Sol_140D0426Q0632.pdf

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Validated Executive Assessment
Solicitation number
140D0426Q0632
Issued by

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This is a Request for Quote (RFQ) for Validated Executive Assessment Services issued by the Department of the Interior (DOI), Office of Employee Development, on behalf of the Senior Executive Service Candidate Development Program (SESCDP).

The solicitation number is 140D0426Q0632, issued on July 2, 2026, with quotes due no later than July 20, 2026, at 5:00 PM EDT. The acquisition is set-aside for small business concerns with a North American Industry Classification Standard (NAICS) code of 611430 (Professional and Management Development Training) and a size standard of $15 million. Two line items are solicited: Item 00001 for Validated Executive Assessment – Cohort 1 (base year), with performance from September 30, 2026, to September 29, 2027, and Item 00002 for Validated Executive Assessment – Cohort 2 (option line item with anticipated exercise date of January 1, 2027). Both items are classified as support professional services with product/service code R499. The contracting officer is Juan Rendon (juan_rendon@ibc.doi.gov, 703-964-5329). All responsible sources may submit quotes, which shall be submitted via email. Questions must be submitted by July 10, 2026, at 5:00 PM EDT. Payment will be made electronically through the Invoice Processing Platform (IPP) system upon successful delivery and Government acceptance of each deliverable, with detailed pricing to be provided per deliverable. The solicitation incorporates FAR clauses by reference and includes provisions addressing contractor responsibilities, labor standards, security requirements, diversity and inclusion compliance, and electronic invoicing procedures.

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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

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 NO.

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 29. AWARD OF CONTRACT: REFERENCE

. 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.

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

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.

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

DATED.

OFFER

ADDENDA

ADDENDA

140D0426Q0632

See Schedule See Schedule

Interior Business Center, AQD Acquisition Services Directorate 381 Elden Street Suite 2000A Herndon VA 20170

07/20/2026 1700 ED

Juan Rendon 7039645329

D52 100.00

D52

Juan Rendon

611430

$15

07/02/2026

ADMINISTERED BY:

Interior Business Center, AQD

Acquisition Services Directorate

381 Elden Street

Suite 2000A

Herndon VA 20170 USA

Continued...

STOCK RECORD (S/R)

STANDARD FORM 1449 (REV. 11/2021) BACK

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED 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. TELEPHONE NUMBER OF AUTHORIZED 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

ACCEPTED,

This is a combined synopsis/solicitation for commercial products or commercial services prepared in accordance with Revolutionary

Federal Acquisition Regulation (FAR) Overhaul

(RFO) part 12. This announcement constitutes the only solicitation. Offers are being requested and a separate written solicitation will not be issued.

Solicitation number 140D0426Q0632 is issued as a Request for Quote (RFQ) for Validated

Executive Assessment Services in support of the

Department of the Interior (DOI), Office of

Employee Development (OED).

This acquisition is set-aside for small business concerns. This solicitation incorporates provisions and clauses by reference. The full text provisions and clauses may be accessed electronically at www.acquisition.gov. The applicable North

American Industry Classification Standard

(NAICS) code is 611430 - Professional and

Management Development Training with a small business size standard of $15M.

Interested offerors must submit any questions concerning this combined synopsis/solicitation by July 10, 2026, 5:00 PM EDT to enable the buyer time to respond. Any questions shall be

Continued...

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGES

NAME OF OFFEROR OR CONTRACTOR

SUPPLIES/SERVICES

(B)

UNIT

(D)

UNIT PRICE

(E)

AMOUNT

(F)

OPTIONAL FORM 336 (4-86)

Sponsored by GSA FAR (48 CFR) 53.110

ITEM NO.

(A)

QUANTITY

(C)

NSN 7540-01-152-8067

140D0426Q0632 submitted via the email addresses provided below and can be submitted before the deadline.

Any questions submitted after this deadline may not be considered.

