Tab 11 - Attach 2 Model TO BAA Draft.pdf

ORDER FOR SUPPLIES OR SERVICES

1. CONTRACT/PURCH ORDER/AGREEMENT NO.

FA865121D00XX

2. DELIVERY ORDER/ CALL NO.

FA8651-21-F-00XX

3. DATE OF ORDER/CALL

(YYYYMMMDD)

4. REQUISITION/PURCH REQUEST NO.

SEE SCHEDULE

5. PRIORITY

DO-A5

6. ISSUED BY AFRL/RWK CODE FA8651 7. ADMINISTERED BY (If Other than 6) CODE 8. DELIVERY FOB

AIR FORCE RESEARCH LABORATORY

MUNITIONS RESEARCH LABORATORY

203 W EGLIN BLVD, BLDG 300

EGLIN AFB, FL 32542-6810

SHANNON K. PARADISE 850-883-7215

SHANNON.PARADISE@US.AF.MIL

X DESTINATION

OTHER

(See Schedule if other)

SCD: PAS: (NONE)

9. CONTRACTOR CODE FACILITY 10. DELIVER TO FOB POINT BY (Date) 11. X IFBUSINESS IS

(YYYYMMMDD) SEE SCHEDULE SMALL

NAME

AND

12. DISCOUNT ITEMS SMALL DISAD-

VANTAGED

ADDRESS N WOMEN-

OWNED

13. MAIL INVOICES TO ADDRESS IN BLOCK

SEE BLOCK 15 (PAYMENT OFFICE)

14. SHIP TO CODE 15. PAYMENT WILL BE MADE BY CODE

SEE SCHEDULE MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATION

NUMBERS IN

BLOCKS 1 AND 2.

EFT:T

16.

DELIVERY/

X

This delivery order/call is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contract.

TYPE CALL

OF

PURCHASE

Reference your furnish the following on items specified herein.

ORDER 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(YYYYMMMDD)

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/SERVICES 20. QUANTITY

ORDERED/

ACCEPTED*

21.

UNIT

22. UNIT PRICE 23. AMOUNT

*If quantity accepted by the Government is same as quantity ordered, indicate by X. If different, enter actual quantity accepted below quantity ordered and encircle.

24. UNITED STATES OF AMERICA

25. TOTAL

$0.00

29.

DIFFERENCES

BY:

CONTRACTING/ORDERING OFFICER

26. QUANTITY IN COLUMN 20 HAS BEEN 27. SHIP NO. 28. D.O. VOUCHER NO. 30. INITIALS

INSPECTED RECEIVED ACCEPTED, AND CONFORMS TO THE

CONTRACT EXCEPT AS NOTED

PARTIAL 32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR

_______ _________________________________________________ FINAL

DATE SIGNATURE AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32. PAYMENT 34. CHECK NUMBER

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

_______ _________________________________________________ PARTIAL 35. BILL OF LADING

DATE SIGNATURE AND TITLE OF CERTIFYING OFFICER FINAL

37. RECEIVED

AT

38. RECEIVED BY (Print) 39. DATE RECEIVED

(YYYYMMMDD)

40. TOTAL CON-

TAINERS

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

DD FORM 1155, JAN 1998 (EG) ConWrite Version 7.4.0.0 PREVIOUS EDITION MAY BE USED Created 25 Feb 2021 1:38 PM

MODEL

LIST OF ATTACHMENTS

Qty Unit Price ITEM SUPPLIES OR SERVICES Purch Unit Total Item Amount

0001 1 EST $0.00

Lot EST $0.00 Noun: MINIATURE SELF DEFENSE MUNITION (MSDM)

HARDWARE-IN-THE-LOOP (HWIL) SUPPORT

PSC: AC12

NSN: N - Not Applicable DD1423 is Exhibit: A Contract type: U - COST PLUS FIXED FEE Inspection: DESTINATION Acceptance: DESTINATION

FOB: DESTINATION

Descriptive Data:

The contractor shall perform Task Order in accordance with the Basic Contract, Description/Specifications, Section J, Exhibits and Attachment 1, Statement of Work.

