NO. REQUEST FOR PURCHASE INSTALLATION DATE Deployed Wing TO: CONTRACTING OFFICER CLASS Deployed CCO THROUGH CONTRACT, PURCHASE ORDER OR Deployed customer DELIVERY ORDER NO. FROM: (Insert RC/CC, if applicable) IT IS REQUESTED THAT SUPPLIES AND SERVICES ENUMERATED BELOW AND IN THE ATTACHED LIST, BE PURCHASED FOR FOR DELIVERY TO NO LATER THAN ESTIMATED ESTIMATED ITEM DESCRIPTION OF MATERIAL OR SERVICES TO BE PURCHASED QUANTITY UNIT UNIT PRICE TOTAL COST 0001 Rapid Building Assessment service (high-end deployment, 1 LS 350,000 350,000 100 buildings) 1 LS 29,500 29,500 0002 Installation costs for data collection and analysis 0003 Ongoing facility monitoring services 1 LS 100,000 100,000 1 LS 100,000 100,000 0004 Maintenance and Support services COORDINATION: COMM: _____________ LGT:________________ LGS:________________ Deliver to: Bldg 1207 / Customer POC:______________________ Phone:_____________________ $ 379,500 TOTAL PURPOSE: Procurement of services to remotely audit installation facilities at a reduced cost to traditional on-site audits. DATE TYPED NAME AND GRADE OF REQUESTING SIGNATURE OFFICIAL TELEPHONE NO. DATE TYPED NAME AND GRADE OF APPROVING OFFICIAL SIGNATURE I certify that the supplies and services listed above and in the attached list are properly chargeable to the following allotments, the available balances of which are sufficient to cover the cost thereof, and funds have been committed. ACCOUNTING CLASSIFICATION AMOUNT DATE TYPED NAME AND GRADE OF CERTIFYING SIGNATURE OFFICIAL AF 9 FORM MAR 77
REQUEST FOR PURCHASE NO. INSTALLATION Deployed Wing DATE TO: CONTRACTING OFFICER Deployed CCO CLASS THROUGH Deployed customer CONTRACT, PURCHASE ORDER OR DELIVERY ORDER NO. FROM: (Insert RC/CC, if applicable) IT IS REQUESTED THAT SUPPLIES AND SERVICES ENUMERATED BELOW AND IN THE ATTACHED LIST, BE PURCHASED FOR FOR DELIVERY TO NO LATER THAN ITEM DESCRIPTION OF MATERIAL OR SERVICES TO BE PURCHASED QUANTITY UNIT ESTIMATED UNIT PRICE ESTIMATED TOTAL COST 0001 0002 0003 0004 Rapid Building Assessment service (high-end deployment, 100 buildings) Installation costs for data collection and analysis Ongoing facility monitoring services Maintenance and Support services COORDINATION: COMM: _____________ LGT:________________ LGS:________________ Deliver to: Bldg 1207 / Customer POC:______________________ Phone:_____________________ 1 1 1 1 LS LS LS LS 350,000 29,500 100,000 100,000 350,000 29,500 100,000 100,000 TOTAL $ 379,500 PURPOSE: Procurement of services to remotely audit installation facilities at a reduced cost to traditional on-site audits. DATE TYPED NAME AND GRADE OF REQUESTING OFFICIAL SIGNATURE TELEPHONE NO. DATE TYPED NAME AND GRADE OF APPROVING OFFICIAL SIGNATURE I certify that the supplies and services listed above and in the attached list are properly chargeable to the following allotments, the available balances of which are sufficient to cover the cost thereof, and funds have been committed. ACCOUNTING CLASSIFICATION AMOUNT DATE TYPED NAME AND GRADE OF CERTIFYING OFFICIAL SIGNATURE AF FORM MAR 77 9
EW-201261%20-%20AF%20Form%209.docx