PAGE 1 OF
5
|
||||
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
|
W52H09-05-D-0260
|
VD01
|
2010JUN28
|
SEE
SCHEDULE
|
DOA5
|
6.
ISSUED BY
|
CODE
|
SPRDL1
|
7.
ADMINISTERED BY (If other than 6)
|
CODE
|
S4402A
|
8.
DELIVERY FOB
|
DLA
WARREN, LAND DETACHMENT @ TACOM
|
||||||
DSCC-ZG
|
DCMA,
TEXAS
|
|||||
MO
KAH (586)282-6487
|
600
NORTH PEARL STREET
|
x
DESTINATION
|
||||
WARREN,
MI 48397-5000
|
SUITE
1630
|
|||||
HTTP://CONTRACTING.TACOM.ARMY.MIL
|
DALLAS
TX 75201-2843
|
¨ OTHER
|
||||
(See
Schedule if
|
||||||
SCD:
A
PAS:
NONE
ADP
PT: HQ0339
|
other)
|
9.
CONTRACTOR
|
CODE
|
0BK64
|
FACILITY
|
10.
DELIVER TO FOB POINT BY (Date)
|
11.
x
IF BUSINESS IS
|
|
(YYYYMMMDD)
|
||||||
●
|
●
|
x SMALL
|
||||
OPTEX
SYSTEMS INC.
|
||||||
1420
PRESIDENTIAL DR
|
SEE
SCHEDULE
|
o
SMALL
|
||||
NAME
RICHARDSON, TX 75081-2439
|
12.
DISCOUNT TERMS
|
DISADVANTAGED
|
||||
AND
|
||||||
ADDRESS
|
o
WOMAN-OWNED
|
|||||
13.
MAIL INVOICES TO THE ADDRESS IN BLOCK
|
||||||
●
|
●
|
|||||
TYPE
BUSINESS: Other Small Business Performing in U.S.
|
See
Block 15
|
14.
SHIP TO
|
CODE
|
15.
PAYMENT WILL BE MADE BY
|
CODE
|
HQ0339
|
MARK
ALL
|
|
SEE
SCHEDULE
|
DFAS-COLUMBUS
CENTER
|
PACKAGES
AND
|
||||
DFAS-CO
WEST ENTITLEMENT OPERATIONS
|
PAPERS
WITH
|
|||||
P.O.
BOX 182381
|
IDENTIFICATION
|
|||||
COLUMBUS,
OH 43218-2381
|
NUMBERS
IN
|
|||||
BLOCKS
1 AND 2
|
||||||
16.
|
DELIVERY/
CALL
|
x
|
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
|
Reference
your o
Oral o
Written Quotation
, Dated
.
|
||
PURCHASE
|
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
(YYYYMMMDD)
|
o If this
box is marked, supplier must sign Acceptance and return the following
number of copies:
|
17.
ACCOUNTING AND APPROPRIATION DATA/LOCAL USE
|
SEE
SCHEDULE
|
18.
ITEM NO.
|
19.
SCHEDULE OF SUPPLIES/SERVICE
|
20.
QUANTITY
|
21.
|
22.
UNIT PRICE
|
23.
AMOUNT
|
ORDERED/
|
UNIT
|
||||
ACCEPTED*
|
|||||
SEE
SCHEDULE
|
|||||
CONTRACT
TYPE:
|
|||||
Firm-Fixed-Price
|
|||||
KIND
OF CONTRACT:
|
|||||
Supply
Contracts and Priced Orders
|
|||||
* If
quantity accepted by the Government is same as quantity ordered, indicate
by x.
If
different, enter actual quantity accepted below quantity ordered and
encircle.
|
24.
UNITED STATES OF AMERICA
|
25. TOTAL
|
$2,500,570.00
|
MORRIS
BELLEVILLE
/SIGNED/
2010JUN28
|
26.
|
|
|
MORRIS.BELLEVILLE@US.ARMY.MIL
(586)282-3766
|
DIFFERENCES
|
||
BY:
CONTRACTING/ORDERING
OFFICER
|
27a.
QUANTITY IN COLUMN 20 HAS BEEN
|
o
INSPECTED o
RECEIVED o
ACCEPTED, AND CONFORMS TO CONTRACT EXCEPT AS NOTED
|
b.
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
|
c.
DATE
(YYYYMMMDD)
|
d.
PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE
|
||
e.
MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE
|
28.
SHIP. NO.
|
29.
D.O. VOUCHER NO.
|
30.
INITIALS
|
|
o
PARTIAL
|
32.
PAID BY
|
33.
AMOUNT VERIFIED CORRECT
FOR
|
f.
TELEPHONE NUMBER
|
g.
E-MAIL ADDRESS
|
o
FINAL
|
||
31.
PAYMENT
|
34. CHECK NUMBER | |||
|
||||
36.
I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT.
|
o
COMPLETE
|
a.
DATE
(YYYYMMMDD)
|
b.
SIGNATURE AND TITLE OF CERTIFYING OFFICER
|
o
PARTIAL
|
35.
BILL OF LADING NO.
|
||
o
FINAL
|
|||||
37.
RECEIVED AT
|
38.
RECEIVED BY (Print)
|
39.
DATE RECEIVED
(YYYYMMMDD)
|
40.
TOTAL CON-
TAINERS
|
41.
S/R ACCOUNT NUMBER
|
42.
