Declaration of Thomas O. Wirth
1. I am the General Counsel of Fairwinds Technologies, LLC ("Fairwinds"). This declaration is based on my personal knowledge, information, and belief.
DISTIL analysis
- Fairwinds and Cyberlux formed teaming relationship in October 2022 to pursue Ukrainian drone contracts
- Strategic agreement amended commission from 10% to 8% on first 1000 K8 drone units sold through non-Fairwinds channels
- HII Mission Technologies awarded prime contract for Model K8 aircraft
- Cyberlux CEO sent spreadsheet in July 2025 calculating $2,348,542.40 commission owed
- 392 drones delivered under original contract, additional 1608 under closeout modification
- Commission based on average unit price of $29,357 across 1000 units
Extracted text
135 pages · 440215 charactersIN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF VIRGINIA Richmond Division
HII MISSION TECHNOLOGIES CORP.,
Interpleader Plaintiff
v. CYBERLUX CORPORATION, et al.,
Civil Action No: 3:25-cv-483-JAG
Interpleader Defendants/Claimants
I, Thomas O. Wirth, make the following declaration under penalty of perjury pursuant to 28 U.S.C. § 1746.
to Fairwinds by Cyberlux in connection with the Contract. True and correct copies of the email and attached spreadsheet are attached as Exhibit 3 to this Declaration.
Executed this 15th day of April, 2026.
Thomas O. Wirth Thomas O. Wirts
FAIRWINDS TECHNOLOGIES
TEAMING AGREEMENT Fairwinds Technologies LLC - Cyberlux Corporation
THIS TEAMING AGREEMENT and all exhibits attached hereto or referenced herein (hereinafter referred to as the "Agreement"), is made and entered into this 26th day of September 2022 between Fairwinds Technologies LLC., a company existing under the laws of Delaware (hereinafter referred to as "Fairwinds") with offices at 920 Melvin Road, Annapolis MD 21403, and Cyberlux Corporation, existing under the laws of Nevada (hereinafter referred to as "Cyberlux") with offices at 800 Park Offices Drive Suite 3209, Research Triangle, NC 27709. Fairwinds and Cyberlux are referred to collectively herein as the "Parties" and individually as a "Party."
WHEREAS, Cyberlux has a substantial product portfolio of drone technology, including their Model- K8 Aircraft which provides infantry units with an offensive and defensive weapon system capable of precision threat neutralization at ranges, that meet the requirements for the current theater of operations; and
WHEREAS, Fairwinds is actively engaged in foreign military sales around the world involving military technology through a variety of relationships, including the DSCA, USASAC, DLA TLS, COCOM's, and embassies, and
WHEREAS, The Government of Ukraine, because of its ongoing defense efforts, has directly contacted Cyberlux by letter and requested international aid in the form of a large shipment of Model K-8 Aircraft, and
WHEREAS, Fairwinds has directly coordinated meetings with representatives of the US Government, Ukraine LNO, DATT, and Partner Nations, and
WHEREAS, the Parties wish to collaborate and leverage their unique skill sets to successfully secure payment through existing funding opportunities for the shipment of said Model K-8 Aircraft, and
WHEREAS, the Parties wish to enter into this Agreement to set forth more fully the terms and conditions pursuant to which the Parties shall enter into any contract(s) resulting therefrom.
NOW, THEREFORE, in consideration of the foregoing, and in reliance on the mutual promises and obligations contained herein, the Parties hereby agree as follows:
6.1 This Agreement shall expire upon the happening of one of the following events, whichever shall occur first:
6.1.1 Written notice from the Client that it will not award a contract.
6.1.2 Written notice from the Client of Client's final rejection of the Proposal or award of a contract for the Project to a firm other than the Parties.
6.1.3 The expiration of 24 months from the date of this Agreement; provided, however, this Agreement shall be extended for one additional year if the Proposal has been submitted and the Client has not provided written notice as to contract award within the 24-month period.
6.1.4 The insolvency, bankruptcy, reorganization under the bankruptcy laws, or assignment for the benefit of creditors of either Party to the extent that there is a reasonable doubt that such Party lacks the resources or ability to properly perform its obligations hereunder.
