W56HZV19D0048W56HZV22F0153.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-0048 W56HZV22F0153 2022FEB23 SEE SCHEDULE DOA4

W56HZV

ACC-DTA

6501 E. 11 MILE RD.

DETROIT ARSENAL, MI 48397-5000

SHELIA A. COUCH

EMAIL: SHELIA.A.COUCH.CIV@ARMY.MIL

S5111A

DCMA HAMPTON

2128 PERSHING AVENUE

FORT EUSTIS, VA 23604

757-527-4700 X

55242

ISOMETRICS, INC.

1266 N SCALES ST

REIDSVILLE, NC 27320-8306

SEE SCHEDULE

X

See Block 15

SEE SCHEDULE

HQ0338

DFAS-COLUMBUS CENTER

SOUTH ENTITLEMENT OPERATIONS

P O BOX 182317

COLUMBUS OH 43218-2317

X

SEE CONTRACT ADMINISTRATION DATA

SEE SCHEDULE

CARRIE ENGLISH

CARRIE.L.ENGLISH.CIV@ARMY.MIL (586)282-3550

2022FEB23 /SIGNED/ 2022FEB23

$34,557,265.86

CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SUPPLEMENTAL INFORMATION

Buyer Name: SHELIA A. COUCH

Buyer Office Symbol/Telephone Number: CCTA-HCP-B/(586)282-8380

Type of Contract 1: Firm Fixed Price

Kind of Contract: Other

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

Surveillance Criticality Designator: B

Weapon System: Tactical POL Distribution Equipment

*** End of Narrative A0000 ***

Contract Number: W56HZV-19-D-0048

Delivery Order: W56HZV-22-F-0153

Delivery Order Amount: $34,557,265.86

1. In accordance with clause 252.216-7006, Ordering, and within maximum ordering and ordering year quantity of 720, this delivery order

W56HZV-22-F-0153 is issued against ordering period four of base contract W56HZV-19-D-0048 and is being issued to fund the following:

CLIN ITEM QTY Unit Price Amount

0014AA TRM 413 $74,375.10 $30,716,916.30

0014AB TRM 48 $74,375.10 $3,570,004.80

0024AA ASL 161 $1,679.16 $270,344.76

2. The total obligated amount of this delivery order is $34,557,265.86.

3. All other terms and conditions of the basic contract remain unchanged and in full force and effect.

*** END OF NARRATIVE A0001 ***

2 11

W56HZV-19-D-0048/W56HZV22F0153

ISOMETRICS, 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

0014 TANK RACK MODULE (TRM)

NSN: 4930-01-612-3541

Mfr CAGE: 55242

Mfr Part Number: 1051A

0014AA PRODUCTION UNITS - ORDERING YEAR 4 413 EA $ 74,375.10000 $ 30,716,916.30 __________________________________ ______________ __________________

COMMODITY NAME: TANK RACK MODULE (TRM)

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P22DP0112T PRON AMD: 02 ACRN: AA

PSC: 4930

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 W502E52022P011A Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 39 30-NOV-2022

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

002 W502E52022P011B Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 30-DEC-2022

FOB POINT: Origin

SHIP TO:

3 11

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

003 W502E52022P011C Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 31-JAN-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

004 W502E52022P011D Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 28-FEB-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

005 W502E52022P011E Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 31-MAR-2023

FOB POINT: Origin

SHIP TO:

4 11

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

006 W502E52022P011F Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 28-APR-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

007 W502E52022P011G Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 31-MAY-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

008 W502E52022P011H Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 30-JUN-2023

FOB POINT: Origin

SHIP TO:

5 11

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

009 W502E52022P011I Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 31-JUL-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

010 W502E52022P011J Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 31-AUG-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

011 W502E52022P011K Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 29-SEP-2023

FOB POINT: Origin

SHIP TO:

6 11

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

012 W502E52022P011L Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 34 31-OCT-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

0014AB PRODUCTION UNITS - ORDERING YEAR 4 48 EA $ 74,375.10000 $ 3,570,004.80 __________________________________ ______________ __________________

COMMODITY NAME: TANK RACK MODULE (TRM)

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P20DP0522T PRON AMD: 02 ACRN: AB

PSC: 4930

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 W502E52041P052 Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 48 30-NOV-2022

FOB POINT: Origin

SHIP TO:

7 11

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

0024 AUTHORIZED STOCKAGE LIST(ASL)

NSN: 9999-99-999-9999

0024AA PRODUCTION UNITS - ORDERING YEAR 4 161 EA $ 1,679.16000 $ 270,344.76 __________________________________ ______________ __________________

COMMODITY NAME: AUTHORIZED STOCKAGE LIST(ASL)

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P22DP0122T PRON AMD: 03 ACRN: AC

PSC: 4930

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 W502E52022P012A Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 27 30-NOV-2022

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

002 W502E52022P012B Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

8 11

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

001 27 30-DEC-2022

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

003 W502E52022P012C Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 27 31-JAN-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

004 W502E52022P012D Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 27 28-FEB-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

005 W502E52022P012E Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

9 11

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

001 27 31-MAR-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

DOC SUPPL

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

006 W502E52022P012F Y00000 M 3

PROJ CD BRK BLK PT _______ __________

GDD

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 26 28-APR-2023

FOB POINT: Origin

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-19-D-0048/W56HZV22F0153

10 11

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_____ _________ _____ ___________ ____ _______________ _________ _____ ___________ ____ __________

0014AA P22DP0112T 2 A.0052688.1.1.1.2 AA $ 30,716,916.30

0014AB P20DP0522T 2 A.0043967.1.1.1.2 AB $ 3,570,004.80

0024AA P22DP0122T 2 A.0052688.1.1.1.2 AC $ 270,344.76

TOTAL $ 34,557,265.86

OBLIGATED OBLIGATED

ACRN ACCOUNTING CLASSIFICATION AMOUNTACRN ACCOUNTING CLASSIFICATION AMOUNT____ _________________________ ______________ _________________________ __________

AA 021 202220242035 A5XDP R02600ARJL7 3101 L076617286 A.0052688.1.1.1.2 021001 $ 30,716,916.30

AB 021 202020222035 A5XDP R02600ARJL7 3101 L076845503 A.0043967.1.1.1.2 021001 $ 3,570,004.80

AC 021 202220242035 A5XDP R02600ARJL7 3101 L076617543 A.0052688.1.1.1.2 021001 $ 270,344.76 __________________

TOTAL $ 34,557,265.86

LINELINE

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

0014AA AA 021 202220242035 A5XDP R02600ARJL7 3101 L076617286 A.0052688.1.1.1.2 021001

0014AB AB 021 202020222035 A5XDP R02600ARJL7 3101 L076845503 A.0043967.1.1.1.2 021001

0024AA AC 021 202220242035 A5XDP R02600ARJL7 3101 L076617543 A.0052688.1.1.1.2 021001

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