FORM CD-404-EF (09-91)

U.8. DEPARTHIlllT OF COHHERCE

I SUPPLY,]:QUIPMENT OR SERVICE ORDER
.......
~::~d...
I. ORDER NUMBER

43-YA-BC-02022I
r-------r----L-------r-----r----T"""-----r--,.,..-------!inquiriesto
2. CONTRACT ORDERED AGAINST 3. PURCHASE 4. DEUVERY 5. ORDER DATE ~. SOURCE the
PAGE I OF 2 Specific PIovisions Apply ORDER ORDER PIocurement 7. SUB 18. DATE PRINTED
NONE X 10119/1999 0Ilice. NONE I 02/1012005
9. SUPPUER'S ADDRESS 31320 10. 1099 TAX: MISC This lWerence Ord... 12. BIUlNG ADDRESS
LAB TECH SYSTEMS ...-.. No. .~ REFERENCE ORDER NO.: OBLlG-2ooo-2022 1-0-0
II. EMPLOYER I.D. ~ IIlUIt appeor oRaU
3822 DUNSINANE DR '------'""""!'==--linvoices and BUREAU OF 1HE CENSUS
13. CONTACT: b4 pacbges. Freight
charge over SIOO
FINANCE DMSION
SILVER SPRING MD 20906 EIlIC WENOCUR requires a Bill of ROOM 3546, BUILDING 3
Lading.
13L TI!L: 301-438-8210
WASHiNGTON DC 20233-4400
13b. FAX: 301-438-8540

14. IS. 16. 17. lB. 19. 20.

UNE DESCRIPTION DEUVERY QUANTITY UNIT UNIT PRICE AMOUNT
fI1!M DATE ISSUE

PROVIDE MAINTENANCE ON 1HE FOLLOWING FOR TIlE

PERIOD OCTOBER I, 1999 THROUGH SEPTEMBER 30, 2000.

I 1HE CENSUS BUREAU HAS A REQUIREMENT FOR REPAlRlNG 10/01/1999 18 25,000.0000 25,000.00
AND SERVICING VIDEO/AUDIO HARDWARE.

PREVIOUS P.O. #43-YA-BC-906507

U.S. DEPARTMENT OF COMMERCE - TERMS AND CONDmONS

The following terms and conditions as well .. any on auached sheets. apply when this document is used as a purchase ord.... If this document is used as a delNe.y ord.... ~ is subject to the terms and conditions of
the contnet referenced in Block #2 of the order. 52.252-2 Cia.... iIlcorpontted by Reference (Apr 84). This contra<:! incorporates the foUowing clauses by ref.....,., with the same force and effect .. if they were
8iven in ruu text. Upon request, the Contracting Officer will malee ruu text available.

NOTE: FUlL TEXT CLAUSES ARE AV AIl.ABI.E AT lITTP:/IWWW.ARNET.GOVIFARlFARQUERYFRAME.HTMI.

NOTE 2 INVOICE MUSt COINCIDE WlTII UNE ITEMS ON PURCHASE ORDER
NOTE 3 INSTRUCTIONS FOR SUBMITTING INVOICES ARE ATTACHED
NOTE 4 CONTRACTOR SHAlL AlLOW THE GOVT 30 DAYS FROM DEUVERY TO INSPECT & ACCEPT
NOTE 5 CONTRACTOR AGREES TO INVOICE NO LESS mAN 30 DAYS AFTER DEl.IVERY
NOTE 6 52.246-2 INSPECTON OF SUPPUES - FIXBD PRICE

21. ORDERED BY (NAME AND TI11.E)

PAMILLER
PURCHSGAGT $25,000.00
26. CONTRAC1lNGIORDERlNG OffiCER SIGNATURE 21. DATE SIGNED 128. PROMPT PAYMENT j29. SmPVIA
LA CATIERTON
1 10/1911999 I YIN/A
30. SmP TO (INCLUDE ON SHIPPING \.ABEL) 3I. ISSUING OffiCE (DO NOT SmP OR BILL TO nus ADDRESS)
REFERENCE ORDER NO.:OBLlG-2000-20221-0-0
BOC MAIN RECEIVING DOCK BUREAU OF THE CENSUS
ROOM 1203A, FOB 4 ACQUlSmON BRANCH, ROOM G-312-3
4700 SILVER i-lILL ROAD 4700 SILVER HILL ROAD
Attn: EM CAGLE
SUITLAND, MD 20746 SUITLAND MD 20746

Pbone:
 I. ORDER NUMBER
FORM CD-404-EF (09-97)
U.S. DEPAR'nIElI'r OF CCHfERCE
SUPPLY, EQUIPMENT OR SERVICE ORDER 43-YA-BC-020221
(COll'rX_TIOH SBEBTI

32. SUPPUER 33. ISSUING OFFICE S.ORDERDATE lB. DATE PRINTED

PAGE 2. OF 2.
1 LAB TECH SYSTEMS BUREAU OF TIlE CENSUS 10/19/1999 I 0211012005
34. 3S. 36. 37. 3B. 39. 40. 41.
LINE MOL QTY QTY FINAL FULL ACCOUNTING CLASSIFICATION OIST% AMOUNT
ITEM RECVD

04 0331 OO<HlOO 21 10-04-03-000 11-04-0009-00-00-00-00 25-20-04-00 000000 100% 25.000.00

42. 43. 44. 4S. 46. SHIP TO ADDRESS 42. 43. 44. 45. 46. SHIP TO ADDRESS
UNE MOL QTY RECEIVING (INCLUDE REFERENCE ORDER NO. LINE MOL QTY RECEIVING (INCLUDE REFERENCI! ORDER NO.
ITEM OFFICE CODE ON SHIPPING LABEL) . ITEM OFFICE COOl! ON StuPPlNG LABEL)

47. 4B. 49. SO.

UNE REQUISITION NUMBER REQUlSmON DESCRIPTION REQUISITIONER INFORMATION
ITEM

9532-0 Maintenace contract/AudioNideo (IT 2000) PH DUNTON (W)301-763-2806 Loc: FB 3 Rm: 2705

!llrll~'i_ll!~::~::~~:·:;II~:lIi!ISI.
52. RECEIPT SIGNATURE 8£ TITI.E 53. RECEIPT DATE
TYPE SffiPMENT

ACCEPTANCE: I CERTIFY 11IAT ARTICLES AND/OR SERVICES ANNOTATED 54. ACCEPTANCE SIGNAlURE 8£ TITI.E 55. ACCEPTANCE DATE
ABOVE HAVE BEEN RECEIVED,INSPECTED AND ACCEPTED AS COMPLYING
WITIJ nus ORDER, AS OF TIfE DATE SHOWN.