SPE8E518Q0175.PDF

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PLATE, METAL Federal contract opportunity
Solicitation number
SPE8E518Q0175
Issued by
Defense Logistics Agency Troop Support Medical

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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.

SPE8E5-18-Q-0175

2. DATE ISSUED

2018 JAN 31

3. REQUISITION/PURCHASE REQUEST NO.

See Schedule

RATING

DO-C9

DLA TROOP SUPPORT

CONSTRUCTION & EQUIPMENT (MAT & ME)

700 ROBBINS AVENUE

PHILADELPHIA PA 19111-5096

USA

Buyer: Jennifer Chau DJC0103 Tel: 215-737-3744 Email: Jennifer.Chau@dla.mil

6. DELIVER BY (Date)

30 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 FEB 01

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 7 PAGES

SPE8E5-18-Q-0175

CONTINUED ON NEXT PAGE

THIS SOLICITATION INCORPORATES THE TERMS AND CONDITIONS SET FORTH IN THE DLA MASTER SOLICITATION FOR EPROCUREMENT AUTOMATED SIMPLIFIED ACQUISITIONS (PART 13) REVISION 37 (April 10, 2017) WHICH CAN BE FOUND ON THE WEB AT:

http://www.dla.mil/Portals/104/Documents/J7Acquisition/Master_Solicitation_Rev-37_APR-10-2017.pdf The provision/ clauses as indicated in the DLA Master Solicitation for solicitations, REVISION 37 (April 10, 2017), and resulting awards are hereby applicable and incorporated by reference. The Master Solicitation can be found on the web at http://www.dla.mil/HQ/Acquisition/Offers/eProcurement.aspx”

ALL QUOTES MUST BE SUBMITTED VIA THE DLA INTERNET BID BOARD SYSTEM (DIBBS) AT: https://www.dibbs.bsm.dla.mil.

MICRO-PURCHASE QUOTES MAY BE AWARDED PRIOR TO RETURN DATE UNLESS THIS SOLICITATION HAS BEEN DESIGNATED FOR AUCTIONING.

NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM 332321 SEE

http://www.sba.gov/content/table-small-business-size-standards

FOR THE CORRESPONDING SMALL BUSINESS SIZE STANDARD.

DFARS 252.225-7001, BUY AMERICAN ACT AND BALANCE OF PAYMENTS PROGRAM, APPLIES TO ALL QUOTES

ABOVE THE MICRO-PURCHASE THRESHOLD.

DESTINATION INSPECTION REQUIRED - FAR 52.246-1 APPLIES.

THIS BUY IS NOT FAST PAY

NO VARIATION IN QUANTITY ALLOWED

This solicitation is being issued under the First Destination Transportation (FDT) program. If this acquisition is for Foreign Military Sales (FMS) or has an APO/FPO ship-to address, FDT will not apply and normal procedures should be followed. For FDT program transportation requirements, see DLAD clauses 52.247-9059 F.O.B. Origin, Government Arranged Transportation and 52.247-9058, First Destination Transportation (FDT) Program – Shipments Originating Outside the contiguous United States (OCONUS). Additional information about FDT can be found on the FDT website at:

(http://www.dla.mil/LandandMaritime/Business/Selling/DLALandandMaritimeProcurementInitiatives/FDTPI.aspx)

Item is urgently needed due to high backorders. Please provide the best delivery you can offer.

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 3 OF 7 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLIES/SERVICES: 9515-01-544-2736

ITEM DESCRIPTION:

PLATE,METAL

RP001: DLA PACKAGING REQUIREMENTS FOR PROCUREMENT

Metal Certification Contract Data Requirements Lists (CDRLs), DD Form 1423s, apply to this procurement. Review the Technical Data Package (TDP) for additional information. If CDRL-METALSCERT is missing from DLA Collaboration Folders (CFolders) they can also be viewed in Appendix 1 of the DLA MASTER LIST OF TECHNICAL AND QUALITY REQUIREMENTS FOUND ON THE WEB AT: http://www.dla.mil/HQ/Acquisition/Offers/eProcurement.aspx

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

AWARDS OF THIS NSN MUST BE SOURCE INSPECTED

UNLESS AWARDED TO A QSLM/QSLD SUPPLIER THAT

IS LISTED ON THE APPLICABLE QSL LIST AND

SUPPLYING MATERIAL THAT IS IN COMPLIANCE

WITH THE QSL PROGRAM.

IY010: QUALIFIED SUPPLIERS LIST FOR DISTRIBUTORS (QSLD) REQUIREMENT (DLA

TROOP SUPPORT JUNE 1994) FOR FSG'S 95 AND 96.

ONLY SUPPLIERS LISTED ON THE QSLD ARE ELIGIBLE FOR AN AWARD PURSUANT TO

THIS SOLICITATION.

SUPPLIERS NOT QUOTING IN COMPLIANCE WITH THE QSLD REQUIREMENT MUST

INDICATE THEY ARE DEVIATING FROM THE REQUIREMENTS OF THE SOLICITATION.

ANY BID/QUOTE/OFFER BASED ON A PRODUCT SUPPLIED BY OTHER THAN AN

APPROVED QSL DISTRIBUTOR, EVEN THOUGH THE PRODUCT MIGHT HAVE BEEN

MANUFACTURED IN ACCORDANCE WITH THE DRAWING(S) AND/OR SPECIFICATION(S)

AS CITED IN THE PURCHASE ORDER

TEXT (POT) IS A BID/QUOTE/OFFER WITH EXCEPTION AND MUST BE SO INDICATED

BY THE

QUOTER/OFFEROR.

ANY PRODUCT FURNISHED UNDER A CONTRACT OR ORDER FOR A PRODUCT DESIGNATED

AS PART OF THE QSL PROGRAM, UNLESS SPECIFICALLY AUTHORIZED BY THE

GOVERNMENT IN WRITING, MUST FULLY COMPLY WITH THE TERMS AND CONDITIONS

OF THE QSL PROGRAM. ANY PRODUCT, WHICH DOES NOT FULLY COMPLY WILL BE

CONSIDERED AN UNAUTHORIZED SUBSTITUTION, AND MAY YIELD CRIMINAL

PENALTIES IN ADDITION TO ANY CIVIL REMEDIES AVAILABLE TO THE GOVERNMENT.

FOR THIS SOLICITATION, AND ANY RESULTING ORDER ISSUED TO AN APPROVED

QSLM/QSLD SUPPLIER

WHOSE QUOTE IS BASED ON COMPLIANCE WITH THE QSL PROGRAM, (EXCEPT IN THE

CASE OF FMS (FOREIGN MILITARY SALE) REQUIREMENTS), REFERENCES TO SOURCE

INSPECTION ARE HEREBY WAIVED. IN SUCH CASES, COQC, PVT, QAP-EQ003, ASQ

H1331, AND RQ006: QUALITY CONFORMANCE INSPECTION REQUIREMENTS, IF

REFERENCED, DO NOT APPLY.

FOR MORE INFORMATION ABOUT THE QSL PROGRAM GO TO THE FOLLOWING WEBSITE:

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 4 OF 7 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 9515-01-544-2736 CONT'D

http://www.dla.mil/TroopSupport/IndustrialHardware/Engineering-and-Techn ical-services/Qualified-Suppliers-List/

-OR- WRITE TO:

DLA TROOP SUPPORT, ATTN: DLA TROOP SUPPORT - FHTF, BLDG 3/B, 700 ROBBINS

AVENUE, PHILADELPHIA, PA 19111-5092

Qualification requirements in procurement note #M03 Qualified Suppliers List for Manufacturers (QSLM)/Qualified Suppliers List for Distributors (QSLD) for Troop Support# apply. The full text of procurement note M03 can be found in the DLA Directive (DLAD) of Procurement Notes on the Web at: http://www.dla.mil/HQ/Acquisition/Offers/eProcurement.aspx.

(END STO)

BAE SYSTEMS LAND ARMAMENTS L.P. 076M6 P/N 6432599-200M1

Bae Systems Protection Systems 54786 P/N 6432599-200M1

IAW REFERENCE QAP 13873 CDRL-METALSCERT-17075

REVISION NR DTD 03/16/2017

PART PIECE NUMBER:

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

0001 9515-01-544-2736 153.000 EA $ ________________ $ ________________

QTY VARIANCE: PLUS 0% MINUS 0%

INSPECTION POINT: DESTINATION

ACCEPTANCE POINT: DESTINATION

FOB: ORIGIN DELIVERY DATE: 30 DAYS ADO

PREP FOR DELIVERY:

PKGING DATA-QUP:001

SHALL BE PACKAGED IN ACCORDANCE WITH ASTM D 3951.

Markings Paragraph When ASTM D3951, Commercial Packaging is specified, the following apply:

•,,All Section “D” Packaging and Marking Clauses take precedence over

ASTM D3951.

