SPRDL119D0036SPRDL119F0095.pdf

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ORDER FOR SUPPLIES OR SERVICES

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 10. DELIVER TO FOB POINT BY (Date) 11. X IF BUSINESS IS

SMALL

SMALL

NAME 12. DISCOUNT TERMS DISADVANTAGED

AND

ADDRESS

WOMAN-OWNED

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. DELIVERY/

CALL THIS DELIVERY ORDER IS ISSUED ON ANOTHER GOVERNMENT AGENCY OR IN ACCORDANCE WITH AND SUBJECT TO TERMS AND CONDITIONS OF ABOVE NUMBERED CONTRACT.

TYPE

OF

ORDER

PURCHASE

Reference your Oral Written Quotation ________________________ , Dated ________________.

____________________________ furnish the following on terms specified herein.

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.

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED

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/SERVICE 20. QUANTITY

ORDERED/

ACCEPTED*

21.

UNIT

22. UNIT PRICE 23. AMOUNT

* If quantity accepted by the Government is 24. UNITED STATES OF AMERICA 25. TOTAL same as quantity ordered, indicate by X. 26.

If different, enter actual quantity accepted below DIFFERENCES quantity ordered and encircle. BY: CONTRACTING/ORDERING OFFICER 27a. QUANTITY IN COLUMN 20 HAS BEEN

INSPECTED RECEIVED ACCEPTED, AND CONFORMS TO CONTRACT EXCEPT AS NOTED ____________________________________________________

b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE c. DATE d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

(YYYYMMMDD) REPRESENTATIVE

e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 28. SHIP. NO. 29. D.O. VOUCHER NO. 30. INITIALS

PARTIAL

32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR

f. TELEPHONE NUMBER g. E-MAIL ADDRESS

FINAL

31. PAYMENT 34. CHECK NUMBER

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

COMPLETE

a. DATE b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

PARTIAL

35. BILL OF LADING NO.

FINAL

37. RECEIVED AT 38. RECEIVED BY (Print) 39. DATE RECEIVED

40. TOTAL CON-

TAINERS

41. S/R ACCOUNT NUMBER 42. S/R VOUCHER NO.

DD FORM 1155, DEC 2001 PREVIOUS EDITION IS OBSOLETE.

SPRDL1-19-D-0036 SPRDL119F0095 2018DEC07 SEE SCHEDULE DOA4

SPRDL1

DLA LAND WARREN

WARREN, MI 48397-5000

ELAINE IONESCU

EMAIL: ELAINE.M.IONESCU.CIV@MAIL.MIL

S2101A

DCMA BALTIMORE

217 EAST REDWOOD STREET

SUITE 1800

BALTIMORE MD 21202-3375

X

51JW4

ALLIED DEFENSE, LLC

8604 DAKOTA DR

GAITHERSBURG, MD 20877-4137

SEE SCHEDULE X

See Block 15

SEE SCHEDULE

HQ0338

DFAS-COLUMBUS CENTER

SOUTH ENTITLEMENT OPERATIONS

P O BOX 182317

COLUMBUS OH 43218-2264

X

SEE CONTRACT ADMINISTRATION DATA

SEE SCHEDULE

ELAINE IONESCU

ELAINE.M.IONESCU.CIV@MAIL.MIL (586)467-1230

2018DEC07 /SIGNED/ 2018DEC07

$20,044.95

CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SUPPLEMENTAL INFORMATION

Buyer Name: ELAINE IONESCU

Buyer Office Symbol/Telephone Number: ZGAB/(586)467-1230

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

Type of Business: Small Disadvantaged Business Performing in U.S.

Surveillance Criticality Designator: C

*** End of Narrative A0000 ***

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SPRDL1-19-D-0036/SPRDL119F0095

ALLIED DEFENSE, LLC

PIIN/SIIN

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

SUPPLIES OR SERVICES AND PRICES/COSTS

0011 PUMP UNIT,HYDRAULIC

NSN: 4320-01-432-6208

Mfr CAGE: 19207

Mfr Part Number: 12395352

0011AA PRODUCTION QUANTITY 15 EA $ 1,336.33000 $ 20,044.95 ____________________ ______________ __________________

COMMODITY NAME: PUMP UNIT,HYDRAULIC

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: EH81L452EH PRON AMD: 02 ACRN: AA

AMS CD: SM2B1100000

PSC: 4320

Description/Specs./Work Statement _________________________________

TOP DRAWING NR: 12395352

DATE: 18-MAY-2018

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING CLAUSE IN BASE LTC

LEVEL PRESERVATION: Military

LEVEL PACKING: B

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

REL CD MILSTRIP ADDR SIG CD MARK FOR TP CD ______ ________ ______ ______ ________ _____

001 W56HZW8122753Z W562RP J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 15 25-JUL-2019

FOB POINT: Destination

SHIP TO:

(W562RP) SR ARMY GENERAL SUPPLY LMP STOCK RE

CENTRAL RECEIVING POINT

7 FRANKFORD AVE BLDG 362

ANNISTON,AL,36201-4199

CONTRACT/DELIVERY ORDER NUMBER ______________________________

SPRDL1-19-D-0036/SPRDL119F0095

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Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

CONTRACT ADMINISTRATION DATA

PRON/ PRON/

AMS CD/ AMS CD/

LINE MIPR/ OBLG JO NO/ OBLIGATEDLINE MIPR/ OBLG JO NO/ OBLIGATED

ITEM GFEBS ATA STAT ACCT ASSIGN ACRN AMOUNTITEM GFEBS ATA STAT ACCT ASSIGN ACRN AMOUNT_____ _________ _____ ___________ ____ _______________ _________ _____ ___________ ____ __________

0011AA EH81L452EH 2 AA $ 20,044.95

SM2B1100000

TOTAL $ 20,044.95

OBLIGATED OBLIGATED

ACRN ACCOUNTING CLASSIFICATION AMOUNTACRN ACCOUNTING CLASSIFICATION AMOUNT____ _________________________ ______________ _________________________ __________

AA 97 X4930AC9D 6D 26KB S20113 W56HZV $ 20,044.95 __________________

TOTAL $ 20,044.95

LINELINE

ITEM ACRN EDI/SFIS ACCOUNTING CLASSIFICATIONITEM ACRN EDI/SFIS ACCOUNTING CLASSIFICATION_____ ____ _______________________________________ ____ __________________________________

0011AA AA 97 0X0X4930AC9D S20113 6D0000SM2B110000026KB S20113 W56HZV

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