OS-501.pdf

361 KB Posted

Attached to
HVAC and Plumbing
Solicitation number
6100025910
Issued by
Somerset County, Scottdale Borough, Pennsylvania

About this file

Written by GovTribe AI ·

This document appears to be a Confirmation of Service form used by the Pennsylvania Department of Transportation (PennDOT) to approve payment to a contractor. The form includes the contractor's name and address, purchase order number, item descriptions and quantities, unit prices, and a total amount. It also includes signatures from the project manager and an SRM/R3 receiver certifying that the services were received satisfactorily and that a goods receipt has been entered into the SAP system.

The form does not provide details about a specific contract opportunity, but rather documents the completion of services provided under an existing purchase order. There is no information included about solicitation details, award dates, contract terms, funding sources, or other salient details related to a contracting opportunity.

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Date Service Rendered: _______________________________ SAP Vendor Number: ________________________________ Contractor Name: ____________________________________ Address (1): ________________________________________ Phone: ____________________________________________ Address (2): ________________________________________ PURCHASE ORDER # ________________________________ State:______________ Zip Code: ____________________

(Reference line items on purchase order that match the services that were performed.)

Item # Description / Product ID Quantity U.O.M. Unit Price Item Total

Total:

Contractor Signature: ________________________________ Date: _____________

CONFIRMATION OF SERVICE

OS-501 (11-12)

www.dot.state.pa.us

PENNDOT USE ONLY

I certify the services represented by the confirmation of service form above were received satisfactorily. Therefore, I approve payment be made.

I certify that I have entered a Goods Receipt in SAP for this service. (Goods Receipts should be entered within 48 hours per Management Directive 310.31)

Project Manager Signature Date (mm/dd/yyyy)

SRM/R3 Receiver Signature Date (mm/dd/yyyy) SRM Confirmation # / R3 Material Document #

Date Service Rendered:
SAP Vendor Number:
Contractor Name:
Address 1:
Phone:
Address 2:
PURCHASE ORDER:
State:
Zip Code:
Date:
Date mmddyyyy:
Item #, Row 1:
Item #, Row2:
Item #, Row4:
Item #, Row5:
Item #, Row3:
Item #, Row6:
Description Product ID, Row 1:
Description Product ID, Row 2:
Description Product ID, Row 3:
Description Product ID, Row 4:
Description Product ID, Row 5:
Description Product ID, Row 6:
UOM, Row 1:
UOM, Row 2:
UOM, Row 3:
UOM, Row 4:
Quantity 1:
Quantity 2:
Quantity 3:
Quantity 4:
Unit Price 1:
ItemTotal1: 0
Unit Price 2:
Unit Price 3:
Unit Price 4:
ItemTotal2: 0
ItemTotal3: 0
ItemTotal4: 0
TOTAL: 0
Quantity 5:
UOM, Row 5:
Unit Price 5:
ItemTotal5: 0
ItemTotal6: 0
Unit Price 6:
UOM, Row 6:
Quantity 6:
Date mmddyyyy_2:
Confirmation Number:

File details come from the government source that posted it. Updated .