Form1155Optional336.pdf

ORDER FOR SUPPLIES OR SERVICES PAGE 1 OF

(Contractor must submit four copies of invoice.)

1.CONTRACT/PURCH ORDER NO. 2.DELIVERY ORDER NO. 3.DATE OF ORDER

(YY/MM/DD)

4.REQUISTION/PURCH REQUEST NO. 5.PRIORITY

N0038325PR0R231

6.ISSUED BY CODE N00383 7.ADMINSTERED BY (If other than 6) CODE

NAVSUP WSS

700 Robbins Avenue Philadelphia, PA 19111

8.Delivery

FOB

DEST

OTHER

Buyer: Code: (See Schedule if other)

Email:

Phone: SCD:

9.CONTRACTOR CODE FACILITY CODE 10.DELIVER TO FOB POINT BY 11.X IF

BUSINESS IS

SMALL

SMALL DISAD

VANTAGED

WOMEN-OWNED

NAME AND

ADDRESS

ATTENTION TO:

12.DISCOUNT TERMS

DUNS #:

13.MAIL INVOICES TO THE ADDRESS IN BLOCK

SEE BLOCK 15

14.SHIP TO CODE 15.PAYMENT WILL BE MADE BY CODE MARK ALL

PACKAGES AND

PAPERS WITH

CONTRACT OR

ORDER NUMBER

SEE ORDER SCHEDULE

16.

TYPE OF

ORDER

DELIVER This delivery order is issues on another government agency or in accordance with and subject to terms and conditions of above numbered contract.

PURCHASE

Reference your furnish the following on terms specified herin

ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRSENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS

AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME.

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED

(YY/MM/DD

If this box is marked, supplier must sign Acceptance and return the following number of copies:

17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE

SEE SCHEDULE

18.ITEM

NO.

19.SCHEDULE OF SUPPLIES/SERVICE 20.QUANTITY

ORDERED/

ACCEPTED*

21.UNIT 22.UNIT PRICE 23.AMOUNT

* If quantity accepted by the Government is same as quantity ordered, indicate by X.If different, enter actual quantity accepted below quantity ordered and encircle.

24.UNITED STATES OF AMERICA 25.TOTAL

26.DIFFERENCE

27.QUANTITY IN COLUMN 20 HAS BEEN

INSPECTED RECEIVED ACCEPTED, AND CONFORMS TO THE

CONTRACT EXCEPT AS NOTED:

b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE c. DATE (YYYYMMMDD) d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 28. SHIP NO 29.D.O. VOUCHER NO 30. INITIALS

PARTIAL

FINAL

32. PAID BY 33.AMOUNT VERIFIED CORRECT FOR

f. TELEPHONE NUMBER g. E-MAIL ADDRESS

31. PAYMENT 34. CHECK NUMBER

36. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT COMPLETE

PARTIAL

FINAL

a.DATE

(YYYYMMMDD)

b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 35. BILL OF LADING NO.

37.RECEIVED

AT

38.RECEIVED BY (Print) 39.DATE

RECEIVED

(YY/MM/DD)

40.TOTAL CON-

TAINERS

41.S/R ACCOUNT NO 42.S/R VOUCHER NO.

DD FORM 1155, DEC 2001 PREVIOUS EDITION IS OBSOLETE

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGES

NAME OF OFFEROR OR CONTRACTOR

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NSN/PART NUMBER and NOMENCLATURE

MILSTRIP(TR)/Serial Number

NSN:

Part Number:

RMC:

Nomenclature:

Serial Number: EA

RTAT:

Throughput Constraint:

Induction Exp.

Date.:

Serial Number: EA

RTAT:

Throughput Constraint:

Induction Exp.

Date.:

TOTAL

FMS Case:

Ship To:

Mark For:

SUPPAD:

TRANSPORTATION SCHEDULE INSTRUCTIONS:

In accordance attached packaging sheet

REPLACEMENT COST/STANDARD PRICE:

NSN 7540-01-152-8067 OPTIONAL FORM 336(4-86)

Sponsered by GSA FAR (48 CFR) 53.110

4868 E PARK 30 DR

COLUMBIA CITY, IN 46725

POC: TANNER CHEEK

EMAIL: TANNER.CHEEK@ULTRA-USSI.COM

SEE CONTINUATION SHEET

NO FAST PAY.

CAV REPORTING IS REQUIRED UNDER SUBJECT AWARD.

THE CONTRACTOR IS REQUIRED TO SHIP BY TRACEABLE MEANS.

SEND A NOTIFICATION OF SHIPMENT TO BOTH THE PCO AND NAVSUP WSS REPAIR MANAGER: SYLK M. SINGLETARY,SYLK.M.SINGLETARY.CIV@US.NAVY.MIL, GOVERNMENT SOURCE INSPECTION IS REQUIRED.

CONTACT DCMC TRANSPORTATION OFFICER FOR SHIPPING INSTRUCTIONS.