S/R VOUCHER NO.
|
|
|
CONTINUATION
SHEET
|
Reference
No. of Document Being Continued
PIIN/SIIN W52H09-05-D-0260/VD01 MOD/AMD
|
Page
2 of
5
|
Name
of Offeror or Contractor: OPTEX
SYSTEMS
|
CONTINUATION
SHEET
|
Reference
No. of Document Being Continued
PIIN/SIIN W52H09-05-D-0260/VD01 MOD/AMD
|
Page
3 of
5
|
Name
of Offeror or Contractor: OPTEX
SYSTEMS
|
ITEM NO
|
SUPPLIES/SERVICES
|
QUANTITY
|
UNIT
|
UNIT PRICE
|
AMOUNT
|
|||||||
SUPPLIES
OR SERVICES AND PRICES/COSTS
|
||||||||||||
0001
|
NSN:
1240-01-483-6103
|
|||||||||||
FSCM:
19200
|
||||||||||||
PART
NR: 12984713
|
||||||||||||
SECURITY
CLASS: Unclassified
|
||||||||||||
0001AB
|
PRODUCTION
QUANTITY
|
200
|
EA
|
$ |
12,502.85000
|
$ |
2,500,570.00
|
|||||
NOUN:
TELESCOPE, PANORAMIC
|
||||||||||||
PRON:
M101F720M1 PRON AMD:
04 ACRN: AA
|
||||||||||||
AMS
CD: 060011
|
||||||||||||
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
|
W52H090137C304
|
W25G1U
|
J
|
1
|
DEL REL CD
|
QUANTITY
|
DEL
DATE
|
||||||
001
|
15
|
28-JAN-2011
|
||||||
002
|
15
|
28-FEB-2011
|
||||||
003
|
15
|
28-MAR-2011
|
||||||
004
|
15
|
28-APR-2011
|
||||||
005
|
15
|
30-MAY-2011
|
||||||
006
|
25
|
29-JUN-2011
|
||||||
007
|
25
|
29-JUL-2011
|
||||||
008
|
25
|
29-AUG-2011
|
FOB
POINT: Destination
|
|||||||
SHIP
TO:
|
|||||||
(W25G1U)
|
SU
W1BG DEF DIST DEPOT SUSQUE
|
|
|
|
|
||
DDSP
NEW CUMBERLAND FACILITY
|
|||||||
2001
NORMANDY DRIVE DOOR 113 TO 134
|
|||||||
NEW
CUMBERLAND PA
17070-5002
|
|||||||
CONTRACT/DELIVERY
ORDER NUMBER
|
|||||||
W52H09-05-D-0260/VD01
|
CONTINUATION
SHEET
|
Reference
No. of Document Being Continued
PIIN/SIIN W52H09-05-D-0260/VD01 MOD/AMD
|
Page
4 of
5
|
Name
of Offeror or Contractor: OPTEX
SYSTEMS
|
ITEM NO
|
SUPPLIES/SERVICES
|
QUANTITY
|
UNIT
|
UNIT PRICE
|
AMOUNT
|
DOC
|
SUPPL
|
||||||||||||||
REL CD
|
MILSTRIP
|
ADDR
|
SIG CD
|
MARK FOR
|
TP CD
|
||||||||||
002
|
W52H090137C305
|
W62G2T
|
J
|
1
|
DEL REL CD
|
QUANTITY
|
DEL
DATE
|
||||||
001
|
10
|
28-JAN-2011
|
||||||
002
|
10
|
28-FEB-2011
|
||||||
003
|
10
|
28-MAR-2011
|
||||||
004
|
10
|
28-APR-2011
|
||||||
005
|
10
|
30-MAY-2011
|
FOB
POINT: Destination
|
||||||
SHIP
TO:
|
||||||
(W62G2T)
|
XR
W1BG DEF DIST DEPOT SAN JOAQUN
|
|||||
TRANSPORTATION
OFFICER
|
||||||
PO
BOX 960001
|
||||||
STOCKTON CA
95296-0130
|
||||||
CONTRACT/DELIVERY
ORDER NUMBER
|
||||||
W52H09-05-D-0260/VD01
|
CONTINUATION
SHEET
|
Reference
No. of Document Being Continued
PIIN/SIIN W52H09-05-D-0260/VD01 MOD/AMD
|
Page
5 of
5
|
Name
of Offeror or Contractor: OPTEX
SYSTEMS
|
PRON/
|
JOB
|
|||||||||||||||
LINE
|
AMS CD/
|
OBLG
|
ORDER
|
ACCOUNTING
|
OBLIGATED
|
|||||||||||
ITEM
|
MIPR
|
ACRN
|
STAT
|
ACCOUNTING
CLASSIFICATION
|
NUMBER
|
STATION
|
AMOUNT
|
|||||||||
0001AB
|
M101F720M1
|
AA
|
2
|
97 X4930AC9G
6D
|
26KB
|
S11116
|
W52H09
|
$ 2,500,570.00
|
||||||||
060011
|
||||||||||||||||
TOTAL
|
$ 2,500,570.00
|
SERVICE
NAME
|
TOTAL
BY ACRN
|
ACCOUNTING
CLASSIFICATION
|
ACCOUNTING
STATION
|
OBLIGATED
AMOUNT
|
|||||||
Army
|
AA
|
97 X4930AC9G
6D
|
26KB
|
S11116
|
W52H09
|
$ 2,500,570.00
|
|||||
TOTAL
|
$ 2,500,570.00
|
LINE
|
|
|||||||
ITEM
|
ACRN
|
EDI |
ACCOUNTING
CLASSIFICATION
|
|||||
0001AB
|
AA
|
97 |
0X0X4930AC9G S11116
|
06D00000600110000026KB
|
S11116
|