BPA F 4220.55 Solicitation/Contract/Order for Services and /or Items

BPA F 4220.55e

OMB #
Expiration Date: XX/2024

U.S. DEPARTMENT OF ENERGY
BONNEVILLE POWER ADMINISTRATION

[Date]
Page 1 of 1

SOLICITATION/CONTRACT/ORDER FOR SERVICES AND/OR ITEMS

PAPERWORK REDUCTION ACT BURDEN DISCLOSURE STATEMENT
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sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send any comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Enterprise Policy Development & Implementation Office,
IM-22, Paperwork Reduction Program (OMB ), US Department of Energy, 1000 Independence Ave, SW, Washington, DC 20585-1290; and to the Office of Management & Budget
(OMB), OIRA, Paperwork Reduction Project (OMB ), Washington, DC 20503.

A. SOLICITATION/CONTRACT/ORDER NUMBER
1. Requisition Number (used only in COOP event): 2. Contract Number:
BPA -...
- ...

3. Award Date:

4. Parent Contract/Award Number:

6. Date Solicitation Issued:

5. Solicitation Number:
BPA-...
- ...

B. CONTACT INFORMATION
FOR SOLICITATION
INFORMATION
CONTACT
10. Delivery To:

7. Name of Contract Specialist:

9. Offer Due Date/Pacific Time:

8. Phone and Email:

11. Freight Terms
12. Payment Terms
13. Contract Type

Commercial

14. Type of Solicitation
15. Offeror (Company Name and Address):

Non Commercial

RFQ

RFP

16. Phone and Email:
17. Email Invoices To:

C. SOLICITATION/CONTRACT/ORDER DETAILS (Attach continuation pages as necessary to list all items.)
18. Item Number

19. Description

20. Quantity

SEE CONTINUATION PAGE

24. Accounting and Appropriation Data (used only in COOP event):

NSS-TMP-0034-1.0

23. Amount

...

$ 0.00

...

$ 0.00

...

$ 0.00

...

$ 0.00

27. Offer Dated:
Your offer on this solicitation, specified in item: 19-23
including any additions or changes set forth herein is
accepted as to items listed.

29a. Name of Contracting Officer:

28a. Name, Email and Title of Signer:

By:_____________________________
(Signature of person authorized.)

22. Unit Price

25. Total Award Amount

26.Contractor is required to
sign
not sign this document and return
this form via email to the Contracting Officer. Contractor agrees to furnish
and deliver all items set forth or otherwise identified above and on any
additional sheets subject to the terms and conditions specified herein.

28b. Signature of Contractor

21. Unit

28c. Date Signed:

29b. Signature of Contracting Officer:
By:______________________________
(Signature of Contracting Officer.)

29c. Date Signed: