HOST AND JUICE SET

ORDER FOR SUPPLIES OR SERVICES 1. CONTRACT/PURCH ORDER/AGREEMENT NO. 2. DELIVERY ORDER/CALL NO. 4. REQUISITION/PURCH REQUEST NO.3. DATE OF ORDER/CALL (YYYYMMMDD) 5. PRIORITY 6. ISSUED BY 7. ADMINISTERED BY (If other than 6) 8. DELIVERY FOB CODE CODE 9. CONTRACTOR FACILITY CODE NAME AND ADDRESS 10. DELIVER TO FOB POINT BY (Date) (YYYYMMMDD) 12. DISCOUNT TERMS 13. MAIL INVOICES TO THE ADDRESS IN BLOCK DESTINATION OTHER (See Schedule if other) 11. X IF BUSINESS IS SMALL SMALL DISAD- VANTAGED WOMEN-OWNED 14. SHIP TO 15. PAYMENT WILL BE MADE BY MARK ALL PACKAGES AND PAPERS WITH IDENTIFICATION NUMBERS IN BLOCKS 1 AND 2. CODE 16. TYPE OF ORDER DELIVERY/ CALL This delivery order/call is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contract. PURCHASE Reference your furnish the following on terms specified herein. ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY

HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME. NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED (YYYYMMMDD) If this box is marked, supplier must sign Acceptance and return the following number of copies: 17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE 18. ITEM NO. 19. SCHEDULE OF SUPPLIES/SERVICES 20. QUANTITY ORDERED/ ACCEPTED* 21. UNIT 22. UNIT PRICE 23. AMOUNT * If quantity accepted by the Government is same as quantity ordered, indicate by X. If different, enter actual quantity accepted below quantity ordered and encircle. 24. UNITED STATES OF AMERICA CONTRACTING/ORDERING OFFICER 25. TOTAL 26. DIFFERENCES 27a. QUANTITY IN COLUMN 20 HAS BEEN INSPECTED RECEIVED ACCEPTED, AND CONFORMS TO THE CONTRACT EXCEPT AS NOTED: b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVEc. DATE (YYYYMMMDD) e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 28. SHIP. NO. 29. D.O. VOUCHER NO. 30. INITIALS 32. PAID BY FINAL PARTIAL 33. AMOUNT VERIFIED CORRECT FOR f. TELEPHONE NUMBER g. E-MAIL ADDRESS 36. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT. a. DATE (YYYYMMMDD) b. SIGNATURE AND TITLE OF CERTIFYING OFFICER DD FORM 1155, DEC 2001 37. RECEIVED AT 38. RECEIVED BY (Print) 39. DATE RECEIVED (YYYYMMMDD) PREVIOUS EDITION IS OBSOLETE. 31. PAYMENT COMPLETE PARTIAL FINAL 40. TOTAL CON- TAINERS 41. S/R ACCOUNT NUMBER 42. S/R VOUCHER NO. 34. CHECK NUMBER 35. BILL OF LADING NO. SPE1C1-20-D-1297 SPE1C1-24-F-3186 2024 MAR 23 7006948720 DLA TROOP SUPPORT C AND T SUPPLY CHAIN 700 ROBBINS AVENUE PHILADELPHIA PA 19111-5096 USA Criticality: C Pre-Award Survey : None 1E401 X MICHIGAN CHURCH SUPPLY CO INC 7166 N SAGINAW RD MOUNT MORRIS MI 48458-2165 USA 2024 APR 08 Net 15 days X SEE SCHEDULE, DO NOT SHIP TO ADDRESSES ON THIS PAGE DEF FIN AND ACCOUNTING SVC BSM P O BOX 182317 COLUMBUS OH 43218-2317 USA X BX: 97X4930 5CBX 001 2620 S33189 $82.41 SPE1C1 SPE1C1 SL4701 DLA TROOP SUPPORT C AND T SUPPLY CHAIN 700 ROBBINS AVENUE PHILADELPHIA PA 19111-5096 USA Local Admin: NINA SHEA Tel: 215 737 0508 Fax: 000-000-0000 Email: Nina.Shea@dla.mil Submit Invoices IAW DFARS 252.232-7003 Isaiah Murray CODE Adobe Professional 8.0 PAGE 1 OF Isaiah Murray Isaiah.R.Murray@dla.mil 2024 MAR 23 1 3 See Section B. Terms and Conditions in accordance with Basic Contract CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: CONTINUED ON NEXT PAGE PAGE 2 OF 3 PAGES SPE1C1-20-D-1297-SPE1C1-24-F-3186 SECTION B DO Counter: 002162 PR: 7006948720 SUPPLIES/SERVICES: 9925014602220 SEE BASIC HOST AND JUICE SET CLIN BASIC QUANTITY UI UNIT PRICE DOLLAR VALUE DELIVERY REF DATE CLIN . 0001 0159 1.000 BX 82.4100 82.41 2024 APR 08 QTY VARIANCE: PLUS 0.00% MINUS 0.00% INSPECTION POINT: DESTINATION ACCEPTANCE POINT: DESTINATION DELIVER FOB: DESTINATION FOB PAYMENT METHOD: CONTRACTOR BULK BREAK POINT: W45J66 0015 CS BN CO A DISTRIBUTI AWCF SSA BLDG 32011 HELL ON WHEELS AVE FORT CAVAZOS TX 76544-0000 US SHIP BY TRACEABLE MEANS. DO NOT USE PARCEL POST. FREIGHT SHIPPING ADDRESS: W45J66 0015 CS BN CO A DISTRIBUTI AWCF SSA BLDG 32011 HELL ON WHEELS AVE FORT CAVAZOS TX 76544-0000 US MARKFOR W45J66 0015 CS BN CO A DISTRIBUTI AWCF SSA BLDG 32011 HELL ON WHEELS AVE FORT CAVAZOS TX 76544-0000 US M/F: (TCN) W45J6640830233 RDD: 107 PROJ: TP 3 SUPP ADD: W9046W SIG: C FOR GOVERNMENT USE ONLY: (IPD) 12 DIC: A0A DIST: V ADV: FC: Z9 W45J6640830233 CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 3 OF 3 PAGES SPE1C1-20-D-1297-SPE1C1-24-F-3186 SECTION B CLIN: 0001 PR: 7006948720 PRLI: 0001 CONT’D GOVT USE External External External Customer RDD/ ITEM PR PRLI PR PRLI Material Need Ship Date . 0001 7006948720 0001 N/A N/A N/A N/A * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *