SF1449 - 70Z02725QPORT0000190.pdf

PDF 805 KB Posted Aug 25, 2025

Attached to: COMMAND PLAQUE BOARDS & PLAQUES Federal contract opportunity
Solicitation number: 70Z02725QPORT0000190
Issued by: Department of Homeland Security US Coast Guard

About this file

Written by GovTribe AI · Aug 25, 2025

This is a Standard Form 1449 (SF 1449) solicitation/contract for commercial products and services issued by USCG Base Portsmouth for various round plaques and administrative items. The solicitation is set aside 100% for Women-Owned Small Business (WOSB) with a North American Industry Classification Standard (NAICS) code of 339950 and a size standard of 500 employees. The document lists seven line items including Administration Command Board, Base Command Board, Enlisted/Civilian of the Quarter Board, and various round plaques ranging from 24" to 35" in size. The solicitation number is 70Z0225QPORT0000190, with an offer due date of 9/01/2025 at 1500 EST, and was issued on 8/25/2025 by Katherine M. Roberts from the U.S. Coast Guard Base in Portsmouth, VA 23703.

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File	Type	Posted
Amendment 0002.pdf	PDF	Sep 4, 2025
AMEND 0002 SPECIFICATION.pdf	PDF	Sep 4, 2025
Amendment 0002 Attachment Page.docx	DOCX document	Sep 4, 2025
DHS LOGO.png	PNG image	Aug 25, 2025
USCG SEAL.jpg	JPG image	Aug 25, 2025
SPECIFICATIONS WORKSHEET.pdf	PDF	Aug 25, 2025
USCG BASE PORTSMOUTH EMBLEM.jpg	JPG image	Aug 25, 2025
TERMS_CONDITIONS_CLAUSES_PROVISIONS_PAYMENT INSTRUCTIONS.pdf	PDF	Aug 25, 2025
ATTACHMENT- SCHEMATICS AND PICTURES.pdf	PDF	Aug 25, 2025

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WOMEN-OWNED SMALL

BUSINESS (WOSB)

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

1. REQUISITION NUMBER PAGE 1 OF

2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY

13b. RATING

14. METHOD OF SOLICITATION

CODE

15. DELIVER TO 16. ADMINISTERED BY CODE

18a. PAYMENT WILL BE MADE BY CODE17a. CONTRACTOR/

OFFEROR

CODE

FACILITY

CODE

TELEPHONE NUMBER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

BELOW IS CHECKED

REQUEST

FOR QUOTE

(RFQ)

INVITATION

FOR BID

(IFB)

REQUEST

FOR

PROPOSAL

(RFP)

SEE ADDENDUM

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Government Use Only)

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH

AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND

ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS

SPECIFIED

29. AWARD OF CONTRACT: REFERENCE OFFER

DATED . . YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR

30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

31b. NAME OF CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

10. THIS ACQUISITION IS UNRESTRICTED OR

NORTH AMERICAN

INDUSTRY CLASSIFICATION

STANDARD (NAICS):

SIZE STANDARD:

13a. THIS CONTRACT IS A

RATED ORDER UNDER

THE DEFENSE PRIORITIES

AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

SET ASIDE: % FOR:

11. DELIVERY FOR FREE ON

BOARD (FOB) DESTINATION

UNLESS BLOCK IS MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

ARE ARE NOT ATTACHED

27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

8(A)

ECONOMICALLY

DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

HUBZONE SMALL

BUSINESS

SMALL BUSINESS

NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30.

STOCK RECORD (S/R)

STANDARD FORM 1449 (REV. 11/2021) BACK

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE RECEIVED (MM/DD/YYYY) 42d. TOTAL CONTAINERS

40. PAID BY

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE

32g. EMAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

PARTIAL FINAL

37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER

36. PAYMENT

COMPLETE PARTIAL FINAL

Standard Form 1449 - Solicitation/Contract/Order for Commercial Products and Commercial Services BarbMWilliams

WOMEN-OWNED SMALL BUSINESS (WOSB)