NOTE: International Traffic in Arms Regulation (ITAR) Restricted. Export control applicable. All data should be submitted in accordance with Exhibit A, Contract Data Requirements List (DD Form 1423).

Performance Period of this task order is (SEE Attach 1 SOO).

Estimated Cost $______

FCCM $______

Fixed Fee $______ Total Price $______

This CLIN is anticipated to be incrementally funded.

PROGRAM MILESTONES

So that the Government can determine whether or not the Contractor is achieving satisfactory technical progress, certain milestones events during the performance of this contract (including Configuration Reviews and Audits) are established. These events are referred to as Program Milestones, are set forth below, and are considered approximate except for the Period of Performance End date.

Program Milestones Completion Date (SEE Attachment 1 SOO)

SHIPMENT ADDRESS

Air Force Research Laboratory Street Address: 101 West Eglin Blvd, Bldg 13 Eglin AFB, FL 32542 Mark For: FA8651-21-F-00xx Ship to BPN: TBD

The contract data requirements specific to this task include:

(SEE ATTACHMENT 1, STATEMENT OF OBJECTIVES)

Qty Unit Price ITEM SUPPLIES OR SERVICES Purch Unit Total Item Amount

0002 OPTION CLIN

Noun: (OPTION) SIMULATION DEVELOPMENT & ANALYSIS

SUPPORT

PSC: AC12

NSN: N - Not Applicable Contract type: U - COST PLUS FIXED FEE Inspection: DESTINATION Acceptance: DESTINATION

FOB: DESTINATION

Descriptive Data:

The contractor shall perform this research and development in accordance with the Basic Contract, Description/Specifications, Section J, Exhibits and Attachment 1, Statement of Work.

NOTE: International Traffic in Arms Regulation (ITAR) Restricted. Export control applicable. All data should be submitted in accordance with Exhibit A, Contract Data Requirements List (DD Form 1423).

Performance Period of this task order is (SEE Attach 1 SOO).

Estimated Cost $______

FCCM $______

Fixed Fee $______ Total Price $______

This CLIN is anticipated to be incrementally funded.

PROGRAM MILESTONES

So that the Government can determine whether or not the Contractor is achieving satisfactory technical progress, certain milestones events during the performance of this contract (including Configuration Reviews and Audits) are established. These events are referred to as Program Milestones, are set forth below, and are considered approximate except for the Period of Performance End date.

Program Milestones Completion Date (SEE Attachment 1 SOO)

SHIPMENT ADDRESS

Air Force Research Laboratory Street Address: 101 West Eglin Blvd, Bldg 13 Eglin AFB, FL 32542 Mark For: FA8651-21-F-00XX

This CLIN may be exercised on date of award of basic IDIQ contract or any time after award of the basic IDIQ with proper notification in accordance with 52.216-9. CLIN must be exercised within six (6) months of the award date of the basic contract.

Additionally, this option, when exercised, may be awarded as a separate task order for administrative convenience. The same terms and conditions set forth in this contract will remain in effect with administrative tailoring/adjustments made for clauses that are obsolete or deleted.

0003 OPTION CLIN

Noun: (OPTION) KHILS RF SIMULATION R&D

PSC: AC12

NSN: N - Not Applicable Contract type: U - COST PLUS FIXED FEE Inspection: DESTINATION Acceptance: DESTINATION

FOB: DESTINATION

Descriptive Data:

The contractor shall perform this research and development in accordance with the Basic Contract, Description/Specifications, Section J, Exhibits and Attachment 1, Statement of Work.

NOTE: International Traffic in Arms Regulation (ITAR) Restricted. Export control applicable. All data should be submitted in accordance with Exhibit A, Contract Data Requirements List (DD Form 1423).

