Task Order Form-OF349+ - 057

PAGE OF PAGES
ORDER FOR SUPPLIES OR SERVICES

IMPORTANT: Mark all packages and papers with contract and/or order numbers. 1 1
1. DATE OF ORDER 2. CONTRACT NO. (If any) 6. SHIP TO:
12/01/2012 GS-00-Q-13-NS-D-3000 a. NAME OF CONSIGNEE
3. ORDER NO. 4. REQUISITION/REFERENCE NO. Insert Information Here
XXXXXXXXXXXX To be inserted b. STREET ADDRESS
5. ISSUING OFFICE (Address correspondence to)
Insert Office Information Here c. CITY d. STATE e. ZIP CODE
**UPDATE ALL SECTIONS IN RED**

7. TO: f. SHIP VIA
a. NAME OF CONTRACTOR
Cynthia Clemins (757-320-9621) DUNS#.603493677 (Cage# 5FS99) TIN# 8. TYPE OF ORDER

43-1408007
b. COMPANY NAME a. PURCHASE [ ] b. DELIVERY -- Except
Sprint Communications Co. LP REF YOUR: for billing instructions on the reverse, this
c. STREET ADDRESS Please furnish the following on the terms delivery order is subject to instructions
and conditions specified on both sides of contained on this side only of this form
12502 Sunrise Valley Drive
d. CITY e. STATE f. ZIP CODE this order and on the attached sheet, if and is issued subject to the terms and
any, including delivery as indicated. conditions of the above-numbered contract.
Reston VA 20196
9. ACCOUNTING AND APPROPRIATION DATA 10. REQUISITIONING OFFICE
Insert Accounting Information Here Insert Information Here

11. BUSINESS CLASSIFICATION (Check appropriate box(es))
a. SMALL b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED

12. F.O.B. POINT 14. GOVERNMENT B/L NO. 15. DELIVER TO F.O.B. POINT ON 16. DISCOUNT TERMS
OR BEFORE (Date)
See block 6
13. PLACE OF
a. INSPECTION b. ACCEPTANCE
See block 6 See block 6
17. SCHEDULE (See reverse for Rejections)
QUANTITY UNIT QUANTITY
ITEM NO. SUPPLIES OR SERVICES ORDERED UNIT PRICE AMOUNT ACCEPTED
(a) (b) (c) (d) (e) (f) (g)
CLIN 0001 TTY Usage Based PPM See Table 1 See Grand Total Usage
CLIN 0002 CAPTEL (Telephonically-Based Services) Usage Based PPM See Table 1 See Grand Total Usage
CLIN 0003 Speech to Speech (Telephonically-Based Services) Usage Based PPM See Table 1 See Grand Total Usage
CLIN 0004 VRS (Internet-Based Services) Usage Based PPM See Table 1 See Grand Total Usage
CLIN 0005 IP RELAY (Internet-Based Services) Usage Based PPM See Table 1 See Grand Total Usage
CLIN 0006 RCC (Internet-Based Services) Usage Based PPM See Table 1 See Grand Total Usage
CLIN 0007 Call Detail Report ICB ICB See Table 1 See Grand Total Usage
CLIN 0008 Rolled Up Invoice Reporting See Grand Total
ICB ICB See Table 1 Usage
Note: This Task Order is for Federal Relay and PPM means
price per minute.
18. SHIPPING POINT 19. GROSS SHIPPING 20. INVOICE NO.

WEIGHT
SEE 21. MAIL INVOICE TO: (Cont.
BILLING a. NAME pages)
INSTRUCTIONS Insert Delivery Information Here
ON b. STREET ADDRESS (or P.O. Box)
REVERSE **Recommen
c. CITY d. STATE e. ZIP CODE d GRANDD
Min of
$30,000** TOTAL
23. NAME (Typed)

22. UNITED STATES OF
John A. Doe
AMERICA BY (Signature)
TITLE: CONTRACTING/ORDERING OFFICER
This information is subject to Sprint’s policies regarding use and is the property of Sprint
and/or its relevant affiliates and may contain restricted confidential or privileged materials intended for the sole use of
the intended recipient. Any review, use, distribution or disclosure is prohibited without authorization.
Contract line Item (CLIN) Tables
Base Year 1 – November 16, 2012 – November 30, 2013
CLIN Description Quantity Fixed Price Per Minute

0001 Voice/FTTY Service Per Minute Usage $4.8350
0002 Federal Speech to Speech (FSS) Per Minute Usage $4.8350
0003 Federal Captioned Telephone (FCTS) Per Minute Usage $4.3443
0004 Federal Internet Protocol (IP) Relay (FIPR) Per Minute Usage $4.8350
0005 Federal Video Relay Service (FVR) Per Minute Usage $10.7800
0006 Federal Captioned Relay (FCR) Per Minute Usage $4.8350
0007 Call Detail Report ICB*
0008 Rolled Up Invoice Reporting Per report $215.60
Note: Pricing is subject to change at any time.
*ICB – Individual Case Basis
Base Year 2 – December 1, 2013 – November 30. 2014

Base Year 3 – December 1, 2014 – November 30, 2015

Base Year 4 – December 1, 2015 – November 30, 2016

Period 5 - Option Year 1 – December 1, 2016 – November 30, 2017

Period 6 - Option Year 2 – December 1, 2017 – November 30, 2018

Period 7 - Option Year 3 – December 1, 2018– November 30, 2019

Period 8 - Option Year 4– December 1, 2019 – November 30, 2020

Sprint Confidential Information – Do Not Forward.

