W56HZV24D0003W912CH24F0109.pdf

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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-24-D-0003 W912CH24F0109 2024JUN06 SEE SCHEDULE DOA5

W912CH

ACC-DTA

6501 E. 11 MILE RD.

DETROIT ARSENAL, MI 48397-5000

VALERIE C. MULLER

EMAIL: VALERIE.C.MULLER.CIV@ARMY.MIL

S2305A

DCMA DETROIT

35803 MOUND ROAD

STERLING HEIGHTS MI 48310

X

6XYB2

BIGELOW FAMILY HOLDINGS LLC

3223 15 MILE ROAD

STERLING HEIGHTS, MI 48310-5348

SEE SCHEDULE X

See Block 15

SEE SCHEDULE

HQ0337

DFAS-COLUMBUS CENTER

NORTH ENTITLEMENT OPERATIONS

P.O. BOX 182317

COLUMBUS OH 43218-2317

X

SEE CONTRACT ADMINISTRATION DATA

SEE SCHEDULE

SARAH TESCHLER

SARAH.J.TESCHLER.CIV@ARMY.MIL (517)588-9264

2024JUN06 /SIGNED/ 2024JUN06

$5,595,229.00

CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SUPPLEMENTAL INFORMATION

Buyer Name: VALERIE C. MULLER

Buyer Office Symbol/Telephone Number: CCTA-ALM-B/(571)588-9193

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

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

Surveillance Criticality Designator: C

Weapon System: Tank, M1 Abrams Family of Vehicles

FMS REQUIREMENT

*** End of Narrative A0000 ***

1. The purpose of this Delivery Order, W912CH-24-F-0109, is to bilaterally call up 41 each Reactive Armor Tiles in accordance with the contract terms established under Indefinite Delivery/Indefinite Quantity (IDIQ) Contract W56HZV-24-D-0003.

The remaining quanitity available on this contract is 0.

2. Section B establishes the following CLINs:

a) CLIN 0031AC is established on a Firm Fixed Price basis to fund a quantity of 9 each M19E1 Green 383 RAT.

b) CLIN 0031AD is established on a Firm Fixed Price basis to fund a quantity of 32 each M19E1 Green 383 RAT.

c) CLIN 0100 is established on a Not Separately Priced basis for the Contract Data Requirements Lists identified in Section J of the base IDIQ Contract W56HZV-24-D-0003.

3. The total obligated amount under this Delivery Order is $5,595,229.00.

4. All terms and conditions established in Contract W56HZV-24-D-0003 apply to this order and remain unchanged and in full force and effect.

*** END OF NARRATIVE A0001 ***

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W56HZV-24-D-0003/W912CH24F0109

BIGELOW FAMILY HOLDINGS LLC

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

0031 M19E1 GREEN 383

NSN: 9999-99-999-9999

Mfr CAGE: 00000

Mfr Part Number: 13108087

0031AC M19E1 GREEN 383 (FIRST ORDERING YEAR) 9 EA $ 136,469.00000 $ 1,228,221.00 _____________________________________ ______________ __________________

COMMODITY NAME: M19E1 GREEN 383

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P24DNF042T PRON AMD: 01 ACRN: AA

PSC: 2590

FMS COUNTRY/CASE: AT/ULX

A quantity of one each consists of 31 M19E1 tiles in accordance with NSN 1375-01-702-3845, the Scope of

Work section C.3.1.3 and the Technical Data Package attachment 0010.

Includes Lot Acceptance Test in accordance with the

Scope of Work section C.3.5.4 and the Technical Data

Package attachment 0010.

These items are for Foreign Military Sales customers.

(End of narrative B001)

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 BAT0851364D018F W36QLP L 3

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 9 14-FEB-2025

FOB POINT: Origin

SHIP TO:

(W36QLP) XR W6TC 596TH USA TRANS SURF BDE

TRANS SDAT OPT

6280 SUNNY POINT RD BLDG 101

SOUTHPORT,NC,28461-7800

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-24-D-0003/W912CH24F0109

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0031AD M19E1 GREEN 383 (FIRST ORDERING YEAR) 32 EA $ 136,469.00000 $ 4,367,008.00 _____________________________________ ______________ __________________

COMMODITY NAME: M19E1 GREEN 383

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: J519A166EH PRON AMD: 02 ACRN: AB

PSC: 1375

FMS COUNTRY/CASE: AT/ULU

A quantity of one each consists of 31 M19E1 tiles in accordance with NSN 1375-01-702-3845, the Scope of

Work section C.3.1.3 and the Technical Data Package attachment 0010.

Includes Lot Acceptance Test in accordance with the

Scope of Work section C.3.5.4 and the Technical Data

Package attachment 0010.

These items are for Foreign Military Sales customers.

(End of narrative B001)

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 BAT0841362D016A BXWULU L 3

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 32 14-FEB-2025

FOB POINT: Origin

SHIP TO:

(W36QLP) XR W6TC 596TH USA TRANS SURF BDE

TRANS SDAT OPT

6280 SUNNY POINT RD BLDG 101

SOUTHPORT,NC,28461-7800

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-24-D-0003/W912CH24F0109

0100 CONTRACT DATA REQUIREMENTS LISTS (CDRLS) 1 LO $ ** NSP ** ________________________________________ __________________

SERVICE REQUESTED: CDRLS DD1423

PSC: R699

CLIN CONTRACT TYPE:

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

Firm Fixed Price

Under this CLIN, the contractor shall provide CDRL deliverables as required in accordance with Section J of the base contract.

(End of narrative B001)

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DLVR SCH PERF COMPL

REL CD QUANTITY DATE ________ ______________ __________

001 1 AS REQUIRED

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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_____ _________ _____ ___________ ____ _______________ _________ _____ ___________ ____ __________

0031AC P24DNF042T 2 F.0009854.18.1.1.1 AA $ 1,228,221.00

0031AD J519A166EH 2 F.0009694.16.2.1.1 AB $ 4,367,008.00

TOTAL $ 5,595,229.00

OBLIGATED OBLIGATED

ACRN ACCOUNTING CLASSIFICATION AMOUNTACRN ACCOUNTING CLASSIFICATION AMOUNT____ _________________________ ______________ _________________________ __________

AA 097 2010XXXX8242 ATO1 A60EE ULX018B 3101 L087176251 F.0009854.18.1.1.1 021001 $ 1,228,221.00

AB 097 2010XXXX8242 ATO1 A60EE ULU016B 3101 L087170520 F.0009694.16.2.1.1 021001 $ 4,367,008.00 __________________

TOTAL $ 5,595,229.00

LINELINE

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

0031AC AA 097 2010XXXX8242 ATO1 A60EE ULX018B 3101 L087176251 F.0009854.18.1.1.1 021001

0031AD AB 097 2010XXXX8242 ATO1 A60EE ULU016B 3101 L087170520 F.0009694.16.2.1.1 021001

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