Order for Supplies or Services, DHHS, 2005
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PAGE OF PAGES ORDER FOR SUPPLIES OR SERVICES 6. SHIP TO: 2. CONTRACT NO. (If any) 1. DATE OF ORDER GS10F0105N 09/12/2005 3 1 IMPORTANT: Mark all packages and papers with contract and/or order numbers. a. NAME OF CONSIGNEE 3. ORDER NO. Multiple Destinations 4. REQUISITION/REFERENCE NO. HHSP233200500163U b. STREET ADDRESS 5. ISSUING OFFICE (Address correspondence to) DHHS/PSC/SAS/DAM PARKLAWN BUILDING, ROOM 5-101 5600 FISHERS LANE ROCKVILLE MD 20857 c. CITY d. STATE e. ZIP CODE f. SHIP VIA 7. TO: a. NAME OF CONTRACTOR VERA INSTITUTE OF JUSTICE INC 356370 8. TYPE OF ORDER b. COMPANY NAME X a. PURCHASE c. STREET ADDRESS VERA INSTITUTE OF JUSTICE, INC. 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. 233 BROADWAY FL 12 d. CITY e. STATE NEW YORK 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. f. ZIP CODE NY 10279-1299 9. ACCOUNTING AND APPROPRIATION DATA 10. REQUISITIONING OFFICE See Schedule DHHS/PSC/SAS/DAM 11. BUSINESS CLASSIFICATION (Check appropriate box(es)) a. SMALL b. OTHER THAN SMALL 12. F.O.B. POINT c. DISADVANTAGED d. WOMEN-OWNED g. WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER THE WOSB PROGRAM f. SERVICE-DISABLED VETERAN-OWNED 13. PLACE OF a. INSPECTION e. HUBZone Destination h. EDWOSB 14. GOVERNMENT B/L NO. 15. DELIVER TO F.O.B. POINT ON OR BEFORE (Date) 16. DISCOUNT TERMS 02/04/2009 b. ACCEPTANCE Destination b. DELIVERY REFERENCE YOUR: Destination 17. SCHEDULE (See reverse for Rejections) ITEM NO. (a) QUANTITY ORDERED UNIT (d) (c) SUPPLIES OR SERVICES (b) UNIT PRICE (e) QUANTITY ACCEPTED (g) AMOUNT (f) Tax ID Number: 13-1941627 DUNS Number: 073299836 1 BASE PERIOD 274,820.00 PRO BONO OUTREACH PILOT PROJECT Continued ... 18. SHIPPING POINT 19. GROSS SHIPPING WEIGHT 17(h) TOTAL (Cont. pages) 20. INVOICE NO. 21. MAIL INVOICE TO: a. NAME SEE BILLING INSTRUCTIONS ON REVERSE b. STREET ADDRESS (or P.O. Box) c. CITY ROCKVILLE 22. UNITED STATES OF AMERICA BY (Signature) PSC/FMS $8,200,000.00 (301) 443-3020 PARKLAWN BUILDING, ROOM 16A-12 5600 FISHERS LANE ROCKVILLE MD 20857 17(i) GRAND TOTAL d. STATE MD e. ZIP CODE $8,474,820.00 20857 23. NAME (Typed) DONALD S. HADRICK TITLE: CONTRACTING/ORDERING OFFICER AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION NOT USABLE OPTIONAL FORM 347 (Rev. 2/2012) Prescribed by GSA/FAR 48 CFR 53.213(f) ORDER FOR SUPPLIES OR SERVICES SCHEDULE - CONTINUATION PAGE NO 2 IMPORTANT: Mark all packages and papers with contract and/or order numbers. DATE OF ORDER CONTRACT NO. ORDER NO. 09/12/2005 GS10F0105N HHSP233200500163U ITEM NO. SUPPLIES/SERVICES (a) (b) QUANTITY UNIT ORDERED (c) (d) UNIT PRICE (e) AMOUNT QUANTITY ACCEPTED (g) (f) Delivery Location Code: ACF HHS/ORR 901 D STREET AEROSPACE BUILDING EIGHTH FLOOR WASHINGTON DC 20447 Amount: $274,820.00 Accounting Info: 2005-G994353-25200-1 Appr. Yr.: 2005 CAN: G994353 Object Class: 25200 Funded: $274,820.00 2 OPTION YEAR I 1,200,000.00 PRO BONO OUTREACH PILOT PROJECT Delivery Location Code: ACF HHS/ACF/ORR/DUCS 901 D STREET, SW AEROSPACE BLDG, 8TH FLOOR WASHINGTON DC 20447 Amount: $1,200,000.00 Accounting Info: 2006-G994223-25200-1 Appr. Yr.: 2006 CAN: G994223 Object Class: 25200 Funded: $1,200,000.00 3 OPTION YEAR II 2,000,000.00 PRO BONO OUTREACH PILOT PROJECT Amount:: $2,000,000.00 Delivery Location Code: ACF HHS/ACF/OAS/IA 901 D STREET, SW AEROSPACE BLDG, 6TH FLOOR WASHINGTON DC 20447 Amount: $2,000,000.00 Accounting Info: 2007-G99UPR7-25200-1 Appr. Yr.: 2007 CAN: G99UPR7 Object Class: 25200 Funded: $500,000.00 Accounting Info: 2007-G99UPR7-25200-2 Appr. Yr.: 2007 CAN: G99UPR7 Object Class: 25200 Funded: $1,500,000.00 4 OPTION YEAR III PRO BONO OUTREACH PILOT PROJECT Continued ... 5,000,000.00 TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $8,200,000.00 AUTHORIZED FOR LOCAL REPODUCTION PREVIOUS EDITION NOT USABLE OPTIONAL FORM 348 (Rev. 4/2006) Prescribed by GSA FAR (48 CFR) 53.213(f) ORDER FOR SUPPLIES OR SERVICES SCHEDULE - CONTINUATION PAGE NO 3 IMPORTANT: Mark all packages and papers with contract and/or order numbers. DATE OF ORDER CONTRACT NO. ORDER NO. 09/12/2005 GS10F0105N HHSP233200500163U ITEM NO. SUPPLIES/SERVICES (a) (b) QUANTITY UNIT ORDERED (c) (d) UNIT PRICE (e) AMOUNT QUANTITY ACCEPTED (g) (f) Delivery Location Code: ACF ACF/ORR 901 D STREET, S.W. WASHINGTON DC 20447 Amount: $5,000,000.00 Accounting Info: 2008-G99UPR8-25102-1 Appr. Yr.: 2008 CAN: G99UPR8 Object Class: 25102 Funded: $5,000,000.00 The total amount of award: $8,474,820.00. The obligation for this award is shown in box 17(i). TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) AUTHORIZED FOR LOCAL REPODUCTION PREVIOUS EDITION NOT USABLE $0.00 OPTIONAL FORM 348 (Rev. 4/2006) Prescribed by GSA FAR (48 CFR) 53.213(f)