•,,In addition to requirements in MIL-STD-129, when Commercial Packaging is used, the Method of Preservation for all MIL-STD-129 marking and labeling shall be “CP” Commercial Pack.

•,,The Unit of Issue (U/I) and Quantity per Unit Pack (QUP) as specified in the contract take precedence over QUP in ASTM D3951.

PARCEL POST ADDRESS:

W62G2T

W1A8 DLA DIST SAN JOAQUIN

25600 S CHRISMAN ROAD

REC WHSE 57

TRACY CA 95304-5000

US

FOR TRANSPORTATION ASSISTANCE SEE DLAD 52.247-9034. FOR FIRST DESTINATION TRANSPORTATION (FDT) AWARDS SEE DLAD

52.247-9059 AND

CONTRACT INSTRUCTIONS INSTEAD.

FREIGHT SHIPPING ADDRESS:

W62G2T

W1A8 DLA DIST SAN JOAQUIN

25600 S CHRISMAN ROAD

REC WHSE 57

TRACY CA 95304-5000

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 5 OF 7 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 9515-01-544-2736 CONT'D

US

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

0002 9515-01-544-2736 154.000 EA $ ________________ $ ________________

QTY VARIANCE: PLUS 0% MINUS 0%

INSPECTION POINT: DESTINATION

ACCEPTANCE POINT: DESTINATION

FOB: ORIGIN DELIVERY DATE: 30 DAYS ADO

PREP FOR DELIVERY:

PKGING DATA-QUP:001

SHALL BE PACKAGED IN ACCORDANCE WITH ASTM D 3951.

Markings Paragraph When ASTM D3951, Commercial Packaging is specified, the following apply:

•,,All Section “D” Packaging and Marking Clauses take precedence over

ASTM D3951.

•,,In addition to requirements in MIL-STD-129, when Commercial Packaging is used, the Method of Preservation for all MIL-STD-129 marking and labeling shall be “CP” Commercial Pack.

•,,The Unit of Issue (U/I) and Quantity per Unit Pack (QUP) as specified in the contract take precedence over QUP in ASTM D3951.

PARCEL POST ADDRESS:

SW3227

DLA DISTRIBUTION RED RIVER

RECEIVING BLDG 499

10TH STREET AND K AVENUE

TEXARKANA TX 75507-5000

US

FOR TRANSPORTATION ASSISTANCE SEE DLAD 52.247-9034. FOR FIRST DESTINATION TRANSPORTATION (FDT) AWARDS SEE DLAD

52.247-9059 AND

CONTRACT INSTRUCTIONS INSTEAD.

FREIGHT SHIPPING ADDRESS:

SW3227

DLA DISTRIBUTION RED RIVER

RECEIVING BLDG 499

10TH STREET AND K AVENUE

TEXARKANA TX 75507-5000

US

GOVT USE

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

0001 0070283208 0001 N/A N/A N/A 01/29/2018

0002 0071294830 0001 N/A N/A N/A 04/07/2018

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 6 OF 7 PAGES

CONTINUED ON NEXT PAGE

SECTION I - CONTRACT CLAUSES

52.204-16 COMMERCIAL AND GOVERNMENT ENTITY CODE REPORTING (JUL 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: (or mark “Unknown”) 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

(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.

“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.

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 7 OF 7 PAGES

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND STATEMENTS (CONTINUED)

(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

PAGE OF

1.6 Requet for Quotation skim Standard form - RFQ Acrobat Distiller 4.0 for Windows D:20001024141244Z D:20090429133228-04'00'

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ZSF18_REQ_NO: SPE8E5-18-Q-0175
ISSUE_DATE:
ZSF18_REQ_PR_NO: See Schedule
SPS-RATING:
AGENCY-NAME:
DELIVERY-DATE:
X-FOB:
X-OTHER:
SHIP-CITY:
SHIP-STATE:
SHIP-STREET:
SHIP-NAME:
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DISC_TEN_DAYS:
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DISC_THIRTY_DAYS:
DISC_DAYS:
DISC_OPN_DAYS:
RFQ-QUOTE-DATE:
RFQ_SIGNER_NAME:
RFQ_SIGNER_TEL:
RFQ_SIGNER_TITLE:
OFFEROR_NAME1:
OFFEROR_NAME2:
OFFEROR_CITY:
OFFEROR_STREET2:
OFFEROR_STREET1:
OFFEROR_STATE:
OFFEROR_ZIP4:
AP-YES:
AP-NO:
RFQ-DUE-DATE:
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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