Attachment_2_Contractor_Material_ODC_Purchase_Request_Form_PDF.pdf
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- Solicitation number
- N00421-19-R-0064
About this file
This document is a contractor material and other direct cost procurement request form used by federal contractors to request the purchase of goods and services in support of government contracts. It collects key details such as the contract and task order numbers, line item numbers, cost centers, justification for purchases, vendor information, item descriptions, quantities, unit costs, and extended totals. The form is intended to document procurement requests from contractors to purchase materials and other direct costs for technical support services under solicitation number N00421-19-R-0064, a presolicitation notice from the Department of the Navy Naval Air Systems Command Naval Air Warfare Center for Air Combat Environment Test and Evaluation Facility support services. No response or award dates were included in the opportunity description.
Contractor Material ODC Purchase Request Form
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Text version
ACRN (if known)
Cost Center:
WBS Element:
Network: Deliver by:
Quantity Unit of Issue Extended Cost
POC:
Phone:
FAX:
Vendor
Cage Code Click to Search
Date/Time Stamp
Tracking # (In-House)
Vendor P/N \ Manf P/N \ NSN
Priority
Justification/Reason For Purchase:
(Requestor's Name (Civilian)
Item Description
CONTRACTOR MATERIAL/ODC PROCUREMENT REQUEST FORM
Phone # Competency Code
Phone #
Recoverable Chargeable Object
Procurement Type: (check one)
Project Number Project Name
Contract Number Task Order Number CLIN
Routine URGENT
Contractor POC
Other Items (check all that apply)
Unit Cost
Purchase Request # Purchase Order #
COR/TPOC - printed name COR / TPOC- signature
Funds Approver - printed name
Post Puchase Use Only
Notes:
Funds Approver - signature Date
Delivery Address: (select from list) Vendor Name, Address, POC, Phone, E-Mail Address:
TOTAL PURCHASE COST:
PCO - printed name PCO- signature Date
Date If value is >= $250,000, PCO approval is required
IT HAZMATSAFETY / PPEINFRASTRUCTURE
Vendor Quote (attach copy)
IT Waiver/Approval Form (attach copy)
PROJECT
http://www.dlis.dla.mil/BINCS/begin_search.aspx http://www.dlis.dla.mil/BINCS/begin_search.aspx https://cage.dla.mil/search
Blank Purchase Form
| Requestors Name CivilianRow1: |
| Phone Row1: |
| Competency CodeRow1: |
| Project NumberRow1: |
| Project NameRow1: |
| Contractor POCRow1: |
| Phone Row1_2: |
| Contract NumberRow1: |
| Task Order NumberRow1: |
| CLINRow1: |
| ACRN if knownRow1: |
| Item DescriptionRow1: |
| Vendor PN Manf PN NSNRow1: |
| QuantityRow1: |
| Unit of IssueRow1: |
| Unit CostRow1: |
| Item DescriptionRow2: |
| Vendor PN Manf PN NSNRow2: |
| QuantityRow2: |
| Unit of IssueRow2: |
| Unit CostRow2: |
| Item DescriptionRow3: |
| Vendor PN Manf PN NSNRow3: |
| QuantityRow3: |
| Unit of IssueRow3: |
| Unit CostRow3: |
| Item DescriptionRow4: |
| Vendor PN Manf PN NSNRow4: |
| QuantityRow4: |
| Unit of IssueRow4: |
| Unit CostRow4: |
| Item DescriptionRow5: |
| Vendor PN Manf PN NSNRow5: |
| QuantityRow5: |
| Unit of IssueRow5: |
| Unit CostRow5: |
| Item DescriptionRow6: |
| Vendor PN Manf PN NSNRow6: |
| QuantityRow6: |
| Unit of IssueRow6: |
| Unit CostRow6: |
| Item DescriptionRow7: |
| Vendor PN Manf PN NSNRow7: |
| QuantityRow7: |
| Unit of IssueRow7: |
| Unit CostRow7: |
| Item DescriptionRow8: |
| Vendor PN Manf PN NSNRow8: |
| QuantityRow8: |
| Unit of IssueRow8: |
| Unit CostRow8: |
| Item DescriptionRow9: |
| Vendor PN Manf PN NSNRow9: |
| QuantityRow9: |
| Unit of IssueRow9: |
| Unit CostRow9: |
| Item DescriptionRow10: |
| Vendor PN Manf PN NSNRow10: |
| QuantityRow10: |
| Unit of IssueRow10: |
| Unit CostRow10: |
| Item DescriptionRow11: |
| Vendor PN Manf PN NSNRow11: |
| QuantityRow11: |
| Unit of IssueRow11: |
| Unit CostRow11: |
| Item DescriptionRow12: |
| Vendor PN Manf PN NSNRow12: |
| QuantityRow12: |
| Unit of IssueRow12: |
| Unit CostRow12: |
| Item DescriptionRow13: |
| Vendor PN Manf PN NSNRow13: |
| QuantityRow13: |
| Unit of IssueRow13: |
| Unit CostRow13: |
| Item DescriptionRow14: |
| Vendor PN Manf PN NSNRow14: |
| QuantityRow14: |
| Unit of IssueRow14: |
| Unit CostRow14: |
| Item DescriptionRow15: |
| Vendor PN Manf PN NSNRow15: |
| QuantityRow15: |
| Unit of IssueRow15: |
| Unit CostRow15: |
| Notes: |
| JustificationReason For Purchase: |
| Cage Code: |
| Cost Center: |
| WBS Element: |
| Network: |
| Group4: Off |
| Date5_af_date: |
| Check Box6: Off |
| Check Box7: Off |
| Extended CostRow1: 0 |
| Extended CostRow2: 0 |
| Extended CostRow3: 0 |
| Extended CostRow4: 0 |
| Extended CostRow5: 0 |
| Extended CostRow6: 0 |
| Extended CostRow7: 0 |
| Extended CostRow8: 0 |
| Extended CostRow9: 0 |
| Extended CostRow10: 0 |
| Extended CostRow11: 0 |
| Extended CostRow12: 0 |
| Extended CostRow13: 0 |
| Extended CostRow14: 0 |
| Extended CostRow15: 0 |
| Total Cost: 0 |
| Delivery Address: |
| Vendor: |
| Dropdown2: [Select to Auto Populate] |
| Manual Address Entry: |
| Attention To: |
| POC: |
| Vendor Phone: |
| Fax: |
| Date Time Stamp: |
| Date 1: |
| Date 3: |
| Date 2: |
| COR/TPOC Printed Name: |
| Funds Approver Printed Name: |
| PCO Printed Name: |
| Purchase Request #: |
| Purchase Order #: |
| Tracking # In-House: |
| Group5: Off |
File details come from the government source that posted it. Updated .