EMALL NON-NSN MATERIALS

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 DATE RECEIVED (YYYYMMMDD) PREVIOUS EDITION IS OBSOLETE. 31.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. SP47W1-20-D-0012 SP47W1-24-F-2769 2024 APR 14 7007217193 DCSO FEDMALL 3990 EAST BROAD STREET COLUMBUS OH 43218 USA Criticality: C Pre-Award Survey : None 6M8Y3 X FEDERAL MERCHANTS CORP. 9465 COUNSELORS ROW STE 110 INDIANAPOLIS IN 46240-3816 USA 2024 JUL 15 Net 30 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 $585.62 SP47W1 SP47W1 SL4701 DCSO FEDMALL 3990 EAST BROAD STREET COLUMBUS OH 43218 USA Local Admin: Jan Hegedus Tel: 215-737-4759 Email: jan.hegedus@dla.mil Submit Invoices IAW DFARS 252.232-7003 Jan Hegedus CODE Adobe Professional 8.0 PAGE 1 OF Jan Hegedus jan.hegedus@dla.mil 2024 APR 14 2 2 Award sent EDI, Do not duplicate shipment See Section B. Terms and Conditions in accordance with Basic Contract CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 2 OF 2 PAGES SP47W1-20-D-0012-SP47W1-24-F-2769 SECTION B DO Counter: 011997 PR: 7007217193 SUPPLIES/SERVICES: MFR. CAGE: 6M8Y3 P/N: 15375RKC080CB11M EMALL Non-NSN Materials 90 CLIN BASIC QUANTITY UI UNIT PRICE DOLLAR VALUE DELIVERY REF DATE CLIN . 0001 0001 2.000 EA 292.8100 585.62 2024 JUL 15 QTY VARIANCE: PLUS 0.00% MINUS 0.00% INSPECTION POINT: DESTINATION ACCEPTANCE POINT: DESTINATION DELIVER FOB: DESTINATION FOB PAYMENT METHOD: CONTRACTOR IN THE CLEAR: MARINE LIGHT ATTACK HELICOPTER SQN 400 RUSSELL AVE BLDG 263 JRB NEW ORLEANS BELLE CHASSE LA 701430103 SHIP BY TRACEABLE MEANS. DO NOT USE PARCEL POST. M/F: (TCN) N094154105AADE RDD: PROJ: TP 3 SUPP ADD: N09415 SIG: A FOR GOVERNMENT USE ONLY: (IPD) 13 DIC: A0E DIST: 4 ADV: FC: KB N094154105AADE GOVT USE External External External Customer RDD/ ITEM PR PRLI PR PRLI Material Need Ship Date . 0001 7007217193 0001 N/A N/A N/A N/A * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *