TE 12 OF347-TO.XLS
XLS spreadsheet 44 KB Posted
- Attached to
- Drivers Training Support Services
- Solicitation number
- LGL08R00010
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Order For Supplies and Services
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OF347 4-06
| TECHNICAL EXHIBIT 12 | OMB CONTROL NO. 1600-0002 | ||||||||||
| ORDER FOR SUPPLIES AND SERVICES | PAGE OF PAGES | ||||||||||
| IMPORTANT: Mark all packages and papers with contract and/or order numbers. | |||||||||||
| 1. DATE OF ORDER | 2. CONTRACT NO. (If any) | 6. SHIP TO: | |||||||||
| a. NAME OF CONSIGNEE | |||||||||||
| 3. ORDER NO. | 4. REQUISITION/REFERENCE NO. | ||||||||||
| b. STREET ADDRESS | |||||||||||
| 5. ISSUING OFFICE (Address correspondence to) | |||||||||||
| c. CITY | d. STATE | e. ZIP CODE | |||||||||
| f. SHIP VIA | |||||||||||
| 7. TO: | |||||||||||
| a. NAME OF CONTRACTOR | 8. TYPE OF ORDER | ||||||||||
| b. COMPANY NAME | a. PURCHASE | ||||||||||
| REFERENCE YOUR: | |||||||||||
| c. STREET ADDRESS | |||||||||||
| d. CITY | e. STATE | f. ZIP CODE | |||||||||
| 9. ACCOUNTING AND APPROPRIATION DATA | 10. REQUISITIONING OFFICE | ||||||||||
| 11. BUSINESS CLASSIFICATION (Check appropriate box(es)) | 12. F.O.B. POINT | ||||||||||
| a. SMALL | b. OTHER THAN SMALL | c. DISADVANTAGED | g. SERVICE-DISABLED VETERAN- OWNED | ||||||||
| d. WOMEN-OWNED | e. HUBZone | f. EMERGING SMALL BUSINESS | |||||||||
| 13. PLACE OF | 14. GOVERNMENT B/L NO. | 15. DELIVER TO F.O.B. POINT ON | 16. DISCOUNT TERMS | ||||||||
| a. INSPECTION | b. ACCEPTANCE | OR BEFORE (Date) | |||||||||
| 17. SCHEDULE (See reverse for Rejections) | |||||||||||
| ITEM NO. | SUPPLIES OR SERVICES | QUANTITY ORDERED | UNIT | UNIT PRICE | AMOUNT | QUANTITY ACCEPTED | |||||
| (a) | (b) | (c) | (d) | (e) | (f) | (g) | |||||
| 18. SHIPPING POINT | 19. GROSS SHIPPING WEIGHT | 20. INVOICE NO. | |||||||||
| 17 (h) TOTAL. | |||||||||||
| SEE BILLING | 21. MAIL INVOICE TO: | (Cont. | |||||||||
| INSTRUCTIONS | a. NAME | pages) | |||||||||
| ON | |||||||||||
| REVERSE | b. STREET ADDRESS (or P.O. Box) | ||||||||||
| 17 (i) | |||||||||||
| c. CITY | d. STATE | e. ZIP CODE | GRAND | ||||||||
| TOTAL | |||||||||||
| 23. NAME (Typed) | |||||||||||
| 22. UNITED STATES OF | |||||||||||
| AMERICA BY (Signature) | |||||||||||
| TITLE: CONTRACTING/ORDERING OFFICER | |||||||||||
| AUTHORIZED FOR LOCAL REPRODUCTION | SOLICITATION LGL08R00010 | OPTIONAL FORM 347 (Rev 4/2006) | |||||||||
| PREVIOUS EDITION NOT USABLE | DRIVERS TRAINING SUPPORT SERVICE | Prescribed by GSA/FAR 48 CFR 53.213(e) | |||||||||
| TECHNICAL EXHIBIT 12 | |||||||||||
| SUPPLEMENTAL INVOICING INFORMATION | |||||||||||
| If desired, this order (or a copy thereof) may be used by the Contractor as the Contractor's invoice, instead of a separate invoice, | |||||||||||
| provided the following statement, (signed and dated) is on (or attached to) the order: "Payment is requested in the amount of | |||||||||||
| $________. No other invoice will be submitted." However, if the Contractor wishes to submit an invoice, the following information must | |||||||||||
| be provided; contract number (if any), order number, item number(s), description of supplies or service, sized, quantities, unit prices, | |||||||||||
| and extended totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs exceed $10 | |||||||||||
| (except for parcel post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an ordering | |||||||||||
| activity during the same billing period, consolidated periodic billings are encouraged. | |||||||||||
| RECEIVING REPORT | |||||||||||
| Quantity in the "Quantity Accepted" column on the face of this order has been: | inspected, | accepted | received by | ||||||||
| me and conforms to contract. Items listed below have been rejected for the reasons indicated. | |||||||||||
| SHIPMENT | PARTIAL | DATE RECEIVED | SIGNATURE OF AUTHORIZED U.S. GOV'T REP. | DATE | |||||||
| NUMBER | FINAL | ||||||||||
| TOTAL CONTAINERS | GROSS WEIGHT | RECEIVED AT | TITLE | ||||||||
| REPORT OF REJECTIONS | |||||||||||
| ITEM NO. | SUPPLIES OR SERVICES | UNIT | QUANTITY REJECTED | REASON FOR REJECTION | |||||||
| SOLICITATION LGL08R00010 | OPTIONAL FORM 347 (REV. 4/2006) BACK | ||||||||||
| DRIVERS TRAINING SUPPORT SERVICE |
b. DELIVERY -- Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of the form and is issued subject to the terms and conditions of the above-numbered contract.
Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.
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