SPRRA221D0011SPRRA221F0024.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.

SPRRA2-21-D-0011 SPRRA221F0024 2021MAY13 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

S3500A

DCMA ALBUQUERQUE

8601 FROST AVE, BLDG. 20203B

ALBUQUERQUE, NM 87117

X

6FN58

R & M GOVERNMENT SERVICES INC.

650 MONTANA AVE STE A

LAS CRUCES, NM 88011-4294

SEE SCHEDULE X

See Block 15

SEE SCHEDULE

HQ0339

DFAS - COLUMBUS CENTER

WEST 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

2021MAY13 /SIGNED/ 2021MAY13

$26,000.00

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: Small Disadvantaged 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-0011 AND IS

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

2. DELIVERY ORDER SPRRA2-21-F-0024 IS FOR 13 EACH OF CABLE ASSEMBLY SPEC, NSN:6150-01-609-2647, P/N: 13646795. THE UNIT PRICE AT WHICH

THE ORDER IS ISSUED IN ACCORDANCE WITH THE BASIC CONTRACT PRICING FOR THE FIRST ORDERING PERIOD IS $2,000.00 EACH FOR CLIN 0001AA FOR

THE PRODUCTION LOT TEST.

3. IDIQ EXPIRATION DATE IS 14 MAY 2026.

4. TOTAL QUANTITY FOR THE 5 YEAR IDIQ CONTRACT IS 33 EACH

5. THE TOTAL AMOUNT FOR THIS DELIVERY ORDER IS $26,000.00.

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

7.20 QUANTITY REMAIN AVAILABLE AFTER DELIVERY ORDER SPRRA2-21-F-0024

*** END OF NARRATIVE A0001 ***

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SPRRA2-21-D-0011/SPRRA221F0024

R & M GOVERNMENT SERVICES INC.

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: 6150-01-609-2647

Mfr CAGE: 18876

Mfr Part Number: 13646795

0001AA PRODUCTION LOT TEST GOVERNMENT FACILITY 13 EA $ 2,000.00000 $ 26,000.00 _______________________________________ ______________ __________________

COMMODITY NAME: CABLE ASSEMBLY,SPEC

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: D11H0005D1 PRON AMD: 03 ACRN: AA

AMS CD: SM2B1100000

PSC: 6150

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

MIL-STD-129 MARKINGS SHALL APPLY

UNIT PACK: 001 INTERMEDIATE PACK: 000

LEVEL PRESERVATION: Military

LEVEL PACKING: B

ESTIMATED MAXIMUM UNIT PACKAGE WEIGHT (POUNDS) AND

SIZE (INCHES)

WT [6.2]

LN [16.5]

WD [16.5]

DP [16.5]

MIL-STD-2073-1

CODES, APPENDIX J

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 [00]

JVIIIA/OPI [M]

ALL WOOD PACKAGING MATERIAL (WPM) MUST BE ISPM-15

COMPLIANT.

SUPPLEMENTAL INFORMATION: COIL CABLE CAP/CUSHION

CONNECTORS

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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

(End of narrative D001)

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Destination

Government Approval/Disapproval Days: 60

Deliveries or Performance _________________________

DOC SUPPL

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

002 SPRRA203110900 W31P0W J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 13 13-FEB-2022

FOB POINT: Destination

SHIP TO:

(W31P0W) SR HEADQUARTERS US ARMY AVIATION &

REDSTONE TECHNICAL TEST CENTER

COTTONWOOD RD BLDG 8022 MF 4500

REDSTONE ARSENAL,AL,35898-8052

CONTRACT/DELIVERY ORDER NUMBER ______________________________

SPRRA2-21-D-0011/SPRRA221F0024

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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 D11H0005D1 2 AA $ 26,000.00

SM2B1100000

TOTAL $ 26,000.00

OBLIGATED OBLIGATED

ACRN ACCOUNTING CLASSIFICATION AMOUNTACRN ACCOUNTING CLASSIFICATION AMOUNT____ _________________________ ______________ _________________________ __________

AA 97 X4930AC9F 6X 26K6 S01021 W31G3H $ 26,000.00 __________________

TOTAL $ 26,000.00

LINELINE

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

0001AA AA 97 0X0X4930AC9F S01021 6X0000SM2B110000026K6 S01021 W31G3H

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