Att 1 DD1155.pdf

0001 93066010 RAGS/DEBRIS W FB551892990551 01

( 2000 KG X $X.XX = $X,XXX.XX )

N21900 RAGS/DEBRIS WITH POL, WASTW UN3175

SOLIDS CONTAINING FLAMMABLE LIQUIDS NOS

(AVIATION FUEL), 4.1, PGII, EWC 15.02.02,

916000POLSOLID, 2 SKIPS, PROFILE 09-42; ORDER

XXXX KG BPS X.XX

EUR X,XXX.XX

ORDER FOR SUPPLIES OR SERVICES

PAGE 1 of

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

(YYYYMMMDD)

4. REQUISITION/PURCH REQUEST NO. 5. PRIORITY

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

DESTINATION

OTHER

(See Schedule if Other)

9. CONTRACTOR CODE FACILITY

NAME

AND

ADDRESS

10. DELIVER TO FOB POINT BY (Date)

(YYYYMMMDD)

12. DISCOUNT TERMS

11. X IF BUSINESS IS

SMALL

SMALL DISAD-

VANTAGED

13. MAIL INVOICES TO THE ADDRESS IN BLOCK

14. SHIP TO CODE 15. PAYMENT WILL BE MADE BY CODE MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATION

NUMBERS IN

BLOCKS 1 AND 2.

16.

TYPE

OF

ORDER

DELIVERY/

CALL

PURCHASE

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

Reference your furnish the following on terms specified herein.

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED

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

17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE

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

20. QUANTITY

ORDERED/

ACCEPTED*

21.

UNIT 22. UNIT PRICE 23. AMOUNT

* If quantity accepted by the government is same as quantity ordered, indicate by X.

If different, enter actual quantity accepted below quantity ordered and encircle

24. UNITED STATES OF AMERICA

BY: CONTRACTING/ORDERING OFFICER

25. TOTAL

26.

DIFFERENCES

27a. QUANTITY IN COLUMN 20 HAS BEEN

INSPECTED RECEIVED

ACCEPTED AND CONFORMS TO

THE CONTRACT EXCEPT AS NOTED

b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

f. TELEPHONE NUMBER g. E-MAIL ADDRESS

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

a. DATE

(YYYYMMMDD)

b. SIGNATURE AND TITLE OF THE CERTIFYING OFFICER

37. RECEIVED

AT

38. RECEIVED BY (Print) 39. DATE RECEIVED

(YYYYMMMDD)

c. DATE

(YYYYMMMDD)

d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

28. SHIP. NO. 29. D.O. VOUCHER NO. 30. INITIALS

32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR

34. CHECK NUMBER

35. BILL OF LADING NO.

42. S/R VOUCHER NO. 41. S/R ACCOUNT NUMBER 40. TOTAL CON-

TAINERS

31. PAYMENT

COMPLETE

PARTIAL

FINAL

PARTIAL

FINAL

DD FORM 1155, DEC 2001 PREVIOUS EDITION IS OBSOLETE. SP4520-10-R-0001, SPAIN ATTACHMENT 1

SP452010D00XX

DEF REUT & MKT SVC/EUROPE

SP4520

CONTRACTOR NAME & ADDRESS

X

X

2010 MAR 15

2009 MAR 01

SEE BLOCK 15

93066010

KLEBER KASERNE BLDG 3227

MANNHEIMER STRASSE

SEE SCHEDULE

67657 KAISERSLAUTERN GE

DFAS-BVDP

PO BOX 369031

COLUMBUS, OH 43236-9031

JOHN DOE, ORDER OFFCR

SP452009D0020-0025

01 97X4930 5CBX 001 25 033189 $X,XXX.XX

FOR ACCOUNTING PURPOSE ONLY EUR 0.670 = $1.00

WOMEN OWNED

ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME.

DOCUMENT NOUN DTID ACC

sq90455 Sample

Optional Form 336 (4-86)

PRESCRIBED BY GSA

FAR(48 CFR) 52.111

NSN 7540-01-152-8067

PREVIOUS EDITIONS USABLE SP4520-10-R-0001, SPAIN ATTACHMENT 1

2continuation sheet of page REFERENCE NO. DOCUMENT BEING CONTINUED

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT

NAME OF OFFICER OR CONTRACTOR

CLIN

SP452009D0020-0025

UNIT PRICE AMOUNT

pages

PICKUP ADDR <FC5643> 423 ABS CEV

EPA WASTE CODE _______ UD QTY PICKED UP ______________ UO UNIT OF ISSUE ________

MANIFEST _____________________ PG/LINE CODE __________ PICKUP DATE ______________

91956005 REQUEST FOR E FC56439180ALC3 01

( 1 EA X $XX.XX = $XX.XX )

N60000 REQUEST FOR EXPEDITED DELIVERY OF IBC

CONTAINERS; TO BE DELIVERED TO RAF ALCONBURY,

POC IS JOAN SMITH, DSN XXX-XXXX

PICKUP ADDR <FC5643>

EPA WASTE CODE _______ UD QTY PICKED UP ______________ UO UNIT OF ISSUE ________

PROMPT PAYMENT (MAR 1994) FAR 52.232-25

AUTH TRANSPORTER NAME ______________________________ AUTH TRANSPORTER EPA # __________

AUTH TSDF NAME ______________________________ AUTH TSDF EPA # __________

TRANS SIGNATURE __________________________________ TRANS PRINTED NAME ________________

KTR SIGNATURE __________________________________ KTR PRINTED NAME ____________________

AUTH COR SIGNATURE __________________________________ AUTH COR PRINTED NAME __________

1 EA

BPS XX.XX

BPS XXX.XX

DOCUMENT NOUN DTID ACC

sq90455 Sample