W56HZV-19-F-0219.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.

W56HZV-19-D-0003 W56HZV19F0219 2019FEB06 SEE SCHEDULE DOA4

W56HZV

U.S. ARMY CONTRACTING COMMAND

WARREN, MICHIGAN 48397-5000

DAVID S. JOLEY

EMAIL: DAVID.S.JOLEY.CIV@MAIL.MIL

S2101A

DCMA BALTIMORE

217 EAST REDWOOD STREET

SUITE 1800

BALTIMORE MD 21202-3375

X

5W3V7 1FDG9

AECOM MANAGEMENT SERVICES, INC.

20501 SENECA MEADOWS PKWY STE 300

GERMANTOWN, MD 20876-7019

SEE SCHEDULE

See Block 15

SEE SCHEDULE

HQ0338

DFAS-COLUMBUS CENTER

SOUTH ENTITLEMENT OPERATIONS

P O BOX 182317

COLUMBUS OH 43218-2264

X

X 2

SEE CONTRACT ADMINISTRATION DATA

SEE SCHEDULE

CHARLES SCOTT

CHARLES.B.SCOTT44.CIV@MAIL.MIL (586)282-6673

2019FEB06 /SIGNED/ 2019FEB06

$5,088,874.06

CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SUPPLEMENTAL INFORMATION

Buyer Name: DAVID S. JOLEY

Buyer Office Symbol/Telephone Number: CCTA-HCP-B/(586)282-8398

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

Type of Business: Large Business Performing in U.S.

Surveillance Criticality Designator: C

Weapon System: Breacher (Grizzly)

*** End of Narrative A0000 ***

Delivery Order W56HZV-19-F-0219 to Contract W56HZV-19-D-0003

1. The purpose of this delivery order is to order the following Hardware and Data Items.

SECTION B

CLIN Item PRON Quantity Unit Price Total Price

0011AA LDCS P18DN0972T 13 $178,879.64 $2,325,435.32

0011AB LDCS P19DN0192T 12 $178,879.64 $2,146,555.68

0021AA ISP P18DN0982T 3 $84,635.00 $253,905.00

0021AB ISP P19DN0202T 3 $84,635.00 $253,905.00

A002 Quality Plan P18DN0962T 1 $15,433.77 $15,433.77

A003 Manufacturing P18DN0962T 1 $24,580.24 $24,580.24

A005 Provisioning Data P18DN0962T 1 $20,979.20 $20,979.20

A007 Safety Assess P18DN0962T 1 $23,499.46 $23,499.46

A013 Logistics Prod P18DN0962T 1 $11,881.68 $11,881.68

A014 SPI Package Data P18DN0962T 1 $8,278.68 $8,278.68

A015 Pack Test Report P18DN0962T 1 $4,720.03 $4,720.03

Total Order Price $5,088,874.06

SUMMARY

2. The amount awarded to the contract is $5,088,874.06

3. All other terms and conditions of the contract are to remain in full force and effect.

*** END OF NARRATIVE A0001 ***

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W56HZV-19-D-0003/W56HZV19F0219

AECOM MANAGEMENT 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

0011 ABV - LDCS Hardware

NSN: 1055-01-586-2559

Mfr CAGE: 1FDG9

Mfr Part Number: 10810001

0011AA ABV LDCS FIRST ORDERING YEAR 13 EA $ 178,879.64000 $ 2,325,435.32 ____________________________ ______________ __________________

COMMODITY NAME: ABV - LDCS Hardware

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P18DN0972T PRON AMD: 01 ACRN: AA

PSC: 1055

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE SECTION D.1.2

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

001 W502E88353N097 W31G1Y J 3

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 13 05-FEB-2020

FOB POINT: Destination

SHIP TO:

(W31G1Y) SR W0LX ANNISTON DEPOT PROP DIV

ANNISTON ARMY DEPOT BLDG 513

7 FRANKFORD AVE

ANNISTON,AL,36201-5021

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0003/W56HZV19F0219

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0011AB ABV LDCS FIRST ORDERING YEAR 12 EA $ 178,879.64000 $ 2,146,555.68 ____________________________ ______________ __________________

COMMODITY NAME: ABV - LDCS Hardware

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P19DN0192T PRON AMD: 01 ACRN: AB

PSC: 1055

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE SECTION D.1.2

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

001 W502E88353N092 W31G1Y J 3

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 12 05-FEB-2020

FOB POINT: Destination

SHIP TO:

(W31G1Y) SR W0LX ANNISTON DEPOT PROP DIV

ANNISTON ARMY DEPOT BLDG 513

7 FRANKFORD AVE

ANNISTON,AL,36201-5021

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0003/W56HZV19F0219

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0021 ABV INITIAL SPARES PACKAGE

