REQUEST FOR CONTRACTUAL PROCUREMENT –NAVCOMPT FORM 2276 (REV



REQUEST FOR CONTRACTUAL PROCUREMENT1.THIS ORDER MUST BE ACCEPTED ON A REIMBURSABLE BASIS ONLY AND IS SUBJECT TO THE CONDITIONS LISTED ON THE REVERSE.2. DOCUMENT NUMBERMOU812- *-10013. REFERENCE NUMBER4. FUNDS EXPIRE ON30 Sep YY5. DMS6. PRIORITY*7. DATE REQUIRED*8. AMENDMENT NO.9.8th Med Bn2D FSSG FMFCLNC10.FOR DETAILSHM1 RIVERSX6-789011. CCO NORTHMAIL INVOICESSame as block #913.ACCOUNTING DATE TO BE CITED ON RESULTING BILLINGSA. ACRNB. APPROPC. SUBD. OBJ CLASSE. CONTROLF. SAG.H. TTI.J.K.AA17Y110627200000002700000272D000000MJ60000000000$30,00014.AMOUNTS WILL NOT BE EXCEEDED IN THE OBLIGATION DOCUMENT WITH PRIOR WRITTEN APPROVAL FROM THE ISSUER.L. TOTAL THIS DOCUMENT$30,000M. CUMULATIVE TOTAL$30,00015.PROCUREMENT BY CONTRACT OF THE FOLLOWING ITEMS IS REQUESTED THESE ITEMS ARE ARE NOT INCLUDED IN THE INTERSERVICE SUPPLY PROGRAM ANDREQUIRED INTERSERVICE SCREENING HAS HAS NOT BEEN ACCOMPLISHED A. ACRNB. ITEM NONOC. FSCD. DESCRIPTION(NAT STOCK NO, SPEC AND/OR DRAWING NO., ETC)E. QTYF. UNITG. ESTIMATEDUNIT PRICEH. ESTIMATEDAMOUNTAMOUNTAA18690BOTTLED WATERSINGLE LITER BOTTLES 625 BX OF 24 BT/BX15,000BT$2.00$30,00016.SEE ATTACHED PAGES FOR DELIVERY SCHEDULES, PRESERVATION AND PACKAGING INSTRUCTIONS, SHIPPING INSTRUCTIONS AND INSTRUCTIONS FOR DISTRIBUTION OF CONTRACTS AND RELATED DOCUMENTS.I. GRAND TOTAL$30,00017.TRANSPORTATION ALLOTMENT (Used if FOB Contractor’s plant)18.I CERTIFY THAT THE FUNDS CITED ARE PROPERLY ARE PROPERLY CHARGEABLE FOR THE WORK OR SERVICES REQUESTED.AUTHORIZING OFFICIAL (NAME, TITLE AND SIGNATURE)Jack KevorkianJ. KEVORKIAN, LCDR, MC USNR19.THIS WORK ORDER IS ACCEPTED AND THE WORK OR SERVICES WILL BE PROVIDED IN ACCORDANCE HEREWITH.ACCEPTING OFFICIAL (NAME, TITLE AND SIGNATURE)NAVCOMPT FORM 2276 (REV. 8-81) S/N 0104-LF-702-276 * = use recent date(s) as applicable. ................
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