W911SA23Q3063 Attachment 5 - Service Ticket.docx

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Protective Clothing Rental and Laundering Service for 45 locations in 9 states (SC, NC, TN, AL, MS, FL, GA, KY, LA) and Puerto Rico
Solicitation number
W911SA-23-Q-3063
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Service Ticket Date of Service: ________________________ Receipt #: _______________ Contract Number: _____________________________________________________________ Location of Service: (Shop Name) _________________________________________________ Address of Service: (Shop Address) _______________________________________________ Company Name: _____________________________________________________________ Company Address: ____________________________________________________________

Contact Phone: ______________________________

Delivery Employee: _____________________________ Phone: ______________________ Clean Uniform Sets Delivered

Dirty Uniform Sets Picked Up

CLIN
Items Description
Total Number
CLIN
Items Description
Total Number
___001
Shop Uniforms Sets
___001
Shop Uniforms Sets
___002
Office Uniforms Sets
___002
Office Uniforms Sets
___003
Jackets Each
___ 003
Jackets Each
____004
Coveralls Each
___004
Coveralls Each

Additional Comments:

Signatures Delivery Employee: _______________________________________ Date: ______________ Authorized Government Employee: ___________________________ Date: _____________

File details come from the government source that posted it. Updated .