SP451011R1003FBO.pdf

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INSTRUCTIONS. This form must be fully completed by all applicants for Munitions List Items (MLI)/Commerce Control List Items (CCLI) prior to acceptance by the U.S. Government and constitutes an integral part of this bid. The information given must be true and correct and will become a part of this contract. Every block MUST have an entry. If necessary, insert ''NONE, '' ''SAME AS BLOCK X ' or ''NOT APPLICABLE'' (do not use ''N/A ''). If the applicant is acting solely as an Agent, a DLA Form 1822 must be signed by the Principal. The term Approving Official is used to indicate the person authorized to act for the U.S. Government (Sales Contracting Officer Plant Clearance Officer or other designated individual). FOR ALL SALES OF PROPERTY APPROVED BY PLANT CLEARANCE OFFICERS UPON THE REMOVAL OF THE PROPERTY, ALL DOCUMENTATION REQUIRED BY THIS FORM WILL BE FORWARDED TO THE IDENTIFIED TRADE

IFB/CONTRACT/OFFER/SF122/SF123 ORDER NO.

END-USE CERTIFICATE

(STATEMENT REGARDING DISPOSITION AND USE OF PROPERTY)

FOR AGENCY USE ONLY

SUB-PURCHASER Form Approved

OMB No. 0704-0382 Expires Jul 31, 2011

TSC PRIMARY

CLD PURCHASER

(Please read Privacy Act Statement on reverse before completing this form.

If additional space is required, use separate sheets and identify by Block Number.)

TYPE OR PRINT ALL INFORMATION

The public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to DoD, Washington Headquarters Services, DIOR (0704-0382), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to either of these addresses. RETURN COMPLETED FORM TO THE OFFICE STATED ON THE IFB, SOLICITATION OR PROPOSAL.

The following applies to all property subject to sale using this form: the use, disposition, export, or re-export of this property, is subject to the publications, penalties, and other provisions of the economic programs administered by the Office of Foreign Assets Control, U.S. Treasury Department, 31 CFR Chapter V.

DATE OF BIRTH (MM/DD/YY) TELEPHONE NUMBER (Include Area Code)PLACE OF BIRTH (City or County, State, Country)

PHYSICAL ADDRESS

2. NATURE OF END-USER'S BUSINESS 3. NATURE OF PRINCIPAL'S BUSINESS 4. FIRM'S ID/FEDERAL TAX NUMBER

B. Resold in the form received for theA. Retention for the following specific use C. The property will not be sold or otherwise (see note): following use (see note) : disposed of for use outside of the United States or to non-U.S. Citizens/Nationals in the United States.

D. The property may be exported or E. Resale after following alteration (description F. If sold, name, address, and telephone number of sub-purchaser(s) :re-exported in the form received to the following country/countries:

of final production) :

in (Country/Countries) :

and distribution in (Country/Countries) :

DLA FORM 1822, JUL 2008 ALL OTHER VERSIONS ARE OBSOLETE PAGE 1 OF 2

MAILING ADDRESS

PDF (DLA)

SECURITY CONTROL OFFICE.

1 2 3 4

YES

NO

THIS STATEMENT IS SUBMITTED IN CONNECTION WITH:

OTHER:EXCHANGESALE

LINE ITEM NUMBER/COMMODITY

NAME (Last, First, Middle) SSN/ALIEN CARD NO./COUNTRY ID

SECTION I. GENERAL INFORMATION

APPLICABILITY. This statement applies to the property for which we have submitted our bid/offer pursuant to the above identified invitation.

OTHER (Specify):CORPORATIONPARTNERSHIPSOLE PROPRIETORSHIP

5. BUSINESS/CORPORATION HEADQUARTERS 6. BRANCH OFFICE

A. NAME A. NAME

B. ADDRESS (Physical location) B. ADDRESS (Physical location)

7. ALL CORPORATE OFFICERS, PARTNERS AND/OR AGENTS ARE TO PROVIDE, ON SEPARATE SHEETS OF PAPER, THEIR NAMES, ADDRESSES, SSNs, DATES AND PLACES OF BIRTH. FAILURE TO PROVIDE THIS INFORMATION COULD RESULT IN SIGNIFICANT DELAY OR DENIAL OF THE AWARD.

SECTION II. END USE/USER INFORMATION. If this is a negotiated exchange, identify the property being exchanged:

1. PURPOSE. THE PROPERTY REFERRED TO IN ABOVE IFB/OFFER NUMBER WILL BE UTILIZED FOR THE FOLLOWING:

Enter and 'X' in the appropriate item(s) below. In the case of resale, Item 1.F. or 1.G. MUST be marked.

G. The customers are unknown at this time. If required by the contract/transfer document, I will obtain prior written approval for the resale of any of the property covered by this contract.

ADDITIONAL INFORMATION: State any other material facts relating to end user and use of the property which may be of value in considering the proposal:

NOTE: Example of specific uses: AIRCRAFT. The bidder/recipient certifies that the aircraft will be used: as a flyable aircraft; as a nonflyable aircraft to be used only for parts, display, or ground instruction, etc.; for resale as a flyable aircraft.

SECTION Ill. UNDERSTANDING AND NOTIFICATIONS 1 . The use, disposition, export and re-export of this property is subject to all applicable U.S. Laws and Regulations, including but not limited to the Arms Export Control Act (22 USC 2751 et seq.); Export Administration Act of 1979 (50 USC App.

2401 et seq.) as continued under Executive Order 12924; International Traffic in Arms Regulations (22 CFR 120 et seq.);

Export Administration Regulations (15 CFR 730 et seq.); Foreign Assets Control Regulations (31 CFR 500 et seq.) and the Espionage Act (18 USC 793 et seq.); which, among other things, prohibit:

A. The making of false statements and concealment of any material information regarding the use or disposition, export or re-export of the property and

B. Any use, disposition, export or re-export of the property not permitted by applicable statute and regulation.

2. The submission of false or misleading information and/or concealment of any material facts regarding the use, disposition or export of this property may constitute a violation of provisions of 18 USC 793/1001, 22 USC 2778/2779, 50 USC App.

2410, and 50 USC App. 1-44. Sanctions for violations will be in conformity with U.S. laws and regulations (including Federal Acquisition Regulations and DoDD 2030.8) and may include the denial of U.S. export privileges and of any participation in future U.S. Government contracts.

3. Transfers of MLI and CCLI property by purchasers/bidders are subject to the requirements of the appropriate licensing department or agency. In many cases, an export license or other authorization may be required. With respect to MLI, registration of the purchaser's/bidder's business with the Department of the State may also be required. It is the responsibility of the purchaser/bidder to determine what the applicable requirements may be and to obtain all necessary authorization or approvals.