PACKAGING AND MARKING SHALL BE IN ACCORDANCE WITH BEST STANDARD COMMERCIAL PACKAGING FOR OVERSEAS SHIPMENT. IF AN ITEM IS FOUND TO BE EITHER BEYOND ECONOMICAL REPAIR (BER) OR BEYOND REPAIR (BR), THE CONTRACTOR SHALL NOTIFY THE DEFENSE CONTRACT MANAGEMENT AGENCY (DCMA) QUALITY ASSURANCE REPRESENTATIVE (QAR) FOR VERIFICATION OF THE ITEM'S CONDITION. THE QAR WILL PROVIDE THEIR ASSESSMENT OF THE ITEM'S CONDITION ALONG WITH ANY OTHER PERTINENT INFORMATION TO THE DCMA ADMINISTRATIVE CONTRACTING OFFICER (ACO). THE ACO WILL ROUTE THE INFORMATION TO THE NAVSUP WSS PROCUREMENT CONTRACTING OFFICER (PCO). THE CONTRACTOR SHALL NOT SCRAP OR CANNIBALIZE THE ITEM UNTIL WRITTEN AUTHORIZATION IS PROVIDED BY THE NAVSUP WSS PCO.

THROUGHPUT CONSTRAINT, AND INDUCTION EXPIRATION DATE INCLUDED IN CLIN REMARKS BELOW ARE DEFINED AS FOLLOWS:

REPAIR TURNAROUND TIME (RTAT): THE CONTRACTUAL DELIVERY REQUIREMENT IS MEASURED FROM ASSET RETURN TO THE DATE OF ASSET ACCEPTANCE UNDER THE TERMS OF THE CONTRACT (DAYS). FOR PURPOSES OF THIS SECTION, RETURN IS DEFINED AS PHYSICAL RECEIPT OF THE F-CONDITION ASSET AT THE CONTRACTOR’S FACILITY AS REFLECTED IN THE ACTION DATE ENTRY IN THE COMMERCIAL ASSET VISIBILITY (CAV) SYSTEM. IN ACCORDANCE WITH THE CAV STATEMENT OF WORK, THE CONTRACTOR IS REQUIRED TO ACCURATELY REPORT ALL TRANSACTIONS BY THE END OF THE FIFTH REGULAR BUSINESS DAY AFTER RECEIPT AND THE ACTION DATE ENTERED IN CAV MUST BE DATED TO REFLECT THE ACTUAL DATE OF PHYSICAL RECEIPT.

THROUGHPUT CONSTRAINT: TOTAL ASSETS TO BE REPAIRED MONTHLY AFTER INITIAL DELIVERY COMMENCES. A THROUGHPUT OF 0000/MONTH REFLECTS NO THROUGHPUT CONSTRAINT.

INDUCTION EXPIRATION DATE: ANY ASSET RECEIVED AFTER THIS DATE IN DAYS IS NOT AUTHORIZED TO BE REPAIRED WITHOUT BI-LATERAL AGREEMENT BETWEEN THE VENDOR AND CONTRACTING OFFICER.

THE CONTRACTOR MUST OBTAIN FINAL INSPECTION AND ACCEPTANCE BY THE GOVERNMENT FOR ALL ASSETS WITHIN THE RTATS ESTABLISHED IN THIS CONTRACT. ANY UNITS THAT MEET THE RTAT REQUIREMENT WITHIN THE SUBCLIN REMARKS SHALL BE PRICED AT THE UNIT PRICE ESTABLISHED IN THIS CONTRACT.

THROUGHPUT CONSTRAINT: TOTAL ASSETS TO BE REPAIRED MONTHLY AFTER INITIAL DELIVERY COMMENCES. A THROUGHPUT OF 0000/MONTH REFLECTS NO THROUGH PUT CONSTRAINT.

INDUCTION EXPIRATION DATE: ANY ASSET RECEIVED AFTER THIS DATE IN DAYS IS NOT AUTHORIZED TO BE REPAIRED WITHOUT BI-LATERAL AGREEMENT BETWEEN THE VENDOR AND CONTRACTING OFFICER.

THE CONTRACTOR MUST OBTAIN FINAL INSPECTION AND ACCEPTANCE BY THE GOVERNMENT FOR ALL ASSETS WITHIN THE RTATS ESTABLISHED IN THIS CONTRACT. ANY UNITS THAT MEET THE RTAT REQUIREMENT WITHIN THE SUBCLIN REMARKS SHALL BE PRICED AT THE UNIT PRICE ESTABLISHED IN THIS CONTRACT.

PRICE REDUCTIONS

ANY ASSETS FOR WHICH THE CONTRACTOR DOES NOT MEET THE REQUIRED RTAT WILL INCUR A PRICE REDUCTION OF TBD PER UNIT. THIS ADJUSTMENT WILL BE IMPLEMENTED VIA A RECONCILIATION MODIFICATION AT THE END OF CONTRACT PERFORMANCE. PRICE REDUCTIONS MADE PURSUANT TO THIS SECTION SHALL NOT LIMIT OTHER REMEDIES AVAILABLE TO THE GOVERNMENT FOR FAILURE TO MEET REQUIRED RTATS, INCLUDING BUT NOT LIMITED TO THE GOVERNMENT’S RIGHT TO TERMINATE FOR DEFAULT.

RECONCILIATION

A RECONCILIATION MODIFICATION WILL BE ISSUED AFTER FINAL INSPECTION AND ACCEPTANCE OF ALL ASSETS INDUCTED UNDER THIS CONTRACT. THE PARTIES HAVE AGREED TO A PRICE (SHOWN ON THE SCHEDULE PAGE) FOR EACH UNIT AT THE NEGOTIATED RTAT. SUCH PRICES ARE BASED ON THE CONTRACTOR MEETING THE RTAT REQUIREMENTS DESCRIBED WITHIN THE SCHEDULE PAGE. IF THE CONTRACTOR DOES NOT MEET THE APPLICABLE RTAT REQUIREMENT, THE PRICE ADJUSTMENT AS STATED SHALL BE APPLICABLE.