SMALL BUSINESS

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

1. REQUISITION NUMBER

PAGE 1 OF

2. CONTRACT NUMBER

3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

b. TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY

13b. RATING

14. METHOD OF SOLICITATION

CODE

15. DELIVER TO

16. ADMINISTERED BY

CODE

18a. PAYMENT WILL BE MADE BY

CODE

17a. CONTRACTOR/

OFFEROR

CODE

FACILITY

CODE

TELEPHONE NUMBER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

BELOW IS CHECKED

REQUEST

FOR QUOTE

(RFQ)

INVITATION

FOR BID

(IFB)

REQUEST

FOR

PROPOSAL

(RFP)

SEE ADDENDUM

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Government Use Only)

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH

AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND

ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS

SPECIFIED

29. AWARD OF CONTRACT: REFERENCE OFFER

DATED . . YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 31b. NAME OF CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

10. THIS ACQUISITION IS

UNRESTRICTED OR

NORTH AMERICAN

INDUSTRY CLASSIFICATION

STANDARD (NAICS):

SIZE STANDARD:

13a. THIS CONTRACT IS A

RATED ORDER UNDER

THE DEFENSE PRIORITIES

AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

SET ASIDE:

% FOR:

11. DELIVERY FOR FREE ON

BOARD (FOB) DESTINATION

UNLESS BLOCK IS MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

ARE

ARE NOT ATTACHED

ARE

ARE NOT ATTACHED

27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA \\iaimain\apps1\Pam_Ward\Logos\Pointer.jpg Right Arrow Pointing to Call the Contact Point for this Solicitation/Contract/Order 8(A)

ECONOMICALLY

DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

SMALL BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

HUBZONE SMALL

BUSINESS

SMALL BUSINESS

NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30.

STOCK RECORD (S/R)

STANDARD FORM 1449 (REV. 11/2021) BACK

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED

INSPECTED

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE 42a. RECEIVED BY (Print) 42b. RECEIVED AT (Location) 42c. DATE RECEIVED (MM/DD/YYYY) 42d. TOTAL CONTAINERS

40. PAID BY

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE 32g. EMAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER

34. VOUCHER NUMBER

35. AMOUNT VERIFIED

CORRECT FOR

PARTIAL

FINAL

37. CHECK NUMBER

38. S/R ACCOUNT NUMBER

39. S/R VOUCHER NUMBER

36. PAYMENT

COMPLETE

PARTIAL

FINAL

1. REQUISITION NUMBER: 31040PR250000190

PAGE 1 OF: 49

2. CONTRACT NUMBER:

4. ORDER NUMBER:

5. SOLICITATION NUMBER: 70Z02725QPORT0000190

7. FOR SOLICITATION INFORMATION CALL: a. NAME: KATHERINE M. ROBERTS, GS7, PA/KS

7. FOR SOLICITATION INFORMATION CALL: b. TELEPHONE NUMBER (No collect calls):

9. ISSUED BY CODE: 70Z027

Percent For : 100

12. DISCOUNT TERMS:

13b. RATING:

15. DELIVER TO: USCG BASE PORTSMOUTH

4000 COAST GUARD BLVD

PORTSMOUTH, VA 23703

16. ADMINISTERED BY CODE: 70Z027

16. ADMINISTERED BY: USCG BASE PORTSMOUTH

4000 COAST GUARD BLVD

PORTSMOUTH, VA 23703

17a. CONTRACTOR/OFFEROR CODE:

17a. CONTRACTOR/OFFEROR:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER:

