SPE7M319Q0092.PDF

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PLUG, PIPE, MAGNETIC Federal contract opportunity
Solicitation number
SPE7M319Q0092
Issued by
Defense Logistics Agency Land and Maritime

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REQUEST FOR QUOTATIONS THIS RFQ IS IS NOT A SMALL BUSINESS SET-ASIDE

4. CERT.FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG. 1

5. ISSUED BY

7. DELIVERY

9. DESTINATION

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5 ON OR

BEFORE CLOSE OF BUSINESS (Date)

IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (See Continuation Sheets)

12. DISCOUNT FOR PROMPT PAYMENT

d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

14. SIGNATURE OF PERSON AUTHORIZED TO SIGN

QUOTATION

16. SIGNER

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not useable

STANDARD FORM 18 (REV. 6-95)

Prescribed by GSA-FAR (48 CFR) 53.215-1(a)

1. REQUEST NO.

SPE7M3-19-Q-0092

2. DATE ISSUED

2018 NOV 20

3. REQUISITION/PURCHASE REQUEST NO.

0077028085

RATING

DO-C9

DLA LAND AND MARITIME

FLUID HANDLING DIVISION

PO BOX 3990

COLUMBUS OH 43218-3990

USA

Buyer: Rajesh Sehgal PMCMDD9 Tel: 614-692-1437 Fax: 614-693-1614 Email: RAJESH.SEHGAL@DLA.MIL

6. DELIVER BY (Date)

154 DAYS ADO

8. TO:

c. CITY

d. STATE

b. STREET ADDRESS

a. NAME OF CONSIGNEE

e. ZIP CODE

a. 10 CALENDAR DAYS

b. 20 CALENDAR DAYS (%) c. 30 CALENDAR DAYS

15. DATE OF QUOTATION

a. NAME (Type or Print)

AREA CODE

c. TITLE (Type or Print)d. CITY

c. COUNTY

b. STREET ADDRESS

e. STATE f. ZIP CODE

See Schedule

2018 NOV 28

NUMBER

FOB DESTINATION

OTHER

(See Schedule)

CAGE

b. TELEPHONE

See attached schedule to complete quote information.

Quoter must also complete the following:

a. Quotation is valid for 90 days from date specified in Block 10 above unless otherwise indicated: _____________ .

b. Prices quoted are:

___ Contained in Commercial Catalog or Published Price List No. ___________________ dated _______________ page __________ .

___ Contained in Internal Price List No. _______________dated ____________________, which may be examined at our facility.

___ Commercial sales of comparable quantities: Quantity ____________ ; Price _____________;

___ Customer ________________________.

___ Other (provide basis) ______________________________________ _______________________________________ .

c. FOB Point: ____ Destination ____ Origin Shipping Point (City, State) _________________________________________ .

d. If delivery period shown in Block 6 is unacceptable, provide best possible delivery: _________________________________.

e. Remittance Address (Name, Street, City, State, ZIP): Same as Block 13 unless otherwise indicated below:

f. Vendor FAX Number: ____________________ Vendor Toll-Free Number: ____________________ Vendor E-mail: ______________________________

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 2 OF 8 PAGES

SPE7M3-19-Q-0092

CONTINUED ON NEXT PAGE

Addition Preference will be give to the best delivery ...

Note 1 Package = 10 Each

MANUAL “Q” SOLICITATION

FOB Origin Incorporating Master Solicitation

THIS SOLICITATION INCORPORATES THE TERMS AND CONDITIONS SET FORTH IN THE REVISION OF THE DLA MASTER SOLICITATION FOR EPROCUREMENT AUTOMATED SIMPLIFIED ACQUISITIONS IN EFFECT ON THE SOLICITATION ISSUE DATE. ALL REVISIONS OF THE DLA MASTER SOLICITATION FOR EPROCUREMENT AUTOMATED SIMPLIFIED ACQUISITIONS CAN BE FOUND ON THE WEB AT: http://www.dla.mil/ HQ/Acquisition/Offers/eProcurement.aspx

DLAD PROCUREMENT NOTES

DLAD Procurement Notes are incorporated by reference, with the same force and effect as if they were in full text. The full text of a DLAD Procurement Note may be accessed electronically at http://www.dla.mil/HQ/Acquisition/Offers/ eProcurement.aspx and via 'References' on the DIBBS homepage.

FDT

This solicitation is issued under the First Destination Transportation (FDT) program to reduce the cost of transportation through the use of Government-arranged transportation utilizing Government contracts and rates. If this award is for FMS or has an APO/FPO ship-to address, these instructions do not apply.

For FDT Program Transportation Requirements, see Procurement Note C16 First Destination Transportation (FDT) Program, Government-Arranged Transportation for Manual Awards, C17 First Destination Transportation (FDT) Program – Shipments Originating from Outside the Contiguous United States, and Procurement Note C20 – Vendor Shipment Module (VSM).

Offers should be submitted based on FOB origin. For offerors whose shipments will originate from outside the contiguous United States, the offeror’s f.o.b. origin price shall include transportation to a contiguous United States location that the offeror selects based on cost-effectiveness or other variables at the offeror’s discretion.

Additional information about FDT can be found at http://www.dla.mil/LandandMaritime/Business/Selling/DLA-Land-and- Maritime-Procurement-Initiatives/FDTPI/

DFARS 252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (MAY 2013)

(a) Definitions. As used in this clause— “Department of Defense Activity Address Code (DoDAAC)” is a six position code that uniquely identifies a unit, activity, or organization.

“Document type” means the type of payment request or receiving report available for creation in Wide Area WorkFlow

(WAWF).

“Local processing office (LPO)” is the office responsible for payment certification when payment certification is done external to the entitlement system.

(b) Electronic invoicing. The WAWF system is the method to electronically process vendor payment requests and receiving reports, as authorized by DFARS 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(c) WAWF access. To access WAWF, the Contractor shall—

(1) Have a designated electronic business point of contact in the System for Award Management at https://www.

acquisition.gov; and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this web site.

(d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training Site before submitting payment requests through WAWF. Both can be accessed by selecting the “Web Based Training” link on the WAWF home page at https://wawf.eb.mil/

(e) WAWF methods of document submission. Document submissions may be via web entry, Electronic Data Interchange, or File Transfer Protocol.

(f) WAWF payment instructions. The Contractor must use the following information when submitting payment requests and receiving reports in WAWF for this contract/order:

(1) Document type. The Contractor shall use the following document type(s).

An invoice and WAWF receiving report (RR) are both required. The invoice and receiving report may be submitted separately or together as a combo type document. See DFARS Appendix F for detailed instructions on preparing the WAWF

RR.

NOTE: For contracts in accordance with Fast Payment Procedures, a Fast Pay (FP) invoice must be connected with a receiving report (RR), so either submit a FP combo or submit a RR and follow with a FP invoice. If there is no registered acceptor, the RR portion of the combo cannot be processed. In this case, submit a stand-alone FP invoice (“accept by” DoDAAC/location is mandatory).

(2) Inspection/acceptance location. The Contractor shall select the following inspection/acceptance location(s) in WAWF, as specified by the contracting officer.

See Award.

(3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system.

Routing Data Table Field Name in WAWFData to be entered in WAWF Pay Official DoDAACSee Page 1 Issue By DoDAACSee Page 1 Admin DoDAACSee Page 1 Inspect By DoDAACSee Award Ship To CodeSee Award Ship From CodeSee Award/Purchase Order if applicable Mark For CodeSee Award/Purchase Order if applicable

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 3 OF 8 PAGES

CONTINUED ON NEXT PAGE

Service Approver (DoDAAC)See Award/Purchase Order if applicable Service Acceptor (DoDAAC)See Award/Purchase Order if applicable Accept at Other DoDAACSee Award/Purchase Order if applicable LPO DoDAAC DCAA Auditor DoDAAC Other DoDAAC(s)

(4) Payment request and supporting documentation. The Contractor shall ensure a payment request includes appropriate contract line item and subline item descriptions of the work performed or supplies delivered, unit price/cost per unit, fee (if applicable), and all relevant back-up documentation, as defined in DFARS Appendix F, (e.g. timesheets) in support of each payment request.

(5) WAWF email notifications. The Contractor shall enter the e-mail address identified below in the “Send Additional Email Notifications” field of WAWF once a document is submitted in the system.

Additional email notifications are not required.

(g) WAWF point of contact.

(1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity’s WAWF point of contact.

Contact the local contract administrator found in block 6 of the DD 1155, block 9 of the SF 1449, or block 5 of the SF 26.

