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SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER.

21-16-416QWF723

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NUMBER

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

8/1/2016

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

JUAN A. SOTO

b. TELEPHONE NUMBER (No Collect calls) (757)856-2564

8. OFFER DUE DATE/ LOCAL TIME

9. ISSUED BY CODE Z63100

COMMANDING OFFICER

USCG TRAINING CENTER YORKTOWN

1 US COAST GUARD TRAINING CENTER

YORKTOWN, VA 23690-5000

Juan.A.Soto@uscg.mil

10. THIS ACQUISITION IS

FORMCHECKBOX

UNRESTRICTED OR FORMCHECKBOX

SET ASIDE: 100 % FOR:

FORMCHECKBOX

SMALL BUSINESS FORMCHECKBOX

EMERGING SMALL

BUSINESS

FORMCHECKBOX

HUBZONE SMALL BUSINESS

NAICS: 333241

SIZE STANDARD: 500emp FORMCHECKBOX

SERVICE-DISABLED VETERAN- FORMCHECKBOX

8 (A)

OWNED SMALL BUSINESS

11. DELIVERY FOR FOB DESTINA-TION UNLESS BLOCK IS MARKED

FORMCHECKBOX

SEE SCHEDULE

12. DISCOUNT TERMS

FORMCHECKBOX

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

FORMCHECKBOX

RFQ FORMCHECKBOX

IFB FORMCHECKBOX

RFP

15. DELIVER TO CODE Z63100

COMMANDING OFFICER

USCG TRAINING CENTER YORKTOWN

1 US COAST GUARD TRAINING CENTER

YORKTOWN, VA 23690-5000

16. ADMINISTERED BY CODE W63100

SAME AS BLOCK 9

17a. CONTRACTOR/OFFEROR CODE C FACILITY CODE

TELEPHONE NO. ATTN:

18a. PAYMENT WILL BE MADE BY CODE

COMMERCIAL INVOICES

USCG FINANCE CENTER

PO BOX 4115

CHESAPEAKE, VA 23327-4115 (800)564-5504

https://www.fincen.uscg.mil/secure/web_invoices.htm

FORMCHECKBOX

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

FORMCHECKBOX

SEE ADDENDUM

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL PRICE

ONE COMPARTMENT SINK

STAINLESS STEEL; 24" X 24" X 14" BOWL SIZE; ROLLED EDGE;

(1) SWING FAUCET MIN 8"; (4) LEGS; NSF

RANGE 10 BURNER NATURAL GAS

OVERALL WIDTH 60"; (10) 30,000 BTU OPEN BURNERS; CAST IRON

GRATES; (2) STANDARD OVENS MIN OF (1) RACK PER;

(4) LEGS; NSF

REFRIGERATED BASE W/ DRAWERS

OVERALL WIDTH MIN 72"; (4) REFRIGERATED DRAWERS; EXTERIOR &

INTERIOR STAINLESS STEEL; NSF

PROOFING CABINET, HEATED

APPROX 25"W X 30"D X 71"H; LOAD SLIDES OR RACKS INCLUDED;

MUST REACH MIN 180 F HOLDING; (1) WINDOW DOOR;

(4) LOCK CASTERS; NSF

REACH-IN REFRIGERATOR

MIN VOLUME 72 CUBIC FT; (3) HINGED DOORS; EXTERIOR & INTEROR

STAINLESS STEEL; MIN OF (9) STANDARD SHELVES; NSF

CHARBROILER, 10 BURNER, NATURAL GAS

OVERALL WIDTH 60"W; (10) 30,000 BTU BURNERS; CAST IRON TOP

GRATES; BACKSPLASH & (2) SIDESPLASH; EXTERIOR STAINLESS STEEL;

MIN 24"D COOKING SURFACE; (6) 4" HEAVY DUTY LOCK CASTERS;

NSF

GRIDDLE 72” FLATTOP, NATURAL GAS

OVERALL WIDTH 72"; THERMOSTAT CONTROL; (6) 30,000 BTU BURNERS;

EXTERIOR STAINLESS STEEL; (4) LEGS; BACKSPLASH & (2) SIDESPLASH

; MIN 24"D COOKING SURFACE; (6) 4" HEAVY DUTY LOCK CASTERS; NSF

RENTAL GRILL PORTATBLE LP GAS

APPROX WIDTH 80"; MIN (10) BURNERS; MIN 24"D COOKING SURFACE;