4. When MLI/CCLI property is transferred, the information in this form regarding the above laws and regulations must be passed to the subsequent purchaser/receiver. Records of Resale in buyer's possession should be available for Trade Security Controls Office review, if requested.

5. The Invitation For Bid and Sale/Exchange Contract number can be referenced when submitting an application for an export license or other authorization to the Department of State for MLI or Department of Commerce for CCLI.

6. The Government expects the Purchaser/Recipient to cooperate with all authorized Government representatives to verify the existence and condition of MLI/CCLI.

SECTION IV. CERTIFICATION STATEMENT TO BE SIGNED BY BIDDER AT TIME OF RESPONSE TO IFB 1 . I do certify that all information given in this Statement Regarding Disposition and Use of Property is true and correct to the best of my knowledge and belief and have not knowingly omitted any information which is inconsistent with this statement.

I understand this statement will be referred to and be a part of the contract of sale/exchange with the U.S. Government. I agree to submit a written request for amendment of this statement to the Approving Official prior to effecting any change of fact or intention from that stated herein or in any prior amendment, whether occurring before or after the release of the commodities, and not to effect such changes without first receiving written approval of the Approving Official.

2. I acknowledge having been advised that the MLI/CCLI property I purchased is controlled by the U.S. Government and in many cases cannot be transferred (exported, sold or given) to a foreign country, a non-U.S. Citizen/National or a non-Permanent US Resident without a valid State/Commerce Department export authorization. Should I transfer this property to a foreign country, a non-U.S. Citizen/National or a non-Permanent US Resident, I will obtain any required authorization before making such transfers. I will not transfer this property to countries, regimes and nationals targeted under the sanctions program administered by the U.S. Treasury Department's Office of Foreign Assets Control.

3. Neither the applicant, corporate officers, directors or partners is:

A. The subject of an indictment for or has been convicted of violating any of the U.S. Criminal statutes enumerated in 22

B. Ineligible to contract with, or to receive, a license or other approval from any agency of the U.S. Government.

CFR 120.27 since the effective date of the Arms Export Control Act, Public Law 94-329, 90 Stat. 729 (June 30, 1976) ; or

4. The person signing this DLA Form 1822 is:

a Citizen of the United States of America, or lawfully admitted to the United States for Permanent Residence and maintains such residence under the Immigration and Nationality Act, as amended (8 USC 1101 (a), 20, 60 Stat. 163) , or a Citizen of , and/or is an official of a foreign government entity in the United States.

B. SIGNATURE C. DATE SIGNEDA. NAME (Type or print)

PRIVACY ACT STATEMENT

10 USC 136; 40 USC 471; 50 USC 2411; 22 USC 2751; and EO 9397.AUTHORITY:

PRINCIPAL PURPOSE(S): Determine applicant eligibility to participate in the program and ensure that property recipients comply with the terms of the sale.

Data may be disclosed to the Departments of State, Commerce, Treasury, Transportation and Justice for determining compliance with applicable laws and regulations and to the General Services Administration to determine presence of

ROUTINE USES:

debarment proceedings against a recipient.

DISCLOSURE: Voluntary; however, failure to provide the requested information may result in ineligibility to receive surplus or foreign personal property. DLA PRIVACY ACT SYSTEM NOTICE S800. 10 DLSC APPLIES - SEE THIS NOTICE FOR FURTHER

INFORMATION.

PAGE 2 OF 2ALL OTHER VERSIONS ARE OBSOLETEDLA FORM 1822, JUL 2008 (BACK) PDF (DLA)

PrimaryYes:

PrimaryNo:

SubYesOne: Off

SubYesTwo: Off

SubYesThree: Off

SubYesFour: Off

SubNoOne: Off

SubNoTwo: Off

SubNoThree: Off

SubNoFour: Off

ConjunctionWith: Off

ConjSpecify:

LineItemComm:

Name:

SSNetc:

DOB:

PlaceofBirth:

Phone:

PhysicalAddress:

MailingAddress:

FirmType: Off

PrincipalBusiness:

EndUserBusiness:

BusinessHQ:

BranchName:

BusAddress:

BranchAddr:

PropID:

Retention: Off

Resold: Off noOutside: Off

ReExport: Off

Resale: Off

Sold: Off

FinalProduction:

Country:

Distribution:

CustUnknown: Off

AdditionalInfo:

RetentionNote:

ResoldNote:

CountryNote:

SoldNotes:

OtherFirm:

FirmIDorTaxNum:

OrderNumber: SP451011R1003 Attachment 1

USCitizen: Off

LawfulResident: Off

IsOtherCitizen: Off

WhatCountry:

Offical: Off

NameofPerson:

Signature:

Datesigned:

ResetMe:

LETTER OF AUTHORIZATION

I, the undersigned, hereby authorize to act as my agent on

Contract with respect to the items listed below and for the purpose indicated by check mark in the boxes provided under "Extent of Authority".

EXTENT OF AUTHORITY LIST ITEM(S)

(Prescribing authority: DRMS-H 4160.3, Volume 1)

Make payment.

Make payment and remove property.

Remove property.

Perform work required under the contract.

Accept and sign for deliveries above or below the quantity variations allowed under the contract.

Sign certifications required prior to Government's permitting release of property.

Other (specify):

SIGNATURE OF PURCHASER

TO:

(PRINT NAME) (PRINT NAME)

DATE

DRMS FORM 1646, DEC 94 (EF) (Previous Edition May Be Used Until Exhausted) s9d3631

Typewritten Text

SP451011R1003 Attachment 2

REPORT OF DISCREPANCY (ROD)

SHIPPING PACKAGING

1. DATE OF PREPARATION 2. REPORT NUMBER

3. TO (Name and address, include ZIP Code) 4. FROM (Name and address, include ZIP Code)

5a. SHIPPER'S NAME 5b. NUMBER AND DATE OF

INVOICE

6. TRANSPORTATION DOCUMENT

NUMBER (GBL, Waybill; TCN, etc.)

7a. SHIPPER'S NUMBER (Purchase order/Shipment, Contract, etc.)

