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Order for Supplies or Services, DHHS, 2005

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PAGE OF PAGES

ORDER FOR SUPPLIES OR SERVICES
6. SHIP TO:

2. CONTRACT NO. (If any)

1. DATE OF ORDER

GS10F0105N

09/12/2005

3

1

IMPORTANT: Mark all packages and papers with contract and/or order numbers.
a. NAME OF CONSIGNEE

3. ORDER NO.

Multiple Destinations

4. REQUISITION/REFERENCE NO.

HHSP233200500163U
b. STREET ADDRESS

5. ISSUING OFFICE (Address correspondence to)

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

c. CITY

d. STATE

e. ZIP CODE

f. SHIP VIA

7. TO:
a. NAME OF CONTRACTOR

VERA INSTITUTE OF JUSTICE INC 356370

8. TYPE OF ORDER

b. COMPANY NAME

X

a. PURCHASE

c. STREET ADDRESS

VERA INSTITUTE OF JUSTICE, INC.

Except for billing instructions on the
reverse, this delivery order is
subject to instructions contained on
this side only of this form and is
issued subject to the terms and
conditions of the above-numbered
contract.

233 BROADWAY FL 12

d. CITY

e. STATE

NEW YORK

Please furnish the following on the terms
and conditions specified on both sides of
this order and on the attached sheet, if
any, including delivery as indicated.

f. ZIP CODE

NY

10279-1299

9. ACCOUNTING AND APPROPRIATION DATA

10. REQUISITIONING OFFICE

See Schedule

DHHS/PSC/SAS/DAM

11. BUSINESS CLASSIFICATION (Check appropriate box(es))
a. SMALL

b. OTHER THAN SMALL

12. F.O.B. POINT
c. DISADVANTAGED

d. WOMEN-OWNED

g. WOMEN-OWNED SMALL BUSINESS (WOSB)
ELIGIBLE UNDER THE WOSB PROGRAM

f. SERVICE-DISABLED
VETERAN-OWNED

13. PLACE OF
a. INSPECTION

e. HUBZone

Destination

h. EDWOSB

14. GOVERNMENT B/L NO.

15. DELIVER TO F.O.B. POINT
ON OR BEFORE (Date)

16. DISCOUNT TERMS

02/04/2009

b. ACCEPTANCE

Destination

b. DELIVERY

REFERENCE YOUR:

Destination

17. SCHEDULE (See reverse for Rejections)

ITEM NO.
(a)

QUANTITY
ORDERED UNIT
(d)
(c)

SUPPLIES OR SERVICES
(b)

UNIT
PRICE
(e)

QUANTITY
ACCEPTED
(g)

AMOUNT
(f)

Tax ID Number: 13-1941627
DUNS Number: 073299836
1

BASE PERIOD

274,820.00

PRO BONO OUTREACH PILOT PROJECT
Continued ...
18. SHIPPING POINT

19. GROSS SHIPPING WEIGHT

17(h)
TOTAL
(Cont.
pages)

20. INVOICE NO.

21. MAIL INVOICE TO:
a. NAME
SEE BILLING
INSTRUCTIONS
ON REVERSE

b. STREET ADDRESS
(or P.O. Box)

c. CITY

ROCKVILLE
22. UNITED STATES OF
AMERICA BY (Signature)

PSC/FMS

$8,200,000.00

(301) 443-3020

PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE
ROCKVILLE MD 20857

17(i)
GRAND
TOTAL

d. STATE

MD

e. ZIP CODE

$8,474,820.00

20857
23. NAME (Typed)

DONALD S. HADRICK
TITLE: CONTRACTING/ORDERING OFFICER

AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE

OPTIONAL FORM 347 (Rev. 2/2012)
Prescribed by GSA/FAR 48 CFR 53.213(f)

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION

PAGE NO

2

IMPORTANT: Mark all packages and papers with contract and/or order numbers.
DATE OF ORDER

CONTRACT NO.

ORDER NO.

09/12/2005 GS10F0105N

HHSP233200500163U

ITEM NO.

SUPPLIES/SERVICES

(a)

(b)

QUANTITY UNIT
ORDERED
(c)
(d)

UNIT
PRICE
(e)

AMOUNT

QUANTITY
ACCEPTED
(g)

(f)

Delivery Location Code: ACF
HHS/ORR
901 D STREET
AEROSPACE BUILDING
EIGHTH FLOOR
WASHINGTON DC 20447
Amount: $274,820.00
Accounting Info:
2005-G994353-25200-1 Appr. Yr.: 2005 CAN: G994353 Object Class: 25200
Funded: $274,820.00
2

OPTION YEAR I

1,200,000.00

PRO BONO OUTREACH PILOT PROJECT
Delivery Location Code: ACF
HHS/ACF/ORR/DUCS
901 D STREET, SW
AEROSPACE BLDG, 8TH FLOOR
WASHINGTON DC 20447
Amount: $1,200,000.00
Accounting Info:
2006-G994223-25200-1 Appr. Yr.: 2006 CAN: G994223 Object Class: 25200
Funded: $1,200,000.00
3

OPTION YEAR II

2,000,000.00

PRO BONO OUTREACH PILOT PROJECT
Amount:: $2,000,000.00
Delivery Location Code: ACF
HHS/ACF/OAS/IA
901 D STREET, SW
AEROSPACE BLDG, 6TH FLOOR
WASHINGTON DC 20447
Amount: $2,000,000.00
Accounting Info:
2007-G99UPR7-25200-1 Appr. Yr.: 2007 CAN: G99UPR7 Object Class: 25200
Funded: $500,000.00
Accounting Info:
2007-G99UPR7-25200-2 Appr. Yr.: 2007 CAN: G99UPR7 Object Class: 25200
Funded: $1,500,000.00
4

OPTION YEAR III
PRO BONO OUTREACH PILOT PROJECT
Continued ...

5,000,000.00

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

$8,200,000.00

AUTHORIZED FOR LOCAL REPODUCTION
PREVIOUS EDITION NOT USABLE

OPTIONAL FORM 348 (Rev. 4/2006)
Prescribed by GSA FAR (48 CFR) 53.213(f)

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION

PAGE NO

3

IMPORTANT: Mark all packages and papers with contract and/or order numbers.
DATE OF ORDER

CONTRACT NO.

ORDER NO.

09/12/2005 GS10F0105N

HHSP233200500163U

ITEM NO.

SUPPLIES/SERVICES

(a)

(b)

QUANTITY UNIT
ORDERED
(c)
(d)

UNIT
PRICE
(e)

AMOUNT

QUANTITY
ACCEPTED
(g)

(f)

Delivery Location Code: ACF
ACF/ORR
901 D STREET, S.W.
WASHINGTON DC 20447
Amount: $5,000,000.00
Accounting Info:
2008-G99UPR8-25102-1 Appr. Yr.: 2008 CAN: G99UPR8 Object Class: 25102
Funded: $5,000,000.00
The total amount of award: $8,474,820.00. The obligation for this award is shown in
box 17(i).

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
AUTHORIZED FOR LOCAL REPODUCTION
PREVIOUS EDITION NOT USABLE

$0.00
OPTIONAL FORM 348 (Rev. 4/2006)
Prescribed by GSA FAR (48 CFR) 53.213(f)

 

 

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