QUOTES IN RESPONSE TO THIS SOLICITATION ARE DUE

NO LATER THAN July 20, 2026, 5:00 PM EDT. The quote responses shall be submitted via email to juan_rendon@ibc.doi.gov.

All responsible sources may submit a quote which shall be considered by the Agency.

Period of Performance: 09/30/2026 to

09/29/2027

00001 Validated Executive Assessment - Cohort 1

Product/Service Code: R499

Product/Service Description: SUPPORT-

PROFESSIONAL: OTHER

This line item is for one cohort to be executed during Fiscal Year (FY) 2027.

00002 Validated Executive Assessment - Cohort 2

(Option Line Item)

Anticipated Exercise Date 01/01/2027

Product/Service Code: R499

Product/Service Description: SUPPORT-

PROFESSIONAL: OTHER

This is an surge line item (optional) for a second cohort to be executed during Fiscal Year

(FY) 2027.

Contracting Officer:

Juan Rendon juan_rendon@ibc.doi.gov

Section 1 - Continuation Pages Section 2 - Clauses

2-1 52.203-17 Contractor Employee Whistleblower Rights. (NOV 2023) 2-2 52.203-19 Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements. (JAN 2017) 2-3 52.204-13 System for Award Management Maintenance. (OCT 2018) 2-4 52.209-6 Protecting the Government's Interest When Subcontracting With Contractors Debarred, Suspended, Proposed for Debarment, or Voluntarily Excluded. (JAN 2025) 2-5 52.209-10 Prohibition on Contracting With Inverted Domestic Corporations. (NOV 2015) 2-6 52.212-4 Contract Terms and Conditions - Commercial Products and Commercial Services. (NOV 2023) 2-7 52.219-6 Notice of Total Small Business Set-Aside. (NOV 2020) 2-8 52.222-3 Convict Labor. (JUN 2003) 2-9 52.222-35 Equal Opportunity for Veterans. (JUN 2020) 2-10 52.222-36 Equal Opportunity for Workers with Disabilities. (JUN 2020) 2-11 52.222-37 Employment Reports on Veterans. (JUN 2020) 2-12 52.222-41 Service Contract Labor Standards. (AUG 2018) 2-13 52.222-50 Combating Trafficking in Persons. (OCT 2025) 2-14 52.222-62 Paid Sick Leave Under Executive Order 13706. (JAN 2022) 2-15 52.224-3 Privacy Training. (JAN 2017) 2-16 52.226-8 Encouraging Contractor Policies To Ban Text Messaging While Driving. (MAY 2024) 2-17 52.232-33 Payment by Electronic Funds Transfer - System for Award Management. (OCT 2018) 2-18 52.232-40 Providing Accelerated Payments to Small Business Subcontractors. (MAR 2023) 2-19 52.233-3 Protest After Award. (AUG 1996) 2-20 52.233-4 Applicable Law for Breach of Contract Claim. (OCT 2004) 2-21 1452.201-70 Authorities and delegations. (SEP 2011) 2-22 52.244-6 Subcontracts for Commercial Products and Commercial Services (Jan 2025) (DEVIATION FEB 2025) ..7 2-23 DOI ELECTRONIC INVOICING Electronic Invoicing and Payment Requirements - Invoice Processing Platform (IPP) (February 2021) 2-24 52.222-90 Addressing DEI Discrimination by Federal Contractors (Deviation APR 2026) 2-25 52.240-91 Security Prohibitions and Exclusions. (Deviation Effective Date) 2-26 52.240-93 Basic Safeguarding of Covered Contractor Information Systems. (Deviation Effective Date)

Section 3 - Attachments Section 4 - Provisions

4-1 52.203-11 Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. (SEP 2024) 4-2 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements-Representation. (JAN 2017) 4-3 52.204-7 System for Award Management. (NOV 2024) 4-4 52.225-25 Prohibition on Contracting with Entities Engaging in Certain Activities or Transactions Relating to Iran- Representation and Certifications. (JUN 2020) 4-5 52.204-90 Offeror Identification. (Deviation Effective Date) 4-6 52.240-90 Security Prohibitions and Exclusions Representations and Certifications. (Deviation Effective Date)

Section 1 - Continuation Pages The Department of Interior (DOI), Acquisition Services Directorate (AQD), on behalf of the Office of Employee Development (OED), has a requirement for a Validated Executive Assessment for the Senior Executive Service, Candidate Development Program (SESCDP) Cohorts.

