REQUEST FOR CONTRACTUAL PROCUREMENT �NAVCOMPT FORM 2276 (REV by billycorgann

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									                                                      REQUEST FOR CONTRACTUAL PROCUREMENT

1.    THIS ORDER MUST BE ACCEPTED ON A REIMBURSABLE BASIS ONLY AND IS SUBJECT TO THE                                         2. DOCUMENT NUMBER
      CONDITIONS LISTED ON THE REVERSE.                                                                                           MOU812- *  -1001
3. REFERENCE NUMBER                           4. FUNDS EXPIRE ON            5. DMS          6. PRIORITY          7. DATE REQUIRED      8. AMENDMENT NO.
                                                                                                                           *
                                                    30 Sep YY                                      *
      th
9.    8 Med Bn                                                                        10.   FOR DETAILS
      2D FSSG FMF                                                                                                      HM1 RIVERS
      CLNC                                                                                                               X6-7890
11.           CCO NORTH                                                             12.   MAIL INVOICES
                                                                                            Same as block #9
                                                                  
13.                                            ACCOUNTING DATE TO BE CITED ON RESULTING BILLINGS
A. ACRN          B. APPROP        C. SUB      D. OBJ CLASS       E. CONTROL       F. SA        G.           H. TT      I.        J.              K.

AA               17Y1106          2720        000                00027            0            000027       2D         000000    MJ60000000000        $30,000
14.    AMOUNTS WILL NOT BE EXCEEDED IN THE OBLIGATION DOCUMENT WITH PRIOR                                   L. TOTAL THIS DOCUMENT                    $30,000
       WRITTEN APPROVAL FROM THE ISSUER.
                                                                                                            M. CUMULATIVE TOTAL                       $30,000
15.

                                          PROCUREMENT BY CONTRACT OF THE FOLLOWING ITEMS IS REQUESTED
                              THESE ITEMS ARE     ARE NOT INCLUDED IN THE INTERSERVICE SUPPLY PROGRAM AND
                                   REQUIRED INTERSERVICE SCREENING HAS        HAS NOT BEEN ACCOMPLISHED 

A. ACRN          B. ITEM       C. FSC      D.                DESCRIPTION                             E. QTY        F. UNIT   G. ESTIMATED    H. ESTIMATED
                     NO                                                   NO
                                           (NAT STOCK NO, SPEC AND/OR DRAWING NO., ETC)                                         UNIT PRICE        AMOUNT
AA                  1           8690       BOTTLED WATER                                                15,000       BT          $2.00           $30,000
                                           SINGLE LITER BOTTLES
                                           625 BX OF 24 BT/BX




16.   SEE ATTACHED PAGES FOR DELIVERY SCHEDULES, PRESERVATION AND PACKAGING INSTRUCTIONS, SHIPPING                                           I. GRAND TOTAL
      INSTRUCTIONS AND INSTRUCTIONS FOR DISTRIBUTION OF CONTRACTS AND RELATED DOCUMENTS.
                                                                                                                                                      $30,000
17.   TRANSPORTATION ALLOTMENT (Used if FOB Contractor’s plant)
18.   I CERTIFY THAT THE FUNDS CITED ARE PROPERLY ARE                     AUTHORIZING OFFICIAL (NAME, TITLE AND SIGNATURE)
      PROPERLY CHARGEABLE FOR THE WORK OR SERVICES
      REQUESTED.                                                          Jack Kevorkian
                                                                          J. KEVORKIAN, LCDR, MC USNR
19.   THIS WORK ORDER IS ACCEPTED AND THE WORK OR                         ACCEPTING OFFICIAL (NAME, TITLE AND SIGNATURE)
      SERVICES WILL BE PROVIDED IN ACCORDANCE
      HEREWITH.

NAVCOMPT FORM 2276 (REV. 8-81) S/N 0104-LF-702-276




                                                                * = use recent date(s) as applicable.




           CON 234/JUL –99/SG/Chapter 10                                      10A-2

								
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