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|SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS |1. REQUISITION NO. |PAGE 1 OF |

|OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 | | |

|2. CONTRACT NO. |3. AWARD/EFFECTIVE DATE |4. ORDER NO. |5. SOLICITATION NO. |6. SOLICITATION ISSUE DATE |

|7. FOR SOLICITATION |a. NAME |b. TELEPHONE NO. (No collect |8. OFFER DUE DATE/LOCAL TIME |

|INFORMATION CALL | |calls) | |

|9. ISSUED BY CODE | |10. THIS ACQUISITION IS |11. DELIVERY FOR FOB |12. DISCOUNT TERMS |

| | | UNRESTRICTED |DESTINATION UNLESS BLOCK | |

| | |SET ASIDE: % FOR |IS MARKED | |

| | |SMALL BUSINESS |SEE SCHEDULE | |

| | | SMALL DISADV. BUSINESS | 13a. THIS CONTRACT IS A RATED ORDER |

| | | |UNDER DPAS (15 CFR 700) |

| | | 8(A) |13b. RATING |

| | |SIC:...