MIN (2) LOCK CASTERS (4 WHEELS TOTAL); BACKSPLASHES &

SIDESPLASHES; NSF

Commercial planetary mixer

8 QUART; 3-SPEED; TIMER; SAFETY GUARD; STAINLESS STEEL BOWL;

WIRE WHIP/BEATER/DOUGH HOOK ATTACHMENTS; NSF

CARVING STATION

STAINLESS STEEL; INFRARED LAMP; DUAL LAMPS; BREATH/SNEEZE

GUARD; MIN 30"W X 25"D CARVING SURFACE; NSF

LOW-TEMP HOLDING CABINET, HEATED

APPROX 30"H X 25W" 30"D; REACH-IN; STAINLESS STEEL;

ADJUSTABLE THERMOSTAT; WITHIN RANGE OF 70 F - 200 F HOLDING;

(4) LOCK CASTERS; NSF

HAND WASHING SINK

STAINLESS STEEL; HANDS-FREE; MIN 6" BOWL DEPTH; GOOSENECK

FAUCET; BACKSPLASH; NSF

INDUCTION STOCK POT W/ COVER, 17-1/2 QT

17-1/2 QUART; (1) FLAT STOCK POT COVER; ALUMINUM CLAD BOTTOM; STAINLESS STEEL; NSF

INDUCTION STOCK POT W/ COVER, 25-12 QT

25-1/2 QUART; (1) FLAT STOCK POT COVER; ALUMINUM CLAD BOTTOM; STAINLESS STEEL; NSF

INDUCTION STOCK POT W/ COVER, 38 QT

38 QUART; (1) FLAT STOCK POT COVER; ALUMINUM CLAD BOTTOM; STAINLESS STEEL; NSF

INDUCTION STOCK POT W/ COVER, 53 QT

53 QUART; (1) FLAT STOCK POT COVER; ALUMINUM CLAD BOTTOM; STAINLESS STEEL; NSF

INDUCTION STOCK POT W/ COVER, 74 QT

74 QUART; (1) FLAT STOCK POT COVER; ALUMINUM CLAD BOTTOM; STAINLESS STEEL; NSF

ROASTING PAN

42 QUART; 21-5/8" X 18-1/8" X 9"; HEAVY DUTY ALUMINUM, LOOP RIVETED HANDLES; NSF

STEAM TABLE PAN W/ COVER, 1/6 SIZE, 4"

1/6 SIZE; 4" DEEP; STAINLESS STEEL; (1) FLAT PAN COVER; ANTI-JAMMING; NSF

STEAM TABLE PAN W/ COVER, 1/6 SIZE, 6"

1/6 SIZE; 6" DEEP; STAINLESS STEEL; (1) FLAT PAN COVER; ANTI-JAMMING; NSF

STEAM TABLE PAN W/ COVER, 1/3 SIZE, 4"

1/3 SIZE; 4" DEEP; STAINLESS STEEL; (1) FLAT PAN COVER; ANTI-JAMMING; NSF

STEAM TABLE PAN W/ COVER, 1/3 SIZE, 6"

1/3 SIZE; 6" DEEP; STAINLESS STEEL; (1) FLAT PAN COVER; ANTI-JAMMING; NSF

STEAM TABLE PAN W/ COVER, HALF SIZE LONG, 4"

HALF SIZE; 4" DEEP; STAINLESS STEEL; (1) FLAT PAN COVER; ANTI-JAMMING; NSF

STEAM TABLE PAN W/ COVER, HALF SIZE LONG, 6"

HALF SIZE; 6" DEEP; STAINLESS STEEL; (1) FLAT PAN COVER; ANTI-JAMMING; NSF

STEAM TABLE PAN W/ COVER, 1/2 SIZE, 4"

1/2 SIZE; 4" DEEP; STAINLESS STEEL; (1) FLAT PAN COVER; ANTI-JAMMING; NSF

STEAM TABLE PAN W/ COVER, FULL SIZE, 4"

FULL SIZE; 4" DEEP; STAINLESS STEEL; (1) FLAT PAN COVER; ANTI-JAMMING; NSF

STEAM TABLE PAN W/ COVER, FULL SIZE, 6"

