SH19-019 BLM 2019 Contract - Laserfiche WebLink

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2 of 26 19. ITEM NO. 20. SCHEDULE OF SUPPLIES/SERVICES 21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT 33. SHIP NUMBER Legacy Doc #: BLM 35. AMOUNT VERIFIED CORRECTFOR 36. PAYMENT ❑ COMPLETE ❑ PARTIAL ❑ FINAL 37. CHECK NUMBER ❑ PARTIAL ❑ FINAL 38. S/R ACCOUNT NUMBER Delivery: 09/30/2019 40. PAID BY 41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print) 41 b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41 c. DATE Account Assignm: K G/L Account: 6100.252R0 42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS Business Area: L000 Commitment Item: 252R00 Cost Center: LLOR940000 Functional Area: L10300000.NU0000 Fund: 19XL1109AF Fund Center: LLOR940000 PR Acct Assign: 01 00010 Law Enforcement Patrols KCSO 25,000.00 The total amount of award: $25,000.00. The obligation for this award is shown in box 26. 32a. QUANTITY IN COLUMN 21 HAS BEEN ❑ RECEIVED ❑ INSPECTED U ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPTAS 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. 32g. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE 33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED CORRECTFOR 36. PAYMENT ❑ COMPLETE ❑ PARTIAL ❑ FINAL 37. CHECK NUMBER ❑ PARTIAL ❑ FINAL 38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY 41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print) 41 b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41 c. DATE 42b. RECEIVED AT (Location) 42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS STANDARD FORM 1449 (REV. 2/2012) BACK