AMS INPUT SHEET- PURCHASE/TASK/DELIVERY ORDER OVER \$25,000

> PREPARER: Fill in all applicable (except shaded) blocks.

  ----------- --------------------- ---------- ---------------------------
  1\. Order                         2\.        
  Number                            Proposal   
                                    Number     

  ----------- --------------------- ---------- ---------------------------

  ------------ -- -- ------------ --------- ---------- -------- --- ------------------- --------- --
  3\. LEAD PR                               4\.                     4a. More than                 
  Number                                    Closeout                [ONE]{.underline}             
                                            PR                      PR                            

  4b. Num of         5\.                               6\. CIC                                    
  Linked PRs         Contractor                        Number                                     
                     VID                                                                          
  ------------ -- -- ------------ --------- ---------- -------- --- ------------------- --------- --

  ------------ -------------- -------- ------------ ---------- ------------
  7\. CPOP VID                8\. PIN               8a. AIN    

  ------------ -------------- -------- ------------ ---------- ------------

  ---------------- -- -- ----------------------- ------------ ---------------
  Over \$25K (Y)es       14\. CAGE Code                       
  (N)o                                                        

  9\. Contractor                                              
  Name                                                        
  ---------------- -- -- ----------------------- ------------ ---------------

  -------------- --------------------------- ---- ------------ ---- ----------
  10\.                                       13                15   
  Contractor                                                        
  Division                                                          

  -------------- --------------------------- ---- ------------ ---- ----------

> **Phone Number TIN**

<table>
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<col style="width: 9%" />
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<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="4">11. Contractor Address</td>
<td colspan="17"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2">(No P.O. Box No.)</td>
<td colspan="2"></td>
<td colspan="2">Street Address</td>
<td colspan="13"></td>
</tr>
<tr class="odd">
<td colspan="4">12 Contractor Address</td>
<td colspan="7"></td>
<td colspan="3"></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="7">City</td>
<td colspan="2">State</td>
<td colspan="2">Zip Code</td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td colspan="4">16a. Place of Performance</td>
<td colspan="17"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2">(No P.O. Box No.)</td>
<td colspan="2"></td>
<td colspan="2">Street Address</td>
<td colspan="13"></td>
</tr>
<tr class="odd">
<td colspan="4">16. Place of Performance</td>
<td colspan="7"></td>
<td colspan="2"></td>
<td colspan="4"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="7">City</td>
<td colspan="2">State</td>
<td colspan="4">17 Zip Code</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="3">18. Award Date</td>
<td colspan="4"></td>
<td colspan="2">80. Current Completion Date</td>
<td></td>
<td colspan="5"></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="6"><p>Enter the year, month, and day (yyyy/mm/dd)</p>
<p>that the Contracting Officer signed the contract.</p></td>
<td colspan="2"><blockquote>
<p>Enter the completion date for this order..</p>
</blockquote></td>
<td colspan="10"></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

<table style="width:100%;">
<colgroup>
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 8%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 2%" />
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<col style="width: 0%" />
<col style="width: 11%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 4%" />
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<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 4%" />
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<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="3">20. PPC</td>
<td></td>
<td colspan="14">21. Kind of Action………………………………………..</td>
<td colspan="2"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="9"><p>01. New Letter Contract</p>
<p>03. New Basic Contract (Not IDC)</p>
<p>23. Order Under Mandatory FSS</p>
<p>24-Order Under Optional FSS</p></td>
<td colspan="9"><p>25-Order Under IDC (Single Award)</p>
<p>26-Order Under BOA</p>
<p>27-Simplified Acquisition Procedures</p>
<p>28-Order Under Multiple Award Contract</p>
<p>61. BPA Call</p></td>
<td colspan="13"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4">22. IDV Type</td>
<td colspan="2"></td>
<td colspan="26">23. Contractor
Type………………………………………………………………………………..</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="9"><p>A. GWAC</p>
<p>B. Indefinite Delivery Contract</p>
<p>D. Basic Ordering Agreement</p>
<p>E. Blanket Purchasing Agreement</p>
<p>F. Multi-Agency Contract</p></td>
<td colspan="6"><p><u>Business</u></p>
<p>01. 8(a) Disadvantaged</p>
<p>03. Disadvantaged Direct</p>
<p>04. Not Disadvantaged</p></td>
<td colspan="8"><p><u>Nonprofit Org.</u></p>
<p>05. Educational (Non-Minority)</p>
<p>15. Educational (HBCU)</p>
<p>25. Educational (Other Minority)</p>
<p>06. Hospital</p>
<p>08. Other Nonprofit (Non-minority)</p>
<p>18. Other Nonprofit (Minority)</p></td>
<td colspan="12"><p><u>State/Local Gov</u>′<u>t</u></p>
<p>09. Educational (Non-Minority)</p>
<p>19. Educational (HBCU)</p>
<p>29. Educational (Other Minority)</p>
<p>10. Hospital</p>
<p>12. Other State/Local Gov′t</p></td>
</tr>
<tr class="odd">
<td colspan="8">24. Woman-Owned Small Business</td>
<td colspan="3"></td>
<td></td>
<td colspan="14"></td>
<td colspan="4"></td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="11">(Y)es or (N)o</td>
<td colspan="8"></td>
<td colspan="10"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5">25. Award Outside US</td>
<td colspan="3"></td>
<td colspan="8">26. Extent of Competition ………………..</td>
<td colspan="2"></td>
<td colspan="8">27. Type of Service/Product</td>
<td></td>
<td colspan="4"></td>
<td colspan="2"></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8"><p>L. Foreign Firm</p>
<p>M. Domestic Firm Performing Outside U.S.</p></td>
<td colspan="6"><p><u>Competed</u></p>
<p>2. Sealed Bid</p>
<p>3. Competed Action - SEB</p>
<p>4. Other Competed Action</p></td>
<td colspan="4"><p><u>Not Competed</u></p>
<p>5. Follow-on to</p>
<p>Competed Action</p>
<p>6. Other Not Competed</p></td>
<td colspan="3"></td>
<td colspan="14">Enter the code from the Product/Service Code Manual
that represents most of the ultimate PO value.</td>
</tr>
</tbody>
</table>