Performance Period of this task order is (SEE Attach 1 SOO).

Estimated Cost $______

FCCM $______

Fixed Fee $______ Total Price $______

This CLIN is anticipated to be incrementally funded.

PROGRAM MILESTONES

So that the Government can determine whether or not the Contractor is achieving satisfactory technical progress, certain milestones events during the performance of this contract (including Configuration Reviews and Audits) are established. These events are referred to as Program Milestones, are set forth below, and are considered approximate except for the Period of Performance End date.

Program Milestones Completion Date (SEE Attachment 1 SOO)

SHIPMENT ADDRESS

Air Force Research Laboratory Street Address: 101 West Eglin Blvd, Bldg 13 Eglin AFB, FL 32542

This CLIN may be exercised on date of award of basic IDIQ contract or any time after award of the basic IDIQ with proper notification in accordance with 52.216-9. CLIN must be exercised within six (6) months of the award date of the basic contract.

Additionally, this option, when exercised, may be awarded as a separate task order for administrative convenience. The same terms and conditions set forth in this contract will

0004 OPTION CLIN

Noun: (OPTION) MAGNETIC AND VISION AIDED NAVIGATION

(MAVAN) DEVELOPMENT

PSC: AC12

NSN: N - Not Applicable DD1423 is Exhibit: A Contract type: U - COST PLUS FIXED FEE Inspection: DESTINATION Acceptance: DESTINATION

FOB: DESTINATION

Descriptive Data:

The contractor shall perform this research and development in accordance with the Basic Contract, Description/Specifications, Section J, Exhibits and Attachment 1, Statement of Work.

NOTE: International Traffic in Arms Regulation (ITAR) Restricted. Export control applicable. All data should be submitted in accordance with Exhibit A, Contract Data Requirements List (DD Form 1423).

Performance Period of this task order is (SEE Attach 1 SOO).

Estimated Cost $______

FCCM $______

Fixed Fee $______ Total Price $______

This CLIN is anticipated to be incrementally funded.

PROGRAM MILESTONES

So that the Government can determine whether or not the Contractor is achieving satisfactory technical progress, certain milestones events during the performance of this contract (including Configuration Reviews and Audits) are established. These events are referred to as Program Milestones, are set forth below, and are considered approximate except for the Period of Performance End date.

Program Milestones Completion Date (SEE Attachment 1 SOO)

SHIPMENT ADDRESS

Air Force Research Laboratory Street Address: 101 West Eglin Blvd, Bldg 13 Eglin AFB, FL 32542

This CLIN may be exercised on date of award of basic IDIQ contract or any time after award of the basic IDIQ with proper notification in accordance with 52.216-9. CLIN must be exercised within six (6) months of the award date of the basic contract.

Additionally, this option, when exercised, may be awarded as a separate task order for administrative convenience. The same terms and conditions set forth in this contract will

0005 OPTION CLIN

Noun: (OPTION) NEXT GENERATION INFRARED SCENE

PROJECTION DEVELOPMENT

PSC: AC12

NSN: N - Not Applicable DD1423 is Exhibit: A Contract type: U - COST PLUS FIXED FEE Inspection: DESTINATION Acceptance: DESTINATION

FOB: DESTINATION

Descriptive Data:

The contractor shall perform this research and development in accordance with the Basic Contract, Description/Specifications, Section J, Exhibits and Attachment 1, Statement of Work.

NOTE: International Traffic in Arms Regulation (ITAR) Restricted. Export control applicable. All data should be submitted in accordance with Exhibit A, Contract Data Requirements List (DD Form 1423).

Performance Period of this task order is (SEE Attach 1 SOO).

Estimated Cost $______

FCCM $______

Fixed Fee $______ Total Price $______

This CLIN is anticipated to be incrementally funded.

