1. WORK ORDER NUMBER
2. DATE OF REQUEST
COMMERCIAL COMMUNICATION
(YYMMDD)
WORK ORDER
3a. NAME OF COMPANY PROVIDING SERVICE (Will correspond with that
4a. NAME OF ORGANIZATION ISSUING WORK ORDER
shown on the MAX LIMIT CSA)
b. ADDRESS (Street, City, State, Zip Code)
b. ADDRESS (Street, City, State, Zip Code)
5a. INSTALLATION NAME
c. Bldg. No.
6a. PERSON TO CONTACT (Last, First, M.I.)
SERVICE
LOCATION
b. ADDRESS (City, State, Zip Code)
d. Room No.
b. TITLE
c. TELEPHONE NO.
7. MAX LIMITS CSA NO.
8. CSA NUMBER
9. PBX STATION NUMBER
10. DESIRED COMPLETION DATE (YYMMDD)
11.
ESTIMATED CHARGES
NO. OF
DESCRIPTION OF SERVICE
UNIT COST
UNITS
MONTHLY
NON-RECURRING
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL ESTIMATED CHARGES
12a. NAME OF REQUESTING OFFICER (Last, First, M.I.)
b. PAY GRADE
c. SIGNATURE
13. REMARKS
DD Form 1367, FEB 82
PREVIOUS EDITIONS ARE OBSOLETE.
Reset
Adobe Professional 7.0
1. WORK ORDER NUMBER
2. DATE OF REQUEST
COMMERCIAL COMMUNICATION
(YYMMDD)
WORK ORDER
3a. NAME OF COMPANY PROVIDING SERVICE (Will correspond with that
4a. NAME OF ORGANIZATION ISSUING WORK ORDER
shown on the MAX LIMIT CSA)
b. ADDRESS (Street, City, State, Zip Code)
b. ADDRESS (Street, City, State, Zip Code)
5a. INSTALLATION NAME
c. Bldg. No.
6a. PERSON TO CONTACT (Last, First, M.I.)
SERVICE
LOCATION
b. ADDRESS (City, State, Zip Code)
d. Room No.
b. TITLE
c. TELEPHONE NO.
7. MAX LIMITS CSA NO.
8. CSA NUMBER
9. PBX STATION NUMBER
10. DESIRED COMPLETION DATE (YYMMDD)
11.
ESTIMATED CHARGES
NO. OF
DESCRIPTION OF SERVICE
UNIT COST
UNITS
MONTHLY
NON-RECURRING
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL ESTIMATED CHARGES
12a. NAME OF REQUESTING OFFICER (Last, First, M.I.)
b. PAY GRADE
c. SIGNATURE
13. REMARKS
DD Form 1367, FEB 82
PREVIOUS EDITIONS ARE OBSOLETE.
Reset
Adobe Professional 7.0
GENERAL INSTRUCTIONS
Local moves and minor changes to leased communications services and facilities will be ordered by this form when the moves and
changes are within the contractual, financial, and administrative limitations established by a Maximum Limits Communications Service
Authorization (MLCSA) issued by a DoD Contracting Officer and by associated implementing or administrative procedures. The
Defense Commercial Communications Office will issue all MLCSA's applicable to the basic services leased under the provisions of DCA
Circular 350-135-1.
All of the local moves and minor changes that are to be made at the same premises on the same private line circuit or under the same
facility MLCSA, and are requested to be accomplished on the same date (but may take the carrier more than one day to accomplish),
related work, they should be cross-referenced.
The original and one copy (both signed) of the work order will be forwarded to the carrier, one signed copy to the Contracting
Officer, one copy to the appropriate DCA action agency when changes are to be made to DCS services, and additional copies distributed
internally in accordance with administrative procedures.
SPECIFIC INSTRUCTIONS
*Item 1. Assigned by the originator as a control number as follows: identifier of submitting activity; order number, starting with #1 for
the first order issued each year; and the last two digits of the year (Example: SAC 20-81). When the work order is composed of more
than one page, enter the page number in this block also.
*Items 2, 3, 4, and 5. Self-explanatory.
Item 6. Name, title and commercial telephone number of a person stationed at the service location who can provide detailed information
pertaining to the move or change desired.
Item 7. Will correspond with that assigned to the Max Limit CSA.
Item 8. Enter the CSA number assigned to the basic circuit or service affected by this work order.
Item 9. Number of the circuit, PBX station, etc., affected by this work order. If the change involves more than one action, enter the
words "Multiple, see below" and provide explicit information in Item 11.
*Item 10. Date on which work is to be completed. THE CARRIER MUST BE GIVEN SUFFICIENT ADVANCE NOTICE.
Item 11. Enter service required showing specific circuit or equipment identification, number of units, and estimated monthly and
non-recurring charges for each move or change. If there are two pages or more, cut off the remainder of all pages except the last page.
Item 12. The requesting official must sign every work order sent to the carrier and to the Contracting Officer.
Item 13. For use by the originator when required to clarify information covered by the work order.
NOTE TO THE CARRIER: It is not necessary to forward a completed CCWO to the Contracting Officer. To support the billing for this
work order, the "Other Charges and Credit Slip" attached to the bill must show the appropriate work order number, the actual recurring
and non-recurring charges, and the actual completion date.
"General Note For Personnel Processing This Report:
Items marked with an asterisk (*) have been registered in the DoD Data Element Program."
DD Form 1367 Reverse, FEB 82
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