AAWSAP Solicitation and Original Order, September 2008

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19.
ITEM NO.
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
32a. QUANTITY IN COLUMN 21 HAS BEEN
□
RECEIVED
□
INSPECTED
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ACCEPTED AND CONFORMS TO THE CONTRACT EXCEPT AS NOTED·
32b. SIGNATURE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE
32c. DATE
32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE
32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE
32f. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE
32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE
33. SHIP NUMBER
34. VOUCHER NUMBER
35. AMOUNT VERIFIED
CORRECT FOR
36. PAYME.NT
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COMPLETE
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PARTIAL
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FINAL
37. CHECK NUMBER
!PARTIAL
!FINAL
I
38. S/R ACCOUNT NO.
39. S/RVOUCHER NUMBER
40. PAID BY
41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT
42a. RECEIVED BY
(Print)
42b. RECEIVED AT
(Location)
142c. DATE REC'D
(YY/MM/ DD)
142d. TOTALCONTAINERS
41 b. SIGNATURE AND TITLE OF CERTIFYING OFFICER
41c. DATE
STANDARD FORM 1449
(REV.2/2012)
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HHM402-08-C-0072