Contact Number GS-00-Q-13-NS-D-3000 Sprint
Task Order Number XXXXXXXXXXXXX
Federal Relay- Billing Contact Information Form

Contact No.: GS-00-Q-13-NS-D-3000
Federal Relay Services (Mark All That Apply with “X”)
** ALL SIX (6) SERVICES **
(CHECK THIS BOX ONLY)
Telephone-based Services Internet-based Services
TTY/VOICE/ASCII/Baudot Video Relay Service (VRS)/ Video Remote
Interpreting (VRI)
Captioned Telephone (CapTel) Internet Protocol (IP) Relay
Speech to Speech Relay Conference Captioning (RCC)
Would you like your agency to be listed on the Federal Relay website as an agency with an Active Task Order?
https://www.federalrelay.us/task-order [ ] YES [ ] NO
Billing Contact Information
Type of Request (Mark one “X”) [ ] New [ ] Modify [ ] Delete
¹Agency Name _____________________________________ AB Code (four digit) ______________
Primary Billing Contact
__________________________ ___________ _________________________________

First Name M.I. Last Name
________________________________________ __________________________________________
Title Organization/Unit
________________________________________ __________________________________________
Street City
_______________________________ ____________________
State Zip Code
Telephone: (Office) (___) ____- ____ Mobile (___) ____- _____ Fax (___) ____- _____
Email: Work _____________________________________________________
Wireless ___________________________________________________
Preferred Method of Receiving Service Request Acknowledgements, Service Order Notifications, Service
Notices and Billing Communications? (Mark “P” for primary and “S” for secondary)
[ ] Work Email [ ] Wireless Email [ ] Fax [ ] Other _________________
Are you able to accept “.zip” files for electronic reports, invoices, etc.? [ ] Yes [ ] No
Secondary Billing Contact
__________________________ ___________ _________________________________

First Name M.I. Last Name
________________________________________ __________________________________________
Title Organization/Unit
________________________________________ __________________________________________
Street City
_______________________________ ____________________
State Zip Code
Telephone: (Office) (___) ____- ____ Mobile (___) ____- _____ Fax (___) ____- _____
Email: Work _____________________________________________________
¹List only Executive Agencies (Appendix A), Other Eligible Users (Appendix B), International Organizations
(Appendix C), and Tribes & Tribal Organizations as listed in GSA Order ADM 4800.2E- Eligibility to Use GSA Sources
of Supply and Services at http://www.gsa.gov/graphics/fas/SignedGSADirective48002F.pdf

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PAGE OF PAGES

ORDER FOR SUPPLIES OR SERVICES

Insert Office Information Here c. CITY d. STATE e. ZIP CODE

**UPDATE ALL SECTIONS IN RED**

Cynthia Clemins (757-320-9621) DUNS#.603493677 (Cage# 5FS99) TIN# 8. TYPE OF ORDER

Insert Accounting Information Here Insert Information Here

a. SMALL b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED

18. SHIPPING POINT 19. GROSS SHIPPING 20. INVOICE NO.

23. NAME (Typed)

Contract line Item (CLIN) Tables

Base Year 1 – November 16, 2012 – November 30, 2013

CLIN Description Quantity Fixed Price Per Minute

Base Year 2 – December 1, 2013 – November 30. 2014

CLIN Description Quantity Fixed Price Per Minute

Base Year 3 – December 1, 2014 – November 30, 2015

CLIN Description Quantity Fixed Price Per Minute

Base Year 4 – December 1, 2015 – November 30, 2016

CLIN Description Quantity Fixed Price Per Minute

CLIN Description Quantity Fixed Price Per Minute

Note: Pricing is subject to change at any time.

*ICB – Individual Case Basis

Period 6 - Option Year 2 – December 1, 2017 – November 30, 2018

CLIN Description Quantity Fixed Price Per Minute

*ICB – Individual Case Basis

Period 7 - Option Year 3 – December 1, 2018– November 30, 2019

CLIN Description Quantity Fixed Price Per Minute

*ICB – Individual Case Basis

Period 8 - Option Year 4– December 1, 2019 – November 30, 2020

CLIN Description Quantity Fixed Price Per Minute

*ICB – Individual Case Basis

Sprint Confidential Information – Do Not Forward.

Federal Relay- Billing Contact Information Form

Billing Contact Information

Type of Request (Mark one “X”) [ ] New [ ] Modify [ ] Delete

¹Agency Name _____________________________________ AB Code (four digit) ______________

Primary Billing Contact

__________________________ ___________ _________________________________

Email: Work _____________________________________________________

[ ] Work Email [ ] Wireless Email [ ] Fax [ ] Other _________________

Secondary Billing Contact

__________________________ ___________ _________________________________

Email: Work _____________________________________________________

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UPDATE ALL SECTIONS IN RED

¹Agency Name _______________________ AB Code (four digit)

____________________ _ _____________________________

____________________ _ _____________________________