18a. PAYMENT WILL BE MADE BY: IPP

SEE PAYMENT INSTRUCTIONS

19. ITEM NUMBER. Line 1 of 8.: 1.00000000

20. SCHEDULE OF SUPPLIES/ SERVICES: ADMINISTRATION COMMAND BOARD

21. QUANTITY: 1.00000000

22. UNIT: EA

23. UNIT PRICE:

24. AMOUNT: 0.00000000

19. ITEM NUMBER. Line 2 of 8.: 2.00000000

20. SCHEDULE OF SUPPLIES/ SERVICES: BASE COMMAND BOARD

21. QUANTITY: 1.00000000

22. UNIT: EA

23. UNIT PRICE:

24. AMOUNT: 0.00000000

19. ITEM NUMBER. Line 3 of 8.: 3.00000000

20. SCHEDULE OF SUPPLIES/ SERVICES: ENLISTED/CIVILIAN OF THE QUARTER BOARD

21. QUANTITY: 1.00000000

22. UNIT: EA

23. UNIT PRICE:

24. AMOUNT: 0.00000000

19. ITEM NUMBER. Line 4 of 8.: 4.00000000

20. SCHEDULE OF SUPPLIES/ SERVICES: ENLISTED/CIVILIAN OFTHE YEAR BOARD

21. QUANTITY: 1.00000000

22. UNIT: EA

23. UNIT PRICE:

24. AMOUNT: 0.00000000

19. ITEM NUMBER. Line 5 of 8.: 5.00000000

20. SCHEDULE OF SUPPLIES/ SERVICES: USCG ROUND PLAQUE 24"

21. QUANTITY: 1.00000000

22. UNIT: EA

23. UNIT PRICE:

24. AMOUNT: 0.00000000

19. ITEM NUMBER. Line 6 of 8.: 6.00000000

21. QUANTITY: 1.00000000

22. UNIT: EA

23. UNIT PRICE:

24. AMOUNT: 0.00000000

19. ITEM NUMBER. Line 7 of 8.: 7.00000000

20. SCHEDULE OF SUPPLIES/ SERVICES: DHS ROUND PLAQUE 24"

20. SCHEDULE OF SUPPLIES/ SERVICES: BASE PORTSMOUTH ROUND PLAQUE 35"

21. QUANTITY: 1.00000000

22. UNIT: EA

23. UNIT PRICE:

24. AMOUNT: 0.00000000

19. ITEM NUMBER. Line 8 of 8.:

20. SCHEDULE OF SUPPLIES/ SERVICES:

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

25. ACCOUNTING AND APPROPRIATION DATA:

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED. INITIALS : 1

29. AWARD OF CONTRACT: REFERENCE OFFER:

DATE. YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS.:

30b. NAME OF SIGNER (Type or print):

30b. TITLE OF SIGNER (Type or print):

31b. NAME OF CONTRACTING OFFICER (Type or print):

10. THIS ACQUISITION IS UNRESTRICTED: 0

10. THIS ACQUISITION IS SET ASIDE:: 1

11. DELIVERY FOR FOB DESTINATION UNLESS BLOCK IS MARKED SEE SCHEDULE: 0

13a. THIS CONTRACT IS A RATED ORDER UNDER DPAS (CODE OF FEDERAL REGULATIONS AT 15 CFR 700): 0

14. METHOD OF SOLICITATION RFQ: 0

10. THIS ACQUISITION IS NAICS:: 339950

10. THIS ACQUISITION IS SIZE STANDARD:: 500 EMP

14. METHOD OF SOLICITATION IFB: 0

14. METHOD OF SOLICITATION RFP: 0

18a. PAYMENT WILL BE MADE BY CODE: 1500 EST

18a. PAYMENT WILL BE MADE BY CODE: 31040

18a. PAYMENT WILL BE MADE BY CODE: USCG BASE PORTSMOUTH

4000 COAST GUARD BLVD

PORTSMOUTH, VA 23703

KATHERINE.M.ROBERTS2@USCG.MIL

29. AWARD OF CONTRACT : 1

29. AWARD OF CONTRACT : 0

29. AWARD OF CONTRACT : 1

29. AWARD OF CONTRACT : 0

27a. ARE ATTACHED: 1

27a. ARE NOT ATTACHED: 0

27b. ARE ATTACHED: 0

27b. ARE NOT ATTACHED: 0

42c. DATE RECEIVED. Enter 2 digit month, 2 digit day and 4 digit year.: 2025-08-25

42c. DATE RECEIVED. Enter 2 digit month, 2 digit day and 4 digit year.: 2025-09-01

3. AWARD/ EFFECTIVE DATE. Enter 2 digit month, 2 digit day and 4 digit year.:

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK IS CHECKED SEE ADDENDUM: 1

