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FOIIK C1>-404-EF (09-91)

U.S. DEPARftlElft' OF CCHtERCE


I SUPPLY, EQUIPMENT OR SERVICE ORDER ::::'"
~ I. ORDERNUMIlER
43-YA-BC-9II924
t-------,..----a.------.. . . - ---.-----r-----.....---------4inquirieslO
2. CONIRACTORDERED AGAINST 3. PURCHASE 4. DELIVI!R.Y S.ORDERDATE 6. SOURCE
Specific ProYioio.. Apply ORDER ORDER
tile
JPnlcurc- 7. SUB 18. DATE PIlJNTED
PAGE 1 OF 2
GS22FOOO7B X 04129/1999 Ollice. NONE '1 0211012005
9. SUPPUER'S ADDRESS 39961 10. 1099 TAX: NONE This Reference Q!der 12. BIUJNG ADDRESS
• ~ No. ~ IlEfl!R.ENCBORDERNO.: OBLlG.I999.11924-0-O
DIGITAL MEDIA GROUP I I. EMPWYER I.D. mu.Uppar on ..
DBA VIDEO LABS CORPORATION iavoioa and BUREAU OF TIm CENSUS
15237 DlSPLAYCT 13. CONTACT: bJf ~ Freighl
__... o_SIOO FINANCE DMSION
ROCKVILLE MD 20850 VALEIUE 1'0SCAK requires a BiD of ROOM 3546, BUllDING 3
13L TEL: 301-217-0000
lIdins.
WASHINGTON DC 20233-4400
13b. FAX: 301-117-9044

14. IS. 16. 17. II. 19. 20.


UNE DESCRIPTION DELIVERY QUAN111Y UNIT UNIT PRICE AMOUNT
ITEM DATE ISSUE

1 VIDEO DUPLICATION & TRANSFER SERVI~ES. 10/1011999 m 25,000.0000 25,000.00

u.s. DEPAllTMI:NT OF COMMDlCE. TDlMS AND CONDmONS


The following terms .... COIldiIio.. IS wdI u II1Y on altlCbcd - . apply wbeft this document is used .. a purd>ose order. If this docu_ is used IS a cJeIMry order. it is 1Ut;ect 'A the lerms and c:onditions of
the contrldrerer-ed ill Block 12 oftheo"'er. 52.252-2 CJauses iIIcorpooated by Reference (Apr 14). This conlJacI incorporaleS the followiag ~ by reference, with tile ...... lOr"" and effect .. if they were
liven ill IirlI ~ Upon r...-, the ContractinI Officer will make fuR text a_bIe.

NOTE: FULL TEXTa.AUSES ARE AVAIUJlLE ATHT1l.:IIWWW.ARNET.GOVIFAIlIFAllQUERYFRAME.HT104L


NOTE 2 INVOICE MUST COINCIDE WITIf UNE ITEMS ON PURCHASE ORDER
NOTE 3 INS7RUCTIONS FOR SUBMIlTlNG INVOICES ARE ATTACHED
NOTE 4 CONlRACTOR SHALL ALLOW TIlE GOVT 30 DAYS FROM DEUVERY TO INSPECT & ACCEPT
NOTES CONlRACTOR AGREES TO INVOICE NO LESS TIlAN 30 DAYS AFTER DELIVERY
NOTE 6 S2.246-2INSPECTON OF SUPPUES - FIXED PRICE

ORDERED BY (NAME AND llTLE)


21.
PAMILLER
PURCHSGAGT
26. CONTRACTINGlORDERING OFFICER SIGNATIJRE
LA CATfERTON
30. SIUP TO (INCLUDE ON SHIPPING LABEL)
22. ;~~_~6~~CAUln::= ~~= ~-:S: IUP=VlA': ":"- S_25_,-0-0 -.-0 -f
0412911999 I
.
y ~ N/A
31. ISSUING OFFICE (DO NOT SIUP OR BJIL TO nos ADDRESS)
REFERENCE ORDER NO.: OBUG-1999-11924-0-o
BOC MAIN RECEIVING DOCK BUREAU OF THE CENSUS '
ROOM 120JA, FOB 4 ACQUISmON BRANCH, ROOM G-312-3
4700 SILVER HILL ROAD 4700 SILVER HILL ROAD
AIIn: E M CAGLE
StJrlLAND, MD 20746 SUITLAND MD 20746

Phone:
FORK CD-404-EF (09-91) I. ORDER NUMBER
11. S. DEPAR'lMEll'r OF COHIIBIlCB SUPPLY, EQUIPMENT OR SERVICE ORDER 43-YA-BC-911924

I
(COll'rINIlATIOII IlIIEET)

32. SUPPLIER 33. ISSUING OFFICI! 5. ORDER DATE 18. DATE PRINTED
PAGI! 2 OF 2
DIGITAL MEDIA GROUP BUREAU OF THE CENSUS 04/29/1999 02/1012005
34. 35. 36. 37. 38. 39. 40. 41.
UNE MDL QTY QTY FINAL FUll. ACCOUNTING CLASSIfICATION DIST% AMOUNT
ITI!M RI!CVD

1 1 1 040200000-000 21 10-02-07-00011-04-0009-00-00-00-0025-20-04-00 000000 100% 25.000.00

42. 43. 44. 4S. 46. SHIP TO ADDRI!SS 42. 43. 44. 45. 46. SHIP TO ADDRI!SS
UNB MDL QTY RI!CI!MNG (lNCUJDI! RI!FEREHCIl ORDER NO. UNE MOL QTY RECEIVING (lNCLUD1! REI'I!RI!NCI! ORDEll NO.
ITEM OFFICI! CODE ON SHIPPING LABEL) ITEM OFFICI! CODI! ON SlUPPlNG LABI!L)

47. 48. 49. 50.


UNE REQUISITION NUMBER REQUISITION DESCRIPTION REQUISITIONER INFORMATION
ITEM

6664-0 Video duplication & lransfer scmces PH DUNTON (W)301-763-2806 Loc: FB 3 Rm: 2705

.. _51_.TYP
__ E_SHIP_MENT ....5_2._RE_CEIPT
_ _S_IG_N_A_TURE
_ _It_TI_TLE -+_53_.RE_CElPT
_ _D_A_n. --1
ACCl!PTANCI!: I CERTIFY mAT ARTIO£S AND/OR SERVICES ANNOTAlED 54. ACCEPTANCI! SIGNA1URI! k TITLE 55. ACCEPTANCI! DATE
ABOVE HAVE BEEN RECEIVED, INSPECTED AND ACCEPTED AS COMPLYlNG
WI1H 11IIS ORDER, AS OF THE DATE SHOWN.

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