W911WN09D0019 Task Order 0001.pdf

6 . ISSUE D BY CODE

W911WN-09-D-0019

1 . CO N TRA CT/P U RCH . O RD E R/

A G RE E M E N T N O .

W 911W N

2 . D E L IVE RY O RD E R/ CA L L N O .

4P AGE 1 OF

5 . P RIO RITY

CODE

8 . DEL IVERY FOB

DEST INAT IONX

OT HE R

(See Sch edule if o t h er)

OR D ER FOR SUPPLIES OR SER VICES

3 . D A TE O F O RD E R/CA L L

2009 A ug 25

4 . RE Q ./ P U RCH . RE Q U E ST N O .

W81ET483434006

SEE IT EM 6

U .S. AR MY EN GIN EER D ISTR IC T, PITTSBU R GH

ATTN C EC T-LR P

W S MOOR H EAD F ED ER AL BU ILD IN G

1000 LIBER TY AVEN U E R OOM 2116

PITTSBU R GH PA 15222-4186

7 . ADM INIST E RE D BY (if o th er th a n 6 )

( YYYYM M M D D )

1 0 . D E L IVE R TO FO B P O IN T BY (D ate)

( YYYYM M M D D )

SH AKA, IN C .

KON O MOR OSKY

504 S 4TH ST

J EAN N ETTE PA 15644-2269

CODE 3ERB39 . CONT RACT OR FACIL IT Y

SEE SCHEDULE

1 2 . D ISCO U N T TE RM S

M A RK IF BU SIN E SS IS1 1 .

X

SM A L L

SM A L L

D ISA D VA N TA G E D

W O M E N -O W N E D

1 3 . M AIL INVOICE S T O T HE ADDRESS IN BLOCK

See Item 15

2 5 . T OT AL $74,432.00

U PPER OH IO R ESID EN T EN GIN EER OF F IC E

D EN ISE POLIZ Z AN O

3510 GR AN D AVEN U E

PITTSBU R GH PA 15225

X

1 7 . ACCOUNT ING AND AP P ROP RIAT ION DAT A/ L OCAL USE

CODE

1 8 . IT E M NO. 1 9 . SCHEDUL E OF SUP P LIE S/ SERVICE S

* If q u a n t i ty a ccep ted b y th e G o ver n m en t is s a m e a s q u a n t i ty a ccep ted b elo w q u a n t i ty o r d er ed a n d en cir cle.

DE L IVE RY/1 6 .

1 4 . SHIP T O

Se e Sche dule

963619 964145

MARK ALL

P AC KAG ES AND

P AP ERS W ITH

IDENTIFIC ATIO N

NUMB ERS IN

B LO C KS 1 AND 2 .

2 3 . AM OUNT

1 5 . P AYM ENT W IL L BE M ADE BY CODE

U S AR MY C OR PS OF EN GR S F IN AN C E C EN TER

5722 IN TEGR ITY D R IVE

ATTN : C EF C -F P

MILLIN GTON TN 38054-5005

Th is d el iv ery o rd er/cal l i s i s s u ed o n an o th er G o v ern men t ag en cy o r in acco rd an ce w i th an d s u b ject to terms an d co n d i t io n s o f ab o v e n u mb ered co n tract .

T YP E CAL L

OF P URCHASE

ORDE R

SEE SCHEDULE

24. UNITED STATES OF AMERICA

TEL: 412-395-7474

EMAIL: James.M.Costantino@usace.army.mil

CONTRACTING / ORDERING OFFICER

q u a n t i ty o r d er ed , in d ica te b y X . If d i f f er en t , en ter a ctu a l

BY: JAMES M COSTANTINO

If t h is bo x is m ark ed, sup p lier m ust sign Accep t an ce an d ret urn t h e fo llo win g n um ber o f co p ies:

NAM E OF CONT RACT OR SIGNAT URE T YP E D NAM E AND T IT L E

( YYYYM M M D D )

DAT E SIGNE D

ACCE P T ANCE. T HE CONT RACT OR HE REBY ACCE P T S T HE OFFE R REP RESE NT ED BY T HE NUM BE RED P URCHASE ORDE R AS IT M AY P REVIOUSL Y HAVE BEE N OR IS NOW M ODIFIE D, SUBJE CT T O AL L OF T HE T E RM S

AND CONDIT IONS SE T FORT H, AND AGRE ES T O P ERFORM T HE SAM E.

