Att_6_--_DD1149_Format_From_Airport_to_Depot.doc
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- Integrated Logistics Support (ILS) Services for te Transporation Security Administration
- Solicitation number
- HSTS04-17-R-CT3014
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Attachment 6 - DD1149 format from airport to depot
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SHIPPING CONTAINER TALLY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
| REQUISITION AND INVOICE/SHIPPING DOCUMENT |
| Form Approved |
OMB No. 0704-0246
Public reporting burden for this collection of information is estimated to average 1 hour 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 Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302 and to the Office of Management and Budget. Paperwork Reduction Project (0704-0246). Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO EITHER OF THESE ADDRESSES. RETURN COMPLETED FORM TO THE ADDRESS IN ITEM 2
1. FROM: (Include Zip Code)
Airport Name (3-digit code)
Street Address 1
Street Address 2
City, State Zip Code
| SHEET NO. |
| NO. OF SHEETS |
| 5. REQUISITION DATE |
6. REQUISITION NUMBER
Agency Internal Use Only
| 1 |
| 1 |
| Date emailed to GPM – does not change subsequently |
7. DATE MATERIAL REQUIRED
Date material expected to be at location in block 2
8. PRIORITY
Expedite
2. TO: (Include ZIP Code) OEM Name
Street Address 1
Street Address 2
City, State Zip Code
9. AUTHORITY OR PURPOSE
To OEM depot for Maintenance, Contract# as applicable RMA# enter RMA (if unit is a loaner add - “TSA LOAN AGREEMENT”)
10. SIGNATURE
ANNETTE, CUYLER
TSA
11a VOUCHER NUMBER & DATE
WO# enter WO
3. SHIP TO: MARK FOR
Additional pertinent information, e.g.
· Off-airport shipping location (e.g. Fedex office is not located on airport property)
· TSA POC name, phone number, email
· OEM POC name, phone number, email
12. DATE SHIPPED
Estimated Date TSE leaves OEM
b. WITNESSED BY:
Leave blank for maintenance
13. MODE OF SHIPMENT
Carrier Name, Mode of Shipment
14. BILL OF LADING NUMBER
Carrier’s Tracking Number
15. AIR MOVEMENT DESIGNATOR OR PORT REFERENCE NO. Leave blank for maintenance
| 4. APPROPRIATIONS SYMBOL AND SUBHEAD |
| AMOUNT |
| ITEM NO. |
| FEDERAL STOCK NUMBER, DESCRIPTION AND CODING OF MATERIAL AND/SERVICES |
| UNIT OF ISSUE |
| QUANTITY REQUESTED |
| SUPPLY ACTION |
| TYPE |
CONTAINER
| CONTAINER NOS |
| UNIT PRICE |
| TOTAL COST |
| (a) |
| (b) |
| (c) |
| (d) |
| (e) |
| (f) |
| (g) |
| (h) |
| (i) |
| 1 |
| Model type/ technology , Part No.: Enter PN S/N: Enter SN C/C: Enter condition code |
| EA |
| Enter quantity |
| Leave blank for maintenance |
| CS |
| # container being shipped |
| Leave blank for maintenance |
| Leave blank for maintenance |
TSA BARCODE: Enter Barcode #
AFTER REPAIR SHIP TO:
Airport Name (3-digit code)
Street Address 1
Street Address 2
City, State Zip Code Technician Name, phone number, email
TSA POC Name, phone number, email
| 16. TRANSPORTATION VIA MATS OR MSTS CHARGEABLE TO Leave blank for maintenance |
| 17. SPECIAL HANDLING- Enter any special instructions |
18.
RECAPIT-ULATION
ISSUED BY
Leave blank for maintenance
TOTAL CON-TAINERS
| TYPE CON-TAINERS |
| DESCRIPTION |
| TOTAL WEIGHT |
| TOTAL CUBE |
| 19. |
RECEIPT
CONTAINERS RECEIVED EXCEPT AS
NOTED
| DATE |
| BY |
| SHEET TOTAL |
Same as block (j)
OF SHIP-MENT
| Enter # |
| Blk(f) |
| Model container holds |
| LBS |
CHECKED BY
QUANTITIES RECEIVED EXCEPT AS
NOTED
| DATE |
| BY |
| GRAND TOTAL |
PACKED BY
| POSTED |
| DATE |
| BY |
| 20. RECEIVER’S |
VOUCHER NO.
FORM DD1149, APR 2000
51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
PREVIOUS EDITIONS MAY BE USED.
----------------------------Leave blank for maintenance--------------------------------
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