CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 4 OF 7 PAGES
SPE300-24-D-P422

Form (CONTINUED)
A. Submit Local Purchase Procurement plan by May 13, 2024 which includes the following elements:
1. Alist of specific items that the contractor currently purchases locally;
2. Alist of local growers from which the contractor sources product;
3. Plans to expand the purchase of local items; and

4. Alist of resources that might assist in efforts to source more local products.

B. Submit a Food Defense Plan (NOTE: download a copy of the DLA Troop Support Food Defense Checklist go to (https:/(www.dla.
mil/P. 104/Document istence/F. ifety/Fe lity/fe fen: heck,pdf) by May 13, 2024,

C. Submit a Quality Control Management Plan by May 13, 2024.
IV. ORDERING CATALOGS
The following are part of Foster-Caviness' offer and are hereby incorporated as part of subject contract:

Offered delivered price to be utilized for first week of ordering. See Attachment 1 for the Pricing Proposal spreadsheet submitted on
December 19, 2023.

Distribution prices for the Contract Period are as follows:

Distribution Price Tier1 _|Tier2__‘|Tier3
Group 1 (North Carolina Troops)

Group 2 (North Carolina Schools)

Group 3 (North Carolina Tribal Reservations)

SUPPLIES OF SERVICES AND PRICES

ITEMS: Full-Line Fresh Fruit and Vegetables

CUSTOMERS: DoD Troop and Non-DoD School and Tribal Reservation Customers in the North Carolina Zone listed in Attachment 2
of this document.

FOB TERMS: FOB Destination for all items.

NOTE: Paragraph (D) of the Economic Price Adjustment provision contained in the Solicitation enforces an upward ceiling on any
economic price adjustments applicable to the instant Contract. Specifically, the aggregate of contract Delivered Price increases for
each line item on the catalog subject to this provision shall not exceed 120 percent (%) for Department of Defense (DoD) Troop and
100 percent (%) for USDA School and Tribal Reservation customers above that line item's initial Delivered Price on the awarded
catalog. The respective percent (%) ceiling for each line item is in effect throughout the entire length of the contract period. To further
illustrate this point, Attachment 1 (Final Pricing) includes a separate column that identifies the percentage EPA ceiling for the
individual Delivered Prices of each line item on the catalog. This price represents the maximum increase in Delivered Price allowable
for the entire 5-year length of the Contract. For additional information, see the EPA provision as specified in the Solicitation. That
said, please be aware that just because an awardee furnishes a price revision on a biweekly basis that falls within the EPA clause's
120 percent (%) for DoD Troops or 100 percent (%) for USDA School and Tribal Reservation customers ceiling, does not
automatically deem that price "fair and reasonable" and thus acceptable. The EPA provision is merely one separate factor that is

CONTINUED ON NEXT PAGE



CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 7 OF 7 PAGES
SPE300-24-D-P422

Part 12 Clauses (CONTINUED)

Data to be entered in

Field Name in WAWF WAWE

Ship From Code

Mark For Code

Service Approver
(DoDAAC)
Service Acceptor
(DoDAAC)

Accept at Other DoDAAC.

LPO DoDAAC

DCAA Auditor DoDAAC

Other DoDAAC(s)

(* Contracting Officer: Insert applicable DDAAC information. If multiple ship to/acceptance locations apply, insert “See Schedule” or “Not applicable.”)
(** Contracting Officer: If the contract provides for progress payments or performance-based payments, insert the DoDAAC for the contract administration
office assigned the functions under FAR 42.302(a)(13).)

(4) Payment request. The Contractor shall ensure a payment request includes documentation appropriate to the type of payment request in accordance with
the payment clause, contract financing clause, or Federal Acquisition Regulation 52.216-7, Allowable Cost and Payment, as applicable.

(5) Receiving report. The Contractor shall ensure a receiving report meets the requirements of DFARS Appendix F.

(g) WAWF point of contact. (1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF
point of contact.

(Contracting Officer: Insert applicable information or “Not applicable.”)
(2) Contact the WAWF helpdesk at 866-618-5988, if assistance is needed.

52.233-3 PROTEST AFTER AWARD (AUG 1996) FAR
252.244-7000 SUBCONTRACTS FOR COMMERCIAL PRODUCTS OR COMMERCIAL SERVICES (NOV 2023) DFARS
52.253-1 COMPUTER GENERATED FORMS (JAN 1991) FAR

252.204-7018 PROHIBITION ON THE ACQUISITION OF COVERED DEFENSE TELECOMMUNICATIONS EQUIPMENT OR SERVICES
(JAN 2023) DFARS

52.204-27 PROHIBITION ON A BYTEDANCE COVERED APPLICATION (JUN 2023) FAR

52.204-28 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT ORDERS -- FEDERAL SUPPLY SCHEDULES,
GOVERNMENTWIDE ACQUISITION CONTRACTS, AND MULTI--AGENCY CONTRACTS (DEC 2023) FAR

52.204-30 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT ORDERS -- PROHIBITION (DEC 2023) FAR

Attachments
List of Attachments
Description File Name
ATTACH_Attachment_1_S |Attachment 1 - Schedule of
chedule_of_Items Items.xisx
ATTACH_Attachment_2_D| Attachment 2 - Delivery
elivery_Schedule Schedule.xIsx
ATTACH_1449_Signed | SPE30024DP422 Signed
Foster.pdf

PID Data - Custom Clause

Header

C1



CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 3 OF 7 PAGES
SPE300-24-D-P422

Form

Standard Element has no Title

|. SOLICITATION/CONTRACT FORM

The terms and conditions set forth in solicitation SPE300-22-R-0002 and Amendment 0001, dated April 13, 2023, are incorporated into subject
contract:

The following documents are incorporated by reference into the subject contract: your final offer dated December 19, 2023, which is being
accepted by the Government to form this contract.

Il. PERFORMANCE PERIOD:

A. Effective Period of the Contract:
Tier 1 - April 2, 2024 through April 1, 2026
Tier 2 - April 2, 2026 through October 1, 2027
Tier 3 - October 2, 2027 through April 2, 2029

Ordering commences on April 14, 2024 with first deliveries beginning April 16, 2024 for Troop customers and April 18, 2023 for
School and Tribal Reservation customers.

B, ESTIMATED DOLLAR VALUE/GUARANTEED MINIMUM/MAXIMUM

All Groups have been awarded together, and therefore, the total 10% Guaranteed Minimum contract dollar value is $1,212,500.00
and the 300% Maximum contract dollar value is $181,875,000.00. The guaranteed minimum and maximum, although based on
estimates, are fixed firm dollar amounts, which are calculated as a percentage of 12 months of the Tier 1 and 5-year estimated dollar
values, respectively. The guaranteed minimum covers the entire contract term (inclusive of all tiers) and, once this obligation is met,
there is no further ordering obligation on the part of the Agency regardless of what tier period said obligation is met within. If multiple
groups are awarded under the contract, the aggregate guaranteed minimum and contract maximum dollar values for those groups
apply to the entire contract, and not on a per group basis.

The 24 Month (1* Tier) Estimate is $24,250,000.00 and the 5 Year (All Tiers) Estimate is $60,625,000.00. The term “5 Year Estimate”
refers to the Government's good faith estimate of the requirement for all Tier periods.

Ill. START-UP PERIOD

The Contractor's startup period will take place prior to the first order and is included in the 24-month Tier 1 period. The Contractor
shall submit a proposed implementation schedule to the Contracting Officer within fifteen (15) days after award highlighting the steps
that will be taken to implement a fully functional distribution account, including all EDI transactions for all customers covered by this
solicitation, An additional sixty (60) days will be granted for actual implementation. No more than ninety (90) days after award will be
permitted for the contractor to have fully functional distribution accounts in place for all customers.

