Attachment 10 - TSA Form 251.docx

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Credential Authentication Technology (CAT)
Solicitation number
HSTS04-14-R-ST4000
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Attachment 11 - TSA Form 251-1.doc DOC document
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Attachment 4 - TSA RMA Guide for OST.pdf PDF
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Request_for_Proposal_-_Credential_Authentication_Technology_(CAT).pdf PDF
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DEPARTMENT OF HOMELAND SECURITY

Transportation Security Administration

VENDOR SHIPPING AND RECEIVING REPORT

INSTRUCTIONS: This form is to be used when a vendor ships sensitive and/or accountable property, including Transportation Security Equipment (TSE) to TSA. Fill out all applicable fields. If there are more than ten (10) units being shipped, continue entries using TSA Form 251-1, Vendor Shipping and Receiving Report Extension and attach/include it with a completed TSA Form 251. If there are 50 units or more of non-TSE property in a shipment, the vendor shall affix a TSA Barcode to each unit and fill in the applicable “TSA Barcode” field. Contracting Officer’s Representative (COR) must sign and date at bottom of form.

SECTION I. Program Office Information

Request Date Prepared By Phone Number

SECTION II. Delivery Information

Manufacturer Contract

Delivery/Task Order Number Contractual Delivery Date

Shipment |_| Full or |_| Partial Estimated Delivery Date

SECTION III. Shipping Information

Part A. Shipping From

Vendor Address

Contact

Phone Number

Part B. Shipping To

TSA Office Address

Contact

Phone Number

Part C. Items Shipped (include the main unit and each individual component by serial number)

CLIN #
Item Description

(Name/Manufacturer/Model)

Price ($)
FAT Date

(TSE Only) SAT Date (TSE Only)

Serial Number
TSA Barcode
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
TSA Form 251-1 Attached: |_| Yes |_| No
Total Units from Extension: 0
Total Number of Units:
Accepted to Date:
Balance Remaining:

Shipping Crate Dimensions:

Notes:

Contracting Officer’s Representative (COR)

Name (printed)
Signature
Date

Previous editions of this form are obsolete TSA Form 251 (8/12) rev. [File: 200.3.2] Page 1 of 1

File details come from the government source that posted it. Updated .