6.1.5 Mutual agreement of the Parties to terminate this Agreement.
6.1.6 Suspension or debarment or either Party, or any other circumstance that renders Party ineligible for participation in the project.
6.2 Upon a material breach of this Agreement by either Party, the non-breaching Party may terminate this Agreement if such breach remains uncured fifteen (15) days after the breaching Party's receipt of notice of the breach and take such other action in law or equity as such non- breaching Party elects.
Fairwinds
Name:
Michael Bristol
Cyberlux
Name:
Mark Schmidt
Title:
Executive VP
Title:
CEO
Address:
Address:
City, State, Zip
Annapolis MD 21403
City, State, Zip
Research Triangle, NC 27709
Phone:
703-472-1940
Phone:
914-434-6608
E-mail:
Michael.bristol@Fairwinds- tech.com
E-mail:
mschmidt@cyberlux.com
IN WITNESS WHEREOF, the Parties represent and warrant that this Agreement is executed by duly authorized representatives of each Party as set forth below on the date first stated above.
Company: Fairwinds Technologies LLC Company: Cyberlux Corporation
Amber Hutchinson 10/3/2022
Mark D. Schmidt 10/03/2022
Signature
Date
Signature
Date
Name:
Amber Hutchinson
Name:
Mark Schmidt
Title:
Director of Contract Management
Title:
CEO
Address:
Address:
Annapolis MD 21403
Research Triangle Park, NC 27709
Phone:
843-344-6581
Phone:
919-434-6608
E-mail:
amber.hutchinson@fairwinds-
E-mail:
mschmidt@cyberlux.com
tech.com
Cyberlux has received an initial request from the Armed Forces of Ukraine for one thousand (1000) Model K-8 Aircraft valued at a total of $38,704,000.00. Fairwinds has agreed to assist in securing a US government contract vehicle for the shipment of these and follow up drone requests.
Facilitate meetings and assist in the securing of payment through a DLA TLS contract vehicle for the shipment of the initial one thousand (1000) drones.
Work with Cyberlux to negotiate an IDIQ with CECOM SAM-D, EUCOM SAM-D, (or additional COCOM as appropriate) for additional drone requests by the Armed Forces of Ukraine.
Act as Reseller for the final shipment of any drones requested through this agreement and its resulting contract vehicles.
Work with Cyberlux to trigger a facility clearance via Sub-contracted task, as appropriate.
Work in good faith to complete a follow-up, strategic agreement, whereby Fairwinds provides Cyberlux with a MIL- waveform, sufficiently hardened for their theaters of operation.
Sole developer and supplier of the Model K-8 Aircraft.
Cyberlux will develop and supply enhancements, variants and changes as requested.
Add Fairwinds as Licensee to their ITAR, DSP, and associated export compliance authorizations Assist in securing contract vehicle for shipment of initial one thousand (1000) drones.
Assist in securing IDIQ with CECOM SAM-D2 ;- , EUCOM SAM-D, (or additional COCOM as appropriate) contract vehicles for additional drone requests by the Armed Forces of Ukraine.
Provide any requested drone orders to Fairwinds, who will act as Reseller, at a discounted rate of twenty (20) percent below MSRP.
If an order is placed and financed by parties unrelated to the US Government and/or any of the entities that Fairwinds is supporting Cyberlux with, Cyberlux will act as Reseller.
In the event that the US Government or International Donation Coordination Center requires direct contract, or orders via another prime contract vehicle where Fairwinds is not acting as Reseller, then Cyberlux will pay Fairwinds 10% of the contract value in lieu of the resulting award, up to 1000 K-8 variants.
Work in good faith to complete a follow-up, strategic agreement, whereby Fairwinds provides Cyberlux with a MIL- waveform, sufficiently hardened for their theaters of operation.
FAIRWINDS TECHNOLOGIES
First Amendment
This First Amendment (the "Amendment Agreement"), dated May 4, 2023, amends the Teaming Agreement (the "Existing Agreement"), executed on October 3, 2022, between Fairwinds Technologies LLC ("Company") and Cyberlux Corporation ("Cyberlux).
Accordingly, the parties agree as follows:
1.1) Paragraph 4 of the Existing Agreement, which deals with submissions to the Government, is amended by inserting the words "for which Fairwinds is acting as mutually agreed upon either Prime or Reseller to" immediately after the word "Government" at the end of the sentence.
1.2) Paragraph 8 of the Existing Agreement, which specifies the level of exclusivity of the deal, is amended by deleting it in its entirety and inserting int its place the following:
"Exclusive Agreement. This is an exclusive agreement, meaning that Fairwinds shall only support Cyberlux, and none of Cyberlux' competitors on the capture of this Ukrainian Government drone request for 1000 Model-K8 drones and any continuation orders and derivative drone orders, and Cyberlux shall not enter into any agreements that would prohibit it from meeting the obligations promised to Fairwinds, should an award be made to Cyberlux for the support of Ukrainian drone
services, except that Cyberlux can enter in any agreements necessary should Fairwinds not be in a position to offer mutually agreed prime or reseller services. Should this occur, Fairwinds is entitled to 8% of the Contract value for up to a total cumulative number of 1000 drone units, as defined in the amended Exhibit A - Statement of Work."
1.3) Exhibit A of the Existing Agreement, which specifies the payment to Fairwinds if the drones were sold through a party other than Fairwinds, is amended by deleting "10%" and inserting in its place "8%". Also, replacing in the same sentence the words "1000 variants" with "a total of 1000 units from the total cumulative awarded units."
To evidence the parties' agreement to this Amendment Agreement, they have signed, executed, and delivered it as shown below.
Signature: Amber Hutchinson
By: Amber Hutchinson Title: IDIQ Director
Date: 6/6/2023
Cyberlux Corporation
Document 178-1 Filed 04/15/26
Page 12 of 135 PageID#
Signature:
Mark. D. Schmidt
By: Mark Schmidt
Title: President & CEO
Date: 06/06/2023
STRATEGIC BUSINESS DEVELOPMENT, SERVICE AND SUPPLY TEAMING AGREEMENT
Relating To IDENTIFICATION AND QUALIFICATION OF BUSINESS OPPORTUNITIES, SUPPORT OF BUSINESS DEVELOPMENT, AND SOLUTIONS DELIVERY
Between FAIRWINDS TECHNOLOGIES LLC And CYBERLUX CORPORATION
This Strategic Business Development, Service, and Supply Teaming Agreement, and all attached appendices, hereinafter referred to as the ("Agreement"), dated May 4, 2023 is entered into and made between Fairwinds Technologies LLC, a Delaware limited liability company ("Fairwinds"), with an address of 920 Melvin Road, Annapolis MD 21403, and Cyberlux Corporation, existing under the laws of Nevada (hereinafter referred to as "Cyberlux"), with offices located at 800 Park Offices Drive, Suite 3209, Research Triangle, NC 27709. Both Fairwinds and Cyberlux are hereinafter also referred to individually and collectively as "Party", or "Parties" respectively.
WHEREAS, Fairwinds is a US-based technology company that is actively engaged in military sales around the world through a variety of relationships, including the DSCA, USASAC, DLA COCOM's, and embassies, and
WHEREAS, Cyberlux has a substantial product portfolio of drone technology, and wishes to grow their portfolio and sales opportunities through military and private contracts, and
WHEREAS, the Parties, have previously entered into a Teaming Agreement executed on 10/3/2022, that established the following business relationship:
WHEREAS, the Parties wish to expand their relationship in an effort to secure new business opportunities, new sales opportunities, improve upon their existing products and services, and collaboratively develop new products and services, and
WHEREAS, the parties may evaluate forming a joint venture or other business structure to pursue the design and development of the Next Generation Radio Technology and Products.
WHEREAS, the Parties intend to collaboratively pursue Drone Technology opportunities, current Generation Communication Product opportunities, Next Generation Radio Design and Product opportunities, and any other new business opportunities contemplated by the Parties, and
WHEREAS, the Parties intend to collaborate on a 'Best Efforts, Exclusive, Right of First Refusal" basis where each Party shall endeavor with best efforts to work exclusively with the other, where opportunities are offered by each Party to jointly pursue, with each Party providing the other the first opportunity to collaborate and pursue the specific opportunity, which can be refused by the other party after evaluation by either for strategic fit, and
WHEREAS, Section 6.1 of the Teaming Agreement executed on 10/3/2022 between the Parties sets forth an expiration upon notice by the US government of the final rejection of the proposal or an award of the contract to a firm other than Fairwinds, and
WHEREAS, where the Parties now wish to enter into this Strategic Business Development, Service, and Supply Teaming Agreement.
Now Therefore, the Parties acknowledge consideration in the form of the mutual covenants and promises set forth herein, and agree to be governed under the following terms:
2.1 In the event of termination, all outstanding fees owed from one party to the other for previously or substantially completed and delivered opportunities worked on under this agreement shall be paid within thirty (30) days of the receipt of such payment from said opportunity.
3.1 Under this agreement, both Parties shall seek to secure sales opportunities documented by additional agreements for specific opportunities and orders.
3.2 .There are no exclusive agreements or arrangements except for the following:
3.2.1 Where Fairwinds is already a dealer or representative of items used in Cyberlux drone products , Fairwinds has the exclusive right of first refusal for supplying those items to Cyberlux. Fairwinds shall also have the exclusive right of first refusal for supplying any DTC (Domo Tactical) product, and Agile 5G radio card technology. Despite the previous sentence, if Cyberlux and Agile enter into any agreement that results in any merger, acquisition, shared ownership, or ownership exchange between the two companies, then Fairwinds shall no longer have the exclusive right of first refusal for supplying Agile 5G radio card technology to Cyberlux.
3.2.2 Cyberlux has the exclusive right of first refusal for supplying drone platform types that are manufactured by Cyberlux to Fairwinds. If Cyberlux does not currently manufacture or have the ability to manufacture a specific drone platform type (Non-Cyberlux Drone) that is needed by Fairwinds, then Cyberlux has the right of first refusal to supply the Non Cyberlux Drone to Fairwinds at the same competitive pricing.
3.3 In accordance with section 5.1 of the Agreement and the existing Teaming Agreement between the parties, if the US Government requires Cyberlux to execute K-8 Drone sales through an entity other than Fairwinds, then Cyberlux shall pay to Fairwinds a fee of 8% of the first 1000 K-8 variant Drones that are sold as consideration for the consulting services and business support that has been provided.
3.4 Further details on the responsibilities and roles of each party are contained in the attached Appendix A
4.1 Invoicing and Payment Schedule. Except as otherwise agreed to in writing, any amount owed by one Party to the other in relation to this agreement, or any subsequent contract awards resulting from this Agreement, shall be paid within thirty (30) days of receipt of funds.
5.1 Bona Fide Commercial Selling Agency. Pursuant to the Teaming Agreement between the parties, executed 10/3/2022, Fairwinds continues to support Cyberlux as a bona fide commercial selling agency in accordance with FAR 52.203-5. Fairwinds is contracted by Cyberlux in accordance with federal law.
5.1.1 No fees paid to Fairwinds by Cyberlux are inequitable or exorbitant when compared to the services performed. The fees are considered customary for similar services related to commercial business.
5.1.2 Fairwinds has adequate knowledge of Cyberlux' product and business, as well as the other necessary qualifications to sell the products or services on their merits.
5.1.3 Cyberlux and Fairwinds have a continuing relationship and are involved in projects other than the sale of the aforementioned original 1000 K-8 Drones.
5.1.4 Fairwinds is a regular and well-established business that has existed for 8 years doing business as a commercial selling agency, contractor, business consultant, and government relations specialist.
5.1.2 Fairwinds agrees that, in the performance of the services contemplated by the Agreement, it shall neither exert nor propose to exert improper influence, as the term is defined in FAR 52.203-5.
