National Mobile Food Services

NATIONAL MOBILE FOOD SERVICES

1. / Contract Number: AG-XXXX-X-XX-XXXX
2. / Invoice Date: XX/XX/XX
3. / Mobile Food Service Unit ID No:
4. / Invoice No:
5. / Incident Name:
6. / Job Code: PXXXXX
7. / Resource Order No: XX-XXX-XXXXXX
Request No: E-XX
8. / Benefiting Unit, Region/Agency:
9. / Paying Unit: Attn: Incident Business-Contracts, USFSAlbuquerqueServiceCenter
101B Sun Avenue, NE Albuquerque, NM 87109
10. / Contractor Name and Address:
11. / Meals Ordered: Enter total number of meals ordered only.
12. / Serve / Cancel / Order Increase / Order Decrease Times: Enter times meals are to be served and time when meal orders were Canceled, Increased, or Decreased.
13. / Menu and Menu Approvals, Major Items & Signatures
14. / Actual Number of Meals Served: Enter the total number of meals served.
15. / Number and Price of Meals for payment Purpose: Enter number of meals served and price per meal.
16. / Totals:
17. / Unit Description and Number: Enter the Unit ID number for the kitchen unit and the Unit ID for the Handwashing Station.
18. / Location: Enter the starting point and the end point for kitchen unit travel.
19. / Mileage: Enter the total miles kitchen unit traveled from starting point to end point and rate per mile.
20. / Usage/Relocation: Enter unit of measure as miles or days and rate per mile or per day.
21. / Totals:
22. / Enter total Supplemental Foods and beverages charges from 1276-B.
23. / Enter Total Miscellaneous Charges and Credits From 1276-B.
24. / Total Invoice Amount: Enter the total amount to be paid for this invoice.
25. / Remarks: Enter any explanatory comments that support the information provided in this invoice.
26. / Print and sign name, title, and phone number of Government Representative.
27. / Print and sign name, title, and phone number of Contractor Representative.
28. / Supplemental Foods and Beverages: Enter all Supplemental Foods and Beverages ordered and received, prices, and totals.
29. / Miscellaneous Charges and Credits: Enter all miscellaneous charges and credits.
30. / Remarks: Enter explanatory comments or remarks.
31. / Enter authorized signatures.