Attachment_2_DD_FORM_250.pdf
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Attachment 2 DD Form 250
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MATERIAL INSPECTION AND RECEIVING REPORT Form Approved OMB No. 0704-0248
The Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, Highway, Suite (0704-0248), 1215 Jefferson Davis 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES.
SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN DFARS, APPENDIX F-401
1. PROC. INSTRUMENT IDEN. (CONTRACT) (ORDER) NO. 6. INVOICE NO./DATE 7. PAGE OF 8. ACCEPTANCE POINT
D
2. SHIPMENT NO. 3. DATE SHIPPED 4. B/L
TCN
5. DISCOUNT TERMS
9. PRIME CONTRACTOR CODE 10. ADMINISTERED BY CODE
11. SHIPPED FROM (If other than 9) CODE FOB D
12. PAYMENT WILL BE MADE BY CODE
13. SHIPPED TO CODE 14. MARKED FOR CODE
15.
ITEM
NO.
16. STOCK/PART NO. DESCRIPTION
(Indicate number of shipping containers - type of container - container number)
17.
QUANTITY
SHIP/REC'D*
18.
UNIT
19.
UNIT PRICE
20.
AMOUNT
21. CONTRACT QUALITY ASSURANCE 22. RECEIVER'S USE
A. ORIGIN
CQA ACCEPTANCE of listed items has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE
NUMBER:
B. DESTINATION
CQA ACCEPTANCE of listed items has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE
NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted
DATE RECEIVED SIGNATURE OF AUTH GOVT REP
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE
NUMBER:
*If quantity received by the Government is the same as quantity shipped, indicate by ( ) mark, if different, enter actual quantity re-ceived below quantity shipped and encircle.
23. CONTRACTOR USE ONLY
DD Form 250, AUG 2000 PREVIOUS EDITION IS OBSOLETE © Copyright 2000, Diverstech Co., All Rights Reserved.
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