5.1.3 The support and services provided by Fairwinds in Cyberlux' contract negotiations with US Government prime contractors or United States Contracting Officers include but are not limited to:
a) Reviewing and providing input to contract drafts.
b) Reviewing of FAR/DFAR flow downs.
c) Reviewing of commercial Terms and Conditions.
d) Providing consultation services through subject matter experts that include Fairwinds officers and employees with over 100 years combined commercial acquisition experience and former Government employees with acquisition training and certification during their Government civilian careers.
6.1 For the duration of this Agreement and the three (3) years immediately following its termination, each party shall keep and procure to be kept secret and confidential all secret or confidential commercial, financial, and technical information, know how, trade secrets, inventions, computer software, and other information whatsoever and in whatever form or medium, whether disclosed orally or in writing, together with all reproductions in whatsoever form and any part or parts of it "confidential information" which relates to either party. This Agreement and its contents are confidential and proprietary.
7.1 Both Parties grant the other a perpetual, irrevocable, worldwide, royalty-free, license- free, license to use, modify, further develop, adapt, exploit, and commercialize any of the Intellectual Property of the other only to the extent that such a license is necessary for the other to fully perform its obligations and role under this document or any future agreements stemming from this document.
7.2 Both Parties agree that the other's Intellectual Property shall not be used in any resulting product solution unless approved by both Parties in writing.
7.3 Except as expressly authorized herein or in writing, neither party shall attempt to reverse engineer, analyze or disassemble, or cause to be reverse engineered, analyzed or disassembled any product, formulation, process technology, sample or other technology provided by the other party, either directly or indirectly. Likewise, neither party shall provide a sample of any product or technology provided to them by the other party to any third party or entity, including but not limited to, any type of lab facility.
Fairwinds Point of Contact:
ATTN:
Jim Sprungle,
Annapolis MD, 21403
james.sprungle@fairwinds-tech.com
703-472-1940
Or
Matt Jones, matthew.jones@fairwinds-tech.com
Cyberlux Point of Contact:
Research Triangle Park, NC 27709
919-434-6608
ATTN:
Mark Schmidt
Mshmidt@cyberlux.com
Entire Agreement. The Parties acknowledge that this Agreement expresses the entire understanding between the Parties, and furthermore supersedes any prior agreements or understandings with respect to the subject matter contained herein.
SIGNATURE AND AUTHORIZATION
EACH PARTY REPRESENTS THAT IT HAS READ THIS DOCUMENT IN ITS ENTIRETY AND AGREES TO PERFORM IN ACCORDANCE WITH THE TERMS AND CONDITIONS CONTAINED HEREIN.
IN WHITNESS WHEREOF, the Parties hereto have caused this agreement to be signed, delivered, and executed by their duly authorized signatories on the dates set forth below.
FAIRWINDS TECHNOLOGIES
BY: Amber Hutchinson
NAME: Amber Hutchinson
TITLE: IDIQ Director
DATE: 06/07/2023
CYBERLUX CORPORATION
BY:
Mark D. Schmidt
NAME: Mark Schmidt
TITLE: President and CEO
DATE: June 7, 2023
APPENDIX A Scope of Work
The Parties shall perform their responsibilities and roles as detailed below.
Fairwinds shall:
a. Fairwinds shall provide pre-sales support for reimbursement of travel expenses at cost with detailed receipt backup
b. Fairwinds shall provide radio customer support FSRs as needed
c. Fairwinds shall provide test event and lab evaluation support
d. Other pre-sales support as assigned
e. Fairwinds shall provide Competitive Technical Market Research and whitepaper development for the Cyberlux Drone business and DATRON acquisition, as required
f. Insight into Future Product Recommendations to address discovered radio market gaps
g. Produce System Concept of Operations and Customer Systems Requirements Development for DATRON, as required.
a. Defense Security Cooperation Agency
b. United States Army Special Operations Command
c. NAVAIR
d. Naval Surface Warfare Center
e. United States Army Security Assistance Command
f. Secretary of the Air Force, International Affairs
g. Special Operations Command Europe
h. United States Central Command
i. Department of State
j. US Embassies and Consulates abroad, as required.
k. Coordination with various Office of Defense Cooperation (ODC) and Liaison Officer (LNO) personnel as required to support US Foreign Military Financed (FMF) and Foreign Military Sales (FMS) as required.
l. Others, as required from time to time.
