Dd Form 1164 – Fill Out and Use This PDF

1. TO (Contractor)

2. FROM (Ordering Office)

a. NAME

a. NAME

b. ADDRESS (Street, City, State, ZIP Code)

b. ADDRESS (Street, City, State, ZIP Code)

3. THIS SERVICE ORDER IS ISSUED AND AN ORDER IS HEREBY PLACED WITH YOU, ACCEPTING YOUR OFFER (ORAL OR WRITTEN) FOR

SERVICES ON (enter date)

,

, SUBJECT TO THE PROVISIONS OF THE BELOW-NUMBERED BASIC

ORDERING AGREEMENT FOR THE FOLLOWING SERVICES:

a. SCAC CODE

b. FEDERAL AGENCY

c. APPROPRIATION

d. BASIC ORDERING AGREEMENT NUMBER

e. MODIFICATION

IDENTITY

NUMBER

f. SERVICE ORDER NUMBER

g. LOT NUMBER

h. LOCATION OF PROPERTY (Street, City, State, ZIP Code)

(1) OLD

(2) NEW

i. ESTIMATED

j. PICK-UP DATE (YYYYMMDD)

k. STORAGE EXPIRATION

l. ESTIMATED WEIGHT

m. WEIGHT IN STORAGE

STORAGE PERIOD

DATE (YYYYMMDD)

(ACTUAL)

n. OWNER

(1) NAME (Last, First, Middle Initial)

(2) PERMANENT ADDRESS (Street, City, State, ZIP Code)

(3) PAY GRADE

(4) SSN

4. NEW ACCOUNTS - SERVICES ORDERED

a. PACKING

b. SPECIAL SERVICES

c. DRAYAGE-IN

d. HANDLING-IN

e. STORAGE

ITEM I

(1) WARDROBE - ITEM IIA

(2) EXPENSIVE/VALUABLE

ITEM III

ITEM IV

ITEM V

ITEM - ITEM IIB

RATE

NO.

RATE

NO.

RATE

ZONE

RATE

RATE

RATE

$

$

$

$

$

$

5. REMOVAL ACTIONS

a. APPROPRIATION IDENTITY

b. STORAGE REMOVAL DATE

c. DELIVERY ADDRESS (Street, City, State, ZIP Code)

(YYYYMMDD)

d. SERVICES ORDERED

(1) HANDLING IN

(2) HANDLING OUT

(3) DRAYAGE-OUT

(4) UNPACKING

(5) WEIGHT

(5) WEIGHT

(5) WEIGHT

ITEM IV

ITEM VI

ITEM VII

ITEM VIII

REHANDLED

REMOVED

REMAINING

RATE

RATE

ZONE

RATE

RATE

$

$

$

$

6. REMARKS

7. SPECIAL INSTRUCTIONS

a. MAIL INVOICES TO:

b. STORAGE AUTHORITY:

c. MAXIMUM WEIGHT CHARGEABLE TO GOVERNMENT

LBS. Weight in excess of such maximum w ill be charged to the ow ner.

d. ESTIMATED COST OF THE SERVICES IS $

. You are not to perform any service w hich w ill result in contract costs in excess of

the above sum, unless authorized in w riting by the ordering officer.

e. ACCOUNTING CLASSIFICATION:

8. CERTIFICATION (To be completed by Ordering Office)

Commercial storage has been determined to be more economical than government storage.

a. TYPED NAME (Last, First, Middle Initial)

b. TITLE

c. SIGNATURE

d. DATE SIGNED

(YYYYMMDD)

DD FORM 1164, SEP 1998

PREVIOUS EDITION IS OBSOLETE.

COPY DESIGNATION:

Original

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ADOBE PROFESSIONAL 8.0

(X)

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