NSN: 9999-99-999-9999

0021AA ABV INITIAL SPARES PACKAGE ORDERING YEAR ONE 3 EA $ 84,635.00000 $ 253,905.00 ____________________________________________ ______________ __________________

COMMODITY NAME: ABV INITIAL SPARES PACKAGE

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P18DN0982T PRON AMD: 01 ACRN: AC

PSC: 1055

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE SECTION D.1.3

LEVEL PRESERVATION: Military

LEVEL PACKING: A

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

001 W502E88353N098 W31G1Y J 3

PROJ CD BRK BLK PT _______ __________

GD5

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 3 05-FEB-2020

FOB POINT: Destination

SHIP TO:

(W31G1Y) SR W0LX ANNISTON DEPOT PROP DIV

ANNISTON ARMY DEPOT BLDG 513

7 FRANKFORD AVE

ANNISTON,AL,36201-5021

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0003/W56HZV19F0219

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0021AB ABV INITIAL SPARES PACKAGE ORDERING YEAR ONE 3 EA $ 84,635.00000 $ 253,905.00 ____________________________________________ ______________ __________________

COMMODITY NAME: ABV INITIAL SPARES PACKAGE

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P19DN0202T PRON AMD: 01 ACRN: AD

PSC: 1055

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE SECTION D.1.3

LEVEL PRESERVATION: Military

LEVEL PACKING: A

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

001 W502E88353N020 W31G1Y J 3

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 3 05-FEB-2020

FOB POINT: Destination

SHIP TO:

(W31G1Y) SR W0LX ANNISTON DEPOT PROP DIV

ANNISTON ARMY DEPOT BLDG 513

7 FRANKFORD AVE

ANNISTON,AL,36201-5021

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0003/W56HZV19F0219

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0200 CONTRACT DATA REQUIREMENTS LIST (CDRL) ______________________________________

A002 QUALITY SYSTEM PLAN 1 LO $ 15,433.77 ___________________ __________________

SERVICE REQUESTED: QUALITY SYSTEM PLAN

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P18DN0962T PRON AMD: 02 ACRN: AE

Inspection and Acceptance _________________________

INSPECTION: Destination ACCEPTANCE: Destination

Deliveries or Performance _________________________

Period of Performance

Start Date: 06-FEB-2019

End Date: 08-APR-2019

DLVR SCH PERF COMPL

REL CD QUANTITY DATE ________ ______________ __________

001 1 08-APR-2019

$ 15,433.77

A003 MANUFACTURING PLAN 1 LO $ 24,580.24 __________________ __________________

SERVICE REQUESTED: MANUFACTURING PLAN

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P18DN0962T PRON AMD: 02 ACRN: AE

Inspection and Acceptance _________________________

INSPECTION: Destination ACCEPTANCE: Destination

Deliveries or Performance _________________________

Period of Performance

Start Date: 06-FEB-2019

End Date: 23-APR-2019

DLVR SCH PERF COMPL

REL CD QUANTITY DATE ________ ______________ __________

001 1 23-APR-2019

$ 24,580.24

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

A005 PROVISIONING DATA 1 LO $ 20,979.20 _________________ __________________

SERVICE REQUESTED: PROVISIONING DATA

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P18DN0962T PRON AMD: 02 ACRN: AE

Inspection and Acceptance _________________________

INSPECTION: Destination ACCEPTANCE: Destination

Deliveries or Performance _________________________

Period of Performance

Start Date: 06-FEB-2019

End Date: 05-FEB-2020

DLVR SCH PERF COMPL

REL CD QUANTITY DATE ________ ______________ __________

001 1 05-FEB-2020

$ 20,979.20

A007 SAFETY ASSESSMENT REPORT 1 LO $ 23,199.46 ________________________ __________________

SERVICE REQUESTED: SAFETY ASSESSMENT REPORT

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P18DN0962T PRON AMD: 02 ACRN: AE

Inspection and Acceptance _________________________

INSPECTION: Destination ACCEPTANCE: Destination

Deliveries or Performance _________________________

Period of Performance

Start Date: 06-FEB-2019

End Date: 21-MAY-2019

DLVR SCH PERF COMPL

REL CD QUANTITY DATE ________ ______________ __________

001 1 21-MAY-2019

$ 23,199.46

A013 LOGISTICS PRODUCT DATA 1 LO $ 11,881.68 ______________________ __________________

SERVICE REQUESTED: LOGISTICS PRODUCT DATA

CLIN CONTRACT TYPE:

Firm Fixed Price

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

PRON: P18DN0962T PRON AMD: 02 ACRN: AE

Inspection and Acceptance _________________________

INSPECTION: Destination ACCEPTANCE: Destination

Deliveries or Performance _________________________

Period of Performance

Start Date: 06-FEB-2019

End Date: 05-FEB-2020

DLVR SCH PERF COMPL

REL CD QUANTITY DATE ________ ______________ __________

001 1 05-FEB-2020

$ 11,881.68

A014 SPECIAL PACKAGING INSTRUCTION 1 LO $ 8,278.68 _____________________________ __________________

SERVICE REQUESTED: SPECIAL PACKAGING INSTRUCTION

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P18DN0962T PRON AMD: 02 ACRN: AE