Foster-Caviness is required to submit the following:

CONTINUED ON NEXT PAGE



CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 5 OF 7 PAGES
SPE300-24-D-P422

Form (CONTINUED)

considered by the Contracting Officer in arriving at his/her final “fair and reasonable" price determinations. Therefore, it is important to
note that all other provisions of the Solicitation/Contract must be adhered to in conjunction with the aforementioned EPA provision.

CATALOG #: North Carolina DoD Troop customers will order under SPE300-24-D-P422, North Carolina Non-DoD School Direct
Deliveries customers will order under SPE300-24-D-S422, and North Carolina Non-DoD Tribal Reservation customers will order
under SPE300-24-D-R422. Foster-Caviness will invoice in accordance with the customer's orders.

All catalog pricing is valid from Sunday thru the following Saturday. Catalog updates must be received no later than 12:00 P.M. EST
the preceding Wednesday.

Troop customers shall place their orders to accommodate at a minimum a 2-day lead time, i.e “skip day” delivery. School and Tribal
Reservation customers shall place their orders to accommodate at a minimum a 4-day lead time. All pricing will be firm-fixed at time of
order by the customer(s).

For Troop customers only, Foster-Caviness will provide up to one emergency order per month per customer at no additional cost to
the Government. As specified by the customer, all emergency order(s) for supplies must be same day or next day. Expeditious
fulfillment of the emergency requirement is imperative.

Once submitted through the applicable electronic ordering system (i.e. STORES or FFAVORS), an order may be cancelled by a
customer up to 1 day before scheduled delivery via written (e.g. Email) notification to the Contractor and the Contracting Officer. Less
than 1 day from delivery, an order may be cancelled by mutual agreement between the customer and the Contractor. In the event of
an act of God, such as extreme weather, the specific situation regarding a cancelled delivery, within less than 1 day, will be dealt with
in an equitable manner by the Contracting Officer, who has the ultimate authority and discretion to resolve said issues.

DELIVERIES AND PERFORMANCE

The following are the designated plant locations for the performance of this contract for all contract line items:
Places of Performance:

Foster-Caviness Inc.

2914 Sandy Ridge Road, Bldg. 1

Colfax, NC 27235

Foster-Caviness Inc.

10810 Withers Cove Park Dr.
Charlotte, NC 28278

Part 12 Clauses
52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND CERTIFICATIONS (DEC 2014) FAR

CONTINUED ON NEXT PAGE



SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

1, REQUISITION NUMBER PAGE 1 OF7

1000131345,
2. CONTRACT NO. 3, AWARD/EFFECTIVE —|4. ORDER NUMBER 5. SOLICITATION NUMBER 6. BOLICITATION ISSUE
DATE
SPE300-24-D-P422 2024 APR 02 SPE300-22-R-0002 2023 APR 12
a, NAME |b. TELEPHONE NUMBER (No collect 8. OFFER DUE DATE/
LOCAL TIME

7. FOR SOLICITATION
INFORMATION CALL:

>

calls)

9. ISSUED BY CODE [SPE300 10. THIS ACQUISITION IS [UNRESTRICTED OR }XISET ASIDE: 100 s6FoR:
DLATROOP SUPPORT smaueusiNess —— [] (WOSB) ELIGIBLE UNDER THE WOMEN-OWNED
700 ROBBINS AVENUE HUBZONE SMALL SMALL BUSINESS PROGRAM
PHILADELPHIA PA 19111-5096 BUSINESS
Usa SERVICE-DISABLED [_] EDWOSB NAICS: 311991
Local Admin: Jillian Blaney DJB0214 Tel: 2157377109 \VETERAN-OWNED
Email Jilian Slaney@da.mil SvALLousINess, =] 8(4) SIZE STANDARD:700
11, DELIVERY FOR FOB DESTINA- 12, DISCOUNT TERMS 73b. RATING
Mane ATES BLOCK IS [[) 13a. THIS CONTRACT IS A
RATED ORDER UNDER