Referen ce y o u r q u o te d ated

Fu rn is h th e fo l lo w in g o n terms s p eci fied h erein . REF :

2 0 . QUANT IT Y

ORDERE D/

ACCE P T ED*

2 1 . UNIT 2 2 . UNIT P RICE

D IFFE RE N CE S

2 6 .

INSP E CT E D RE CE IVED ACCEP T E D, AND CONFORM S T O T HE

CONT RACT EXCEP T AS NOT E D

2 7 a. QUANT IT Y IN COL UM N 2 0 HAS BE E N

( YYYYM M M D D )

c. DAT E d. P RINT E D NAM E AND T IT L E OF AUT HORIZ ED

GOVERNM E NT RE P RE SENT AT IVE

b. SIGNAT URE OF AUT HORIZ E D GOVE RNM E NT RE P RE SENT AT IVE

e. M AIL ING ADDRE SS OF AUT HORIZ ED GOVE RNM ENT REP RESE NT AT IVE

36. I ce r tify th is account is cor re ct and prope r for paym e nt.

g. E -M AIL ADDRESSf. T EL EP HONE NUM BE R

a. DAT E

( YYYYM M M D D )

b. SIGNAT URE AND T IT LE OF CE RT IFYING OFFICE R

2 8 . SHIP NO. 2 9 . DO VOUCHER NO. 3 0 .

INIT IAL S

3 2 . P AID BY 3 3 . AM OUNT VE RIFIED

CORRE CT FOR

3 5 . BIL L OF LADING NO.

3 4 . CHE CK NUM BE R

3 7 . RE CEIVED AT 3 8 . RECE IVE D BY

( YYYYM M M D D )

3 1 . P AYM E NT

COM P L ET E

P ART IAL

FINAL

P ART IAL

FINAL

DD For m 1155, DEC 2001 P RE VIOUS EDIT ION IS OBSOL ET E .

3 9 . DAT E RE CE IVED 4 0 . T OT AL

CONT AINERS

4 1 . S/R ACCOUNT NO. 4 2 . S/R VOUCHE R NO.

AD D R ESS

AN D

N AME

Section B - Supplies or Services and Prices

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 74,432 Lump Sum $1.00 $74,432.00 Tionesta Sewer Line Repairs

FFP

The total of this line item includes reimbursement of actual payment bonds and construction of project in accordance with the specifications, drawings and unit price schedule attached.

FOB: Destination

PURCHASE REQUEST NUMBER: W81ET483434006

NET AMT $74,432.00

ACRN AA

CIN: W81ET4834340060002

$74,432.00

Section G - Contract Administration Data

ACCOUNTING AND APPROPRIATION DATA

AA: 96 NA X 3123.0000 H4 X 08 2439 018260 96364 3230 72D9BB NA 41KHFD

AMOUNT: $74,432.00

CIN W81ET4834340060002: $74,432.00

Section J - List of Documents, Exhibits and Other Attachments

PRICE SCHEDULE

TIONESTA LAKE

TIONESTA CREEK

FOREST COUNTY, PENNYSLVANIA

SECTION 00010

SUPPLIES OR SERVICES AND PRICES/COSTS

Item Description Quantity U/M U/P Amount

0001 Non-ARRA Funded Items

0001AA Reimbursement for Actual Performance NOT TO EXCEED $ 1,858.00 And Payment Bonds Premium

0001AB Digital Progress Images 3 Sets $ 87.33 $ 262.00

0001AC Sediment and Erosion Control 1 Lump Sum $ 612.00

0001AD 36” Reinforced Concrete Pipe Culvert and End Walls 1 Lump Sum $22,734.00

0001DE 6” SDR35 PVC Sewer Line, Campground Area 150 Linear Feet $ 83.06 $12,460.00

TOTAL, Non-ARRA Funded Items 0001AA through 0001AE $ 37,926.00

0002 ARRA Funded Items

0002AA 6” SDR35 PVC Sewer Line, Office Area 280 Linear Feet $ 83.06 $23,259.00

0002AB 4’ Diameter Precast Concrete Manholes 2 Each $2,623.00 $ 5,246.00

0002AC Bituminous Overlay 1 Lump Sum $ 6,846.00

0002AD Concrete Sidewalk 1 Lump Sum $ 875.00

0002AE Project Sign 1 Lump Sum $ 280.00

TOTAL, ARRA Funded Items 0002AA through 0002AE $ 36,506.00

TOTAL, All Items 0001AA through 0002AE $74,432.00