FULL SIZE; 6" DEEP; STAINLESS STEEL; (1) FLAT PAN COVER; ANTI-JAMMING; NSF

CUTTING BOARD, MULTI-COLOR

12"W X 18"D X 1/2";(1) SET OF SIX (WHITE, BLUE, RED, YELLOW, TAN, GREEN); POLYETHYLENE, STAIN RESISTANT; NSF

MAGNETIC KNIFE HOLDER

18" LONG; NSF

SQUARE FOOD CONTAINER, 2 QT

2 QUART; (1) LID THAT FITS; SCRATCH RESISTANT; POLYETHYLENE; NSF

SQUARE FOOD CONTAINER, 4 QT

4 QUART; (1) LID THAT FITS; SCRATCH RESISTANT; POLYETHYLENE; NSF

SQUARE FOOD CONTAINER, 6 QT

6 QUART; (1) LID THAT FITS; SCRATCH RESISTANT; POLYETHYLENE; NSF

SQUARE FOOD CONTAINER, 8 QT

8 QUART; (1) LID THAT FITS; SCRATCH RESISTANT; POLYETHYLENE; NSF

SQUARE FOOD CONTAINER, 12 QT

12 QUART; (1) LID THAT FITS; SCRATCH RESISTANT; POLYETHYLENE; NSF

SQUARE FOOD CONTAINER, 18 QT

18 QUART; (1) LID THAT FITS; SCRATCH RESISTANT; POLYETHYLENE; NSF

SQUARE FOOD CONTAINER, 22 QT

22 QUART; (1) LID THAT FITS; SCRATCH RESISTANT; POLYETHYLENE; NSF

SHEET PAN, FULL

18"W X 26"D X 1"H; ALUMINUM; NSF

SOLID SERVING SPOON

15"; STAINLESS; NSF

SLOTTED SERVING SPOON

15"; STAINLESS; NSF

CAN RACK

DESIGNED FOR #10 AND #5 CANS; MOBILE; (4) CASTERS W/ BRAKES; ALUMINUM

MIXING BOWL, 3 QT

3 QUART; STAINLESS; 9-3/8" DIAMETER; 4" DEPTH; NSF

MIXING BOWL, 8 QT

8 QUART; STAINLESS; 13-1/4" DIAMETER; 5-3/8" DEPTH; NSF

MIXING BOWL, 13 QT

13 QUART; STAINLESS; 16" DIAMETER; 6" DEPTH; NSF

MIXING BOWL, 30 QT

30 QUART; STAINLESS; 21-5/8" DIAMETER; 21-5/8" DEPTH; NSF

SPATULA

13-7/8"; TAPERED EDGE; HEAT RESISTANT TO 600 F; NSF

UTILITY CART

33"L X 16"W X 37"H; POLYPROPYLENE; 300 LB CAPACITY; (4) CASTERS; NSF

WIRE GRATE

FITS INSIDE FULL SIZE SHEET PAN; NSF

COMBINATION FOOD PROCESSOR

COMMERICAL GRADE; 7 QUART; (1) STAINLESS STEEL BOWL; ATTACHMENTS (S-BLADE, GRATING DISC, SLICING DISC); NSF

IMMERSION BLENDER

COMMERICAL GRADE; 14"; NSF

SERVING LADLE, 72 OZ

72 OUNCES; 17" LONG; HOOKED HANDLE; 8-1/8" DIAMETER BOWL; NSF

MIXING PADDLE

36" LONG; STAINLESS STEEL; NSF

MIXING BOWL W/ DOLLY

(1) 80 QUART MIXING BOWL W/ STAND & DOLLY; STAINLESS STEEL; NSF

BANQUET CART

APPROX 28"L X 62"H; (4) SHELF; STAINLESS STEEL; (4) CASTERS; NSF

BANQUET CART

