SOW_ATTACHMENT_002_Example_Aviation_Fuel_Delivery_Ticket.pdf

EXAMPLE OF AVIATION FUEL DELIVERY TICKET

Delivery Ticket Date Contract Number Delivery Order Number

Fuel Order Number (Provided by Contracting Officer or Ordering Official

Contractor's Name Contractor's Telephone Number

E-mail Address

Driver's Full Name Driver License Number Driver's Identification Number

Driver's License Issue Date Driver's License Expiration Date Vehicle Plate Number

Vehicle VIN Number Aircraft Model Aircraft Tail Number

Fuel Location by Country of Origin Type of Fuel Delivered Amount of Fuel Ordered in Liters

Amount of Fuel Delivered INTO Aircraft Fuel Level of Vehicle Prior To Delivery

Remaining Fuel after Delivery

Seal Number/Verification Region Location

Province Installation Fuel Delivered To

“I certify that on [insert date], [insert Contractor’s name] furnished the supplies or services called for by Contract No. [insert contract # & delivery order #] IAW all applicable requirements.

I further certify that the supplies or services are of the quality specified and conform in all respects with the contract requirements, including specifications, drawings, preservation, packaging, packing, marking requirements, and physical item identification (part number), and are in the quantity shown on this or on the attached acceptance document.

Date of Execution: _____________________________________________ Signature: ____________________________________________________ Title/Organization/Office: _________________________________________”