NATIONAL MOBILE SHOWER FACILITIES
1.
Paying Unit: Attn: Incident Business-Contracts, USFS Albuquerque Service Center
101B Sun Avenue, NE Albuquerque, NM 87109
2.
Contractor Name, Address, and TIN & DUNS No.
3.
Contract Number: 53-024B-4-XXXX
4.
Invoice Date: XX/XX/XX
5.
Shower ID No:
6.
Invoice No:
7.
Incident Name:
8.
Job Code: PXXXXX
9.
Resource Order No: XX-XXX-XXXXXX
Request No: E-XX
10. Benefiting Unit, Region/Agency:
11. Unit Description:
12. Unit Identification Number:
13. Location: Enter City and State from location at time of dispatch to the Incident.
14. Mileage: Enter actual mileage from verified odometer readings.
15. Usage and Prices: Enter amount of usage & price (Payment for partial days shall be made at one half
the daily rate when service is provided for 8 hours or less, at the beginning and end of the use period).
16. Relocation Fee: Enter the number of moves ordered and actual mileage to new location from verified
odometer readings.
17. Transporting Water: Enter the total number of Miles for the potable water vehicle to transport water
and the price per mile to be paid.
18. Intermittent Use: Enter the total number of hours that the potable water vehicle was used in support of
camp operations away from their shower unit. (Record time to the nearest quarter hour).
19.
Totals:
20. Enter total miscellaneous charges and credits from 1276-D.
21. Total Invoice Amount:
22. Remarks: Document Contractor’s beginning & ending odometer readings from DDP to Incident.
Document purpose of Intermittent Use, Relocations, etc.
23. Government Representative must sign & print their name, title, work address, & phone number
24. Contractor’s Representative must sign & print Their name, title, & phone number. Payment will not be
processed without a signature from an authorized representative.