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ORDER FOR SUPPI 'S OR SERVICES Form approved PAGE 1 of (Contractor must subm- .jur copies of invoice.) RMW CMB No. 0704-0187 Expires Dec 31, 1993 2 Public reporting burden for this coec Ion o in orma Ion Is estimatedo average our per response, including e time or revetwing instructions, searching existing a a sources, gathering an maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA, 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project(0704-0187), Washington, DC 20503, PLEASE DO NOT RETURN YOUR FORM TO EITHER OF THESE ADDRESSES SEND YOUR COMPLETED FORM TO THE PROCUREMENT OFFICAL IDENTIFIED IN ITEM 6. 1. CONTRACTIPURCH ORDER N0. 2. DELIVERY ORDER NO. 3. DATED)OFORDER 4. ryyMMMD REQUISITION/PURCH REQUEST NO. 5. PRIORITY SP31000OP0842 100 MAY 26 SEE SCHEDULE 6, ISSUED BY CODE SP3100 7. ADMINISTERED BY (if other than 6) CODE DEFENSE DISTRIBUTION CENTER 8 DELIVERY FOB DC -)DC -A PROCUREMENT OFFICE D DEST }{ DEST 2001 MISSION DR BLDG 81 OTHER NEW CUMBERLAND PA 17070-5001 (See chedule if Other) 9. CONTRACTOR CODE 11979N FACILITY CODE 10. DELIVER TO FOB POINT BY (Date) 11. MARK IF BUSINESS IS • . (YYMMMDO) MAY 26 0011 SMALL OFFICE OF EMERGENCY SERVICES SMALLDISAD- 12. DISCOUNT TERMS NAME AND ROOM 610 COURTHOUSE VANTAGED WOMEN -OWNED ADDRESS 222 E. WEBER AVENUE 13. MAIL INVOICES TO STOCKTON CA 95202 • SEE BLOCK 15 14. SHIP TO CODE SB32 00 15. PAYMENT WILL BE MADE BY CODE BELOW MARK ALL DEE DEPOT SAN JOAQUIN -- SEE BLOCK 19 PACKAGES AND SUPPLY BRANCH SUPPLIES/SERVICES PAPERS WITH CONTRACTOR WHSE 3 TRACY SITE (SB3200) ORDLR NUMBER TRACY CA 95376-5000 16. This delivery order is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contractTYPEOF LDEVER Reference your furnish the following on terms specified herein. ORDECHASE }{ 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: (YYMMDD) 17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE 01 97X4930.5BE0 00193 P900 25 S33181 $1,372.95 8' ITEM NO. 19, SCHEDULE OF SUPPLIES/SERVICE 21 ORDERED/ UNIT 22 UNIT PRICE 23. AMOUNT ACCEPTED' DOCUMENT NOUN NSN/MFG-PART-NUM ACC 0001 01383190 SH-HMMPFEE 99990OT311152 01 1 EA $660.00000 $660.00 PAYMENT OF FEES; 2000 HMMP ANNUAL FEE - FOR FACILITY AT 700 E ROTH RD, LATHROP CA PE, ACCOUNT #3822 3 12000 i - PAYMENT IS MADE BY GOVERNMENT CHECK #1006 ��',t,GLYfu I MI SC . CHARGE S OFFIC£ CGUPTf 30?GEPJCy Si $22.95 • If quantity accepted by the government is same as 24, ITE ;STAT 25. TOTAL 1 , 37 2.95 �AMERICA quantity ordered, indicate by X. It different, enter -��- actual quantity accepted below quantity ordered and DIF encircle BY: CONTRACTING/ORDERING OFFICER 26. QUANTITY IN COLUMN 20 HAS BEEN 27. SHIP, NO, 28. D.O. VOUCHER NO. 30. J1 INSPECTED ®RECEIVED ❑ ACCEPTED AND MS TO INITIALS THE CONTRACT EXCEPT ANOTED ❑ PARTIAL 32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR FINAL DATE SIGNATURE OF AUTHORIZED GOVERNMENT OFFICIAL COMPLETE 34. CHECK NUMBER 36. I certify this account is correct and proper for payment. PARTIAL 35. BILL OF LADING NO. DATE SIGNATURE AND TITLE OF CERTIFYING OFFICER FINAL 37. RECEIVED AT 38. RECEIVED BY (Print) 39. DATE RECEIVED 40. TOTAL CONTAINERS 41. SIR ACCOUNT NUMBER 42. SIR VOUCHER NO. 1 yymmmoo) DD FORM 1155, APR 93 (EF) PREVIOUS EDITION MAY BE USED 4601361