APPROX 28"L X 70"H; (5) SHELF; STAINLESS STEEL; (4) CASTERS; NSF

INGREDIENT BIN, 27 GL

27 GALLON; CLEAR SLIDING LID; (4) CASTERS; POLYTHYLENE; WHITE; NSF

INGREDIENT BIN, 36 GL

36 GALLON; CLEAR SLIDING LID; (4) CASTERS; POLYTHYLENE; WHITE; NSF

INGREDIENT BIN, 44 GL

44 GALLON; CLEAR SLIDING LID; (4) CASTERS; POLYTHYLENE; WHITE; NSF

PLASTIC SHELVING UNIT

APPROX 24" X 60" X 67"H; POLYPROPYLENE; (4) CASTERS; NSF

PLASTIC SHELVING UNIT

APPROX 24" X 60" X 75"H; POLYPROPYLENE; (4) CASTERS; NSF

PLASTIC FOOD PAN, 4" HALF SIZE

4" DEEP; 1/2 PAN; POLYCARBONATE; BLACK; ANTI-JAMMING; FRAMED; NSF

PLASTIC FOOD PAN, 6" HALF SIZE

6" DEEP; 1/2 PAN; POLYCARBONATE; BLACK; ANTI-JAMMING; FRAMED; NSF

PLASTIC FOOD PAN, 4" FULL SIZE

4" DEEP; FULL PAN; POLYCARBONATE; BLACK; ANTI-JAMMING; FRAMED; NSF

PLASTIC FOOD PAN, 6" FULL SIZE

6" DEEP; FULL PAN; POLYCARBONATE; BLACK; ANTI-JAMMING; FRAMED; NSF

PLASTIC FOOD PAN, 4" THIRD SIZE

4" DEEP; 1/3 PAN; POLYCARBONATE; BLACK; ANTI-JAMMING; FRAMED; NSF

PLASTIC FOOD PAN, 6" THIRD SIZE

6" DEEP; 1/3 PAN; POLYCARBONATE; BLACK; ANTI-JAMMING; FRAMED; NSF

PLASTIC FOOD PAN, 4" SIXTH SIZE

4" DEEP; 1/6 PAN; POLYCARBONATE; BLACK; ANTI-JAMMING; FRAMED; NSF

PLASTIC FOOD PAN, 6" SIXTH SIZE

6" DEEP; 1/6 PAN; POLYCARBONATE; BLACK; ANTI-JAMMING; FRAMED; NSF

PLASTIC FOOD PAN, 4" LONG 1/2 SIZE

4" DEEP; 1/2 LONG PAN; POLYCARBONATE; LACK; ANTI-JAMMING; FRAMED; NSF

PIE PAN

11-1/4" X 1-1/4"; ALUMINUM

ROLLING PIN

15" - 18" POLYETHYLENE; NSF

ROLLER DOCKER

FOR DOCKING DOUGH; NSF

CAKE PAN, REMOVABLE BOTTOM

8" X 3"; ALUMINUM; NSF

CAKE PAN, REMOVABLE BOTTOM

9" X 3"; ALUMINUM; NSF

CAKE PAN, REMOVABLE BOTTOM

10" X 3"; ALUMINUM; NSF

CAKE PAN, SQUARE

12-3/4" X 9" X 2"; ALUMINUM; NSF

TRAY DRYING RACK

24"W X 60"L X 75"H; (3) SHELF; (4) CASTERS; ANIT-MICROBIAL COATING; NSF

DUNNAGE RACK

21"D X 30"W X 12"H; SLOTTED TOP; POLYPROPYLENE; NSF

KNIFE SET

CARVING TOOL SET; 9-PIECE; HEAVY DUTY STORAGE ROLL INCLUDED; NSF

KNIFE SET

10-PIECE; PARING KNIFE; UTILITY KNIFE; BONING KNIFE; CHEF'S KNIFE; BREAD KNIFE; BREAD KNIFE; SANTOKU-GRANTON; CARVER KNIFE & FORK; SHARPENING STEEL; COMMERICAL GRADE; HEAVY DUTY STORAGE ROLL; NSF

