DD1155 v2.pdf

14. SHIP TO

ORDER FOR SUPPLIES OR SERVICES

PAGE 1 OF

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

(YYYYMMMDD)

4. REQUISITION/PURCH REQUEST NO. 5. PRIORITY

6. ISSUED BY CODE 7. ADMINISTERED BY (If other than 6) CODE 8. DELIVERY FOB

DESTINATION

OTHER

(See Schedule if other)

10. DELIVER TO FOB POINT BY (Date)

(YYYYMMMDD)

12. DISCOUNT TERMS

13. MAIL INVOICES TO THE ADDRESS IN BLOCK

11. X IF BUSINESS IS

SMALL

SMALL DISAD-

VANTAGED

WOMEN-OWNED

CODE 15. PAYMENT WILL BE MADE BY CODE

MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATION

NUMBERS IN

BLOCKS 1 AND 2.

16.

TYPE

OF

ORDER

DELIVERY/

CALL

PURCHASE

This delivery order/call is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contract.

Reference your furnish the following on terms specified herein.

ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED 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.

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

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED

(YYYYMMMDD)

17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE

18. ITEM NO. 19. SCHEDULE OF SUPPLIES/SERVICES

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

29.

DIFFERENCE

S

30. INITIALS26. QUANTITY IN COLUMN 20 HAS BEEN

INSPECTED RECEIVED ACCEPTED, AND CONFORMS TO THE

CONTRACT EXCEPT AS NOTED

DATE SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

27. SHIP. NO.

PARTIAL

FINAL

31. PAYMENT

COMPLETE

PARTIAL

FINAL

28. D.O. VOUCHER NO.

32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR

34. CHECK NUMBER

35. BILL OF LADING NO.

42. S/R VOUCHER NO.

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

DATE SIGNATURE AND TITLE OF CERTIFYING OFFICER

37. RECEIVED

AT

38. RECEIVED BY (Print) 39. DATE RECEIVED

(YYYYMMMDD)

40. TOTAL CON-

TAINERS

41. S/R ACCOUNT NUMBER

DD FORM 1155, JAN 1998 (EG) PREVIOUS EDITION MAY BE USED.

CONTRACTING/ORDERING

Designed using Perform Pro, WHS/DIOR, Jan 98

9. CONTRACTOR CODE FACILITY

l l l l

NAME

AND

ADDRES

S

BY:

N6945020R0006 DO-C2

N69450

NAVFAC SE

Yorktown Avenue, Bldg. 903 P.O. Box 30 NAS Jacksonville, FL 32212

X

See Schedule

See WAWF Clause

X

N68732 DFAS-Cleveland Accounts Payable, 1240 E 9th Street Cleveland, OH 44199

X

See page 2 See Page 2

DD1155 Page 2

SCHEDULE OF SUPPLIES/SERVICES

The offeror agrees to perform the work required at the proposed Firm-Fixed-Price specified below in strict accordance with the terms and conditions and regulatory requirements of this solicitation if this offer is accepted by the Government in writing within 120 calendar days after the date offers are due.

Proposal shall include all labor, equipment, materials, lower-tier subcontractors, and supplies necessary to complete the activities specified in the solicitation.

The offeror agrees to furnish any required performance and payment bonds.

Contract Line Items / Schedule of Supplies and Services

Item 0001 B1428 – Entire Building Renovation $________________________

Basis of Item 0001 shall be the entire work completed in accordance with the B1428 Entire Building Renovation Design RFP and B1428 Drawings.

A firm-fixed price is required for the bid item. No provision is made for economic price adjustment.

All post award submittals, correspondence, contact, etc. shall be directed to the office identified in Block 6 of the DD Form 1155. Specific point of contact is:

(Name and contact info to be completed at time of award)