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PREVIOUS PO #YA132304SE0391
21. ORDERED BY (NAME AND TITLE) 22. FOR INQUIRIES CALL 23. FOB POINT 24 DISCOUNT TERMS ~
L_A_V_AN_C_E
SUPVY PURCHSG AGT ---L_3_0_1-_76_3_-1_8_4_0_~-D_E_S_TlN_ _.......·_0_'Yc_·TiD_0_D_et__30_ ~=-
-=- $31,000.00-1
I-
26. CONTRACTlNGfORDERlNG omCER S1GNATIJRE 121. DATE SIGNED 12a. PROMPT PAYMENT 29. SHIP VIA
LA VANCE .. 1212012004 I Y N/A
30. SHIP TO (INCLUDE ON SffiPPlNG LABEL) ] I. ISSUING OffiCE (Do NOT SHIP OR BILL TO TIllS ADDRESS)
REFERENCE ORDER NO.: OBLIG-2005-98356-0-0
BOC MAIN RECEIVING DOCK BUREAU OF TIIE CENSUS
ROOM 1203A, FOB 4 ACQUlSmON BRANCH, ROOM G-312-3
4700 SILVER HILL ROAD 4700 SILVER HILL ROAD
Attn: P H DUNTON
SUITLAND, MD 20746 SUllLAND MD 20746
Phone:
FORM CD-404-EF (09-91) I. ORDEil NUMBER
U.S. DBl'AR'JHBH'l' 01' C<HlBRCB
SUPPLY, EQUIPMENT OR SERVICE ORDER 43·YA-BC-5983S6
lCOllnNOATIOII SBBBT)
PAGE 2 OF 2
32.SUPPUER 33. ISSUING OFFICI! ~. ORDEilDATI! lB. DATI! PRINTED
ALIED VAN DOREN 1 BUREAU OF TIlE CENSUS 1212012004 I 0211012005
34. 3~. 36. 37. 31. 39. 40. 41.
LINIl MOL QTY QTY FINAL FULL ACCOUNTING O.ASSIflCATION DlST" AMOUNT
ITEM RI!CVD
1 1 1 04 0200000-000 21 10-02-07-000 1l-04-OOO9...()().()()..()()..()0 25-20-04-00 00000o 100" 31.000.00
42. 43. 44. 45. 46. SHIP TO ADDRESS 42. 43. 44. 45. 46. SIDP TO ADDRESS
LINIl MOL QTY IlI!CIlIVJNG (INCUJDI! JlEIII!IlIlNCIl ORDER. NO. UNB MOL QTY IlI!CIlIVJNG (lNa.uDB ItEfllRENCI! ORDEIl NO.
ITEM OFFICI! CODE OH SHIPPING LABl!L) ITEM OFFICI! CODE ON SHIPPING LABEL)
: ~I. TYPE SHIPMENT 52. RECEIPI' SIGNATIJRE "" TIllJ! 53. RECEIPT DATE
ACCJ;PTANCE: I CERTIFY THAT ARTICLES AND/OR SERVICES ANNOTA'J1!D ~. ACCEPTANCE S1GNATIJRE "" 1lllJ! 55. ACCEPTANCE DAlE
ABOVE HAVE BEEN RECE1VED,INSPEClED AND ACCEPTED AS COMPI.Y1NG
WTnI TInS ORDER, AS OF 1HE DATI! SHOWN.