APPENDIX A (continued)
Cyberlux shall:
Dantin, Joanna
From:
Jim Sprungle <james.sprungle@fairwinds-tech.com>
Sent:
Tuesday, July 8, 2025 6:09 PM
To:
Robert Miller; Toby Wirth
Subject:
FW: Commission calculation
Attachments:
Fairwinds Commission Calculation.xlsx; PNWA9432056002AXX DD Form 250 (pg. 1) - Cyberlux - Signed.pdf; PNWA9432056002BXX DD Form 250 (pg. 1) - Cyberlux - Signed.pdf; PNWA9432056002CXX DD Form 250 - Cyberlux - Signed.pdf; PNWA9432056002CXX DD Form 250 2 - Cyberlux - Signed.pdf; Invoice for Truck 1 Final.pdf; Truck 1 Signed DD250s_corrected_05212025.pdf; Invoice for Truck 2 Final.pdf; Truck 2 Signed DD250s.pdf; Truck 3 - Signed DD250s.pdf; Truck 3 - Signed Invoice.pdf; Truck 4 - DD250s_05062025.pdf; Truck 4 - Invoice - Signed.pdf
Thoughts on next steps? I will send a revised invoice tomorrow for $2.3M.
Jim Sprungle CEO 443.223.0301 fairwinds-tech.com
From: Mark Schmidt <mschmidt@cyberlux.com>
Sent: Tuesday, July 8, 2025 7:01 PM To: Jim Sprungle <james.sprungle@fairwinds-tech.com> Cc: Loren Buck <lbuck@cyberlux.com>
Subject: Fw: Commission calculation
WARNING - EXTERNAL EMAIL - This email originated from outside of the organization. Do not click links or open attachments unless you recognize the sender and know the content is safe.
(This is a resend due to size. I put the rest of the invoices and DD250s in a second email.)
Jim, please find the attached spreadsheet on the applicable 1000 drone shipment commission. I've included all the applicable invoices and the DD250s for all the drone shipments for transparency. With the SWO and ultimate contract modification, there are a few elements to the calculation. Loren and I are available to answer any questions and to step through the spreadsheet as you'd like.
V/R - Mark
Mark Schmidt | President and CEO
mschmidt@cyberlux.com 919-434-6608
CYBERLU
® Harnessing the Future Visit our Website
From: postmaster@fairwinds-tech.com <postmaster@fairwinds-tech.com>
Sent: Tuesday, July 8, 2025 5:49 PM To: james.sprungle@fairwinds-tech.com <james.sprungle@fairwinds-tech.com>
Subject: Undeliverable: Commission calculation
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From: Mark Schmidt <mschmidt@cyberlux. com> To: "james . sprungle@fairwinds-tech . com" <james . sprungle@fairwinds-tech. com
CC: Loren Buck <1buck@cyberlux.com>
Subject: Commission calculation
Thread-Topic: Commission calculation
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Date: Tue, 8 Jul 2025 21:47:43 +0000
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Page 30 of 135 PageID#
$ -
INVOICE SUMMARY
Cumulative
CLIN 0001 Accounting
Truck
Invoice #
Ship Date
CYBL Amount
Total Amount
Cumulative
$ 22,776,605.40 Due CYBL
To USG
$ 22,776,605.40 USG "Credit"
CLIN
Total
CYBL
CLIN 0002 Cost
20230829-HII-1012
$ 1,353,669.18
$ 1,353,669.18
$ -
$ (22,776,605.40)
CLIN 0003 Cost