  --------------------- -------------------------------------------------
  Order Number:         

  --------------------- -------------------------------------------------

<table>
<colgroup>
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<col style="width: 18%" />
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2">111. Price/Estimated Cost</td>
<td colspan="5"></td>
<td colspan="10">30. Bundling of Contract...............………..</td>
<td colspan="2"></td>
<td colspan="5">82. Physically Complete Date</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7"></td>
<td colspan="10"><p>A-Mission Critical B-OMB Circular A-76</p>
<p>C-Other N-Not Bundled</p></td>
<td colspan="2"></td>
<td colspan="5"><strong>(Do not fill in unless you are closing out the
contract)</strong></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="3">28. Solicitation Issue Date</td>
<td colspan="5"></td>
<td colspan="10">29. Solicitation Identifier</td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td colspan="18">32. Order Description (Describe in succinct, meaningful
terms) 100 characters</td>
<td colspan="10"></td>
</tr>
<tr class="odd">
<td colspan="28"></td>
</tr>
<tr class="even">
<td colspan="28"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td>33. CICA Applicabilty</td>
<td colspan="2"></td>
<td colspan="9"></td>
<td colspan="2"></td>
<td colspan="10">35. Contract Type . ............... ...............
..................</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="12"><p>1-Pre-CICA, 2-Post-CICA,</p>
<p>3-Simplified Acquisition Procedures,</p>
<p>4-Commercial Item Under Test Program</p></td>
<td colspan="2"></td>
<td colspan="7"><p>01. Fixed Price, Firm</p>
<p>02. Fixed Price, Redetermination</p>
<p>03. Fixed Price, Economic Price</p>
<p>Adjustment</p>
<p>04. Fixed Price, Incentive</p>
<p>05. Cost No Fee</p>
<p>06. Cost Sharing</p>
<p>07. Cost Plus Fixed Fee</p>
<p>08. Cost Plus Incentive Fee</p>
<p>09. Time and Materials</p></td>
<td colspan="5"><p>10. Labor-hour</p>
<p>12. Cost Plus Award Fee</p>
<p>13. Fixed Price Level</p>
<p>of Effort</p>
<p>14. Fixed Price Award Fee</p>
<p>15. Order dependent</p>
<p>16. Combination</p>
<p>17. Fixed Price Award Term</p>
<p>18. Cost Plus Award Term</p>
<p>19. Other</p></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="3" rowspan="2">36. Procurement Synopsized... (Y)es (N)o (U)
No, due to urgency</td>
<td colspan="3"></td>
<td colspan="6" rowspan="2"><p>37. Synopsis Waiver Exception</p>
<p>(Y)es SBA/OFPP Waiver Program</p>
<p>(N)o Not applicable</p></td>
<td colspan="2"></td>
<td colspan="7" rowspan="2"></td>
<td colspan="5" rowspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="9" rowspan="2"><p>38. Percent Performance Based……</p>
<p>A= 100% B= 90-99% C= 80-89% D=70-79 E= 60-69%</p>
<p>F= 50-59% G= 40-49% H=30-39% J= 20-29%</p>
<p>K= 10-19% L= 1-9% N=None/Not PBC</p></td>
<td></td>
<td colspan="14" rowspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="3">40. Number of Offers Received</td>
<td colspan="3"></td>
<td colspan="5">41. Solicitation Procedures</td>
<td></td>
<td colspan="11"><blockquote>
<p>42. Authority Other Than Full and Open...................</p>
</blockquote></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="4">(Note: For all HQS-initiated solicitations, e.g., AO′s,
NRA′s, Phase I SBIR′s, etc, use ″999”.)</td>
<td colspan="9"><p>A. Full and Open Competition - Sealed Bid</p>
<p>B. Full and Open Competition - Competitive</p>
<p>C. Full and Open Competition - Combination</p>
<p>D. Architect - Engineer</p>
<p>E. NASA Research Announcement</p>
<p>Announcement of Opportunity</p>
<p>F. Multiple Award Schedule</p>
<p>G. Alternate Source</p>
<p>K. Set-Asides</p>
<p>L. Other Than Full and Open Competition</p></td>
<td colspan="7"><p>A. Unique Source (1)</p>
<p>B. Follow-on Contract (1)</p>
<p>C. Unsolicited Research Proposal (1)</p>
<p>D. Patent/Data Rights (1)</p>
<p>E. Utilities (1)</p>
<p>F. Standardization (1)</p>
<p>G. Only One Source- Other (1)</p>
<p>H. Urgency (2)</p></td>
<td colspan="6"><p>J. Mobilization, Essential R&amp;D Capabilities, or
Expert</p>
<p>Services (3)</p>
<p>L. International Agreement (4)</p>
<p>M. Authorized by Statute (5)</p>
<p>N. Authorized for Resale (5)</p>
<p>P. National Security (6)</p>
<p>Q. Public Interest (7)</p></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="6">31. Referenced Contract Number</td>
<td colspan="10"></td>
<td colspan="7"></td>
<td colspan="3"></td>
<td></td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 0%" />
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<col style="width: 25%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 4%" />
<col style="width: 30%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td>43. Labor Statutes</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2">45. NAICS Code……………………….…</td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"><blockquote>
<p>N. Not Subject to Labor Statutes</p>
<p>1. Walsh-Healy Act</p>
<p>3. Service Contract Act</p>
<p>4. Davis-Bacon Act</p>
</blockquote></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2">Please refer to Designated Industry list in FAR 19.1005
and Targeted Industry list in NFS 1819.1005 to see if NAICS Code used is
listed. This will determine if Block 60 – Demo Test is Yes or No</td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 0%" />
<col style="width: 31%" />
<col style="width: 6%" />
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="4">46. Any Delegation
Issued.................…………...............</td>
<td></td>
<td colspan="8">47. Multiyear Contracting (NOT merely multiple-year)
(Y)es (N)o</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="10">Multi-year contracts are issued under specific
Congressional authority for specific programs. They authorize
performance beyond the period for which funding has been appropriated,
without having to exercise options for each program year. They normally
include a cancellation ceiling, i.e., the maximum amount the Gov't will
pay for termination if the remaining funding is not appropriated.</td>
</tr>
<tr class="odd">
<td colspan="4">48. Advisory/Asst. Services Contract (Y)es (N)o</td>
<td></td>
<td colspan="8">49. Support Service Contract (Y)es (N)o</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td colspan="5"></td>
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td colspan="4">50. Cost Accounting Standards Clause (Y)es (N)o</td>
<td></td>
<td colspan="8">51. New Technology/Patent Rights (Y)es (N)o</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"></td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="8"></td>
<td colspan="2">Order Number:</td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4">52. Subcontracting Program Plan…………………….</td>
<td colspan="2"></td>
<td colspan="8">53. SBIR
Award........................……………................</td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><p>A-Plan Not Included</p>
<p>B-Plan Not Required</p>
<p>C-Plan Required-Incentive Not Included</p>
<p>D-Plan Required-Incentive Included</p></td>
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="5"><p>N-Not SBIR</p>
<p>1-Phase I</p>
<p>2-Phase II</p>
<p>3-Phase III</p></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