14, METHOD OF SOLICITATION

CO seescHeoue Net 10 days DPAS (15 CFR 700) Cw i we

15, DELIVER TO CODE 16. ADMINISTERED BY CODE [SPE300
SEE SCHEDULE teat, PAS: Nove

We. CONTRACTOR! GODE [1VPK7 J FAGLITY [ [18a PAYMENT WILL BE MADE BY CODE [SL4701

FOSTER-CAVINESS CO, INC
2914 SANDY RIDGE RD BLDG!
COLFAX NC 27235-9625

USA

‘TELEPHONE NO. 3366620571

DEF FIN AND ACCOUNTING SVC
BSM

PO BOX 182317
COLUMBUS OH 432182317

17b, CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

18b, SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

OFFER BELOWIS CHECKED, [“] see ADDENDUM
19, 20. 21. 22, 23. 24,
ITEM NO, SCHEDULE OF SUPPLIES/SERVICES QUANTITY | UNIT | UNIT PRICE AMOUNT

See Schedule

25. ACCOUNTING AND APPROPRIATION DATA

26, TOTAL AWARD AMOUNT (For Govt. Use Only)

[_] 272. SOLICITATION INCORPORATES BY REFERENCE FAR 62.2121, 52.212-4, FAR 52.212-3 AND 52.212-5 ARE ATTACHED, ADDENDA
27. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

$181,875,000.00
[JARE |_| ARENOTATTAGHED,
ARE [_] ARENOT ATTACHED.

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN
COPIES TO ISSUING OFFICE, CONTRACTOR AGREES TO FURNISH AND

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY
ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

[X] 29. AWARD OF CONTRACT: REF. sPescozanoc

DATED __2023-De19_. YOUR OFFER ON SOLICITATION (BLOCK 5),
INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH ,
HEREIN IS ACCEPTED AS TO ITEMS: see schedule of items

OFFER

30a, SIGNATURE OF OFFEROR/CONTRACTOR

‘31a, UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

Amy Paradiy

30b, NAME AND TITLE OF SIGNER (Type or Print) [30c. DATE SIGNED _|31b, NAME OF CONTRACTING OFFICER (Type or Print) [31e. DATE SIGNED
‘Amy Paradis
Amy.Paradis@dla,mil 2024 APR 02

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (rev. 2/2012)
Prescribed by GSA=FAR (48 CFR) 53.212


CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 6 OF 7 PAGES
SPE300-24-D-P422

Part 12 Clauses (CONTINUED)

252.204-7009 LIMITATIONS ON THE USE OR DISCLOSURE OF THIRD-PARTY CONTRACTOR REPORTED CYBER INCIDENT
INFORMATION (JAN 2023) DFARS

252.204-7012 SAFEGUARDING COVERED DEFENSE INFORMATION AND CYBER INCIDENT REPORTING (JAN 2023) DFARS

252.204-7014 LIMITATIONS ON THE USE OR DISCLOSURE OF INFORMATION BY LITIGATION SUPPORT CONTRACTORS (JAN
2023) DFARS

252,215-7014 EXCEPTION FROM CERTIFIED COST OR PRICING DATA REQUIREMENTS FOR FOREIGN MILITARY SALES INDIRECT
OFFSETS (DEC 2022) DFARS

252.223-7009 PROHIBITION OF PROCUMENT OF FLOURINATED AQUEOUS FILM-FORMING FOAM FIRE-FIGHTING AGENT FOR
USE ON MILITARY INSTALLATIONS (OCT 2023) FAR

52,232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS SUBCONTRACTORS (MAR 2023) FAR

252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (JAN 2023) DFARS

As prescribed in 232.7004 (b), use the following clause:

(a) Definitions. As used in this clause -

Department of Defense Activity Address Code (DoDAAC) is a six position code that uniquely identifies a unit, activity, or organization.