26. TOTAL AWARD AMOUNT (FOR GOVERNMENT USE ONLY):

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER : 0

10. THIS ACQUISITION IS 8(A): 0

10. THIS ACQUISITION IS SMALL BUSINESS: 0

10. THIS ACQUISITION IS SMALL BUSINESS: 1

10. THIS ACQUISITION IS SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS: 0

10. THIS ACQUISITION IS HUBZONE SMALL BUSINESS: 0

32b. Sign here if you are the Authorized Government Representative.:

41b. Sign here if you are the Certifying Officer. :

19. ITEM NUMBER. Line 1 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES: *SEE ATTACHMENTS FOR SPECIFICATIONS

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

19. ITEM NUMBER. Line 2 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES: WORKSHEET, CLAUSES/PROVISIONS/PAYMENT

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

19. ITEM NUMBER. Line 3 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES: INSTRUCTIONS/SCHEMATIC & PICTURES

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

19. ITEM NUMBER. Line 4 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES:

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

19. ITEM NUMBER. Line 5 of 28.:

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

19. ITEM NUMBER. Line 6 f 28.:

20. SCHEDULE OF SUPPLIES/SERVICES:

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

19. ITEM NUMBER. Line 7 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES:

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

20. SCHEDULE OF SUPPLIES/SERVICES:

21. QUANTITY:

22. UNIT:

24. AMOUNT:

19. ITEM NUMBER. Line 8 of 28.:

19. ITEM NUMBER. Line 9 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES:

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

19. ITEM NUMBER. Line 10 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES:

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22. UNIT:

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24. AMOUNT:

19. ITEM NUMBER. Line 11 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES:

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22. UNIT:

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19. ITEM NUMBER. Line 12 of 28.:

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19. ITEM NUMBER. Line 13 of 28.:

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19. ITEM NUMBER. Line14 of 28.:

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19. ITEM NUMBER. Line 15 of 28.:

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22. UNIT:

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19. ITEM NUMBER. Line 16 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES:

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19. ITEM NUMBER. Line 17 of 28.:

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19. ITEM NUMBER. Line 18 of 28.:

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19. ITEM NUMBER. Line 20 of 28.:

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19. ITEM NUMBER. Line 21 of 28.:

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19. ITEM NUMBER. Line 23 of 28.:

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19. ITEM NUMBER. Line 24 of 28.:

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19. ITEM NUMBER. Line 25 of 28.:

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19. ITEM NUMBER. Line 28 of 28.:

20. SCHEDULE OF SUPPLIES/SERVICES:

21. QUANTITY:

22. UNIT:

23. UNIT PRICE:

24. AMOUNT:

32a. QUANTITY IN COLUMN 21 HAS BEEN ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32d. PRINTED NAME OF AUTHORIZED GOVERNMENT REPRESENTATIVE:

32d. PRINTED TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE.:

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE:

32F. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE:

32G. EMAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE:

33. SHIP NUMBER:

34. VOUCHER NUMBER:

35. AMOUNT VERIFIED CORRECT FOR:

37. CHECK NUMBER:

38. S/R ACCOUNT NUMBER:

39. S/R VOUCHER NUMBER:

40. PAID BY:

41b. TITLE OF CERTIFYING OFFICER:

42a. RECEIVED BY (Print):

42b. RECEIVED AT (Location):

42d. TOTAL CONTAINERS:

32a. QUANTITY IN COLUMN 21 HAS BEEN RECEIVED: 0

32a. QUANTITY IN COLUMN 21 HAS BEEN INSPECTED : 0

32a. QUANTITY IN COLUMN 21 HAS BEEN ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: 0

41c. DATE. Enter 2 digit month, 2 digit day and 4 digit year.:

33. SHIP NUMBER PARTIAL: 0

33. SHIP NUMBER FINAL: 0

32c. If you are the Authorized Government Representative, enter the date you signed this form (enter 2 digit month, 2 digit day and 4 digit year).:

36. PAYMENT COMPLETE: 0

36. PAYMENT PARTIAL: 0

36. PAYMENT FINAL: 0

File details come from the government source that posted it. Updated Aug 25, 2025.