  ---------------------------------------------------------------------------- ----------------------- --- ---- ------------------ ------------------------ -------- ---
  54\. STTR                                                                                                     55\. Contract                                        
  Award\...\...\...\...\...\...\...\...\...\...\...\...\..............\.....                                    funded by Foreign                                    
                                                                                                                Gov′t/Int′l                                          
                                                                                                                Org.............                                     

                                                                               N-Not STTR 1-Phase I 2-                             (Y)es (N)o                        
                                                                               Phase II 3- Phase III                                                                 
  ---------------------------------------------------------------------------- ----------------------- --- ---- ------------------ ------------------------ -------- ---

<table style="width:100%;">
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<col style="width: 4%" />
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<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 0%" />
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<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 2%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="19">56. Cost and Performance
Reporting.................</td>
<td colspan="6"></td>
<td colspan="25">57. Property Financial Reporting.......………………….…</td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="17"><p>N. None required 2. NF 533M only</p>
<p>3. NF 533M &amp; 533Q</p></td>
<td colspan="8"></td>
<td colspan="20">(Y)es (N)o</td>
<td colspan="9"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="19">58. Commercial Item Acquisition (Y)es (N)o</td>
<td colspan="6"></td>
<td colspan="20"></td>
<td colspan="9"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="11"></td>
<td colspan="13"></td>
<td colspan="18"></td>
<td colspan="10"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="19">59. Country of
Manufacture.........................…………..</td>
<td colspan="6"></td>
<td colspan="23">60. Demonstration Test Program</td>
<td colspan="5"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="15"></td>
<td colspan="12"></td>
<td></td>
<td colspan="21">(Y)es, (N)o Answer (Y)es for all contracts in the NAICS
Codes listed in FAR and NFS Parts 19.10. <strong>If (N)o, Questions 61,
62, and 63 must be left blank.</strong></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="18">61. Emerging Small Business (Y)es (N)o …………………</td>
<td colspan="6"></td>
<td colspan="24">62. Emerging Sm. Bus. Reserve Award (Y)es (N)o</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="12">63. Size of Small Business………………...</td>
<td colspan="2"></td>
<td colspan="23">64. Value Engineering Clause... (Y)es (N)o</td>
<td colspan="2"></td>
<td colspan="10">65. Ethnic Type</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="19">See size standard to determine which category (FAR
19.102, 13 CFR, part 121):</td>
<td colspan="20"></td>
<td colspan="15" rowspan="2"><p>A. Asian-Indian American</p>
<p>B. Asian-Pacific American</p>
<p>C Black American</p>
<p>D Hispanic American</p>
<p>E Native American</p>
<p>F Other Certified</p>
<p>N No Reporesentation</p></td>
</tr>
<tr class="even">
<td colspan="7"><p><u>Number of Employees</u></p>
<p>A. 50 or Fewer E. 501 - 750</p>
<p>B. 51 - 100 F. 751 - 1000</p>
<p>C. 101 - 250 G. Over 1000</p>
<p>D. 251 - 500</p></td>
<td colspan="4"><u>OR</u></td>
<td colspan="29"><p><u>Average Annual Gross Revenue</u></p>
<p>M. $1,000,000 or Less N. $1,000,001 - $2,000,000</p>
<p>P. $2,000,001 - $3,500,000 R. $3,500,001 - $5,000,000</p>
<p>S. $5,000,001 - $10,000,000 T. $10,000,000 - $17,000,000</p>
<p>Z. Over $17,000,000</p></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4">66. Effective Date</td>
<td colspan="10"></td>
<td colspan="20">67. Security Code (Y)es (N)o</td>
<td colspan="3"></td>
<td colspan="14">68. Equipment Code (Y)es (N)o</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4">69. Administrator’s Code</td>
<td colspan="4"></td>
<td colspan="10">70. CO’s Code</td>
<td colspan="4"></td>
<td colspan="12">71. Negotiator’s Code</td>
<td colspan="3"></td>
<td colspan="9">71a. Negotiator’s Phone</td>
<td colspan="8"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">72. COTR Name</td>
<td colspan="21"></td>
<td colspan="11">73. Org. Code</td>
<td colspan="3"></td>
<td colspan="10"></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="23">Last Name and First Initial</td>
<td colspan="11"></td>
<td colspan="3"></td>
<td colspan="10"></td>
<td colspan="7"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3">74. Contract Funding Code</td>
<td colspan="3"></td>
<td colspan="14">74a. Lg/Sm Business</td>
<td colspan="4"></td>
<td colspan="27">75. Reason Not Small Business …………………………………………</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="9"><p>F – Fully Funded</p>
<p>I – Incrementally Funded</p>
<p>U – Unfunded</p></td>
<td colspan="11"><p>(L)arge</p>
<p>(S)mall</p></td>
<td colspan="9"></td>
<td colspan="12"><p>A No known sm. bus. source</p>
<p>B SB not solicited</p>
<p>C SB solicited and no offer received</p></td>
<td colspan="13"><p>D SB solicited and offer was</p>
<p>not low</p>
<p>Z Other reason</p></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4">76. A-76 Action (Y)es (N)o</td>
<td colspan="3"></td>
<td colspan="23"></td>
<td colspan="3"></td>
<td colspan="18">77. Purchase Card for Pmt (Y)es (N)o</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="5">80a. Final Invoice Paid Date</td>
<td colspan="8"></td>
<td colspan="32">81. Ultimate Completion Date</td>
<td colspan="9"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="17">83. Other Preference Programs……………………..</td>
<td colspan="6"></td>
<td colspan="12"></td>
<td colspan="16">84. HUBZone Small Business Concern</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="35"><p>A. Directed to JWOD Nonprofit Agency D. No
Preference Program</p>
<p>B. Small Business Set-Aside E. Very Small Business Set-Aside ($2,500
- $50K)</p>
<p>C. Reserved</p>
<p><strong>NOTE: If a preference program is selected under item 85 or
87, item 83 must be blank.</strong></p></td>
<td colspan="7">(Y)es or (N)o</td>
<td colspan="12"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="26">85. HUBZone Program</td>
<td colspan="5"></td>
<td colspan="19">87. Small Disadv’d Business Program</td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="9"><p>A. HUBzone Sole source</p>
<p>B. HUBZone Set-Aside</p>
<p>C. HUBZone Price Evaluation Preference</p></td>
<td colspan="23"><p>D. Combined HUBZone</p>
<p>Preference/SDB Price Adjustment</p>
<p>E. Not Applicable</p></td>
<td colspan="8"><p>A. 8(A) Contract Award</p>
<p>B. 8(A) with HUBZone Priority</p>
<p>C. SDB Set-Aside</p></td>
<td colspan="14"><p>D. SDB Price Evaluation Adjustment</p>
<p>E. SDB Participation Program</p>
<p>F. Not Applicable</p></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="18">88. HUBZone Price Evaluation Preference Percent</td>
<td colspan="3"></td>
<td colspan="29">89. SDB Price Evaluation Adjustment Percent
Difference</td>
<td colspan="4"></td>
</tr>
</tbody>
</table>