Period of Performance:

Base: 09/30/2026 - 09/29/2027

Due Dates:

Questions shall be submitted via email to the contracting officer, Juan Rendon, at juan_rendon@ibc.doi.gov NLT July 10, 2026, by 5:00 PM EDT.

Quotes shall be submitted via email at juan_rendon@ibc.doi.gov NLT July 20, 2026, by 5:00 PM EDT.

Point of Contact:

The Government Point Of Contact for this acquisition is the contracting officer:

Juan Rendon juan_rendon@ibc.doi.gov 703-964-5329

Section 2 - Clauses The deviation effective date for all clauses not already displaying a date is MAR 2026.

2-1 52.203-17 Contractor Employee Whistleblower Rights. (NOV 2023)

2-2 52.203-19 Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements. (JAN 2017)

2-3 52.204-13 System for Award Management Maintenance. (OCT 2018)

2-4 52.209-6 Protecting the Government's Interest When Subcontracting With Contractors Debarred, Suspended, Proposed for Debarment, or Voluntarily Excluded. (JAN 2025)

2-5 52.209-10 Prohibition on Contracting With Inverted Domestic Corporations. (NOV 2015)

2-6 52.212-4 Contract Terms and Conditions - Commercial Products and Commercial Services.

(NOV 2023)

2-7 52.219-6 Notice of Total Small Business Set-Aside. (NOV 2020)

2-8 52.222-3 Convict Labor. (JUN 2003)

2-9 52.222-35 Equal Opportunity for Veterans. (JUN 2020)

2-10 52.222-36 Equal Opportunity for Workers with Disabilities. (JUN 2020)

2-11 52.222-37 Employment Reports on Veterans. (JUN 2020)

2-12 52.222-41 Service Contract Labor Standards. (AUG 2018)

2-13 52.222-50 Combating Trafficking in Persons. (OCT 2025)

2-14 52.222-62 Paid Sick Leave Under Executive Order 13706. (JAN 2022)

2-15 52.224-3 Privacy Training. (JAN 2017)

2-16 52.226-8 Encouraging Contractor Policies To Ban Text Messaging While Driving. (MAY 2024)

2-17 52.232-33 Payment by Electronic Funds Transfer - System for Award Management. (OCT 2018)

2-18 52.232-40 Providing Accelerated Payments to Small Business Subcontractors. (MAR 2023)

2-19 52.233-3 Protest After Award. (AUG 1996)

2-20 52.233-4 Applicable Law for Breach of Contract Claim. (OCT 2004)

2-21 1452.201-70 Authorities and delegations. (SEP 2011)

(a) The Contracting Officer is the only individual authorized to enter into or terminate this contract, modify any term or condition of this contract, waive any requirement of this contract, or accept nonconforming work.

(b) The Contracting Officer will designate a Contracting Officer's Representative (COR) at time of award. The COR will be responsible for technical monitoring of the contractor's performance and deliveries. The COR will be appointed in writing, and a copy of the appointment will be furnished to the Contractor. Changes to this delegation will be made by written changes to the existing appointment or by issuance of a new appointment.

(c) The COR is not authorized to perform, formally or informally, any of the following actions:

(1) Promise, award, agree to award, or execute any contract, contract modification, or notice of intent that changes or may change this contract;

(2) Waive or agree to modification of the delivery schedule;

(3) Make any final decision on any contract matter subject to the Disputes Clause;

(4) Terminate, for any reason, the Contractor's right to proceed;

(5) Obligate in any way, the payment of money by the Government.