DOUGH CUTTER

STAINLESS STEEL BLADE; POLYPROPYLENE HANDLE; NSF

CAN OPENER

MANUAL; COMMERICAL GRADE; UP TO 11"; STAINLESS STEEL; NSF

PORTION SCALE

DIGITAL, FOOD-SERVICE SCALE; 20 LB; STAINLESS STEEL; SELF-CALIBRATING; NSF

PORTION SCALE

DIGITAL, FOOD-SERVICE SCALE; 10 LB; LCD DISPLAY; STAINLESS STEEL; FIELD RECALIBRATABLE; NSF

WORK TABLE

96"W X 48"D; STAINLESS STEEL; ROLLED EDGE FRONT & BACK; STAINLESS STEEL UNDERSHELF; (8) STAINLESS STEEL LEGS; NSF

HEAVY DRAWER ASSEMBLY

FOR WORKTABLE; 20" X 20" X 5"; STAINLESS STEEL; REMOVABLE DRAWERS; NSF

TABLE CASTERS

FOR WORKTABLE; SET OF EIGHT - (4) SWIVEL (4) BRAKE; 5" DIAMETER; 250 LB CAPACITY PER

WORK TABLE

96"W X 36"D; STAINLESS STEEL; ROLLED EDGE FRONT & BACK; STAINLESS STEEL UNDERSHELF; (8) STAINLESS STEEL LEGS; NSF

POT RACK

FOR WORKTABLE; 88"W X 20"D; TABLE MOUNT; STAINLESS STEEL; TRIPLE BAR DESIGN; (24) DOUBLE PRONGED HOOKS; NSF

SOLID TURNER

SPATULA; 8" X 3"; NSF

PERFORATED TURNER

PERFORATED SPATULA; 8" X 3"; NSF

SOLID TURNER

SPATULA; 4" X 9"; NSF

POT FORK

8" LONG; STANLESS STEEL; NSF

GRATER

STAINLESS STEEL; NSF

PIZZA CUTTER

WHEEL BLADE; NSF

SANDWICH SPATULA

10" BLADE; STAINLESS STEEL; NSF

SANDWICH SPATULA

8" BLADE; STAINLESS STEEL; NSF

SANDWICH SPATULA

6" BLADE; STAINLESS STEEL; NSF

BAKER SPATULA

10" BLADE; STAINLESS STEEL; NSF

BAKER SPATULA

4-/14"L X 3/4"W BLADE; STAINLESS STEEL; NSF

BAKER SPATULA

8" BLADE; STAINLESS STEEL; NSF

GRATER

9" BOX STYLE GRATER; MULTI SLICING PATTERNS; NSF

TONGS

12"; STAINLESS STEEL; NSF

BLENDER

COMMERICAL GRADE BLENDER; 64 OUNCE CONTAINER; BLADE ATTACHMENTS; VITAMIX PREFERRED; NSF

BLENDER CONTAINER

ADDITIONAL 64 OUNCE CONTAINER; NSF

SQUEEZE BOTTLE

PLASTIC, 24OZ. NSF

SQUEEZE BOTTLE

TWIN TIP; 24OZ. NSF

BOULLION STRAINER

8" DIAMETER; STAINLESS STEEL MESH; NSF

SAUCE DISPENSER

1 OZ; GUN TYPE; NSF

PLASTIC SHELVING UNIT

24"W X 60"L X 72"H; 5-TIER; POLYPROPYLENE EXTERIOR; NSF

PLASTIC SHELVING UNIT

24"W X 54"L X 72"H; 5-TIER; POLYPROPYLENE EXTERIOR; NSF

PLASTIC SHELVING UNIT

24"W X 72"L X 72"H; 4-TIER; POLYPROPYLENE EXTERIOR; NSF

00001 00001 00003

00001 00001

00001

00001

00001

00003

00002

00001

00001

00002

00002

00003

00003

00002 ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea ea

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Government Use Only)

FORMCHECKBOX

27a. SOLICITATION INCORPORATED BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA FORMCHECKBOX

ARE FORMCHECKBOX

ARE NOT ATTACHED

FORMCHECKBOX

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA FORMCHECKBOX

ARE FORMCHECKBOX

ARE NOT ATTACHED

FORMCHECKBOX

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ________

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

FORMCHECKBOX

29. AWARD OF CONTRACT: REF OFFER

DATED . YOUR OFFER ON SOLICITATION (BLOCK 5) INCLUDING ANY

ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS.

30a. SIGNATURE OF OFFEROR/CONTRACTOR

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (Type or print)

30c. DATE SIGNED

31b. NAME OF CONTRACTING OFFICER (Type or print)

MARIA L. NESTICO

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (REV. 3/2005)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA – FAR (48 CFR) 53.212

STANDARD FORM 1449 (REV 3/2005)

Prescribed by GSA - FAR (48 CFR) 53.212

ORDER NUMBER

RFQ# 21-16-416QWF723

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL PRICE

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED FORMCHECKBOX

INSPECTED FORMCHECKBOX

ACCEPTED, AND CONFORM TO THE CONTRACT, EXCEPT AS NOTED: ________________________________________

32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
32c. DATE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE
32f. TELEPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER

34. VOUCHER NUMBER

35. AMOUNT VERIFIED CORRECT FOR

36. PAYMENT

COMPLETE FORMCHECKBOX

PARTIAL FORMCHECKBOX

FINAL

37. CHECK NUMBER

FORMCHECKBOX

PARTIAL FORMCHECKBOX

FINAL

38. S/R ACCOUNT NO.

39. S/R VOUCHER NUMBER

40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT
42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD)

42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 3/2005) BACK

_1534045711.unknown

_1534047521.unknown

_1534045670.unknown

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