 5: |
| UNIT CUBE. LINE 1 of 5: |
| Line Cube. This is a calculated field. line 1 of 5: 0.00000000 |
| Value LINE 1 of 5: |
| Stock No. Nomenclature (Describe what you are shipping) line 2 of 5: |
| TYPE UNIT: LINE 2 of 5 |
Enter the shipping units description.
BX = BOX; BW = Blanket Wrap;
CRT = Crate; CS = Case; CTN = Carton;
CYL = Cylinder; DRM = Drum; EA = Each;
SET; KIT; ROL = ROLL:
| UNITS Shipped. line 2 of 5: |
| UNIT WEIGHT LINE 2 of 5: |
| UNIT CUBE. LINE 2 of 5: |
| Line Cube. This is a calculated field. line 2 of 5: 0.00000000 |
| Value LINE 2 of 5: |
| Stock No. Nomenclature (Describe what you are shipping) line 3 of 5: |
| TYPE UNIT: LINE 3 of 5 |
Enter the shipping units description.
BX = BOX; BW = Blanket Wrap;
CRT = Crate; CS = Case; CTN = Carton;
CYL = Cylinder; DRM = Drum; EA = Each;
SET; KIT; ROL = ROLL:
| UNITS Shipped. line 3 of 5: |
| UNIT WEIGHT LINE 3 of 5: |
| UNIT CUBE. LINE 3 of 5: |
| Line Cube. This is a calculated field. line 3 of 5: 0.00000000 |
| Value LINE 3 of 5: |
| Stock No. Nomenclature (Describe what you are shipping) line 4 of 5: |
| TYPE UNIT: LINE 4 of 5 |
Enter the shipping units description.
BX = BOX; BW = Blanket Wrap;
CRT = Crate; CS = Case; CTN = Carton;
CYL = Cylinder; DRM = Drum; EA = Each;
SET; KIT; ROL = ROLL:
| UNITS Shipped. line 4 of 5: |
| UNIT WEIGHT LINE 4 of 5: |
| UNIT CUBE. LINE 4 of 5: |
| Line Cube. This is a calculated field. line 4 of 5: 0.00000000 |
| Value LINE 4 of 5: |
| Stock No. Nomenclature (Describe what you are shipping) line 5 of 5: |
| TYPE UNIT: LINE 5 of 5 |
Enter the shipping units description.
BX = BOX; BW = Blanket Wrap;
CRT = Crate; CS = Case; CTN = Carton;
CYL = Cylinder; DRM = Drum; EA = Each;
SET; KIT; ROL = ROLL:
| UNITS Shipped. line 5 of 5: |
| UNIT WEIGHT LINE 5 of 5: |
| UNIT CUBE. LINE 5 of 5: |
| Line Cube. This is a calculated field. line 5 of 5: 0.00000000 |
| Value LINE 5 of 5: |
| Column Totals. UNITS shipped. This is a calculated field.: 0 |
| Column Totals. UNIT WEIGHT per item. This is a calculated field.: 0 |
| VALUATION TOTAL: $0 |
| Enter number of pallets.: |
| Empty pallets weight select from drop down menu: |
| Total Pallet Weight. This is a calculated field. Number of pallets times XX pounds.: 0 |
| Total shipment weight. This is a calculated field. : 0 |
| BOX CUBE CALCULATOR - (Enter dimentional values in INCHES that are greater than 0. |
You may use decimals or whole numbers. Do not use letters or other symbols.) (Length multiplied by Width multiplied by Height, divided by 17 28). Enter length (ENTER NUMBERS ONLY):
| Enter width (ENTER NUMBERS ONLY): |
| Enter height (ENTER NUMBERS ONLY): |
| Total shipment weight. This is a calculated field. : 0.0 |
| Total shipment cubic volume. This is a calculated field. : 0 |
| VALUE OF PROPERTY IN THIS SHIPMENT. Value of property in this shipment should normally equal the depreciated value for used property or new value if new property. |
Enter the current dollar value of your property. This amount will appear on the V C B L for full value liability protection.
Standard liability is actual value up $250,000. Special arrangements are necessary for up to $5 million liability protection.:
| Enter distance to destination : |
| CONTACT PERSON AT THE PICKUP/SHIPPING FACILITY: |
| Commercial Phone Number. Enter 10-digit telephone number including area code.: |
| Extension: |
| E-MAIL ADDRESS: |
| CONTACT PERSON AT THE DESTINATION/RECEIVING FACILITY: |
| Commercial Phone Number. Enter 10-digit telephone number including area code.: |
| Extension: |
| E-MAIL ADDRESS: |
| SEND V C B L COPY TO THIS PERSON: |
| Commercial Phone Number. Enter 10-digit telephone number including area code.: |
| Extension: |
| E-MAIL ADDRESS: |
| REQUIRED FIELD: Obligation number: |
| REQUIRED FIELD: appropriation number: |
| Receiving Official's name and Title : |
| VENDOR'S ORDER NUMBER: |
| VA requisition number/purchase order number: |
| Date of Requisition. Enter 2-digit month, 2-digit day and 4-digit year.: |
| Approving Official's name and title: |
| signature of accountable officer: |
| Date. Enter 2-digit month, 2-digit day and 4-digit year.: |
| Date received. Enter 2-digit month, 2-digit day and 4-digit year.: |
| Date. Enter 2-digit month, 2-digit day and 4-digit year.: |
| Date of Voucher. Enter 2-digit month, 2-digit day and 4-digit year.: |
| V A STATION Voucher number: |
File details come from the government source that posted it. Updated .