SPRRA221D0009SPRRA221F0005.pdf

PAGE 1 OF

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.

SPRRA2-21-D-0009 SPRRA221F0005 2020NOV23 SEE SCHEDULE DOA2

SPRRA2

DEFENSE LOGISTICS AGENCY

5201 MARTIN ROAD/DLA-AVN-AH

REDSTONE ARSENAL AL 35898-7340

MICHAEL (CODY) ROMINE

EMAIL: MICHAEL.1.ROMINE@DLA.MIL

S1103A

DCMA ATLANTA

2300 LAKE PARK DRIVE, SUITE 300

SMYRNA GA 30080

X

31068

DUTCH VALLEY SUPPLY CO.

970 PROGRESS CENTER AVE

LAWRENCEVILLE, GA 30043-4803

SEE SCHEDULE

X

See Block 15

SEE SCHEDULE

HQ0338

DFAS-COLUMBUS CENTER

SOUTH ENTITLEMENT OPERATIONS

P O BOX 182317

COLUMBUS OH 43218-2317

X

X 2

SEE CONTRACT ADMINISTRATION DATA

SEE SCHEDULE

STEVON WALKER

STEVON.WALKER@DLA.MIL (256)690-5713

2020NOV23 /SIGNED/ 2020NOV23

$99,811.14

CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SUPPLEMENTAL INFORMATION

Buyer Name: MICHAEL (CODY) ROMINE

Buyer Office Symbol/Telephone Number: DLA-AVIATION/(256)924-7907

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

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

Surveillance Criticality Designator: B

Weapon System: Patriot

*** End of Narrative A0000 ***

1. THIS DELIVERY ORDER IS ISSUED WITH FIRM FIXED PRICES AND FIRM DELIVERY SCHEDULE PURSUANT TO BASIC CONTRACT SPPRA2-21-D-0009 AND IS

SUBJECT TO AND INCORPORATED BY REFERENCE ALL PROVISIONS OF THE INDEFINITE DELIVERY/INDEFINITE QUANTITY (IDIQ) CONTRACT.

2. DELIVERY ORDER SPRRA2-21-F-0005 IS FOR 22 EACH OF CABLE ASSEMBLY SPEC, NSN:5995-01-624-5133, P/N: K3491274. THE UNIT PRICE AT WHICH

THE ORDER IS ISSUED IN ACCORDANCE WITH THE BASIC CONTRACT PRICING FOR THE FIRST ORDERING PERIOD IS $4,536.87 EACH FOR CLIN 0001AA FOR

THE PRODUCTION QUANTITY.

3. IDIQ EXPIRATION DATE IS 30 NOVEMBER 2025.

4. TOTAL QUANTITY FOR THE 5 YEAR IDIQ CONTRACT IS 82 EACH.

5. THE TOTAL AMOUNT FOR THIS DELIVERY ORDER IS $99,811.14.

6. ACCELERATED DELIVERY AT NO ADDITIONAL COST TO THE GOVERNMENT IS ACCEPTABLE.

7.60 QUANTITY REMAIN AVAILABLE AFTER DELIVERY ORDER SPRRA2-21-F-0005.

8. SCIOTEQ LLC CAGE 4DL36 CONFIRMED THAT DUTCH VALLEY CAGE 31068, IS AN AUTHORIZED DISTRIBUTOR.

9. SCIOTEQ PN K3491274 WILL BE USED IN LIEU OF ARMY PN 13638919-5 PER PAID ACTION I-23576.

*** END OF NARRATIVE A0001 ***

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SPRRA2-21-D-0009/SPRRA221F0005

DUTCH VALLEY SUPPLY CO.

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

0001 CABLE ASSEMBLY,SPEC

NSN: 5995-01-624-5133

Mfr CAGE: 18876

Mfr Part Number: 13638919-5

0001AA MIL-STD-129 MARKINGS SHALL APPLY 22 EA $ 4,536.87000 $ 99,811.14 ________________________________ ______________ __________________

COMMODITY NAME: CABLE ASSEMBLY,SPEC

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: D10H0155D1 PRON AMD: 04 ACRN: AA

AMS CD: SM2B1100000

PSC: 5995

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

MIL-STD-129 MARKINGS SHALL APPLY

UNIT PACK: 001 INTERMEDIATE PACK: 000

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

ESTIMATED MAXIMUM UNIT PACKAGE WEIGHT (POUNDS) AND

SIZE (INCHES)

WT [5.3]

LN [14.0]

WD [14.0]

DP [12.0]

THE FOLLOWING MIL-STD-2073-1 CODES, APPENDIX J SHALL

APPLY:

JI/A/MP [41]

JII/CD [1]

JIII/PM [00]

JIV/WM [00]

JV/CD [NA]

JVI/CT [A]

JVII/UC [ED]

JVII/IC [00]

JIX/A/PK [F]

JX/SM [ZZ]

JVIIIA/OPI[M]

SUPPLEMENTAL INFORMATION:

ZZ=COIL CABLE CAP/CUSHION

CONNECTORS

(End of narrative D001)

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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

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

002 W31G3H0239AF01 W90BTD J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 22 20-SEP-2021

FOB POINT: Destination

SHIP TO:

(W90BTD) SR HEADQUARTERS US ARMY AVIATION &

AMCOM FLEET MGT CENTER AFMC

HOLBROOK RD BLDG 722

FORT BLISS,TX,79916-5801

CONTRACT/DELIVERY ORDER NUMBER ______________________________

SPRRA2-21-D-0009/SPRRA221F0005

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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_____ _________ _____ ___________ ____ _______________ _________ _____ ___________ ____ __________

0001AA D10H0155D1 2 AA $ 99,811.14

SM2B1100000

TOTAL $ 99,811.14

OBLIGATED OBLIGATED

ACRN ACCOUNTING CLASSIFICATION AMOUNTACRN ACCOUNTING CLASSIFICATION AMOUNT____ _________________________ ______________ _________________________ __________

AA 97 X4930AC9F 6X 26K6 S01021 W31G3H $ 99,811.14 __________________

TOTAL $ 99,811.14

LINELINE

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

0001AA AA 97 0X0X4930AC9F S01021 6X0000SM2B110000026K6 S01021 W31G3H

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