20230829-HII-1013
$ 1,403,585.21
$ 2,757,254.39
$ -
$ (22,776,605.40)
CLIN 0001
Truck1
20230829-HII-1014
4/25/25
$ 1,994,110.32
$ 4,751,364.71
$ 7,121,822.57
$ 7,121,822.57
$ (15,654,782.83)
$ 7,121,822.57
$ 1,994,110.32
$ 5,127,712.25
CLIN 0001
Truck2
20230829-HII-1015
4/28/25
$ 1,978,756.15
$ 6,730,120.86
$ 7,066,986.24
14,188,808.81
$ (8,587,796.59)
$ 7,066,986.24
$ 1,978,756.15
$ 5,088,230.09
CLIN 0001
Truck3
20230829-HII-1016
5/2/25
$ 2,104,910.92
$ 8,835,031.78
$ 7,517,539.00
21,706,347.81
$ (1,070,257.59)
$ 7,517,539.00
$ 2,104,910.92
$ 5,412,628.08
CLIN 0001
Truck4
20230829-HII-1017
5/5/25
$ 2,104,910.92
$ 10,939,942.70
$ 7,517,539.00
29,223,886.81
$ 6,447,281.41
$ 7,517,539.00
$ 2,104,910.92
$ 5,412,628.08
CLIN 0001
Truck5
20230829-HII-1018
5/8/25
$ 2,688,510.06
13,628,452.76
$ 4,423,916.96
$ 33,647,803.77
$ 10,871,198.37
$ 4,423,916.96
$ 2,688,510.06
$ 1,735,406.90
CLIN 0001
Truck6
20230829-HII-1019
5/12/25
$ 3,138,629.76
16,767,082.52
$ 3,138,629.76
$ 36,786,433.53
$ 14,009,828.13
$ 3,138,629.76
$ 3,138,629.76
$ -
CLIN 0001
Truck7
20230829-HII-1020
5/28/25
$ 2,759,934.81
$ 19,527,017.33
$ 2,759,934.81
$ 39,546,368.34
$ 16,769,762.94
CLIN 0001
Truck8
20230829-HII-1021
6/3/25
$ 4,212,791.47
$ 23,739,808.80
$ 4,212,791.47
$ 43,759,159.81
$ 20,982,554.41
CLIN 0004
20230829-HII-1024
$ 1,615,972.07
$ 25,355,780.87
CLIN 0002 Profit
20230829-HII-1022
$ 203,050.38
$ 25,558,831.25
CLIN 0003 Profit
20230829-HII-1023
$ 210,537.78
$ 25,769,369.03
Due:
CLIN 0001
$ 20,982,554.41
CLIN 0002/0003 Cost
$ 2,757,254.39
CLIN 0004
$ 1,615,972.07
CLIN 0002/0003 Profit
$ 413,588.16
Total Due
$ 25,769,369.03
Original Contract Shipments DD250s
Qty
Unit Price
CYBL Amount
PNWA9432056002AXX K8-1 Drone
$40,500.00
$972,000.00
K8-2 Drone
$36,900.00
$1,771,200.00
PNWA9432056002BXX K8-1 Drone
$40,500.00
$1,944,000.00
K8-2 Drone
$36,900.00
$2,656,800.00
PNWA9432056002CXX K8-1 Drone
$40,500.00
$1,620,000.00
K8-2 Drone
$36,900.00
$3,247,200.00
PNWA9432056002CXX K8-1 Drone
$40,500.00
$972,000.00
K8-2 Drone
$36,900.00
$1,771,200.00
$14,954,400.00
Commission Calculation
Drones
Payment
$ 14,954,400
Original Contract
$ 43,759,160
Closeout Modification
$ 58,713,560
$ 29,357
Per unit average
$ 29,356,780
$ 2,348,542
8% Commission
Notes: CLIN 0001 is the shipping of drones in closeout modification. Other CLINs related to expense reimbursements related to closing out the contract
EXHIBAse 3:25-cv-00483-JAG Document 178-1 Filed 04/15/26 Page 31 of 135 PageID#
OMB No. 0704-0248 OMB approval expires: 20240131
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
BPC CASE NW-P-LDA / GS00Q140ADU109
TDL1-023
TCN PNWA9432056002AXX
SPRING, TX
CODE :
CODE :
HII 12730 FAIR LAKES CIR. FAIRFAX, VA 22033
FEDSIM / DMATS CONTRACT #:
GS00Q140ADU109
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. Suite A 105
HII 12730 FAIR LAKES CIR.
