M67001-16-T-0005_Technical_Exhibit_1.pdf

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Repair and maintenance of electric washers & dryers
Solicitation number
M67001-16-T-0005
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M67001-16-T-0005 Technical Exhibit 1

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M67001-16-T-0005 Technical Exhibit 1

REQUEST INSTALLATION / RELOCATION / REMOVAL

INSTALLATION RELOCATION REMOVAL

BUILDING NUMBER______________ DATE OF REQUEST _________________________

REMOVE WASHERS AND DRYERS IN BARRACKS DUE FOR RENOVATION

WASHER

MODEL

DRYER

MODEL

WASHER

ID#

WASHER SERIAL # DRYER ID # DRYER

SERIAL #

REQUESTOR: _______________DATE: ____________________PHONE: _______________

CONTRACT OFFICERS REPRESENTATIVE: ____________ SIGNATURE: ____________

CONTRACTOR: ____________________________

CONTRACTOR SIGNATURE: ____________________ DATE COMPLETED: ___________

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