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ORDER NUMBER
U. S. DEPAIl.THEHT OF COMMERCE SUPPLY, EQUIPMENT OR SERVICE ORDER Uselhis Order
Number for 43-YA-BC-488 152
1------'"'T---....L------..,..----..-..,.;----r-----......
2. CONTRACT ORDERED AGAINST 3. PURCHASE 4. DEUVERY Y. ORDER DATE
--------!inquiriesIO
the
PAGE I OF 3 Specific Provisions Apply ORDER ORDER P r _ 7. SUB S. DATE PRINTED
NONE X 03/0812004 0fIic:e. NONE 0211012005
9. SUPPUER'S ADDRESS 10. 1099 TAX: MISC This Refereuce der 12. BILLING ADDRESS
No. REfERENCI! ORDER NO.: OBLlG-2004-88152-0-0
II. EMPLOYER I.D. must Ippear on aD
invoices and BUREAU OF TIlE CENSUS
13. CONTACT: pawses. FreiBht FINANCE DIVISION
c1wse over $100
THERESE ALLEN .equires a BBI of ROOM 3546, BUllDING 3
Lading.
1Ja.TEL:_
WASHINGTON DC 20233-4400
IJb.FAX~f.p
PREVIOUS PO #43YABC257975
21. ORDERED BY (NAME AND TITLE) 22. FOR INQUIRIES CALL 23. FOB POINT 24. DISCOUNT TERMS
LAVANCE 301-763-1840 DESTIN 0% inO net 30
SUPVY PURCHSG AGT $7,500.00
26. CONTRACTlNGIORDERING OffiCER SIGNATURE 27. DATE SIGNED
LAVANCE 0310812004 N/A
30. SHIP TO (INCLUDE ON SHIPPING LABEL) 31. ISSUING OffiCI! (DO NOT SHIP OR BILL TO T\{JS ADDRESS)
OBLlG-2004-88152-0-o
REFERENCE ORDER NO.:
BOC MAIN RECElVlNG DOCK BUREAU OF TIlE CENSUS
ROOM 1203A. FOB 4 ACQUlSmON BRANCH, ROOM G-312-3
4700 SILVER IDLL ROAD 4700 SILVER HILL ROAD
Alto: S B MASSIE
SUITLAND, MD 20746 SUITLAND MD 20746
Phone:
U"~
'~ORll
CD-404-EF (09-97) I. ORDER NUMBER
U.S. DEPARTMEII'l' OF COHHERCE SUPPLY, EQUIPMENT OR SERVICE ORDER 43·YA-BC-488152
Number for
1------""T-:-~=__:l_ __=_.......---_r----~...,....--T_----_r~=~----__1iaquiries 10
2. CONTRACT ORDEIlED AGAINST 3. PURCHASE 4. DEUVl!RY S~ORDER DATI! 6. SOURCE the
PAGE 2 OF 3 Specific Provisions Apply ORDER ORDER Procurement 7. SUB 8. DATI! PRINTED
NONE X 03/0812004 0fIice. NONE 0211012005
9. SUPPUEll'S ADDRI!SS 39967 10. 1099 TAX: , MlSC This Reference 12. BIWNG ADDRI!SS
No. Rl!Fl!RENCE ORDER NO.: OBLlG-2004-88152-o-o
tt.I!MPLOYI!R J.D. must appear on aD
invoices and BUREAU OF THE CENSUS
13. CONTACT: packages. Freight FINANCE DMSION
ebarB' over $100
1'HEIlESE AU-EN requires a BiU of ROOM 3546. BUILDING 3
Ladins·
13a.TI!t.:~
WASHINGTON DC 20233-4400
I3b. F A X : . _ _ _ t)U
14. IS. 16. 17. 18. 19. 20.
lJMI! DESCRIPTION DEUVERY QUANI1TY UNIT UNIT PRICE AMOUNT
ITEM DATI! ISSUE:
21. ORDERED BY (NAM!! AND TInE) 22. FOR INQUIRIES CALL 23. FOB POINT 24. DISCOUNT TERMS
LAVANCE 301-763-1840 DESTIN 0% in 0 net 30
SUPVY PURCHSG AGT $7,500.00
26. CONTRACTING/ORDERING OFFICER SIGNATURE 27 DATI! SIGNED
LAVANCE 03/0812004 N/A
30. SIDP TO (INCLUDE ON SHIPPING LABEL) 31. ISSUING OFFICE (DO NOT SIDP OR Bill TO nus ADDRESS)
OBLlG-2004-88152-0-0
REFERENCE ORDER NO.:
BOC MAIN RECElV1NG DOCK BUREAU OF THE CENSUS
ROOM 1203A, FOB 4 ACQUISmON BRANCH, ROOM G-312-3
4700 SILVER HILL ROAD 4700 SILVER HILL ROAD
Atbl: S B MASSIE
SUITLAND. MD 20746 SUITLAND MD 20746
Phone:
I. ORDER NUMBER
Fopt1 CD-404-EF (09-97)
U. S. DEPARtMENT OF COHMERCE
SUPPLY, EQUIPMENT OR SERVICE ORDER 43-YA-BC-488 152
(CONTl:HUATl:OII SHEET)
32. SUPPUER 33. IssuiNG OFFICE 5. ORDER DATE 18. DATE PRINTED
PAGE 3 OF
1 TIlERESE ALLEN PRODUCTIONS BUREAU OF TIlE CENSUS 03/0812004 I 02/1012005
34. 35. 36. 37. 38. 39. 40. 41.
UNE MOL QTY QTY FINAL FULL ACCOUNTING CLASSIFICATION D1ST'Yo AMOUNT
ITEM RECVD
040200000-000 21 10-02-07-000 11-04-0009-00-00-00-0025-20-04-00 000000 100% 7.500.00
42. 43. 44. 45. 46. SHIP TO ADDRESS 42. 43. 44. 45. 46. SHIP TO ADDRESS
UNE MOL QTY RECEIVJNG (INCLUDE REFERENCE ORDER NO. UNE MOL QTY RECEIVING (IN<UJDE REFERENCE ORDER NO.
ITEM OFFICE CODE ON SHIPPING LABEL) ITEM OFFICE COOl! ON SHIPPING LABEL)
ACCEPTANCE: I CERTIFY lllAT ARTICLES ANDIORSERVICES ANNOTATED 54. ACCEPTANCE SIGNATURE&: TITI.E 55. ACCEPTANCE DATE
ABOVE HAVE BEEN RECEIVED, INSPECTED AND ACCEPTED AS COMPLV1NG
WITH nus ORDER. AS OF nJE DATE SHOWN.