  --------------------- -------------------------------------------------
  Order Number:         

  --------------------- -------------------------------------------------

+---------------------------+---+-----------------------------------+---+---+
| 86\. Veteran Owned Sm Bus |   | 115\. Multiple Award Contract     |   |   |
| Award                     |   | Fair Opportunity                  |   |   |
+---------------------------+---+-----------------------------------+---+---+
| A. Service Disabled       |   | (Only applies to calls, delivery  |   |   |
| Veteran Owned             |   | orders, and task orders;          |   |   |
|                           |   | **otherwise leave blank**)        |   |   |
| Small Business            |   |                                   |   |   |
|                           |   | A. Fair Opportunity Process       |   |   |
| B. Veteran Owned Small    |   |                                   |   |   |
| Business                  |   | B. Urgency                        |   |   |
|                           |   |                                   |   |   |
| C. Not Veteran Owned      |   | C. One/Unique Source              |   |   |
| Small Business            |   |                                   |   |   |
|                           |   | D. Follow-on Contract             |   |   |
|                           |   |                                   |   |   |
|                           |   | E. Minimum Guarantee              |   |   |
+---------------------------+---+-----------------------------------+---+---+

+-----------------------------------+---+---+------------------------+---+
| 90\. Environmental Protection     |   |   | 91\. Use of Recovered  |   |
| Agency (EPA) Designated Products  |   |   | Material Clauses       |   |
+-----------------------------------+---+---+------------------------+---+
| A. Purchase Contained Required    |   |   | A. FAR 52.223-4,       |   |
| Minimum Recovered Material        |   |   | Recovered Material     |   |
| Content                           |   |   | Certification,         |   |
|                                   |   |   |                        |   |
| B. No Minimum Recovered Material  |   |   | B FAR 52.223-4,        |   |
| Content; Unable to Competitively  |   |   | Recovered Material     |   |
|                                   |   |   | Certification and      |   |
| Acquire w/in Reasonable Time      |   |   |                        |   |
|                                   |   |   | FAR 52.223-9, Estimate |   |
| C. No Minimum Recovered Material  |   |   | of Percentage of       |   |
| Content; Unable to Acquire at     |   |   | Recovered              |   |
|                                   |   |   |                        |   |
| Reasonable Price                  |   |   | Material Content for   |   |
|                                   |   |   | EPA Designated         |   |
| D. No Minimum Recovered Material  |   |   | Products.              |   |
| content; Unable to Acquired at    |   |   |                        |   |
|                                   |   |   | C. Neither clause      |   |
| Reasonable Performance Standards  |   |   | stated in B is         |   |
|                                   |   |   | included in the        |   |
| E. No EPA Product(s) Required.    |   |   | contract.              |   |
+-----------------------------------+---+---+------------------------+---+

  ------------------------------------- ---- ------------------------- ---
  92\. Name of Major Program that this                                 
  procurement is related to (100                                       
  characters)                                                          

