Electronically Signed Award W56HZV19D0003_W56HZV20F0145.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 W56HZV20F0145 2020JAN21 SEE SCHEDULE DOA4

W56HZV

ACC-DTA

6501 E. 11 MILE RD.

DETROIT ARSENAL, MI 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 43218-2317

X

X 2

SEE CONTRACT ADMINISTRATION DATA

SEE SCHEDULE

CHARLES SCOTT

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

2020JAN21 /SIGNED/ 2020JAN21

$1,406,850.62

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 ***

Amount Previously Awarded on Contract: $5,088,874.06

Award Amount of Current Action: $1,406,850.62 _____________

Total Amount Awarded on Contract: $6,495,724.68

Delivery Order W56HZV-20-F-0145 to Contract W56HZV-19-D-0003

1. The purpose of this delivery order is award seven additional production units to the first ordering year. As a result, the following is incorporated into the contract:

SECTION B

2. CLIN 0011AA, LINEAR DEMOLITION CHARGE SYST, is awarded for an additional seven units at a price of $200,978.66 per unit for a total amount of $1,406,850.62. Completed units are to be delivered by 22 Jan 2021.

CONCLUSION

3. $1,406,850.62 in funding is awarded on this delivery order.

4. 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/W56HZV20F0145

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 LINEAR DEMOLITION CHARGE SYST

NSN: 9999-99-999-9999

0011AA FIRST ORDERING YEAR - ABV LDCS 7 EA $ 200,978.66000 $ 1,406,850.62 ______________________________ ______________ __________________

COMMODITY NAME: LINEAR DEMOLITION CHARGE SYST

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P20DN0052T PRON AMD: 01 ACRN: AA

PSC: 1055

IAW C.1.1 of the base contract W56HZV-19-D-0003.

(End of narrative C001)

Packaging and Marking _____________________

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

001 W502E80016N005 W31G1Y J 3

PROJ CD BRK BLK PT _______ __________

GD5

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 7 22-JAN-2021

FOB POINT: Destination

SHIP TO:

(W31G1Y) XR 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/W56HZV20F0145

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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 P20DN0052T 2 A.0043964.1.1.1.2 AA $ 1,406,850.62

TOTAL $ 1,406,850.62

OBLIGATED OBLIGATED

ACRN ACCOUNTING CLASSIFICATION AMOUNTACRN ACCOUNTING CLASSIFICATION AMOUNT____ _________________________ ______________ _________________________ __________

AA 021 202020222033 A5XDN G82925ARF08 3101 L065839408 A.0043964.1.1.1.2 021001 $ 1,406,850.62 __________________

TOTAL $ 1,406,850.62

LINELINE

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

0011AA AA 021 202020222033 A5XDN G82925ARF08 3101 L065839408 A.0043964.1.1.1.2 021001

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