Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698059038367.pdf (Georgia)
Page: 1 of 2 SGG80017M0349 ORDER FOR SUPPLIES OR SERVICES IMPORTANT: Mark all packages and papers with contract and/or order numbers.

1.

DATE OF ORDER 27 Feb 2017 3.

ORDER NO.

SGG80017M0349 2.

CONTRACT NO.

(If any) 4.

REQUISITION/REFERENCE NO.

PR6147263 a.

NAME OF CONSIGNEE SGG80017M0349, TBILI PAGE OF PAGES Page 1 6.

SHIP TO: AMERICAN EMBASSY TBILISI 5.


ISSUING OFFICE (Address correspondence to) AMERICAN EMBASSY TBILISI 11 GEORGE BALANCHINE STREET ATTN: GSO/PROCUREMENT TBILISI, 0131 Contact Name: Tamari Jashi Phone: 995-32-277000 Email: JashiT2@state.gov b.

STREET ADDRESS PR6147263, TBILI 11 GEORGE BALANCHINE STREET ATTN: WAREHOUSE c. CITY TBILISI f. SHIP VIA d. STATE e. ZIP CODE 0131 7.

TO: 8.

TYPE OF ORDER CONTACT PHONE NUMBER (+995 32) 2 47 88 77 E-MAIL: info@tenders.ge FAX: (+995 595) 38 36 35 a.
PURCHASE ORDER REFERENCE YOUR: _______ Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.

b.

DELIVERY ORDER -- Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of this form and is issued subject to the terms and conditions of the above-numbered contract.

a.

NAME OF CONTRACTOR KAKHA KAPANADZE DUNS NUMBER 123456787 b.
COMPANY NAME ELKO Ltd Legal Name: Tenders.ge c. STREET ADDRESS 32 SABURTALO ST. d. CITY TBILISI e. STATE f. ZIP CODE 0180 10.

REQUISITIONING OFFICE AMERICAN EMBASSY TBILISI ATTN: GSO 9.ACCOUNTING AND APPROPRIATION DATA 1900-2017--19___X45190001-5242-EUR--8790-SGG80017M0349-2528---- ---- $12.20USD Funds Certification Officer Signature: 11. BUSINESS CLASSIFICATION (Check appropriate box(es)) a.

SMALL b.
SMALL b.

OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED e. HUBZone f. SERVICE-DISABLED VETERAN-OWNED g. WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER h. EDWOSB THE WOMEN-OWNED SMALL BUSINESS PROGRAM 12.

F.O.B.

POINT Destination 13.

PLACE OF a.

INSPECTION b.

ACCEPTANCE 14.

GOVERNMENT B/L NO.

15.

DELIVER TO F.O.B.

POINT ON OR BEFORE (Date) 08 Mar 2017 16.

DISCOUNT TERMS ITEM NO.

(a) SUPPLIES OR SERVICES (b) QUANTITY ORDERED (c) UNIT (d) UNIT PRICE (e) AMOUNT (f) QUANTITY ACCEPTED (g) 17.
SCHEDULE (See reverse for Rejections) SEE LINE ITEM DETAIL 18.

SHIPPING POINT SEE BILLING INSTRUCTIONS ON REVERSE 19.

GROSS SHIPPING WEIGHT 21.

MAIL INVOICE TO: 20.

INVOICE NO.

a.

NAME AMERICAN EMBASSY TBILISI b.

STREET ADDRESS (or P.O.

Box) 11 GEORGE BALANCHINE STREET ATTN: GSO/PROCUREMENT c. CITY TBILISI d. STATE 22.

UNITED STATES OF AMERICA BY (Signature) e. ZIP CODE 0131 23.

NAME Typed Cassandra J Divjak TITLE: CONTRACTING/ORDERING OFFICER 17(h) TOT.

(Cont.
(Cont.

pages) 30.00GEL 17(i) (GRAND TOTAL) AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION NOT USABLE OPTIONAL FORM 347(REV.

9/2012) Prescribed by GSA/FAR 48 CFR 53.213(f) ORDER FOR SUPPLIES OR SERVICES SCHEDULE - CONTINUATION IMPORTANT: Mark all packages and papers with contract and/or order numbers.

DATE OF ORDER 27 Feb 2017 TITLE GSO- Advertisement of GOV TPL Insurance Solicitation CONTRACT NO.

ORDER NO.

SGG80017M0349 Page: 2 of 2 SGG80017M0349 PAGE NO.

ITEM NO.
ITEM NO.

(a) 0001 SUPPLIES OR SERVICES (b) Advertisement of Solicitation for Third Party Liability insurance for US Embassy Tbilisi Government Owned Vehicles QUANTITY ORDERED (c) 1.00 UNIT (d) each UNIT PRICE (e) 30.00GEL AMOUNT (f) 30.00GEL QUANTITY ACCEPTED (g) AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION NOT USABLE OPTIONAL FORM 348 (REV.
9/2012) Prescribed by GSA - FAR (48 CFR) 53.213(f) TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17h) 30.00GEL CONTINUATION TO OF 347  PAYMENT The vendor will be compensated for the services actually performed.

The Government will process payment under NET 30 payment terms after the completion of services and submission of vendor’s invoice to the US Embassy Tbilisi whichever occurs later.

To constitute a proper invoice, the invoice must include the following information and/or attached documentation: 1.
Name and Address of the Contractor 2.

Date of invoice 3.

Unique Vendor Invoice Number 4.

Remittance Contact Information 5.

Payment Terms 6.

Total days worked 7.

Total Invoice Amount 8.

Requisition Number, Contract Number and Order/Award Number, with modification number if applicable.

9.

Order line item number and information (see below instructions) 10.

The name of the contractor on the invoice must match the information indicated on the order/award 11.
Electronic funds transfer (EFT) banking information IMPORTANT: For proper payment, the invoice must detail products and/or services delivered on a line item basis in direct accordance with the corresponding order/award/contract.
Each line item must contain the following information: (1) Description of the services rendered for each line item (2) Line Item Quantity (3) Line Item Unit Price (4) Total Line Item Invoicing Amount (5) Delivery Date (6) Contract Line Item Number (CLIN) Invoice shall be submitted to the following address: Financial Management Office US Embassy Tbilisi, 11 George Balanchine St. Tbilisi, Georgia.

For payment enquires please contact: VoucheringWebPASSTbilisi@state.gov