                                                                       

                                                                       

  93\. Program Acronym (25 characters)                                 
  Use **exact** official acronym.                                      
  ------------------------------------- ---- ------------------------- ---

+--------------------------------+---+---+---+----------------------------+---+
| 94\. Funding Agency -- IT      |   |   | 9 |                            |   |
| Commercial Item Category       |   |   | 5 |                            |   |
|                                |   |   | \ |                            |   |
|                                |   |   | . |                            |   |
|                                |   |   | F |                            |   |
|                                |   |   | u |                            |   |
|                                |   |   | n |                            |   |
|                                |   |   | d |                            |   |
|                                |   |   | i |                            |   |
|                                |   |   | n |                            |   |
|                                |   |   | g |                            |   |
|                                |   |   | A |                            |   |
|                                |   |   | g |                            |   |
|                                |   |   | e |                            |   |
|                                |   |   | n |                            |   |
|                                |   |   | c |                            |   |
|                                |   |   | y |                            |   |
|                                |   |   | ( |                            |   |
|                                |   |   | 4 |                            |   |
|                                |   |   | p |                            |   |
|                                |   |   | o |                            |   |
|                                |   |   | s |                            |   |
|                                |   |   | i |                            |   |
|                                |   |   | t |                            |   |
|                                |   |   | i |                            |   |
|                                |   |   | o |                            |   |
|                                |   |   | n |                            |   |
|                                |   |   | s |                            |   |
|                                |   |   | ) |                            |   |
+--------------------------------+---+---+---+----------------------------+---+
| (Report the appropriate code   |   |   |   | This field may be blank.   |   |
| if Funding Agency is DOD and   |   |   |   | If reporting an award done |   |
| the Type of Product/Service    |   |   |   | by your Center on behalf   |   |
| Code begins with 70 or D3, is  |   |   |   | of another federal agency, |   |
| UO12, or ends with 70.         |   |   |   | and 100% of the funding    |   |
| **Otherwise, leave blank**.)   |   |   |   | comes from that other      |   |
|                                |   |   |   | agency, report the         |   |
| A. Commercially Available      |   |   |   | four-digit agency code     |   |
| Off-The-Shelf Item.            |   |   |   | (FIPS 95) of the funding   |   |
|                                |   |   |   | agency. The FIPS 95 code   |   |
| B. Other Commercial Item.      |   |   |   | will be placed on the      |   |
|                                |   |   |   | Purchase Request by the    |   |
| C. Nondevelopmental Item       |   |   |   | finance office. A list of  |   |
|                                |   |   |   | valid codes are available  |   |
| D. Noncommercial Item          |   |   |   | at                         |   |
|                                |   |   |   | <http://FPDS.GS            |   |
| E. Commercial Service          |   |   |   | A.GOV/fpds/downloads.htm>. |   |
|                                |   |   |   |                            |   |
| F. Noncommercial Service       |   |   |   |                            |   |
+--------------------------------+---+---+---+----------------------------+---+

<table>
<colgroup>
<col style="width: 39%" />
<col style="width: 4%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 32%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="3">96. Funding Agency – Department of Defense Activity
Address Code (DODAAC). (6 positions)</td>
<td colspan="2"></td>
<td colspan="4">97. Funding Agency - Reason for Purchase</td>
<td></td>
</tr>
<tr class="even">
<td colspan="4">If the award being reported in Funding Agency (Item 83)
is for the Department of Defense (begins with 17, 21, 57, 96CE, or 97)
enter the six digit Department of Defense Activity Address Code
(DODAAC).</td>
<td colspan="2"></td>
<td colspan="4"><p>Report the appropriate code if Funding Agency is DOD
and the Type of Product/Service Code begins with 70 or D3, is UO12, or
ends with 70. <strong>Otherwise, leave blank</strong>.</p>
<p>A. Convenience and Economy</p>
<p>B. Expertise</p>
<p>C. Specifically Authorized</p>
<p>D. Authorized by Executive Order</p>
<p>E. Modification or Extension of an existing order</p>
<p>F. Other</p></td>
</tr>
<tr class="odd">
<td colspan="3">98. Funding Agency – Clinger-Cohen Act</td>
<td colspan="2"></td>
<td colspan="3" rowspan="2"><p>99. DOD Claimant Program Code</p>
<p>If Funding Agency is DOD, report the appropriate code from the DOD
Procurement Coding Manual Section III</p>
<p>(Obtain code from DOD requirements office)</p></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="3"><p>Report the appropriate code if Funding Agency is DOD
and the Type of Product/Service Code begins with 70 or D3, is UO12, or
ends with 70. <strong>Otherwise, leave blank</strong>.</p>
<p>(Y)es. The DOD program office has certified that the IT purchase
meets the planning requirements in 40 USC 1422 and 1423</p>
<p>(N)o. The DOD program office has not provided the
certification.</p></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>101. Other Statutory Authority</td>
<td></td>
<td colspan="5">120. Fee Paid for Use of IDV</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="2"><p>For a Multi-agency contract, indicate the
statutory authority:</p>
<p>A. Space Act (NASA always uses the Space Act instead of</p>
<p>the Economy Act)</p>
<p>B. IG Act</p>
<p>C. Other (cite:__________________)</p></td>
<td colspan="5" rowspan="2">Amount of administrative fee paid to another
Agency for placing this order against their indefinite delivery
vehicle.</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
</tr>
</tbody>
</table>

  --------------------- -------------------------------------------------
  Order Number:         

  --------------------- -------------------------------------------------

**The following five fields are required if this procurement is for
research (PSC in block 27 starts with "A") or if the contractor is an
educational institution or nonprofit organization. These fields are from
NF1356, CASE Report; see that form for definitions. The field numbers
are the CASE field numbers preceded by "C".**