Document type means the type of payment request or receiving report available for creation in Wide Area WorkFlow (WAWE).

Local processing office (LPO) is the office responsible for payment certification when payment certification is done external to the entitlement system.
Payment request and receiving report are defined in the clause at 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(b) Electronic invoicing. The WAWF system provides the method to electronically process vendor payment requests and receiving reports, as authorized by
Defense Federal Acquisition Regulation System (DFARS) 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(c) WAWF access. To access WAWF, the Contractor shall -

(1) Have a designated electronic business point of contact in the System for Award Management at https://www.sam.gov and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this Web site.

(d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training Site
before submitting payment requests through WAWF. Both can be accessed by selecting the “Web Based Training” link on the WAWF home page at https://
wawf.eb.mil/.

(e) WAWF methods of document submission. Document submissions may be via Web entry, Electronic Data Interchange, or File Transfer Protocol.

(£) WAWE payment instructions. The Contractor shall use the following information when submitting payment requests and receiving reports in WAWF for
this contract or task or delivery order:

(1) Document type. The Contractor shall submit payment requests using the following document type(s):

(i) For cost-type line items, including labor-hour or time-and-materials, submit a cost voucher.

(ii) For fixed price line items -

(A) That require shipment of a deliverable, submit the invoice and receiving report specified by the Contracting Officer.

(Contracting Officer: Insert applicable invoice and receiving report document type(s) for fixed price line items that require shipment of a deliverable.)

(B) For services that do not require shipment of a deliverable, submit either the Invoice 2in1, which meets the requirements for the invoice and receiving
report, or the applicable invoice and receiving report, as specified by the Contracting Officer.

(Contracting Officer: Insert either “Invoice 2in1” or the applicable invoice and receiving report document type(s) for fixed price line items for services.)
(iii) For customary progress payments based on costs incurred, submit a progress payment request.

(iv) For performance based payments, submit a performance based payment request.

(v) For commercial financing, submit a commercial financing request.

(2) Fast Pay requests are only permitted when Federal Acquisition Regulation (FAR) 52.213-1 is included in the contract.

[Note: The Contractor may use a WAWF “combo” document type to create some combinations of invoice and receiving report in one step.]

(3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating
payment requests and receiving reports in the system.

