SAMPLE TASK ORDER FOR SUPPLIES OR SERVICES

Important: Mark all packages and papers with contract and/or order numbers.

Page of Pages 

1 2

1. Date or Order

07/28/2020

2. Contract No. (if any)

24361820D0002

6. Ship to:

a. Name of Consignee

Employment Services, Washington, DC 

3. Order No.

24361820F0058

4. Requisition/Reference No.

b. Street Address

Office of Personnel Management 

1900 E St NW

5. Issuing Office (Address correspondence to)

OPO - PHILADELPHIA 

US Office of Personnel Management 

600 ARCH STREET 

Suite 2000 

Philadelphia PA 19106-1596 c. City

Washington 

d. State

DC 

e. Zip Code

20515-0001 

7. To f. Ship Via

a. Name of Contractor

HealthEquity Inc 8. Type of Order

b. Company Name a. Purchase

Reference Your

Contract 24361820D0002

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

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.

c. Street Address

15 SCENIC POINTE DRIVE, STE. 100

d. City

DRAPER

e. State

UT

f. Zip Code

84020

9. Accounting and Appropriation Data 10. Requisitioning Office

11. Business Classification (Check appropriate box[es]) 12. F.O.B. Point

Destination 

13. Place of 14. Government B/L No. 15. Deliver to F.O.B. Point on

or Before (Date)

16. Discount Terms

a. Inspection

Destination

b. Acceptance

Destination

17. Schedule (See reverse for Rejections)

Item No. 

(a)

Supplies or Services 

(b)

Quantity 

Ordered 

(c)

Unit 

(d)

Unit 

Price 

(e)

Amount (f)

Quantity 

Accepted 

(g)

DUNS Number: 793506390 

This Task Order is issued to provide Federal Flexible 

Spending Account (FSAFEDS) Administration Services 

to the enrolled employees from The Office of 

Personnel Management for the period identified below. 

Continued ... 

See billing 

instructions 

on reverse

18. Shipping Point 19. Gross Shipping Weight 20. Invoice No.

$27,825.00 

17(h) 

Total 

(Cont. 

pages) 21. Mail Invoice to

a. Name

Invoice as per Instructions

b. Street Address in Individual Task Orders

$27,825.00

17(i) 

Grand 

Total 

c. City d. State e. Zip Code

20. United States of

America by (Signature)

23. Names (Typed)

Barbara A. Hansen 

Title: Contracting/Ordering Officer

Authorized for Local Reproduction

Previous Edition Not Usable 

Optional Form 347 (Rev. 5/2011)

Prescribed by GSA/FAR 48 CFR 53.213(f)

X

a. Small

f. Service-Disabled

b. Other Than Small

g. Women-Owned Small Business (WOSB)

Eligible Under the Women-Owned

Small Business Program

c. Disadvantaged d. Women-Owned e. HUBZone

h. Economically Disadvantaged

Women-Owned Small Business (WOSB)

 
Important: Mark all packages and papers with contract and/or order numbers.

Date of Order 

07/28/2020

Contract No. 

24361820D0002

Order No. 

24361820F0058

Item No. 

(a) 

Supplies/Services 

(b) 

Quantity 

Ordered 

(c) 

Unit 

(d)

Unit 

Price 

(e) 

Amount 

(f) 

Quantity 

Accepted 

(g) 

Invoicing per schedule stated in Contract

24361820D0002.

Invoice instructions (agency specific) are

attached.

Admin Office:

OPO - DC

US Office of Personnel Management

1900 E St. NW

Washington DC 20415-7710

Period of Performance: 01/01/2021 to

12/31/2021

00002 Base Period One Services - 01/01/2021 27,825.00

through 12/31/2021, includes:

HCFSA Administration,

$2.65/participant/month

LE HCFSA Administration

$2.65/participant/month

DCFSA Administration,

$2.65/participant/month

Quantities of each are based upon Open

Season Enrollment numbers as provided.

Quantities may change based on additional

(out of season) enrollments, and

modification may be necessary to account

for those quantity changes.

The total amount of award: $27,825.00. The

obligation for this award is shown in box

17(i).

Continuation

Page No.

2

Total Carried Forward to 1st page (Item 17(h))

SAMPLE TASK ORDER FOR SUPPLIES OR SERVICES SCHEDULE - CONTINUATION

$27.825.00

Authorized for Local Reproduction

Previous Edition Not Usable 

Optional Form 347 (Rev. 5/2011)

Prescribed by GSA/FAR 48 CFR 53.213(f)
1752.232-70 Invoice Requirements Large Business (Oct 2012) 

(a) A proper invoice must include the following items (except for interim payments on cost

reimbursement contracts for services):

(1) Name and address of the contractor.

(2) Invoice date and invoice number. (Contractors should date invoices as close as possible to the

date of transmission.)

(3) Contract number or other authorization for supplies delivered or services performed (including

order number and contract line item number).

(4) Description, quantity, unit of measure, unit price, and extended price of supplies delivered or

services performed.

(5) Shipping and payment terms (e.g., shipment number and date of shipment, discount for prompt

payment terms). Bill of lading number and weight of shipment will be shown for shipments on

Government bills of lading.

(6) Name and address of contractor official to whom payment is to be sent (must be the same as that

in the contract or in a proper notice of assignment).

(7) Name (where practicable), title, phone number, and mailing address of person to notify in the

event of a defective invoice.

(8) Taxpayer Identification Number (TIN). The contractor must include its TIN on the invoice only if

required by agency procedures. (See 4.9 TIN requirements.)

(9) Electronic funds transfer (EFT) banking information.

(i) The contractor shall have submitted correct EFT banking information in accordance with the

applicable solicitation provision (e.g., 52.232-38, Submission of Electronic Funds Transfer

Information with Offer), contract clause (e.g., 52.232-33, Payment by Electronic Funds

Transfer-Central Contractor Registration, or 52.232-34, Payment by Electronic Funds

Transfer-Other Than Central Contractor Registration), or applicable agency procedures.

(ii) The last four digits of the contractor’s bank account must be shown on each invoice

submitted for payment. This information will be used as a cross-reference in situations where

the EFT banking information in the Central Contract Registration is suspect.

(iii) EFT banking information is not required if the Government waived the requirement to pay by

EFT.

(10) The vendor’s certification that their EFT banking information in the Central Contractor

Registration is current, accurate and complete as of the date of the invoice.

(11) Any other information or documentation required by the contract (e.g., evidence of

shipment).

(b) Any invoice that does not contain all of the information listed in paragraph (a) above will be rejected

as improper, and a new complete corrected invoice must be submitted. The payment due date for the

corrected invoice will be calculated from the date it is received in the Prompt Pay e-mail box.

(c) ALL large business invoices—without exception—must have unique identifying numbers, and be

submitted via e-mail to OPM’s Prompt Pay e-mail box at: PromptPay@opm.gov

Please note that OPM cannot guarantee payment of invoices sent by any other means, such as regular

mail or e-mail to other addresses.

(d) Please attach only one invoice to each e-mail, and use the following format for the subject line of the

e-mail: <Contractor name>&<Invoice no>&<Amount>&<Contract Number>/<Call or Order

Number>

Example: ABC Co&AB-1298433&10000.00&OPM00-00-X-0000/X0000

(e) Payment due dates will only be calculated from the date that invoices are received in the Prompt Pay

e-mail box.

(f) Inquiries regarding payment of invoices should be e-mailed to InvoiceInquiries@opm.gov. The

relevant invoice must be attached to the inquiry e-mail, and the subject line of the e-mail must state

“INQUIRY,” followed by the information described in paragraph (d) above.
Example: INQUIRY: ABC Co&AB-1298433&10000.00&OPM00-00-X-0000/X0000 

Do NOT use the Prompt Pay e-mail box for inquiries. 

(g) If the supplies, services, technical or other reports are rejected for failure to conform to the technical

requirements of the contract, or for damage in transit or otherwise, the invoice will be rejected and

returned to the Contractor.