+---------------+----+---+---+----+---------------+---+-----------------+
| C-3.          |    |   |   |    | C-4.          |   |                 |
| Principal     |    |   |   |    | Alternate     |   |                 |
| Investigator  |    |   |   |    | Principal     |   |                 |
|               |    |   |   |    | Investigator  |   |                 |
| (Two initials |    |   |   |    |               |   |                 |
| and last      |    |   |   |    | (Two initials |   |                 |
| name)         |    |   |   |    | and last      |   |                 |
|               |    |   |   |    | name)         |   |                 |
+---------------+----+---+---+----+---------------+---+-----------------+
|               |    |   |   |    |               |   |                 |
+---------------+----+---+---+----+---------------+---+-----------------+
| C-6. Primary  |    |   |   |    | C-9.          |   |                 |
| NASA Tech     |    |   |   |    | Alternate     |   |                 |
| Officer       |    |   |   |    | NASA Tech     |   |                 |
|               |    |   |   |    | Officer       |   |                 |
| (Two initials |    |   |   |    |               |   |                 |
| and last      |    |   |   |    | (Two initials |   |                 |
| name)         |    |   |   |    | and last      |   |                 |
|               |    |   |   |    | name)         |   |                 |
+---------------+----+---+---+----+---------------+---+-----------------+
|               |    |   |   |    |               |   |                 |
+---------------+----+---+---+----+---------------+---+-----------------+
| C-14. Field   |    |   |   |    |               |   |                 |
| of Science or |    |   |   |    |               |   |                 |
| Engineering   |    |   |   |    |               |   |                 |
|               |    |   |   |    |               |   |                 |
| (Obtain from  |    |   |   |    |               |   |                 |
| requirements  |    |   |   |    |               |   |                 |
| office)       |    |   |   |    |               |   |                 |
+---------------+----+---+---+----+---------------+---+-----------------+
| **PHYSICAL    |    |   | * |    |               | * |                 |
| SCIENCES**    |    |   | * |    |               | * |                 |
|               |    |   | M |    |               | E |                 |
| 11 ASTRONOMY  |    |   | A |    |               | N |                 |
|               |    |   | T |    |               | V |                 |
| 12 CHEMISTRY  |    |   | H |    |               | I |                 |
|               |    |   | / |    |               | R |                 |
| 13 PHYSICS    |    |   | C |    |               | O |                 |
|               |    |   | O |    |               | N |                 |
| 19 PHYSICAL   |    |   | M |    |               | M |                 |
| SCIENCE,      |    |   | P |    |               | E |                 |
| NEC\*         |    |   | U |    |               | N |                 |
|               |    |   | T |    |               | T |                 |
|               |    |   | E |    |               | A |                 |
|               |    |   | R |    |               | L |                 |
|               |    |   | S |    |               | S |                 |
|               |    |   | * |    |               | C |                 |
|               |    |   | * |    |               | I |                 |
|               |    |   |   |    |               | E |                 |
|               |    |   | 2 |    |               | N |                 |
|               |    |   | 1 |    |               | C |                 |
|               |    |   | M |    |               | E |                 |
|               |    |   | A |    |               | * |                 |
|               |    |   | T |    |               | * |                 |
|               |    |   | H |    |               |   |                 |
|               |    |   | E |    |               | 3 |                 |
|               |    |   | M |    |               | 1 |                 |
|               |    |   | A |    |               | A |                 |
|               |    |   | T |    |               | T |                 |
|               |    |   | I |    |               | M |                 |
|               |    |   | C |    |               | O |                 |
|               |    |   | S |    |               | S |                 |
|               |    |   |   |    |               | P |                 |
|               |    |   | 2 |    |               | H |                 |
|               |    |   | 2 |    |               | E |                 |
|               |    |   | C |    |               | R |                 |
|               |    |   | O |    |               | I |                 |
|               |    |   | M |    |               | C |                 |
|               |    |   | P |    |               | S |                 |
|               |    |   | U |    |               | C |                 |
|               |    |   | T |    |               | I |                 |
|               |    |   | E |    |               | E |                 |
|               |    |   | R |    |               | N |                 |
|               |    |   | S |    |               | C |                 |
|               |    |   | C |    |               | E |                 |
|               |    |   | I |    |               | S |                 |
|               |    |   | E |    |               |   |                 |
|               |    |   | N |    |               | 3 |                 |
|               |    |   | C |    |               | 2 |                 |
|               |    |   | E |    |               | G |                 |
|               |    |   | S |    |               | E |                 |
|               |    |   |   |    |               | O |                 |
|               |    |   | 2 |    |               | L |                 |
|               |    |   | 9 |    |               | O |                 |
|               |    |   | M |    |               | G |                 |
|               |    |   | A |    |               | I |                 |
|               |    |   | T |    |               | C |                 |
|               |    |   | H |    |               | A |                 |
|               |    |   | / |    |               | L |                 |
|               |    |   | C |    |               | S |                 |
|               |    |   | O |    |               | C |                 |
|               |    |   | M |    |               | I |                 |
|               |    |   | P |    |               | E |                 |
|               |    |   | U |    |               | N |                 |
|               |    |   | T |    |               | C |                 |
|               |    |   | E |    |               | E |                 |
|               |    |   | R |    |               | S |                 |
|               |    |   | S |    |               |   |                 |
|               |    |   | , |    |               | 3 |                 |
|               |    |   | N |    |               | 3 |                 |
|               |    |   | E |    |               | O |                 |
|               |    |   | C |    |               | C |                 |
|               |    |   | \ |    |               | E |                 |
|               |    |   | * |    |               | A |                 |
|               |    |   |   |    |               | N |                 |
|               |    |   |   |    |               | O |                 |
|               |    |   |   |    |               | G |                 |
|               |    |   |   |    |               | R |                 |
|               |    |   |   |    |               | A |                 |
|               |    |   |   |    |               | P |                 |
|               |    |   |   |    |               | H |                 |
|               |    |   |   |    |               | Y |                 |
|               |    |   |   |    |               |   |                 |
|               |    |   |   |    |               | 3 |                 |
|               |    |   |   |    |               | 9 |                 |
|               |    |   |   |    |               | E |                 |
|               |    |   |   |    |               | N |                 |
|               |    |   |   |    |               | V |                 |
|               |    |   |   |    |               | I |                 |
|               |    |   |   |    |               | R |                 |
|               |    |   |   |    |               | O |                 |
|               |    |   |   |    |               | N |                 |
|               |    |   |   |    |               | M |                 |
|               |    |   |   |    |               | E |                 |
|               |    |   |   |    |               | N |                 |
|               |    |   |   |    |               | T |                 |
|               |    |   |   |    |               | A |                 |
|               |    |   |   |    |               | L |                 |
|               |    |   |   |    |               | S |                 |
|               |    |   |   |    |               | C |                 |
|               |    |   |   |    |               | I |                 |
|               |    |   |   |    |               | E |                 |
|               |    |   |   |    |               | N |                 |
|               |    |   |   |    |               | C |                 |
|               |    |   |   |    |               | E |                 |
|               |    |   |   |    |               | S |                 |
|               |    |   |   |    |               | , |                 |
|               |    |   |   |    |               | N |                 |
|               |    |   |   |    |               | E |                 |
|               |    |   |   |    |               | C |                 |
|               |    |   |   |    |               | \ |                 |
|               |    |   |   |    |               | * |                 |
+---------------+----+---+---+----+---------------+---+-----------------+
| **            |    |   | * |    |               | * |                 |
| ENGINEERING** |    |   | * |    |               | * |                 |
|               |    |   | L |    |               | P |                 |
| 41            |    |   | I |    |               | S |                 |
| AERONAUTICAL  |    |   | F |    |               | Y |                 |
|               |    |   | E |    |               | C |                 |
| 42            |    |   | S |    |               | H |                 |
| ASTRONAUTICAL |    |   | C |    |               | O |                 |
|               |    |   | I |    |               | L |                 |
| 43 CHEMICAL   |    |   | E |    |               | O |                 |
|               |    |   | N |    |               | G |                 |
| 44 CIVIL      |    |   | C |    |               | Y |                 |
|               |    |   | E |    |               | * |                 |
| 45 ELECTRICAL |    |   | S |    |               | * |                 |
|               |    |   | P |    |               |   |                 |
| 46 MECHANICAL |    |   | S |    |               | 6 |                 |
|               |    |   | Y |    |               | 1 |                 |
| 47 METALLURGY |    |   | C |    |               | B |                 |
| AND MATERIALS |    |   | H |    |               | I |                 |
|               |    |   | O |    |               | O |                 |
| 49            |    |   | L |    |               | L |                 |
| ENGINEERING,  |    |   | O |    |               | O |                 |
| NEC\*         |    |   | G |    |               | G |                 |
|               |    |   | Y |    |               | I |                 |
|               |    |   | * |    |               | C |                 |
|               |    |   | * |    |               | A |                 |
|               |    |   |   |    |               | L |                 |
|               |    |   | 5 |    |               |   |                 |
|               |    |   | 1 |    |               | 6 |                 |
|               |    |   | B |    |               | 2 |                 |
|               |    |   | I |    |               | S |                 |
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|               |    |   | L |    |               | C |                 |
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|               |    |   | C |    |               | A |                 |
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|               |    |   | C |    |               | C |                 |
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|               |    |   | N |    |               |   |                 |
|               |    |   | C |    |               | 6 |                 |
|               |    |   | E |    |               | 9 |                 |
|               |    |   | S |    |               | P |                 |
|               |    |   |   |    |               | S |                 |
|               |    |   | 5 |    |               | Y |                 |
|               |    |   | 4 |    |               | C |                 |
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|               |    |   | T |    |               | \ |                 |
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|               |    |   |   |    |               |   |                 |
|               |    |   | 5 |    |               |   |                 |
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|               |    |   | R |    |               |   |                 |
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|               |    |   | L |    |               |   |                 |
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|               |    |   | C |    |               |   |                 |
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|               |    |   | C |    |               |   |                 |
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|               |    |   | S |    |               |   |                 |
|               |    |   |   |    |               |   |                 |
|               |    |   | 5 |    |               |   |                 |
|               |    |   | 6 |    |               |   |                 |
|               |    |   | M |    |               |   |                 |
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|               |    |   | D |    |               |   |                 |
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|               |    |   | L |    |               |   |                 |
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|               |    |   | C |    |               |   |                 |
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|               |    |   | S |    |               |   |                 |
|               |    |   |   |    |               |   |                 |
|               |    |   | 5 |    |               |   |                 |
|               |    |   | 9 |    |               |   |                 |
|               |    |   | L |    |               |   |                 |
|               |    |   | I |    |               |   |                 |
|               |    |   | F |    |               |   |                 |
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|               |    |   | C |    |               |   |                 |
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|               |    |   | N |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
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|               |    |   | \ |    |               |   |                 |
|               |    |   | * |    |               |   |                 |
+---------------+----+---+---+----+---------------+---+-----------------+
|               |    |   | * |    |               | * |                 |
|               |    |   | * |    |               | * |                 |
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|               |    |   | S |    |               | \ |                 |
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|               |    |   | * |    |               | \ |                 |
|               |    |   |   |    |               | * |                 |
|               |    |   | 7 |    |               | * |                 |
|               |    |   | 1 |    |               | * |                 |
|               |    |   | A |    |               |   |                 |
|               |    |   | N |    |               | 9 |                 |
|               |    |   | T |    |               | 9 |                 |
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|               |    |   | T |    |               |   |                 |
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|               |    |   | Y |    |               |   |                 |
|               |    |   | 7 |    |               |   |                 |
|               |    |   | 4 |    |               |   |                 |
|               |    |   | L |    |               |   |                 |
|               |    |   | I |    |               |   |                 |
|               |    |   | N |    |               |   |                 |
|               |    |   | G |    |               |   |                 |
|               |    |   | U |    |               |   |                 |
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|               |    |   | S |    |               |   |                 |
|               |    |   | T |    |               |   |                 |
|               |    |   | I |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
|               |    |   | S |    |               |   |                 |
|               |    |   |   |    |               |   |                 |
|               |    |   | 7 |    |               |   |                 |
|               |    |   | 5 |    |               |   |                 |
|               |    |   | P |    |               |   |                 |
|               |    |   | O |    |               |   |                 |
|               |    |   | L |    |               |   |                 |
|               |    |   | I |    |               |   |                 |
|               |    |   | T |    |               |   |                 |
|               |    |   | I |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
|               |    |   | A |    |               |   |                 |
|               |    |   | L |    |               |   |                 |
|               |    |   | S |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
|               |    |   | I |    |               |   |                 |
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|               |    |   | N |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
|               |    |   | E |    |               |   |                 |
|               |    |   | 7 |    |               |   |                 |
|               |    |   | 6 |    |               |   |                 |
|               |    |   | S |    |               |   |                 |
|               |    |   | O |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
|               |    |   | I |    |               |   |                 |
|               |    |   | O |    |               |   |                 |
|               |    |   | L |    |               |   |                 |
|               |    |   | O |    |               |   |                 |
|               |    |   | G |    |               |   |                 |
|               |    |   | Y |    |               |   |                 |
|               |    |   |   |    |               |   |                 |
|               |    |   | 7 |    |               |   |                 |
|               |    |   | 9 |    |               |   |                 |
|               |    |   | S |    |               |   |                 |
|               |    |   | O |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
|               |    |   | I |    |               |   |                 |
|               |    |   | A |    |               |   |                 |
|               |    |   | L |    |               |   |                 |
|               |    |   | S |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
|               |    |   | I |    |               |   |                 |
|               |    |   | E |    |               |   |                 |
|               |    |   | N |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
|               |    |   | E |    |               |   |                 |
|               |    |   | , |    |               |   |                 |
|               |    |   | N |    |               |   |                 |
|               |    |   | E |    |               |   |                 |
|               |    |   | C |    |               |   |                 |
|               |    |   | \ |    |               |   |                 |
|               |    |   | * |    |               |   |                 |
+---------------+----+---+---+----+---------------+---+-----------------+

