12.a.3.Attachment_3_-_DHS700-21_MIRR_(BB1124).pdf

PDF 27 KB Posted Apr 21, 2017

Attached to: Charter Bus Service for U. S. Coast Guard Personnel
Solicitation number: HSCG84-17-Q-BB1124
Issued by: Department of Homeland Security US Coast Guard

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Attachment 3 - Material Inspection and Receiving Report

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Amendment_0003_HSCG84-17-Q-BB1124_(SF-30).pdf	PDF	May 5, 2017
12.a.Solit_Amendment0003.pdf	PDF	May 5, 2017
12.a.Solit_Amendment0002.pdf	PDF	May 2, 2017
Amendment_0002_HSCG84-17-Q-BB1124_(SF-30).pdf	PDF	May 2, 2017
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12.a.2.Attachment_2_-_RAPIDgate_(BB1124).doc	DOC document	Apr 21, 2017

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DEPARTMENT OF HOMELAND SECURITY

MATERIAL INSPECTION AND RECEIVING REPORT

DATE

1. CONTRACT NO. 2. ORDER NO. 3. REPORT NO.

4. MATERIAL AND/OR SERVICES INSPECTED

5. CONTRACTOR

6. MANUFACTURER

7. PLACE OF INSPECTION

INSPECTION DATES QUANTITYCONTRACT LINE

ITEM NO(S)

(If applicable)

10. RECEIVED 10. READY 11. STARTED 12. COMPLETED 13. REJECTED 14. ACCEPTED

DHS Form 700-21 (12-03)

REPORTS

THIS

REPORT

TOTAL TO

DATE

15. SUBMITTED

16. REJECTED

17. ACCEPTED

18. QUANTITY ON

ORDER

19. ACCEPTED TO

DATE

20. BALANCE

REMAINING

21. REMARKS (Use Continuation Sheet for Additional Entries)

22. INSPECTED BY 23. TITLE

The materials and/or serices listed herein have been iinspected or certified test data has been examined, by me or under my supervision. The materials and/or services listed above as accepted conform to contract requirements. Those listed as rejected do not conform and may not be delivered, except as authorized under "Remarks."

24. SIGNATURE OR NAME 25. TITLE 26. DATE

CPrestipino Typewritten Text

HSCG84-17-Q-BB1124

CPrestipino Typewritten Text

CPrestipino Typewritten Text Attachment 3 - MIRR Sample

INSPECTION DATES QUANTITYCONTRACT LINE

ITEM NO(S)

(If applicable)

10. RECEIVED 10. READY 11. STARTED 12. COMPLETED 13. REJECTED 14. ACCEPTED

3. REPORT NO.

DEPARTMENT OF HOMELAND SECURITY

MATERIAL INSPECTION AND RECEIVING REPORT (Cont'd )

DHS Form 700-21 (12-03) Page 2

DATE:

CONTRACT_NO:

ORDER_NO:

REPORT_NO:

MATERIAL:

CONTRACTOR:

MANUFACTURER:

PLACE_INSPECTION:

LINE1:

REC_DATE1:

READY1: 3

START1:

COMPLETED1:

REJECTED1:

ACCEPTED1:

LINE2:

RECEIVE2:

READY2:

START2:

COMPLETED2:

REJECTED2:

ACCEPTED2:

LINE3:

RECEIVE3:

READY3:

START3:

COMPLETED3:

REJECTED3:

ACCEPTED3:

LINE4:

RECEIVE4:

READY4:

START4:

COMPLETED4:

REJECTED4:

ACCEPTED4:

LINE5:

RECEIVE5:

READY5:

START5:

COMPLETED5:

REJECTED5:

ACCEPTED5:

PREVIOUS1:

THIS1:

TOTAL1:

PREVOUS2:

THIS2:

TOTAL2:

PREVIOUS3:

THIS3:

TOTAL3:

QUANT_ORDER:

ACCEPTED_DATE:

BAL_REMAINING:

REMARKS:

INSPECTED_BY:

TITLE:

TITLE2:

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