(d) The Contractor shall comply with the written or oral direction of the Contracting Officer or authorized representative(s) acting within the scope and authority of the appointment memorandum. The Contractor need not proceed with direction that it considers to have been issued without proper authority. The Contractor shall notify the Contracting Officer in writing, with as much detail as possible, when the COR has taken an action or has issued direction (written or oral) that the Contractor considers to exceed the COR's appointment, within 3 days of the occurrence. Unless otherwise provided in this contract, the Contractor assumes all costs, risks, liabilities, and consequences of performing any work it is directed to perform that falls within any of the categories defined in paragraph (c) prior to receipt of the Contracting Officer's response issued under paragraph (e) of this clause.

(e) The Contracting Officer shall respond in writing within 30 days to any notice made under paragraph (d) of this clause.

A failure of the parties to agree upon the nature of a direction, or upon the contract action to be taken with respect thereto, shall be subject to the provisions of the Disputes clause of this contract.

(f) The Contractor shall provide copies of all correspondence to the Contracting Officer and the COR.

(g) Any action(s) taken by the Contractor, in response to any direction given by any person acting on behalf of the Government or any Government official other than the Contracting Officer or the COR acting within his or her appointment, shall be at the Contractor's risk.

(End of clause)

2-22 52.244-6 Subcontracts for Commercial Products and Commercial Services (Jan 2025)

(DEVIATION FEB 2025)

2-23 DOI ELECTRONIC INVOICING Electronic Invoicing and Payment Requirements - Invoice Processing Platform (IPP) (February 2021)

Payment requests must be submitted electronically through the U. S. Department of the Treasury's Invoice Processing Platform System (IPP).

"Payment request" means any request for contract financing payment or invoice payment by the Contractor. To constitute a proper invoice, the payment request must comply with the requirements identified in the applicable Prompt Payment clause included in the contract, or the clause 52.212-4 Contract Terms and Conditions - Commercial Items included in commercial item contracts. The IPP website address is: https://www.ipp.gov.

Under this contract, the following documents are required to be submitted as an attachment to the IPP invoice:

Detailed pricing will be provided per deliverable. Invoices will be submitted upon successful delivery and Government acceptance of each deliverable. Additional supporting documentation may be requested at the discretion of the Contracting Officer's Representative (COR) or the Contracting Officer (CO).

The invoice must contain the following:

a. Contractor name and address

b. Billing period of performance covered for services

c. Invoice number

d. Date

e. Name, title, email address, and phone number of the invoice point of contact

The Contractor must use the IPP website to register access and use IPP for submitting requests for payment. The Contractor Government Business Point of Contact (as listed in SAM) will receive enrollment instructions via email from the Federal Reserve Bank of St. Louis (FRBSTL) within 3 - 5 business days of the contract award date. Contractor assistance with enrollment can be obtained by contacting the IPP Production Helpdesk via email IPPCustomerSupport@fiscal.treasury.gov or phone (866) 973-3131.

If the Contractor is unable to comply with the requirement to use IPP for submitting invoices for payment, the Contractor must submit a waiver request in writing to the Contracting Officer with its proposal or quotation.

(End of Local Clause)

2-24 52.222-90 Addressing DEI Discrimination by Federal Contractors (Deviation APR 2026)

(a) Definitions. As used in this clause-

Program participation means membership or participation in, or access or admission to: training, mentoring, or leadership development programs; educational opportunities; clubs; associations; or similar opportunities that are sponsored or established by the contractor or subcontractor.

Racially discriminatory diversity, equity, and inclusion (DEI) activities means disparate treatment based on race or ethnicity in the recruitment, employment (e.g., hiring, promotions), contracting (e.g., vendor agreements), program participation, or allocation or deployment of an entity's resources.

