ORDER FOR SUPPLIES OR SERVICES
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PAGE
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OF PAGES
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1
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12
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IMPORTANT: Mark all packages and
papers with contract and/or order numbers.
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1. DATE OF ORDER
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2. CONTRACT NO. (if any)
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6. SHIP TO:
AMD00269
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13 Mar 2003
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a. NAME OF
CONSIGNEE
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Ult
Dest: AMD00269
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3. ORDER NO.
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4.
REQUISITION/REFERENCE NO.
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Nat'l Telecom and Info Admin
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DG1335-03-SE-0336
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NTIA909-3-0050CH
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b. STREET ADDRESS
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5. ISSUING OFFICE Address correspondence to: AMD00065
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1401 Constitution Ave., N.W.
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DOC/NOAA/OFA/External Customers
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Room 4888
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c/o CAMS Support Center
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c. CITY
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d. STATE
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e. ZIP CODE
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209 Perry Parkway, Suite 5
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Washington
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DC
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20230
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Gaithersburg, MD 20877-2171
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f. SHIP VIA
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Carol A.Silverman
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301-258-4506
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7. TO: 00001568
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TIN: 954712218
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8. TYPE OF ORDER
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a. Name of
Contractor
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X
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a. PURCHASE
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b. DELIVERY
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Internet Corporation for Assigned Names and Numbers
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REFERENCE
YOUR:2/28/03 Proposal
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.
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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.
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b. Company Name
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c. Street Address
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4676 Admiralty Way, Suite 330
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d.City Marina del Rey
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e. State
CA
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f. Zip 90292-6601
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9. ACCOUNTING AND
APPROPRIATION
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BOC:
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OBLIGATED AMT:
$0.00
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10. REQUISITIONING
OFFICE
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N/A
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NTIA
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11. BUSINESS
CLASSIFICATION (Check appropriate
box(es))
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a. SMALL
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X
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b. OTHER THAN SMALL
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c. DISADVANTAGED
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d. WOMEN-OWNED
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12. F.O.B. POINT
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14. GOVERNMENT B/L
NO.
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15. DELIVER TO F.O.B. POINT ON OR BEFORE
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16. DISCOUNT TERMS
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DESTINATION
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13. PLACE OF
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30 Sep 2003
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00.00%
0 Days
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a. INSPECTION
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b. ACCEPTANCE
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See Block 6
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See Block 6
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Net
30
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17. SCHEDULE
(See reverse for Rejections)
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SUPPLIES OR SERVICES
(b)
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QUANTITY ORDERED
(c)
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UNIT
(d)
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UNIT PRICE
(e)
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AMOUNT
(f)
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QTY ACCEPT.
(g)
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The Contractor agrees to provide all services as specified
herein:
/s/_Louis Touton__________ _15Mar2003
Signature: Date:
Title: Vice President
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0001
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Base Period (4/1/03
- 9/30/03)
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1
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LT
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0.00
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0.00
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0002
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Option Period 1 (10/1/03
- 9/30/04)
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1
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LT
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0.00
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0.00
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0003
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Option Period 2 (10/1/04
- 9/30/05)
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