(2) For technical WAWF help, contact the WAWF helpdesk at 866-618-5988.

(End of clause)

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 4 OF 8 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLIES/SERVICES: 4730-00-045-9769

ITEM DESCRIPTION:

PLUG, PIPE.

RP001: DLA PACKAGING REQUIREMENTS FOR PROCUREMENT

A metal casting process was identified as a means to manufacture this item. Tooling is required to produce a casting. For sourcing, tooling, materials or other information, please contact the appropriate assistance team: (Aviation, C&E Supply Chains) DSCR.AFCAT@dla.mil; (Land & Maritime Supply Chains) DSCC.cast.forge@dla.mil

1 PG = 10 EA

Hazard Communication Standard Notice:

Effective June 1, 2015, Federal Standard No. 313-E, Material Safety Data, Transportation Data and Disposal Data for Hazardous Materials Furnished to Government Activities, establishes the requirement for preparation and submission of Safety Data Sheets (SDS) in lieu of Material Safety Data Sheets (MSDS) by suppliers who provide hazardous materials to government activities.

The Occupational Safety and Health Administration (OSHA) has modified its Hazard Communication Standard (HCS) to conform to the United Nations Globally Harmonized System of Classification and Labeling of Chemicals.

As a result of this change, GSA revised Federal Standard No. 313-E requiring Safety Data Sheets for classifying chemicals and communicating the applicable information on labels.

In accordance with the revised standard after June 1, 2015:

1. Suppliers will be required to submit, to the contracting officer for review and approval prior to award, safety data sheets consistent with the requirements found at 29 C.F.R. 1910.1200 for hazardous materials delivered to the Government.

2. Suppliers will also be required to submit, to the contracting officer for review and approval prior to award, Hazardous Communication Standard (HCS) labels in accordance with 29 C.F.R. 1910.1200 requirements or current Consumer Product Safety Act (CPSA), Federal Hazardous Substance Act (FHSA) labels when subject to labeling requirements under those statutes. This product labeling is required for hazardous materials delivered to the Government.

3. Finally, suppliers must train their employees on the new safety data sheets, hazardous communication labels, and requirements of 29 C.F.R.

1910.1200.

For more information on SDS, refer to OSHAs website, available at:

https://www.osha.gov/law-regs.html

For information on 29 C.F.R. 1910.1200, refer to the below link:

https://www.osha.gov/dsg/hazcom/index.html

RA001: THIS DOCUMENT INCORPORATES TECHNICAL AND/OR QUALITY REQUIREMENTS

(IDENTIFIED BY AN 'R' OR AN 'I' NUMBER) SET FORTH IN FULL TEXT IN THE

DLA MASTER LIST OF TECHNICAL AND QUALITY REQUIREMENTS FOUND ON THE WEB

AT: http://www.dla.mil/HQ/Acquisition/Offers/eProcurement.aspx. FOR

SIMPLIFIED ACQUISITIONS, THE REVISION OF THE MASTER IN EFFECT ON THE

SOLICITATION ISSUE DATE OR THE AWARD DATE CONTROLS. FOR LARGE

ACQUISITIONS, THE REVISION OF THE MASTER IN EFFECT ON THE RFP ISSUE DATE

APPLIES UNLESS A SOLICITATION AMENDMENT INCORPORATES A FOLLOW-ON

REVISION, IN WHICH CASE THE AMENDMENT DATE CONTROLS.

RQ011: REMOVAL OF GOVERNMENT IDENTIFICATION FROM NON-ACCEPTED SUPPLIES

MAGNETIC, STEEL MATERIAL, PLAIN UNCOATED

FINISH, RECESS SOCKET HEAD, 0.4 INCH NOMINAL

HEAD HEIGHT, 0.375 INCH BODY LENGTH,

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 5 OF 8 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 4730-00-045-9769 CONT'D

4.0 OZ MAGNETIC LIFT RATING,

3/8-18 NPTF NOMINAL PIPE SIZE, PER COMMERCIAL

ITEM DESCRIPTION TITLED, "PLUGS, PIPE, MAGNETIC,

HEADLESS: IRON, STEEL OR ALUMINUM ALLOY."

FULL AND OPEN COMPETITION APPLIES.

CLASS I OZONE DEPLETING CHEMICALS ARE NOT TO BE

USED NOR INCORPORATED IN ANY ITEMS TO BE

DELIVERED UNDER THIS CONTRACT.THIS PROHIBITION

SUPERSEDES ALL SPECIFICATION REQUIREMENTS BUT

DOES NOT ALLEVIATE ANY PRODUCT REQUIREMENTS.

SUBSTITUTE CHEMICALS MUST BE SUBMITTED FOR

APPROVAL UNLESS THEY ARE AUTHORIZED BY THE

SPECIFICATION REQUIREMENTS.

IAW BASIC CID A-A-59432B

REVISION NR B DTD 01/19/2015

PART PIECE NUMBER: AA59432-06

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

0001 4730-00-045-9769 13,000.000 PG $ ________________ $ ________________

PLUG,PIPE,MAGNETIC

QTY VARIANCE: PLUS 0% MINUS 0%

INSPECTION POINT: DESTINATION

ACCEPTANCE POINT: DESTINATION

FOB: ORIGIN DELIVERY DATE: 154 DAYS ADO

PREP FOR DELIVERY:

PKGING DATA - MIL-STD-2073-1D, 15 DEC 1999

QUP:001 PRES MTHD:10 CLNG/DRY:1 PRESV MAT:00

WRAP MAT:CA CUSH/DUNN MAT:00 CUSH/DUNN THKNESS:0

UNIT CONT:A1 OPI:O

PACK CODE:U

MARKING SHALL BE IN ACCORDANCE WITH MIL-STD-129.

SPECIAL MARKING CODE:ZZ -ZZ Special Requirements

PALLETIZATION SHALL BE IN ACCORDANCE WITH MD00100452 REV B DATED JULY 01, 2008

Boxes, packages, and items containing magnetized material suitable for shipment by military aircraft in conformance with MIL-S-4473, shall be marked in accordance with MIL-STD-129. Magnetized materials suitable for shipment by commercial air shall be marked in conformance with CFR 49.

Boxes, packages, and items containing magnetized material not suitable for shipment by military aircraft in conformance with MIL-S-4473, shall be conspicuously marked on two opposite sides with a red caution label having white lettering. Magnetic tapes data shall be conspicuously labeled on both interior and exterior containers.

IP025: PACKAGING, MARKING, AND SHIPPING OF HAZARDOUS MATERIALS

PARCEL POST ADDRESS:

SW0400

DLA DISTRIBUTION RICHMOND

DISTRIBUTION OPERATIONS DDRV-G

8000 JEFFERSON DAVIS HWY

RICHMOND VA 23297-5900

US

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SECTION B

SUPPLY/SERVICE: 4730-00-045-9769 CONT'D

FOR TRANSPORTATION SEE DLAD DLAD PROC NOTE C19. FOR FIRST DESTINATION TRANSPORTATION SEE DLAD PROC NOTE C20 AND

CONTRACT

FREIGHT SHIPPING ADDRESS:

SW0400

DLA DISTRIBUTION RICHMOND

CHIPPENHAM PARKWAY RTE 150 ENTRANCE

GATE 13 BLDG 44 B BAY S.3RD STREET

RICHMOND VA 23297-5900

US

GOVT USE

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

0001 0077028085 0001 N/A N/A N/A 03/01/2019

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SECTION A - SOLICITATION/CONTRACT FORM

52.204-16 COMMERCIAL AND GOVERNMENT ENTITY CODE REPORTING (JUL 2016) FAR

SECTION I - CONTRACT CLAUSES

52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS (OCT 2016) FAR

52.204-15 SERVICE CONTRACT REPORTING REQUIREMENTS FOR INDEFINITE-DELIVERY CONTRACTS (OCT 2016) FAR

52.204-18 COMMERCIAL AND GOVERNMENT ENTITY CODE MAINTENANCE (JUL 2016) FAR

52.204-20 PREDECESSOR OF OFFEROR (JUL 2016) FAR

As prescribed in 4.1804(d), insert the following provision:

(a) Definitions. As used in this provision -

“Commercial and Government Entity (CAGE) code” means -

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics Agency (DLA) Commercial and Government Entity (CAGE) Branch to identify a commercial or government entity; or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency (NSPA) to entities located outside the United States and its outlying areas that the DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

“Predecessor” means an entity that is replaced by a successor and includes any predecessors of the predecessor.