PROGRAM MILESTONES

So that the Government can determine whether or not the Contractor is achieving satisfactory technical progress, certain milestones events during the performance of this contract (including Configuration Reviews and Audits) are established. These events are referred to as Program Milestones, are set forth below, and are considered approximate except for the Period of Performance End date.

Program Milestones Completion Date (SEE Attachment 1 SOO)

SHIPMENT ADDRESS

Air Force Research Laboratory Street Address: 101 West Eglin Blvd, Bldg 13 Eglin AFB, FL 32542

This CLIN may be exercised on date of award of basic IDIQ contract or any time after award of the basic IDIQ with proper notification in accordance with 52.216-9. CLIN must be exercised within six (6) months of the award date of the basic contract.

Additionally, this option, when exercised, may be awarded as a separate task order for administrative convenience. The same terms and conditions set forth in this contract will

0006 OPTION CLIN

Noun: (OPTION) GROUND MISSILE DEFENSE (GMD)

PSC: AC12

NSN: N - Not Applicable DD1423 is Exhibit: A Contract type: U - COST PLUS FIXED FEE Inspection: DESTINATION Acceptance: DESTINATION

FOB: DESTINATION

Descriptive Data:

The contractor shall perform this research and development in accordance with the Basic Contract, Description/Specifications, Section J, Exhibits and Attachment 1, Statement of Work.

NOTE: International Traffic in Arms Regulation (ITAR) Restricted. Export control applicable. All data should be submitted in accordance with Exhibit A, Contract Data Requirements List (DD Form 1423).

Performance Period of this task order is (SEE Attach 1 SOO).

Estimated Cost $______

FCCM $______

Fixed Fee $______ Total Price $______

This CLIN is anticipated to be incrementally funded.

PROGRAM MILESTONES

So that the Government can determine whether or not the Contractor is achieving satisfactory technical progress, certain milestones events during the performance of this contract (including Configuration Reviews and Audits) are established. These events are referred to as Program Milestones, are set forth below, and are considered approximate except for the Period of Performance End date.

Program Milestones Completion Date (SEE Attachment 1 SOO)

SHIPMENT ADDRESS

Air Force Research Laboratory Street Address: 101 West Eglin Blvd, Bldg 13 Eglin AFB, FL 32542

This CLIN may be exercised on date of award of basic IDIQ contract or any time after award of the basic IDIQ with proper notification in accordance with 52.216-9. CLIN must be exercised within six (6) months of the award date of the basic contract.

Additionally, this option, when exercised, may be awarded as a separate task order for administrative convenience. The same terms and conditions set forth in this contract will

SECTION F PERFORMANCE OR DELIVERY:

SHIP MARK TRANS

ITEM SUPPLIES SCHEDULE DATA QTY TO FOR PRI DATE

0001 1 TBD TBD ASREQ

Noun: MINIATURE SELF DEFENSE MUNITION (MSDM)

HARDWARE-IN-THE-LOOP (HWIL) SUPPORT

Descriptive Data:

WAWF Ship to BPN is TBD. Contractor is required to submit a DD250Z via WAWF as a Stand-Alone Receiving Report at $0 in order to confirm Program Manager's receipt and acceptance of the final report and deliverables. Inspection and acceptance point should be marked as "D" for destination.

Payment Instructions:

https://www.acq.osd.mil/dpap/dars/pgi/pgi_htm/PGI204_71.htm#payment_instructions

SECTION I - CONTRACT CLAUSES:

FAR 52.217-09 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within six (6) months; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 15 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 60 months.

SECTION J - LIST OF ATTACHMENTS:

DOCUMENT PGS DATE TITLE

ATTACHMENT 1 1 05 FEB 2021 STATEMENT OF OBJECTIVES DRAFT

PLACEHOLDER

Weapon Engagement Simulation Technology for Advanced Research (WESTAR) Task Order FA8651-21-F-00XX - Statement of Objectives Draft

5 February 2021

This document will be provided under separate cover in accordance with the Broad Agency Announcement (BAA) Full Text Announcement.