PerFORM PRO FORM 2.02AD-838D, BPA - Invoice-Receipt CertificationShirley A. Monroe11/91 editionxt-r- This is a two-page form. Print page 1 on white paper and page 2 on yellow paper. INSTRUCTIONS USE THIS FORM ONLY IF THE PURCHASE ORDER NUMBER (BLOCK 8 OF FORM AD-838) BEGINS WITH "45" Specific Instructions are contained in help boxes attached to the individual blocks (except for blocks 16, 17, and 19). The instructions for these blocks are as follows: 16. The approving officer's signature is required in this block. 17. Enter the date this form is signed. 19. Attach all billing documents (itemized invoices) to the back of this form and mail to this NFC address. The use of a window envelope is optional. CAUTION: Multiple invoices attached to a single AD-838D are acceptable only when the payment due date is the same. BPA Order No. P.    s7-7-1. Enter the blanket purchase agreement (BPA) order number as indicated on Form AD-838, Purchase Order, Block 8.Vendor/Seller ID No. P. ## _>_>2. Enter the Social Security Number (SSN) (XXX-XX-XXXX), Employer Identification Number (EIN) (XX-XXXXXXX), or the DUNS Number (XX-XXX-XXXX) obtained from the seller. This number must be identical to the one shown on the AD-838, Block 9B, Seller's Ident. No.Vendor Payment Ref # P. ,, >>5. Enter the vendor payment reference number (invoice number, account number, etc.). Do not exceed 20 characters. In the case of multiple invoices, include no more than 20 characters and attach only those invoices that can be identified within the 20 characters. If there are no invoice numbers, account numbers, etc., on the payment document, enter the date of the invoice or statement as MMDDYY.Line Item # @. w>w> ))8. This should not be a sequential line item number beginning with 01. If the AD-838 establishing the BPA did not include line items, then the number 01 should be used for all line items. However, if different accounting is used, then it should be 01, 02, 03, etc.Fund Code @. 22 $$9. Use when Block 13 will be completed. This code supports the accounting classification regardless of whether or not it was indicated on the AD-838.Unit Code @. ,, ))10. Use only by Forest Service when Block 13 will be completed. This code supports the accounting classification regardless of whether or not it was indicated on the AD-838.Budget Object @. $ $ ==11. Enter the budget object code when different from the budget object code on the establishing order. If no budget object code was entered on the establishing order, it must be entered here.SF 281 Code @. = = H3312. Enter the SF 281 code when different from the establishing order.Accounting Classification @. = = ==13. Enter the accounting classification when different from the establishing order. If no accounting classification was entered on the establishing order, it must be entered here and Blocks 8 and 11 must be completed. NOTE: When a different accounting classification is shown here, it will not replace the stored accounting from the AD-838. to change the accounting classification on the AD-838, amend it.$ AmountCB. ' ' $$14. Enter the dollar amount of line item charges from billing document(s) less any discounts., e.g. volume, credit, and trade-in. Do not deduct term discounts as these are automatically computed by the system.TotalntR.  == ==[$ AMOUNT] o4o415. Enter the total amount to be paid to the vendor. This total must agree with the total of the billing document(s) that will be attached.S@ G5G5 66 Telephone # @. ))==**() - ==18. Enter the phone number where the authorized official can be reached for additional information. Check the appropriate block to indicate if the phone number is an FTS or commercial number.Date Rec'd/Accepted @. >> >>3. Enter the date the goods or services were received and accepted or the date the service period ended. When single multiple invoices are submitted in a billing cycle, use latest date. When invoices are consolidated in a billing cycle (established with a vendor), enter the last day of that transaction cycle. (Note: This can only be done when the vendor/seller agrees to the payment due date.)Date Billing Stmt. Rec'd. @. O2O2 G2G24. Enter the date the itemized billing statement(s) was received. When no billing statement was received, enter the datae the latest invoice was received. (Note: This can only be done when the vendor/seller agrees to the payment due date.)Vendor's Remit Name/Addre @. **" 116. Complete this block if the remittance address is different from the name and/or mailing address of the vendor/seller identified in Block 10 on the AD-838. If not different, leave blank. CAUTION: Agencies must ensure that a correct remittance address is indicated on the AD-838 when this block is left blank. This address should correspond with the remit to address on the seller's invoice. When an invoice is received from a vendor enrolled in EFT, refer to the originating AD-838 and verify whether VXP followed by the vendor identification number and the complete remittance address is present. If the Vendor Express identification is not present on the originating AD-838 or is different from the Vendor Express information provided on the vendor's invoice, the agency must include the full address (with VXP and the 9-digit vendor identification number) to ensure that the vendor is paid through EFT.Swiss"System"Courier1DutchHelvetica"Times CG ATTUnivers (WN)#Univers ATT"CG Times (WN)Arial".!Za $ Q%B 6cHh0X"`"`  BPA Order No. 444441. BLANKET PURCHASE AGREEMENT (BPA) ORDER NUMBERQ7cb[h0X"`"` Vendor/Seller ID No.2&W@ 2W@2. VENDOR/SELLER IDENT. NUMBERq7E7c [;h0X"`"` *?8 ?84. DATE BILLING STATEMENT RECEIVEDqc7c5E[h;"`"` Dg3 g33. DATE GOODS RECEIVED/ACCEPTED/ SERVICE PERIOD END DATEQ] n0X"`"`  Vendor Payment Ref # !&<!<5. VENDOR PAYMENT REFERENCE NUMBER %B2xH}0"`"`?W3 ?W36. VENDOR'S REMITTANCE NAME AND ADDRESS T P (Street or P.O. Box, City, State, and Zip Code) PT EComplete this block only when the remittance address is different from Block 10 on Form AD-838ETPtQo20"`"`  pO3o3 O3o37. In approving this voucher, I have determined that the items billed were received, inspected, and accepted as complying with the BPA indicated in Block 1.CQ4DWCD3XQ6DWFk  Line Item #  D4zkWChD3XDzk6k  Fund Code  |k4WhD3X|kl  Unit Code ))4WD3X6W  Budget Object 44QWxDd  6=6=15. TOTAL {iiUU4W2xDd  Total Qxdy""`  !m3!319. Attach billing documents and mail to:  P T (Use of Window Envelope is Optional) TPdolQ  $sO< $O<><17. DATEu$; 1"`"`  Telephone # :; >?;>;18. PHONE ET  (Area Code and Number) TE<2 3X<2$9 S  29q"``` 5#5FORM AD-838D UDSA (Rev. 11/91)'`8 `  >>NFCcf}5E[;3f}[u"`"` Date Rec'd/Accepted@@5<5<@=@=,3,3Month66LDay"Year%4WD3Xl(  SF 281 Code 554WD3X6W(  Accounting Classification 5542WD3X26   $ Amount '5'5VXgpTd1 `VXgTd1 `jp1 `j1 `  X"`?4?4FTS COMM z dzdX 4X xdQkZ-` "``41;4;DESIGN SOFTWARE: PERFORM PRO PLUS BY DELRINAu$xu$ du$ 2 Qx2xddQ%B2%BHH2%B2 HQ%BQxHdQW2WDD!20X`$!$13 ACCOUNTING CLASSIFICATION>14 DOLLAR AMOUNT!20X>> SF- 281 CODE!20X33 BUDGET OBJECT|k!2h0XO=O= UNIT CODED!zk2Ch0X?=?= FUND CODEQ!D2C0X33 LINE ITEM NO.!xd Dy2~0 Vendor's Remit Name/Addre 7Ef} [;3mf}[U"`"` Date Billing Stmt. Rec'd.oo!!==w=w=MonthDayYear RECEIPmEXQ!DCX `??8D!zkChX `??9Q!2#B(H   =w=BPA INVOICE-RECEIPT CERTIFICATION P ET See Completion Instructions On Reverse of Agency CopyTEP )#+Z<#+ 222o o\Xv v\kkX \  X \X MN8cTLi0 ` ==45 -zk!hX `'!'!10!X `##11 !X `##12 '`8 0 ` G!G!AGENCY