*\*Not Elsewhere Classified (For interdisciplinary projects and others
not listed by discipline name.)*

*\*\*For interdisciplinary projects which cannot be classified within
any of the preceding main fields.*

  --------------------- -------------------------------------------------
  Order Number:         

  --------------------- -------------------------------------------------

> Cost Information

<table>
<colgroup>
<col style="width: 0%" />
<col style="width: 27%" />
<col style="width: 9%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 27%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 14%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 2%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="4"><p>111. FIXED PRICE OR ESTIMATED COST</p>
<p>PLUS FEES (Basic Only)</p></td>
<td colspan="4">110. TOTAL IF ALL OPTIONS ARE EVENTUALLY EXERCISED (if
applicable)</td>
<td colspan="6">113. OBLIGATED</td>
</tr>
<tr class="even">
<td colspan="3">Fixed Price or Estimated Cost</td>
<td colspan="5">Total Contract Value</td>
<td colspan="6">Fixed Price or Estimated Cost</td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td>$</td>
<td colspan="3"></td>
<td>$</td>
<td colspan="3"></td>
<td colspan="6">$</td>
</tr>
<tr class="even">
<td colspan="8">Basic/Fixed Fee</td>
<td colspan="2">Total Fees</td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td></td>
<td>$</td>
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
<td colspan="6">$</td>
</tr>
<tr class="even">
<td colspan="8">Target Incentive Fee</td>
<td colspan="3">Total Obligated</td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td></td>
<td>$</td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="6">$</td>
</tr>
<tr class="even">
<td colspan="8">Maximum Award Fee</td>
<td colspan="5">114. Funded Thru date</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td>$</td>
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="4">Total Price or Cost With Fees</td>
<td colspan="11"></td>
</tr>
<tr class="odd">
<td></td>
<td>$</td>
<td colspan="3"></td>
<td></td>
<td colspan="3"></td>
<td colspan="6"></td>
</tr>
</tbody>
</table>

> 115a. Deliverables (80 characters) **(OPTIONAL)**
>
> (If more than 5, consolidate those with same due dates. Do NOT include
> administrative reports)

  ----- ------------- ------------------------------------------------ -- ------ ------- ----------
        Description                                                       Due            
                                                                          Date           

  1\.                                                                                    
  ----- ------------- ------------------------------------------------ -- ------ ------- ----------

  ----- ------------------------------------------------ -- -----------------
  2\.                                                       

  ----- ------------------------------------------------ -- -----------------

  ----- ------------------------------------------------ -- -----------------
  3\.                                                       

  ----- ------------------------------------------------ -- -----------------

  ----- ------------------------------------------------ -- -----------------
  4\.                                                       

  ----- ------------------------------------------------ -- -----------------

  ----- ------------------------------------------------ -- -----------------
  5\.                                                       

  ----- ------------------------------------------------ -- -----------------

> 116a. **Period of Performance (POP) Option End Date**

  ---------------- ------------------- ---------------- -------------------
  POP Option End                       POP Option End   
  Date (1)                             Date (2)         

  ---------------- ------------------- ---------------- -------------------

  ---------------- ------------------- ---------------- -------------------
  POP Option End                       POP Option End   
  Date (3)                             Date (4)         

  ---------------- ------------------- ---------------- -------------------