7b. OFFICE ADMINISTRATION CONTRACT 8. REQUISTIONER'S NUMBER (Requi-sition, Purchase Request, etc)

9. SHIPMENT, BILLING, AND RECEIPT DATA 10. DISCREPANCY DATA 11.

AC-2

TION

CODENSN/PART NUMBER AND

NOMENCLATURE

(a)

UNIT

OF ISSUE

(b)

QUANTITY

SHIPPED/

BILLED

(c)

RECEIVED

(d)

QUAN-

TITY

(a)

PRICE

(b)

TOTAL

COST

CODE1

12. REMARKS (Continue on separate sheet of paper if necessary)

1DISCREPANCY CODES 2 ACTION CODES

CONDICTION OF MATERIAL

C1 — In condition other than that indicated on release/ receipt document C2 — Expired shelf life C3 — Damaged parcel post shipment

SUPPLY DOCUMENTATION

D1 — Not received D2 — Illegible or mutilated D3 — Incomplete improper or without authority (Only when receipt cannot be properly process)

MISDIRECTED MATERIAL

M1 — Addressed to wrong activity

OVERAGE/ DUPLICATE SHIPMENTS

O1 — Quantity in excess of that on receipt docu-ment O2 — Quantity in excess of that requested (Other than unit of issue pack) O3— Quantity duplicates shipment

PACKING DISCREPANCY

P1 — Improper preservation P2 — Improper packing P3 — Improper marking P4 — Improper unitization

PRODUCT QUALITY DEFICIENCIES

Q1 — Deficient material (Applicable to Grant Aid and FMS shipments only)

SHORTAGE OF MATERIAL

S1 — Quantity less than that on receipt document S2 — Quantity less than that requested (Other than unit of issue pack) S3 — Non-receipt of parcel post shipments ITEMS TECHNICAL DATA MARKINGS (i.e, Name Plates, Log Books, Opening Handbooks, Special Instructions, etc.)

T1 — Missing T2 — Illegible or mutilated T3 — Precautionary operational markings missing T4 — Inspection data missing or incomplete T5 — Serviceability operating data missing or incomplete T6 — Warranty data missing WRONG ITEM (Identify requested item as a separate copy in item 9 above) W1 — Incorrect item received W2 — Unacceptable substitute

OTHER DISCREPANCIES

Z1 — See remarks

1A— Disposition instructions re-quested (Reply on reverse) 1B— Material being retained (See remarks) 1C— Supporting supply documenta-tion requested 1D— Material still required expedite shipment (Not applicable to

FMS)

1E— Local purchase material to be returned at supplier's expense unless disposition instructions to the contrary are received within 15 days (Reply on re-verse) (Not applicable to FMS) 1F— Replacement shipment requested (Not applicable to FMS) 1G— Reshipment not required. Item to be re-requisitioned.

1H— No action required. Information only 1Z— Other action requested (See remarks)

13. FUNDING AND ACCOUNTING DATA

14a. TYPED OR PRINTED NAME, TITLE, AND PHONE NUMBER OF PRE-

PARING OFFICAL

14b. SIGNATURE

15. DISTRIBUTION ADDRESSEES FOR COPIES

16. FROM: 17. DISTRIBUTION ADDRESSEES FOR COPIES

18. TO:

Use window envelope to mail this document. Insert name, and address, including ZIP Code, starting one typing space below the left dot.

Each address line must NOT extent beyond right dot.

Address must not exceed four singles space typing lines.

19. IN ACCORDANCE WITH NOTICE OF DISCREPANCY ON FACE OF THIS FORM:

a. MATERIAL

HAS

BEEN

WILL

BE

SHIPPED

DOCUMENT NUMBER

NO RECORD OF SHIPMENT. RESUBMIT REPORT TO

b. PROPER OFFICE UNDER APPROPRIATE REGULATION.

AN ADJUSTMENT IN BILL-

ING HAS BEEN / WILL BE

c. PROCESSED AS A: CREDIT DEBIT

INVOICE/BILL

d. ATTACHED

PROOF OF DELIVERY (Parcel Post Shipments) OR EVIDENCE OF

e. SHIPMENTS ENCLOSED.

AN ADJUSTMENT IN BILLING FOR THE REPORTED DISCREPANCY WILL NOT BE PROCESSED FOR THE FOLLOWING REASON

f. WHICH IS CITED IN THE INDICATED REGULATION.

(1) REASON FOR NOT PROCESSING (2) PRESCRIBING REGULATION

(a) DISCREPANCY WAS NOT REPORTED WITHIN THE TIME

FRAMES ALLOWED AND/OR

(b) DOLLAR VALUE DOES NOT MEET THE CRITERIA PRE-

SCRIBED IN THE REGULATION OR AGREEMENT INDI-

CATED IN 19f(2)

(a) CHAPTER 5 OF THE GSA HANDBOOK. DISCREPANCIES OR

DEFICIENCIES IN GSA OR DOD SHIPMENTS, MATERIAL,

OR BILLINGS (FPMR 101-26.8)

(b) CHAP.2 AND/OR 7 OF DOD 4000.25-7-M, MILITARY STAND-

ARD BILLING SYSTEM (MILSBILLS) AND/OR DD 1513, U.S.

DOD OFFER AND ACCEPTANCE, AS APPLICABLE.

20. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL:

PROCESS FOR DISPOSAL IN ACCORDANCE

a. WITH SERVICE/AGENCY DIRECTIVES.

c. RETAIN MATERIAL AT NO CHARGE.

REPRESENTATIVE WILL CALL FOR DISCUS-

b. SION CONCERNING DISPOSITION IN:

d. MATERIAL WILL BE PICKED UP IN:

DAYS

DAYS

e. SHIP MATERIAL (Specify location):

(1) GBL APPROPRIATIONS CHARGEABLE:

(2) CHARGES COLLECT-VIA: FREIGHT EXPRESS PARCEL POST ($ postage advanced herewith.

NOTE: Please enclose postage. Material cannot to returned Parcel Post collect.)(3) PARCEL POST LABEL ATTACHED (4) FREIGHT PREPAID

f. OTHER (Specify)

IF MATERIAL IS STILL REQUIRED,

21. SUBMIT NEW REQUISITION

REPLACEMENT WITH SATISFACTORY

22. MATERIAL WILL BE MADE ON OR BEFORE:

23. REMARKS (Continue on separate sheet of paper if necessary)

24a. TYPED OR PRINTED NAME AND PHONE NUM-

BER OF PREPARING OFFICAL

24b. SIGNATURE 24c. DATE

STANDARD FORM 364 BACK (REV. 2-80)

REPORT OF DISCREPANCY (ROD)

SHIPPING

PACKAGING

1. DATE OF PREPARATION

2. REPORT NUMBER

3. TO (Name and address, include ZIP Code)

4. FROM (Name and address, include ZIP Code)

5a. SHIPPER'S NAME

5b. NUMBER AND DATE OF

INVOICE

6. TRANSPORTATION DOCUMENT

NUMBER (GBL, Waybill; TCN, etc.)

7a. SHIPPER'S NUMBER (Purchase order/Shipment, Contract, etc.)