Routing Data Table *

Data to be entered in

Field Name in WAWF WAWEF

Pay Official DODAAC

Issue By DoDAAC

Admin DoDAAC

Inspect By DoDAAC

Ship To Code

CONTINUED ON NEXT PAGE



SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

1. REQUISITION NUMBER
1000131345

PAGE 1 OF 7

2, CONTRACT NO. 3. AWARDIEFFECTIVE 4. ORDER NUMBER Is, SOLICITATION NUMBER: om SOLICITATION ISSUE
‘SPE300-24-D-P422 2024 APR 02 ‘SPE300-22-R-0002 2023 APR 12
la, NAME pb. TELEPHONE NUMBER (No collect 8. orrer DUE DATE!
7. FOR SOLICITATION cals) mTM
INFORMATION CALL:
9. ISSUED BY cope |SPE300 10. THIS ACQUISITION IS [Clunrestricten or [XJSET ASIDE: _100_ssFoR:
'WOMEN-OWNED SMALL BUSINESS
DLA TROOP SUPPORT ae rENCE [2X] staus eusness 1 Woss) ELIGIBLE UNDER THE WOMEN-OWNED
700 ROBBINS AVENUE eences ‘SMALL SMALL BUSINESS PROGRAM
PHILADELPHIA PA 19111-5096 BUSINESS
USA " * SERVICE-DISABLED [/] EOWosB NAICS: 311991
Local Admin: tian Blaney 0480214 Tek: 2157377109 C1 SercRAN-OWNED
Email Jillian Blaney@ala.mil Swacteusiness [L] 8(4) ‘SIZE STANDARD:700
71. DELIVERY FOR FOB DESTINA- 12. DISCOUNT TERMS 13b, RATING
TION UNLESS BLOCK IS oO 13a, THIS CONTRACT IS A
RATED ORDER UNDER crs OD oF LIGITATION
Oo Net 10 days DPAS (15 CFR 700)
SEE SCHEDULE I] Fra Ol tes BK rr
15. DELIVER TO ‘CODE 16. ADMINISTERED BY CODE [sPesoo
SEE SCHEDULE itty. PAS None
17a. CONTRACTOR! ~ CODE [ex FACILITY, (8a. PAYMENT WILL BE MADE BY CODE = {SL4701
OFFEROR CODE
DEF FIN AND ACCOUNTING SVC
FOSTER-CAVINESS CO, INC BSM.
2914 SANDY RIDGE RD BLDG | PO BOX 182317
COLFAX NC 27235-9625 COLUMBUS OH 43218-2317
USA USA
‘TELEPHONE NO. 3366620571
77. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN]18b. SUBMIT INVOICES TO ADDRESS: SHOWN IN BLOCK 78a UNLESS BLOCK
Oo OFFER BELOW IS CHECKED. ‘SEE ADDENDUM
19. 20. 21. 22, 23, 24,
ITEM NO, SCHEDULE OF SUPPLIES/SERVICES QUANTITY | UNIT. ‘UNIT PRICE. “AMOUNT

See Schedule

"25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govi. Use Oniy)
$181,875,000.00

[_] 270. SOLICITATION INCORPORATES BY REFERENCE FAR 62.212-1, §2.212-4, FAR §2.212-8 AND 52212-6 ARE ATTACHED. ADDENDA. [Jane [Jane nor arracen.
27b, CONTRACTIPURGHASE ORDER INCORPORATES BY REFERENCE FAR 52.2124, FAR 62.212-51S ATTACHED. ADDENDA Dajare FE] arenorarracten.
28, CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN __1 29. AWARD OF CONTRACT: REF, sre0022s002 OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DELIVER ALL Ty !S SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND
ADD) L SHEETS SYBJECT TO THE eens AND CONDITIONS SPECIFIE

DATED __2023-Dec-19__ YOUR OFFER ON SOLICITATION (BLOCK 5),
ON ANY _| INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH ,
ED HEREIN IS ACCEPTED AS TO ITEMS: see schedule of items

Wa, a — RORICONTI

(Sta, UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

[30c. DATE SIGNED

i, o2/ a]

A AND am OF SIGNER (Type or Print)
Spot. Bland (EO

fate, NAME OF CONTRACTING OFFICER (Type or Print) (Sie. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE,

STANDARD FORM 1449 (rev. 2/2012)
Prescribed by GSA - FAR (48 CFR) 53.212


19. 20, 21, 22, 23. 24,
ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY | UNIT UNIT PRICE AMOUNT
32a QUANTITY IN COLUMN 21 HAS BEEN
(Jreceiveo [inspected [_JaccePTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED
32b, SIGNATURE OF AUTHORIZED GOVERNMENT '32c, DATE 32d, PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE REPRESENTATIVE

'32e, MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32f, TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER

[_] PARTIAL [/] FINAL

134. VOUCHER NUMBER: 35. AMOUNT VERIFIED: 36. PAYMENT
CORRECT FOR

[-] comecere [7] PARTIAL

(fina

37, CHECK NUMBER

38. S/R ACCOUNT NO.

39, S/R VOUCHER NUMBER | 40, PAID BY

41a. | CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT _|42a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER | 41c. DATE

42. RECEIVED AT (Location)

'42c, DATE REC'D (YY/MM/DD)

42d. TOTAL CONTAINERS

STANDARD FORM 1449 (rev. 2/2012) BACK