Attachment 10_TE-7Sample Service Order Form - 88th RSC PMCM.pdf

CONTRACTOR:

CUSTOMER ORGANIZATION:

FACILITY NAME/NUMBER:

SERVICE ORDER DATE:

Check if applicable:

One of these boxes must be checked: ROUTINE URGENT EMERGENCY

Select State where work will occur

Labor Classification Reg Labor Hours

Reg Labor Rate

Reg Labor Amount OT Hours Contr O/T Rate OT Amount

Qty Unit Unit Price Amount

Amount

Amount

ODC Notes:

Amount

Clarifications/Exclusions:

Contractor confirms there is an AHA associated with the work being performed in this SO included in the Accident Prevention Plan (APP)

Contractor acknowledges there is an activity associtated with the SO that requires an additional plan or program that will be included in an APP addendum.

SO DESCRIPTION: (include LOCATION - attach additional sheets as required):

Contractor acknowledges there is NOT an AHA associated with the work being performed in this SO included in the APP. AHA is attached for review with the SO.

SUB Charge Rate: _____ %

TOTAL SUB COST

Profit on Outside Vendor: ___%

Description

G&A: _____ %

TOTAL ODC COST

TOTAL MSE COST

Labor Notes:

88th RSC

CONTRACT & TO NO.:

CLIN TO BE CHARGED:

W912DY-

SERVICE ORDER NAME:

SO REQUEST NO:

Site Safety & Health Officer (SSHO) will inspect before, during and after work.

Quality Control Officer will inspect during testing.

MSE Notes:

Description

Freight/Shipping

Fully Burdened MSE

SUBCONTRACTOR COSTS

NOTE: Profit shall not be applied to GSA/JCI Catalog Materials.

Total OT Labor Profit On Labor: _____ %

TECHNICAL EXHIBIT TE - 9.0: BASEOPS SERVICE ORDER FORM

PART I - SERVICE ORDER INFORMATION

LABOR UTILIZED

PART II - COST SUMMARY

MATERIALS/SUPPLIES/EQUIPMENT

Total Regular Labor

TOTAL LABOR COST

State Tax: _____ % MSE Charge Rate: _____ %

Profit On MSE: _____ %

Subtotal MSE

One of these boxes must be checked:

Description

Description

Freight/ShippingSUB Notes:

OTHER DIRECT COSTS

TRAVEL

CONTRACTOR:

CUSTOMER ORGANIZATION:

FACILITY NAME/NUMBER:

SERVICE ORDER DATE:

Check if applicable:

One of these boxes must be checked: ROUTINE URGENT EMERGENCY

Clarifications/Exclusions:

Contractor confirms there is an AHA associated with the work being performed in this SO included in the Accident Prevention Plan (APP)

Contractor acknowledges there is an activity associtated with the SO that requires an additional plan or program that will be included in an APP addendum.

SO DESCRIPTION: (include LOCATION - attach additional sheets as required):

Contractor acknowledges there is NOT an AHA associated with the work being performed in this SO included in the APP. AHA is attached for review with the SO.

88th RSC

CONTRACT & TO NO.:

CLIN TO BE CHARGED:

W912DY-

SERVICE ORDER NAME:

SO REQUEST NO:

TECHNICAL EXHIBIT TE - 9.0: BASEOPS SERVICE ORDER FORM

PART I - SERVICE ORDER INFORMATION

One of these boxes must be checked:

Travel Notes:

CEHNC-UMCS SO FORM (Mod.) DTD 30 SEP 2013 SO FORM AUTHOR: CEHNC-UMCS KO

DATE/TIME WORK COMPLETED

FOR FINAL BILLING

OVERTIME LABOR TO BE CHARGED

I certify that the services under the above Service Order have been satisfactorily completed.

PART IV - CERTIFICATION OF SERVICES

CONTRACTING OFFICER OR OO:

E-SIGNED & DATED:

This is a Notice to Proceed in the Not to Exceed amount indicated in the "TOTAL SO COSTS TO BE INVOICED." This SO is considered technically acceptable and within scope. The cost/price has been determined to be fair and reasonable.

QUAILITY ASSURANCE EVALUATOR:

E-SIGNED & DATED:

TOTAL TRAVEL COST

E-SIGNED & DATED:

TOTAL SO COSTS TO BE INVOICED

PART III - AUTHORIZATION

E-SIGNED & DATED:

CUSTOMER: SO is accepted and requests NTP from KO.

E-SIGNED & DATED:

CONRACTOR: Receipt & Acceptance Acknowledged.

HNC PROJECT ENGINEER: for non-emergency >$2,500 (Verified following

G&A: _____ %

Yes No

Service Order