(b) In connection with the performance of work under this contract, the Contractor agrees as follows:

(1) The Contractor will not engage in any racially discriminatory DEI activities;

(2) The Contractor will furnish all information and reports, including providing access to books, records, and accounts, as required by the Contracting Officer, for purposes of ascertaining compliance with this clause;

(3) In the event of the Contractor's or a subcontractor's noncompliance with this clause, this contract may be canceled, terminated, or suspended in whole or in part, and the Contractor or subcontractor may be declared ineligible for further Government contracts;

(4) The Contractor will report any subcontractor's known or reasonably knowable conduct that may violate this clause to the Contracting Officer and take any appropriate remedial actions directed by the Contracting Officer; and

(5) The Contractor will inform the Contracting Officer if a subcontractor sues the Contractor and the suit puts at issue, in any way, the validity of this clause.

(6) The Contractor recognizes that compliance with the requirements of this clause are material to the Government's payment decisions for purposes of 31 U.S.C. 3729(b)(4).

(c) The Contractor must include the substance of this clause, including this paragraph (c), in subcontracts at any tier, including those for commercial products and commercial services, except those where the place of delivery or performance is outside the United States.

(End of clause)

2-25 52.240-91 Security Prohibitions and Exclusions. (Deviation Effective Date)

2-26 52.240-93 Basic Safeguarding of Covered Contractor Information Systems. (Deviation Effective Date)

Section 3 - Attachments Attachment

Number Title Date

1 B08 SOL Attachment No. 1 - PWS 07/02/2026 2 B08 SOL Attachment No. 2 - Wage Rate 07/02/2026 3 B08 SOL 52.212-1 Instructions to Offerors 07/02/2026 4 B08 SOL 52.212-2 Evaluation Factors 07/02/2026

Section 4 - Provisions The deviation effective date for all provisions not already displaying a date is MAR 2026.

4-1 52.203-11 Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. (SEP 2024)

4-2 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements-Representation. (JAN 2017)

4-3 52.204-7 System for Award Management. (NOV 2024)

4-4 52.225-25 Prohibition on Contracting with Entities Engaging in Certain Activities or Transactions Relating to Iran-Representation and Certifications. (JUN 2020)

4-5 52.204-90 Offeror Identification. (Deviation Effective Date)

4-6 52.240-90 Security Prohibitions and Exclusions Representations and Certifications.

(Deviation Effective Date)

Solicitation/Contract/Order for commercial products and commercial services
Requisition number
Contract number
Award/Effective date
Order number
Solicitation number
Solicitation issue date
For solicitation information call:
Name
Telephone number
Offer due date/local time
Issued by
Code
This acquisition is
NAICS
Size standard
Delivery for free on board (FOB) destination unless block is marked
Discount terms
This contract is a rated order under the defense priorities and allocations system - DPAS
Rating
Method of solicitation
Deliver to
Code
Administered by
Code
Contractor/Offeror
Code
Facility code
Telephone number
Check if remittance is different and put such address in offer
Payment will be made by
Code
Submit invoices to address shown in block 18a unless block below is checked
Accounting and appropriation data
Total award amount
Solicitation incorporates by reference
Addenda
Contract/purchase order incorporates by reference
Addenda
Contractor is required to sign this doc. and return:
Award of contract: reference
Signature of offeror/contractor
Name and title of signer
Signer date signed
Signature of contracting officer
Name of contracting officer
Contracting officer date signed
Authorized for local reproduction. Previous edition is not usable
Standard Form 1449 (Rev. 11/2021)
Quantity in column 21 has been
Signature of authorized government representative
Date
Printed name and title of authorized government representative
Mailing address authorized government representative
Telephone number of authorized government representative
Email number of authorized government representative
Ship number
Voucher number
Amount verified correct for
Payment
Check number
Stock record (S/R)
S/R account number
S/R voucher number
Paid by
I certify this account is correct and proper for payment
Signature and title of certifying officer
Date
Received by
Received at
Date received
Total containers
Standard Form 1449 (rev. 11/2021) Back

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