Attachment_5_Product_Ordering_Form.docx
DOCX document 13 KB Posted
- Solicitation number
- W911S6-18-Q-0001
About this file
Attachment 5 - Product Ordering form. This form is for post award ordering from the quantities listed on the contract.
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Text version
ATTACHMENT 5 –Order Example Form
| Task Order # X |
| Blend |
| Delivery date |
| *Contractor’s delivery date |
| Number/ Concentration |
| Certificate |
CLIN 000X
Sub-CLIN A $xxxx.xx 10 ppm Cl2 in N2, 16 Aug 16
4 @ 10 ppm
Yes
CLIN 2005
Sub-CLIN B
$xxxx.xx 500 ppm Cl2 in N2, 16 Aug 16
6 @ 500 ppm
Yes
Delivery Comments
Total $XXXX.xx Cl2 in N 1-250 ppm
Cl22 in N 500-10,000 ppm
Size 30 AL, C10 2015 psig Valve Connection: C-10 Al.
Size 30 AL, 2015 psig Valve Connection: C-10 Al.
Blend Tolerance: 10-15% Accuracy: 2-5%
Blend Tolerance: 10-15% Accuracy: 2-5%
Government Approval:
Date: ____________
NOTE: Form is to be completed by the government, including item description, quantity and date needed. Contractor shall respond with date items can be supplied. If that is acceptable to government, the COR or contracting officer will sign form and send back to contractor to process.
File details come from the government source that posted it.