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 DATE RECEIVED (YYYYMMMDD) PREVIOUS EDITION IS OBSOLETE. 31.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. SPE605-21-D-8526 SPE605-24-F-XP6N 2024 MAR 27 7006991753 DLA ENERGY POST, CAMPS, AND STATIONS 8725 JOHN J. KINGMAN ROAD FORT BELVOIR VA 22060 USA Criticality: C Pre-Award Survey : None 8E236 X COLONIAL OIL INDUSTRIES, INC. 101 N LATHROP AVE SAVANNAH GA 31415-1054 USA 2024 APR 02 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 5CFX 001 2620 S33189 $14,071.40 SPE605 SPE605 SL4701 DLA ENERGY POST, CAMPS, AND STATIONS 8725 JOHN J. KINGMAN ROAD FORT BELVOIR VA 22060 USA Initiator: SARINA TREGO
SARINA.TREGO@US.AF.MIL Submit Invoices IAW DFARS 252.232-7003 John Parson CODE Adobe Professional 8.0 PAGE 1 OF John Parson
John.Parson@dla.mil 2024 MAR 27 7,000 2 See Section B. Terms and Conditions in accordance with Basic Contract CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 2 OF 2 PAGES SPE605-21-D-8526-SPE605-24-F-XP6N SECTION B DO Counter: 000383 PURCHASE PGM: 3.24 Additional Nomination Information Nomination number: 00000000110000485195 Vehicle: TT Contact Info: SARINA TREGO
SARINA.TREGO@US.AF.MIL 813-828-2074 PR: 7006991753 SUPPLIES/SERVICES: 9130014702024 SEE BASIC FUEL,ETHANOL E85 CLIN BASIC QUANTITY UI UNIT PRICE DOLLAR VALUE DELIVERY REF DATE CLIN . 0001 0002 7,000.000 UG6 2.0102 14071.40 SEE BELOW QTY VARIANCE: PLUS 10.00% MINUS 10.00% INSPECTION POINT: DESTINATION ACCEPTANCE POINT: DESTINATION ACCEPTANCE DODAAC: SE5F0G DELIVER FOB: DESTINATION FOB PAYMENT METHOD: CONTRACTOR PERIOD OF PERFORMANCE 2024 APR 02 - 2024 APR 02 MODE OF SHIPMENT: TT TANK TRUCK LOCATION ID: MACDILL DELIVERY DODAAC: SE5F0G 6 SUPS LGSF HILLSBOROUGH MACDILL AFB , FL 33621 US BLDG P45 DELIVERY HOURS: 0700-1430 ON WEEKDAYS. CALL THE FUELS SERVICE CENTER AT 813-828-2074 TO ARRANGE ESCORT FROM TANKER WAY GATE . POC: TSGT TREGO EMAIL:
6LRS.LGRF.FUELSSERVCENTER@US.AF.MIL