7b. OFFICE ADMINISTRATION CONTRACT

8. REQUISTIONER'S NUMBER (Requi-sition, Purchase Request, etc)

9. SHIPMENT, BILLING, AND RECEIPT DATA

10. DISCREPANCY DATA

11.

AC-2

TION

CODE

NSN/PART NUMBER AND

NOMENCLATURE

(a)

UNIT

OF ISSUE

(b)

QUANTITY

SHIPPED/

BILLED

(c)

QUANTITY

RECEIVED

(d)

QUAN-

TITY

(a)

UNIT

PRICE

(b)

TOTAL

COST

CODE1

12. REMARKS (Continue on separate sheet of paper if necessary)

1DISCREPANCY CODES

2 ACTION CODES

CONDICTION OF MATERIAL

C1 — In condition other than that indicated on release/ receipt document

C2 — Expired shelf life

C3 — Damaged parcel post shipment

SUPPLY DOCUMENTATION

D1 — Not received

D2 — Illegible or mutilated

D3 — Incomplete improper or without authority

(Only when receipt cannot be properly process)

MISDIRECTED MATERIAL

M1 — Addressed to wrong activity

OVERAGE/ DUPLICATE SHIPMENTS

O1 — Quantity in excess of that on receipt docu-ment

O2 — Quantity in excess of that requested (Other than unit of issue pack)

O3— Quantity duplicates shipment

PACKING DISCREPANCY

P1 — Improper preservation

P2 — Improper packing

P3 — Improper marking

P4 — Improper unitization

PRODUCT QUALITY DEFICIENCIES

Q1 — Deficient material (Applicable to Grant Aid and FMS shipments only)

SHORTAGE OF MATERIAL

S1 — Quantity less than that on receipt document

S2 — Quantity less than that requested (Other than unit of issue pack)

S3 — Non-receipt of parcel post shipments

ITEMS TECHNICAL DATA MARKINGS (i.e, Name

Plates, Log Books, Opening Handbooks, Special

Instructions, etc.)

T1 — Missing

T2 — Illegible or mutilated

T3 — Precautionary operational markings missing

T4 — Inspection data missing or incomplete

T5 — Serviceability operating data missing or incomplete

T6 — Warranty data missing

WRONG ITEM (Identify requested item as a separate copy in item 9 above)

W1 — Incorrect item received

W2 — Unacceptable substitute

OTHER DISCREPANCIES

Z1 — See remarks

1A— Disposition instructions re-quested (Reply on reverse)

1B— Material being retained (See remarks)

1C— Supporting supply documenta-tion requested

1D— Material still required expedite shipment (Not applicable to

FMS)

1E— Local purchase material to be returned at supplier's expense unless disposition instructions to the contrary are received within 15 days (Reply on re-verse) (Not applicable to FMS)

1F— Replacement shipment requested

(Not applicable to FMS)

1G— Reshipment not required. Item to be re-requisitioned.

1H— No action required. Information only

1Z— Other action requested (See remarks)

13. FUNDING AND ACCOUNTING DATA

14a. TYPED OR PRINTED NAME, TITLE, AND PHONE NUMBER OF PRE-

PARING OFFICAL

14b. SIGNATURE

15. DISTRIBUTION ADDRESSEES FOR COPIES

16. FROM:

17. DISTRIBUTION ADDRESSEES FOR COPIES

18. TO:

Use window envelope to mail this document. Insert name, and address, including ZIP Code, starting one typing space below the left dot. Each address line must NOT extent beyond right dot. Address must not exceed four singles space typing lines.

19. IN ACCORDANCE WITH NOTICE OF DISCREPANCY ON FACE OF THIS FORM:

a. MATERIAL

HAS

BEEN

WILL

BE

SHIPPED

DOCUMENT NUMBER

NO RECORD OF SHIPMENT. RESUBMIT REPORT TO

b. PROPER OFFICE UNDER APPROPRIATE REGULATION.

AN ADJUSTMENT IN BILL-

ING HAS BEEN / WILL BE

c. PROCESSED AS A:

CREDIT

DEBIT

INVOICE/BILL

d. ATTACHED

PROOF OF DELIVERY (Parcel Post

Shipments) OR EVIDENCE OF

e. SHIPMENTS ENCLOSED.

AN ADJUSTMENT IN BILLING FOR THE REPORTED DISCREPANCY WILL NOT BE PROCESSED FOR THE FOLLOWING REASON

f. WHICH IS CITED IN THE INDICATED REGULATION.

(1) REASON FOR NOT PROCESSING

(2) PRESCRIBING REGULATION

(a) DISCREPANCY WAS NOT REPORTED WITHIN THE TIME

FRAMES ALLOWED AND/OR

(b) DOLLAR VALUE DOES NOT MEET THE CRITERIA PRE-

SCRIBED IN THE REGULATION OR AGREEMENT INDI-

CATED IN 19f(2)

(a) CHAPTER 5 OF THE GSA HANDBOOK. DISCREPANCIES OR

DEFICIENCIES IN GSA OR DOD SHIPMENTS, MATERIAL,

OR BILLINGS (FPMR 101-26.8)

(b) CHAP.2 AND/OR 7 OF DOD 4000.25-7-M, MILITARY STAND-

ARD BILLING SYSTEM (MILSBILLS) AND/OR DD 1513, U.S.

DOD OFFER AND ACCEPTANCE, AS APPLICABLE.

20. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL:

PROCESS FOR DISPOSAL IN ACCORDANCE

a. WITH SERVICE/AGENCY DIRECTIVES.

c. RETAIN MATERIAL AT NO CHARGE.

REPRESENTATIVE WILL CALL FOR DISCUS-

b. SION CONCERNING DISPOSITION IN:

d. MATERIAL WILL BE PICKED UP IN:

DAYS

DAYS

e. SHIP MATERIAL (Specify location):

(1) GBL APPROPRIATIONS CHARGEABLE:

(2) CHARGES COLLECT-VIA:

FREIGHT

EXPRESS

PARCEL POST

($ postage advanced herewith.

NOTE: Please enclose postage. Material cannot to returned Parcel Post collect.)

(3) PARCEL POST LABEL ATTACHED

(4) FREIGHT PREPAID

f. OTHER (Specify)

IF MATERIAL IS STILL REQUIRED,

21. SUBMIT NEW REQUISITION

REPLACEMENT WITH SATISFACTORY

22. MATERIAL WILL BE MADE ON OR BEFORE:

DATE

23. REMARKS (Continue on separate sheet of paper if necessary)

24a. TYPED OR PRINTED NAME AND PHONE NUM-

BER OF PREPARING OFFICAL

24b. SIGNATURE

24c. DATE

STANDARD FORM 364 BACK (REV. 2-80)

8.2.1.4029.1.523496.503679

REPORT OF DISCREPANCY (ROD). SHIPPING: 0

REPORT OF DISCREPANCY (ROD). PACKAGING: 0

1. DATE OF PREPARATION. Enter 2 digit month, 2 digit day and 4 digit year.:

2. REPORT NUMBER.: SP451011R1003 Att 3

3. TO (Name and address, include ZIP Code).:

4. FROM (Name and address, include ZIP Code).:

5a. SHIPPER'S NAME.:

5b. NUMBER OF INVOICE.:

24c. DATE. Enter 2 digit month, 2 digit day and 4 digit year.:

6. TRANSPORTATION DOCUMENT NUMBER (GBL, Waybill; TCN, etc.).:

7a. SHIPPER'S NUMBER (Purchase order/Shipment, Contract, etc.).:

7b. OFFICE ADMINISTRATION CONTRACT.:

8. REQUISTIONER'S NUMBER (Requisition, Purchase Request, etc).:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 1 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 7 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 6 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 5 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 4 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 3 of 7.:

11. ACTION CODE. (See 2 below).:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

10b. DISCREPANCY DATA. UNIT PRICE.:

10a. DISCREPANCY DATA. QUANTITY.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9a. SHIPMENT, BILLING, AND RECEIPT DATA. NSN/PART NUMBER AND NOMENCLATURE. 2 of 7.:

9b. SHIPMENT, BILLING, AND RECEIPT DATA. UNIT OF ISSUE.:

9c. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY SHIPPED/ BILLED.:

9d. SHIPMENT, BILLING, AND RECEIPT DATA. QUANTITY RECEIVED.:

10a. DISCREPANCY DATA. QUANTITY.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

TOTAL COST.:

10b. DISCREPANCY DATA. UNIT PRICE.:

10d. DISCREPANCY DATA. CODE. (See 1 below).:

11. ACTION CODE. (See 2 below).:

12. REMARKS (Continue on separate sheet of paper if necessary):

13. FUNDING AND ACCOUNTING DATA:

14a. TYPED OR PRINTED NAME, TITLE, AND PHONE NUMBER OF PREPARING OFFICAL.:

14b. SIGNATURE.:

24b. SIGNATURE.:

15. DISTRIBUTION ADDRESSEES FOR COPIES.:

16. FROM::

17. DISTRIBUTION ADDRESSEES FOR COPIES.:

18. TO::

a. MATERIAL. HAS BEEN SHIPPED.: 0

a. MATERIAL. WILL BE SHIPPED.: 0

DOCUMENT NUMBER.:

b. NO RECORD OF SHIPMENT. RESUBMIT REPORT TO ROPER OFFICE UNDER APPROPRIATE REGULATION.: 0

c. AN ADJUSTMENT IN BILLING HAS BEEN / WILL BE PROCESSED AS A:: 0

c. AN ADJUSTMENT IN BILLING HAS BEEN / WILL BE PROCESSED AS A: CREDIT.: 0

c. AN ADJUSTMENT IN BILLING HAS BEEN / WILL BE PROCESSED AS A: DEBIT.: 0

d. INVOICE/BILL ATTACHED.: 0

e. PROOF OF DELIVERY (Parcel Post Shipments) OR EVIDENCE OF SHIPMENTS ENCLOSED.: 0

f. AN ADJUSTMENT IN BILLING FOR THE REPORTED DISCREPANCY WILL NOT BE PROCESSED FOR THE FOLLOWING REASON WHICH IS CITED IN THE INDICATED REGULATION.: 0

(1) REASON FOR NOT PROCESSING. (a) DISCREPANCY WAS NOT REPORTED WITHIN THE TIME FRAMES ALLOWED AND/OR.: 0

(b) DOLLAR VALUE DOES NOT MEET THE CRITERIA PRESCRIBED IN THE REGULATION OR AGREEMENT INDICATED IN 19f(2).: 0

(b) CHAPTER 2 AND/OR 7 OF DOD 4000.25-7-M, MILITARY STANDARD BILLING SYSTEM (MILSBILLS) AND/OR DD 1513, U.S. DOD OFFER AND ACCEPTANCE, AS APPLICABLE.: 0

(a) CHAPTER 5 OF THE GSA HANDBOOK. DISCREPANCIES OR DEFICIENCIES IN GSA OR DOD SHIPMENTS, MATERIAL, OR BILLINGS (FPMR 101-26.8).: 0

20a. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. PROCESS FOR DISPOSAL IN ACCORDANCE WITH SERVICE/AGENCY DIRECTIVES.: 0

20c. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. RETAIN MATERIAL AT NO CHARGE.: 0

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REDERENCED MATERIAL. SHIP MATERIAL (Specify location):: 0

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REDERENCED MATERIAL. OTHER.: 0

20b. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. REPRESENTATIVE WILL CALL FOR DISCUSSION CONCERNING DISPOSITION IN:: 0

20d. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. MATERIAL WILL BE PICKED UP IN:: 0

20. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. DAYS.:

20. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. DAYS.:

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. SHIP MATERIAL (Specify location): (1) GBL APPROPRIATIONS CHARGEABLE.: 0

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. SHIP MATERIAL (Specify location): (2) CHARGES COLLECT-VIA:: 0

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. SHIP MATERIAL (Specify location): (3) PARCEL POST LABEL ATTACHED.: 0

(2) CHARGES COLLECT-VIA: FREIGHT.: 0

(2) CHARGES COLLECT-VIA: EXPRESS.: 0

(2) CHARGES COLLECT-VIA: PARCEL POST.: 0

(Dollar amount) for postage advanced herewith. NOTE: Please enclose postage. Material cannot to returned Parcel Post collect.:

20f. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCE MATERIAL. OTHER (Specify).:

21. IF MATERIAL IS STILL REQUIRED, SUBMIT NEW REQUISITION.: 0

22. REPLACEMENT WITH SATISFACTORY MATERIAL WILL BE MADE ON OR BEFORE:: 0

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

23. REMARKS (Continue on separate sheet of paper if necessary).:

24a. TYPED OR PRINTED NAME OF PREPARING OFFICAL.:

24a. TYPED OR PRINTED PHONE NUMBER OF PREPARING OFFICAL.:

24b. SIGNATURE. THIS IS A PROTECTED FIELD.:

20e. THE FOLLOWING DISPOSITION IS TO BE MADE OF THE REFERENCED MATERIAL. SHIP MATERIAL (Specify location): (4) FREIGHT PREPAID: 0

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

1. REQUISITION NUMBER

2. CONTRACT NO. 3. AWARD/EFFECTIVE

4. ORDER NUMBER

SP4510-11-R-1003

5. SOLICITATION NUMBER

2011 AUG 05

6. SOLICITATION ISSUE

Joe Bednar PZMPO07

a. NAME

Phone: 269-961-7546

b. TELEPHONE NUMBER (No Collect calls)

2011 SEP 16

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY CODE SP4510

DLA DISPOSITION SERVICES - EBS

FEDERAL CENTER

74 N WASHINGTON

BATTLE CREEK MI 49037-3092

USA

10. THIS ACQUISITION IS

UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

EMERGING SMALL

BUSINESS

8 (A)

SERVICE-DISABLED VETERAN-

OWNED SMALL BUSINESS

562920NAICS:

SIZE STANDARD:

11. DELIVERYFOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/ CODE

OFFEROR

FACILITY

CODE

TELEPHONE NO.

18a. PAYMENT WILL BE MADE BY CODE

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

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

22.

23.

UNIT PRICE

24.

AMOUNT

See Schedule

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

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

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

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

30b. NAME AND TITLE OF SIGNER (Type or Print) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or Print) 31c. DATE SIGNED

SEE SCHEDULE

7. FOR SOLICITATION

INFORMATION CALL:

SEE SCHEDULE

48PAGE 1 OF

12:00 AM

STANDARD FORM 1449 (REV. 3/2005)

Prescribed by GSA - FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE ADDENDUM

xNew Text

32a. QUANTITY IN COLUMN 21 HAS BEEN

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

COMPLETE PARTIAL FINAL

STANDARD FORM 1449 (REV. 3/2005) BACK

36. PAYMENT

PARTIAL FINAL

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

22.

23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

CORRECT FOR

37. CHECK NUMBER

38. S/R ACCOUNT NO. 39. S/R VOUCHER NUMBER 40. PAID BY

42a. RECEIVED BY (Print)

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

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

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

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42b. RECEIVED AT (Location)

Supplies/Services: P999-V00009574

ITEM DESCRIPTION:

Shredded Circuit Boards

NOTE: Period of Performance for all CLINs is an estimate only and may be adjusted for actual award date. Initial Bid Schedule is for Base Period only, see Performance Work Statement (PWS) for complete Bid Schedule to include options, and the complete PWS schedule is to be utilized for price proposals in lieu of this initial schedule.

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT .

0001 P999-V00009574 150,000 LB $.________________ $.________________

Shredded Circuit Boards

PRICING TERMS: Firm Fixed Price

PREP FOR DELIVERY:

See Attached Performance Work Statement.

PERIOD OF PERFORMANCE: 01/20/2012 - 01/19/2013

GOVT USE

External External External Customer RDD/ ITEM PR PRLI PR PRLI Material Need Ship Date .

0001 N/A N/A N/A N/A N/A N/A

Supplies/Services: P999-V00009575

Destruction other than Circuit Boards

0002 P999-V00009575 9,500,000 LB $.________________ $.________________

Destruction other than Circuit Boards

PRICING TERMS: Firm Fixed Price

CONTINUED ON NEXT PAGE

PAGE 3 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

SUPPLY/SERVICE: P999-V00009575 CONT'D

ITEM PR PRLI PR PRLI Material Need Ship Date .

0002 N/A N/A N/A N/A N/A N/A

Supplies/Services: P999-V00009576

Staged 40 Ft. Minimum Trailers

0003 P999-V00009576 480 EA $.________________ $.________________

Staged 40 Ft.

Minimum Trailers

PRICING TERMS: Firm Fixed Price

ITEM PR PRLI PR PRLI Material Need Ship Date .

0003 N/A N/A N/A N/A N/A N/A

Supplies/Services: P999-V00009577

20 Foot Trailers

PAGE 4 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

SUPPLY/SERVICE: P999-V00009577 CONT'D

0004 P999-V00009577 20 25 EA $.________________ $.________________

Foot Trailers

PRICING TERMS: Firm Fixed Price

ITEM PR PRLI PR PRLI Material Need Ship Date .

0004 N/A N/A N/A N/A N/A N/A

Supplies/Services: P999-V00009579

Northeast (Min. 40ft Trailer)

0005 P999-V00009579 134 EA $.________________ $.________________

Northeast (Min.

40ft Trailer)

PRICING TERMS: Firm Fixed Price

ITEM PR PRLI PR PRLI Material Need Ship Date .

0005 N/A N/A N/A N/A N/A N/A

PAGE 5 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

SUPPLY/SERVICE: P999-V00009580 CONT'D

Supplies/Services: P999-V00009580

Southeast (Min. 40ft Trailer)

0006 P999-V00009580 152 EA $.________________ $.________________

Southeast (Min.

40ft Trailer)

PRICING TERMS: Firm Fixed Price

ITEM PR PRLI PR PRLI Material Need Ship Date .

0006 N/A N/A N/A N/A N/A N/A

Supplies/Services: P999-V00009581

NorthCentral(Min. 40ft Trailer)

0007 P999-V00009581 25 EA $.________________ $.________________

NorthCentral(Min.

40ft Trailer)

PRICING TERMS: Firm Fixed Price

PAGE 6 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

SUPPLY/SERVICE: P999-V00009582 CONT'D

External External External Customer RDD/ ITEM PR PRLI PR PRLI Material Need Ship Date .

0007 N/A N/A N/A N/A N/A N/A

Supplies/Services: P999-V00009582

SouthCentral (Min. 40ft Trailer)

0008 P999-V00009582 75 EA $.________________ $.________________

SouthCentral (Min.

40ft Trailer)

PRICING TERMS: Firm Fixed Price

See Attached Statement of Work.

ITEM PR PRLI PR PRLI Material Need Ship Date .

0008 N/A N/A N/A N/A N/A N/A

Supplies/Services: P999-V00009583

Southwest (Min. 40ft Trailer)

0009 P999-V00009583 137 EA $.________________ $.________________

Southwest (Min.

40ft Trailer)

PRICING TERMS: Firm Fixed Price

PAGE 7 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

SUPPLY/SERVICE: P999-V00009583 CONT'D

ITEM PR PRLI PR PRLI Material Need Ship Date .

0009 N/A N/A N/A N/A N/A N/A

Supplies/Services: P999-V00009584

NorthWest (Min. 40ft Trailer)

0010 P999-V00009584 30 EA $.________________ $.________________

NorthWest (Min.

40ft Trailer)

PRICING TERMS: Firm Fixed Price

ITEM PR PRLI PR PRLI Material Need Ship Date .

0010 N/A N/A N/A N/A N/A N/A

Supplies/Services: P999-V00009578

Contractor Loading

PAGE 8 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

SUPPLY/SERVICE: P999-V00009578 CONT'D

0011 P999-V00009578 16 EA $.________________ $.________________

Contractor Loading

PRICING TERMS: Firm Fixed Price

PREP FOR DELIVERY:

See Attached Performance Work Statement.

ALSO SEE PERFORMANCE WORK STATEMENT FOR COMPLETE BID SCHEDULE WITH ALL OPTION PERIODS.

ITEM PR PRLI PR PRLI Material Need Ship Date .

0011 N/A N/A N/A N/A N/A N/A

PAGE 9 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

Form

Statement of Work

Insert (copy and paste) text for the Statement of Work here

Performance Work Statement

BID SCHEDULE

ELECTRONIC SCRAP DEMANUFACTURING SERVICES

BASE PERIOD 1 (12 months)

CLIN DESCRIPTION EST. QTY Unit UNIT PRICE TOTAL 0001 Shredded Circuit Boards

(See 1.21) 150,000 lbs

0002 Destruction other than Circuit boards (See 1.22)

9,500,000 lbs

0003 Staged 40 Foot Minimum Trailers (See 1.34) 480 ea 0004 20 Foot Trailers (All zones) 25 ea 0005 Northeast (Min. 40 ft Trailer) 134 ea 0006 Southeast (Min. 40 ft Trailer) 152 ea 0007 North Central (Min. 40 ft Trailer) 25 ea 0008 South Central (Min. 40 ft Trailer) 75 ea 0009 Southwest (Min. 40 ft Trailer) 137 ea 0010 Northwest (Min. 40 ft Trailer) 30 ea 0011 Contractor Loading (See 1.16.3) 16 ea

Total Base Period: ____________

OPTION I (12 months)

1001 Shredded Circuit Boards

1002 Destruction other than

1003 Staged 40 Foot Minimum Trailers (See 1.34) 480 ea 1004 20 Foot Trailers (All zones) 25 ea 1005 Northeast (Min. 40 ft Trailer) 134 ea 1006 Southeast (Min. 40 ft Trailer) 152 ea 1007 North Central (Min. 40 ft Trailer) 25 ea 1008 South Central (Min. 40 ft Trailer) 75 ea 1009 Southwest (Min. 40 ft Trailer) 137 ea 1010 Northwest (Min. 40 ft Trailer) 30 ea 1011 Contractor Loading (See 1.16.3) 16 ea

Total Option I: ____________

PAGE 10 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

OPTION II 1 (12 months)

2001 Shredded Circuit Boards

2002 Destruction other than

2003 Staged 40 Foot Minimum Trailers (See 1.34) 480 ea 2004 20 Foot Trailers (All zones) 25 ea 2005 Northeast (Min. 40 ft Trailer) 134 ea 2006 Southeast (Min. 40 ft Trailer) 152 ea 2007 North Central (Min. 40 ft Trailer) 25 ea 2008 South Central (Min. 40 ft Trailer) 75 ea 2009 Southwest (Min. 40 ft Trailer) 137 ea 2010 Northwest (Min. 40 ft Trailer) 30 ea 2011 Contractor Loading (See 1.16.3) 16 ea

Total Option II: ____________

OPTION III 1 (12 months)

3001 Shredded Circuit Boards

3002 Destruction other than

3003 Staged 40 Foot Minimum Trailers (See 1.34) 480 ea 3004 20 Foot Trailers (All zones) 25 ea 3005 Northeast (Min. 40 ft Trailer) 134 ea 3006 Southeast (Min. 40 ft Trailer) 152 ea 3007 North Central (Min. 40 ft Trailer) 25 ea 3008 South Central (Min. 40 ft Trailer) 75 ea 3009 Southwest (Min. 40 ft Trailer) 137 ea 3010 Northwest (Min. 40 ft Trailer) 30 ea 3011 Contractor Loading (See 1.16.3) 16 ea

Total Option III: ____________

PAGE 11 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

OPTION IV 1 (12 months)

4001 Shredded Circuit Boards

4002 Destruction other than

4003 Staged 40 Foot Minimum Trailers (See 1.33.3 and 1.34) 480 ea 4004 20 Foot Trailers (All zones) 25 ea 4005 Northeast (Min. 40 ft Trailer) 134 ea 4006 Southeast (Min. 40 ft Trailer) 152 ea 4007 North Central (Min. 40 ft Trailer) 25 ea 4008 South Central (Min. 40 ft Trailer) 75 ea 4009 Southwest (Min. 40 ft Trailer) 137 ea 4010 Northwest (Min. 40 ft Trailer) 30 ea 4011 Contractor Loading (See 1.16.3) 16 ea

Total Option IV: ____________

Grand Total All Periods: ____________

Zone States Included Estimate per 12-month period

Northeast Michigan, Indiana, Ohio, Kentucky, Virginia, West Virginia, Washington DC, Pennsylvania, New York, New Hampshire, New Jersey, Maine, Connecticut, Rhode Island, Maryland, Delaware, Vermont

2,200,000lbs

Southeast Tennessee, North Carolina, South Carolina, Georgia, Florida, Mississippi, Alabama

2,500,000lbs

North Central North Dakota, South Dakota, Wisconsin, Iowa, Nebraska, Kansas, Missouri, Illinois, Montana

400,000lbs

South Central Texas, Oklahoma, Louisiana, Missouri

1,250,000lbs

Northwest Montana, Wyoming, Oregon, Washington, Idaho

2,250,000lbs

Southwest California, Nevada, Utah, Arizona, Colorado, New Mexico

450,000lbs

PAGE 12 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

PERFORMANCE WORK STATEMENT

ELECTRONIC SCRAP DEMANUFACTURING SERVICES

1.1 BACKGROUND:

1.1.1. The Defense Logistics Agency, Disposition Services, is appointed by the Department of Defense (DoD) for the implementation of environmentally sound procedures for the disposition of electronics that have reached the end of their useful life. Our mission is to responsibly demanufacture and recycle excess electronics in accordance with all Federal, state, local and international laws as well as in a manner consistent with requirements in Executive Order 13423, US Department of Defense Electronics Stewardship Implementation Plan – February 2008, and the DoD Strategic Sustainability Performance Plan. Excess electronics will be demanufactured and recycled when due to either demilitarization requirements or operability, they are unable to be reutilized, transferred, donated or sold to eligible recipients.

1.1.2 Excess electronic equipment that fails the Reutilization, Transfer, Donation or Sales (R/T/D/S) cycle is the subject matter of this contract. This excess electronic equipment will include equipment that requires demilitarization (DEMIL required), or is non-DEMIL required, and may contain personally identifiable information (PII).

1.2 PURPOSE

1.2.1 The purpose of this solicitation is to award one service disposal contract to properly execute and manage the disposal of excess U.S Government electronic equipment. Management activities include the following acts:

1.2.1.1 Transportation (as applicable) and receipt of electronic equipment at the contractor’s or subcontractor’s processing facility.

1.2.1.2 Compliant management and disposal of hazardous substances, materials and wastes removed from electronic equipment and components during the de-manufacturing process in accordance with all regulatory requirements.

1.2.1.3 Removal/sanitization of Personally Identifiable Information (PII): An electronics recycler shall sanitize, purge, or destroy data on hard drives and other data storage devices (the National Institute of Standards and Technology’s (NIST’s) Guidelines for Media Sanitation – Special Publication 800-88 88 lists categories of devices which need sanitization consideration), unless otherwise requested in writing by the customer

1.2.1.3 The complete destruction of all demil required electronic equipment at one physical location.

1.2.1.4 Complete, proper and compliant disposition (including recycling or disposal) that adheres to all applicable legal requirements for processed property that the contractor takes title to after destruction of the property (See clause 1.19)

1.2.2 The contractor shall process electronic property into four categories:

1.2.2.1 Clean, sorted metals and non-metals suitable for subsequent commercial recycling

1.2.2.2 Hazardous wastes (Resource Conservation and Recovery Act (RCRA), Toxic Substance Control Act (TSCA) or State regulated) to be disposed of at a RCRA or TSCA or State permitted commercial Treatment, Storage or Disposal Facility (TSDF) found on DLA Disposition Services approved listing at http://www.dispositionservices.dla.mil/newenv/documents/qualfac.pdf.

1.2.2.3 Solid waste to be recycled, reclaimed or disposed of in an environmentally compliant manner by the contractor.

1.2.2.4 Ozone depleting substances (refrigerants) regulated under the Clean Air Act Amendments of 1990 section 608.

1.2.2.5 For the remainder of this Performance Work Statement, this process is collectively referred to as “de-manufacturing.”

1.3 COMPLIANCE WITH APPLICABLE LAWS AND REGULATIONS: The contractor shall comply with all International, Federal, State and local laws and regulations relating to the duties, obligations, and performance under this contract, and shall obtain all licenses and pay all fees and other charges required. This includes, but is not limited to, all applicable environmental RCRA, TSCA, Clean Air Act (CAA), Clean Water Act (CWA) or State regulations, U.S. Dept. of State International Traffic in Arms Regulation (ITAR), U.S. Dept.

of Commerce Export Administration Regulation (EAR), Dept. of Defense and other trade security control regulations, Department of Transportation (DoT) and Occupational Safety and Healthy (OSHA) laws and regulations.

1.3.1. Contactor and subcontractor facilities used to satisfy requirements to process electronics (see 1.2.2.) shall each meet the same legal and regulatory standards above.

PAGE 13 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

1.4 OBLITERATION OF DOD MARKINGS: The contractor shall ensure that any DoD markings or markings of any DoD installation or generator are obliterated from the property furnished. The contractor shall ensure its processes are adequate to remove any such markings and agrees that the removal of all DoD markings is a responsibility the contractor maintains under this contract. Failure to satisfy this responsibility will be considered a material breach of this contract entitling the government to exercise its right to terminate the contract for default and/or seek other available remedies.

1.5 PROPERTY ELIGIBILITY

1.5.1 The Government will provide a variety of electronic property and associated hardware for processing The property may contain capacitors, electron tubes (cathode ray tubes (CRTs, pentodes, diodes, triodes, triodes, pentodes, klystrons, magnetrons, wave guide tubes, amplifiers, etc.), switches, batteries, printed circuit boards, and other components typically found in electronic equipment. This property includes, but is not limited to, electronic components, drawers, modules, circuit cards/boards, radios, radar, test equipment, computers and a variety of United States (U.S.) military ground, naval and air electronic warfare equipment and miscellaneous commercial electronic property. Note that televisions and CRT glass may be received for processing, but quantities are expected to be minimal.

1.5.2 Electronic equipment, eligible for processing under this contract, may be located at any Government facility within: The United States of America, including the District of Columbia, Guam, Puerto Rico, Japan, Republic of Korea, Guantanamo Bay, Cuba and outlaying areas and minor outlaying islands (see the definitions at FAR 2.101).

1.6 ACRONYMS

ACO Administrative Contracting Officer AOR Area of Responsibility CAA Clean Air Act CCLI Commodity Control List Items COR Contracting Officer’s Representative COTR Contracting Officer’s Technical Representative CLIN Contract Line Item Number GR Government Representative CSF Commercial Surveillance Firm CWA Clean Water Act CSFR Commercial Surveillance Firm Representative DEMIL Demilitarization DLA Defense Logistics Agency DoD Department of Defense DoT Department of Transportation EUC End Use Certificate GFP/GFM Government Furnished Property/Material KO Contracting Officer MLI Munitions List Item NSN National Stock Number OSHA Occupational Safety and Health Act PCB Polychlorinated Biphenyl PM Precious Metals RCRA Resource Conservation Recovery Act RTD/S Reutilization, Transfer, Donation / Sales TSCA Toxic Substance Control Act TSC Trade Security Control TSCRO Trade Security Control Resident Office

1.7 DEFINITIONS

COMMERCE CONTROL LIST ITEMS (CCLI): CCLI are items controlled for export by the Bureau of Export Administration, U.S.

Department of Commerce under 15 CFR Subchapter C, Parts 730-800. "Dual use" items fall into this category. CCLI is normally assigned a Demil code of “Q” and requires Trade Security Controls.

CONTRACTING OFFICER: The contracting officer is the individual with the authority to enter into contracts and task orders, the authority to administer, manage and terminate contracts and make related determinations and findings.

CONTROLLED PROPERTY: (TSC Controlled Property): Any material identified as being a Munitions List Item or Commerce Control List Item.

PAGE 14 OF 48 PAGESCONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED:

DAYS: Days means calendar days unless otherwise noted.

DEMANUFACTURING: See clause 1.2.2.5.

DEMILITARIZATION: (DEMIL) A Government term used to define the act of destroying the military offensive or defensive advantages inherent in certain types of equipment or material.

DEMILITARIZATION CERTIFICATION: A certificate signed by a technically qualified U.S. Government representative and countersigned (verified) by a technically qualified U.S. Government representative (American citizen) who actually witnessed the demilitarization of the material and/or inspected the residue.