Inspection and Acceptance _________________________

INSPECTION: Destination ACCEPTANCE: Destination

Deliveries or Performance _________________________

Period of Performance

Start Date: 06-FEB-2019

End Date: 05-FEB-2020

DLVR SCH PERF COMPL

REL CD QUANTITY DATE ________ ______________ __________

001 1 05-FEB-2020

$ 8,278.68

A015 PACKAGING TEST REPORT 1 LO $ 4,720.03 _____________________ __________________

SERVICE REQUESTED: PACKAGING TEST REPORT

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P18DN0962T PRON AMD: 02 ACRN: AE

Inspection and Acceptance _________________________

INSPECTION: Destination ACCEPTANCE: Destination

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

Deliveries or Performance _________________________

Period of Performance

Start Date: 06-FEB-2019

End Date: 05-FEB-2020

DLVR SCH PERF COMPL

REL CD QUANTITY DATE ________ ______________ __________

001 1 05-FEB-2020

$ 4,720.03

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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 P18DN0972T 2 A.0035119.1.1.1.1 AA $ 2,325,435.32

0011AB P19DN0192T 2 A.0039554.1.1.1.4 AB $ 2,146,555.68

0021AA P18DN0982T 2 A.0035119.1.1.1.1 AC $ 253,905.00

0021AB P19DN0202T 2 A.0039554.1.1.1.4 AD $ 253,905.00

A002 P18DN0962T 2 A.0035119.1.1.1.1 AE $ 15,433.77

A003 P18DN0962T 2 A.0035119.1.1.1.1 AE $ 24,580.24

A005 P18DN0962T 2 A.0035119.1.1.1.1 AE $ 20,979.20

A007 P18DN0962T 2 A.0035119.1.1.1.1 AE $ 23,199.46

A013 P18DN0962T 2 A.0035119.1.1.1.1 AE $ 11,881.68

A014 P18DN0962T 2 A.0035119.1.1.1.1 AE $ 8,278.68

A015 P18DN0962T 2 A.0035119.1.1.1.1 AE $ 4,720.03

TOTAL $ 5,088,874.06

OBLIGATED OBLIGATED

ACRN ACCOUNTING CLASSIFICATION AMOUNTACRN ACCOUNTING CLASSIFICATION AMOUNT____ _________________________ ______________ _________________________ __________

AA 021 201820202033 A5XDN G82925ARF08 3101 L059829141 A.0035119.1.1.1.1 021001 $ 2,325,435.32

AB 021 201920212033 A5XDN G82925ARF08 3101 L059829641 A.0039554.1.1.1.4 021001 $ 2,146,555.68

AC 021 201820202033 A5XDN G82925ARF08 3101 L059829849 A.0035119.1.1.1.1 021001 $ 253,905.00

AD 021 201920212033 A5XDN G82925ARF08 3101 L059830005 A.0039554.1.1.1.4 021001 $ 253,905.00

AE 021 201820202033 A5XDN G82925ARF08 3101 L059829039 A.0035119.1.1.1.1 021001 $ 109,073.06 __________________

TOTAL $ 5,088,874.06

LINELINE

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

0011AA AA 021 201820202033 A5XDN G82925ARF08 3101 L059829141 A.0035119.1.1.1.1 021001

0011AB AB 021 201920212033 A5XDN G82925ARF08 3101 L059829641 A.0039554.1.1.1.4 021001

0021AA AC 021 201820202033 A5XDN G82925ARF08 3101 L059829849 A.0035119.1.1.1.1 021001

0021AB AD 021 201920212033 A5XDN G82925ARF08 3101 L059830005 A.0039554.1.1.1.4 021001

A002 AE 021 201820202033 A5XDN G82925ARF08 3101 L059829039 A.0035119.1.1.1.1 021001

A003 AE 021 201820202033 A5XDN G82925ARF08 3101 L059829039 A.0035119.1.1.1.1 021001

A005 AE 021 201820202033 A5XDN G82925ARF08 3101 L059829039 A.0035119.1.1.1.1 021001

A007 AE 021 201820202033 A5XDN G82925ARF08 3101 L059829039 A.0035119.1.1.1.1 021001

A013 AE 021 201820202033 A5XDN G82925ARF08 3101 L059829039 A.0035119.1.1.1.1 021001

A014 AE 021 201820202033 A5XDN G82925ARF08 3101 L059829039 A.0035119.1.1.1.1 021001

11 12

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

LINELINE

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

A015 AE 021 201820202033 A5XDN G82925ARF08 3101 L059829039 A.0035119.1.1.1.1 021001

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