“Successor” means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

(b) The Offeror represents that it [ ] is or [ ] is not a successor to a predecessor that held a Federal contract or grant within the last three years.

(c) If the Offeror has indicated “is” in paragraph (b) of this provision, enter the following information for all predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in reverse chronological order):

Predecessor CAGE code:

Predecessor legal name:

(Do not use a “doing business as” name)

(End of provision)

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND STATEMENTS

52.204-17 OWNERSHIP OR CONTROL OF OFFEROR (JUL 2016) FAR

As prescribed in 4.1804(b), use the following provision:

(a) Definitions. As used in this provision -

“Commercial and Government Entity (CAGE) code” means -

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics Agency (DLA) Commercial and Government Entity (CAGE) Branch to identify a commercial or government entity; or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 8 OF 8 PAGES

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND STATEMENTS (CONTINUED)

(NSPA) to entities located outside the United States and its outlying areas that the DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

“Highest-level owner” means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

“Immediate owner” means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

(b) The Offeror represents that it [ ] has or [ ] does not have an immediate owner. If the Offeror has more than one immediate owner (such as a joint venture), then the Offeror shall respond to paragraph (c) and if applicable, paragraph (d) of this provision for each participant in the joint venture.

(c) If the Offeror indicates “has” in paragraph (b) of this provision, enter the following information:

Immediate owner CAGE code:

Immediate owner legal name:

(Do not use a “doing business as” name)

Is the immediate owner owned or controlled by another entity?: [ ] Yes or [ ] No.

(d) If the Offeror indicates “yes” in paragraph (c) of this provision, indicating that the immediate owner is owned or controlled by another entity, then enter the following information:

Highest-level owner CAGE code:

Highest-level owner legal name:

(Do not use a “doing business as” name)

(End of provision)

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REQUEST FOR QUOTATIONS

THIS RFQ IS IS NOT A SMALL BUSINESS SET-ASIDE

4. CERT.FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG. 1

5. ISSUED BY

7. DELIVERY

9. DESTINATION

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5 ON OR

BEFORE CLOSE OF BUSINESS (Date) IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (See Continuation Sheets)

12. DISCOUNT FOR PROMPT PAYMENT

d. CALENDAR DAYS

NUMBER

PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

16. SIGNER

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not useable STANDARD FORM 18 (REV. 6-95) Prescribed by GSA-FAR (48 CFR) 53.215-1(a)

8. TO:

See Schedule See attached schedule to complete quote information.

f. Vendor FAX Number: Vendor Toll-Free Number: Vendor E-mail:

e. Remittance Address (Name, Street, City, State, ZIP): Same as Block 13 unless otherwise indicated below:

d. If delivery period shown in Block 6 is unacceptable, provide best possible delivery:

c. FOB Point:

Origin Shipping Point (City, State) Destination Other (provide basis) Commercial sales of comparable quantities: Quantity ; Price ;

Customer Contained in Internal Price List No. dated , which may be examined at our facility.

Contained in Commercial Catalog or Published Price List No. dated page

b. Prices quoted are:

a. Quotation is valid for 90 days from date specified in Block 10 above unless otherwise indicated: __________________ .

Quoter must also complete the following:

NUMBER

FOB DESTINATION

OTHER

(See Schedule)

CAGE

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ZSF18_BLOCK11: See attached schedule to complete quote information.

Quoter must also complete the following:

a. Quotation is valid for 90 days from date specified in Block 10 above unless otherwise indicated: _____________ .

b. Prices quoted are:

___ Contained in Commercial Catalog or Published Price List No. ___________________ dated _______________ page __________ .

___ Contained in Internal Price List No. _______________dated ____________________, which may be examined at our facility.

___ Commercial sales of comparable quantities: Quantity ____________ ; Price _____________;

___ Customer ________________________.

___ Other (provide basis) ______________________________________ _______________________________________ .

c. FOB Point: ____ Destination ____ Origin Shipping Point (City, State) _________________________________________ .

d. If delivery period shown in Block 6 is unacceptable, provide best possible delivery: _________________________________.

e. Remittance Address (Name, Street, City, State, ZIP): Same as Block 13 unless otherwise indicated below:

f. Vendor FAX Number: ____________________ Vendor Toll-Free Number: ____________________ Vendor E-mail: ______________________________

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