Spring TX 77388
FAIRFAX, VA 22033
CODE :
CODE :
Dover Air Force Base - FY9125 436 APS/TRTCI 550 Atlantic Street, Dover AFB, DE 19902
POLAND
Flighteye Model K8-1 Drone System
EA
$40500.00
972,000
Flighteye Model K8-2 Drone System
EA
$36900.00
1,771,200
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :unselected: CQA :selected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
RAMSEY.COLLIN,LYLE.159529 Digitally signedby
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:Collin Ramsey
TITLE:
Mechanical Engineer
MAILING ADDRESS:
NSWC Crane, BLDG 3395, 300 HWY 361
Crane, IN 47522-5001
COMMERCIAL
TELEPHONE NUMBER:
812-854-1303
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
RAMSEY.COLLIN.LYLE.159529 Digitally signed by
RAMSEY COLLINLYLE 1595295714
Dute: 2023.11.36-20:41:10-05:00
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:Collin Ramsey
TITLE:
Mechanical Engineer
MAILING ADDRESS: NSWC Crane, BLDG 3395, 300 HWY 361 Crane, IN 47522-5001
COMMERCIAL
TELEPHONE NUMBER:
812-854-1303
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
of
RAMSEY COLLIN LYLE. 1505295714
Thuốc: 2023.11.06 20:41:00-4500
OMB No. 0704-0248 OMB approval expires: 20240131
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
BPC CASE NW-P-LDA / GS00Q140ADU109
TDL1-023
TCN PNWA9432056002BXX
SPRING, TX
CODE :
CODE :
HII 12730 FAIR LAKES CIR. FAIRFAX, VA 22033
FEDSIM / DMATS CONTRACT #:
GS00Q140ADU109
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. Suite A 105
HII 12730 FAIR LAKES CIR.
Spring TX 77388
FAIRFAX, VA 22033
CODE :
CODE :
Dover Air Force Base - FY9125 436 APS/TRTCI 550 Atlantic Street, Dover AFB, DE 19902
POLAND
Flighteye Model K8-1 Drone System
EA
$40500.00
1,944,000
Flighteye Model K8-2 Drone System
EA
$36900.00
2,656,800
Seal
S/Ns
CRT 1: BOX 1A: 2615130 CRT 5: BOX 5A: 2615058 BOX 1B: 2615052 BOX 5B: 2615070
:unselected:
CRT 2: BOX 2A: 2615054 CRT6: BOX 6A: 2615068 BOX 2B: 2615053 BOX 6B: 2615063
:unselected:
CRT 3: BOX 3A: 2615056 CRT 7: BOX 7A: 2615064 BOX 3B: 2615055 BOX 7B: 2615065
:unselected:
CRT 4: BOX 4A: 2615057 CRT 8: BOX 8A: 2615062 BOX 4B: 2615059 BOX 8B: 2615061
:unselected:
a. ORIGIN :unselected: CQA :selected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
WILSON.SAMUEL.DOUGLASS. Digitally signedby
WILSON SAMUEL DOUGLASS 1604792947
Thute: 2023.11.29 12:15:08 -06100
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:Samuel Wilson
TITLE:
Engineer
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
812-227-9365
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
WILSON SAMUEL.DOUGLASS. Digitally signed by
WIL SCIN SAMUEL. IKRMIL ASS. 1604792947
Dute: 2023.11 29 12:16:01 -06/00
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:Samuel Wilson
TITLE:
Engineer
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
812-227-9365
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
of
OMB No. 0704-0248 OMB approval expires: 20240131
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
BPC CASE NW-P-LDA / GS00Q140ADU109
TDL1-023
TCN PNWA9432056002CXX
SPRING, TX
CODE :
CODE :
HII 12730 FAIR LAKES CIR. FAIRFAX, VA 22033
FEDSIM / DMATS CONTRACT #:
GS00Q140ADU109
CODE : FOB:
CODE :
CYBERLUX CORPORATION 21631 Rhodes Rd. Suite A 105 Spring TX 77388
FAIRFAX, VA 22033
CODE :
CODE :
Dover Air Force Base - FY9125 436 APS/TRTCI 550 Atlantic Street, Dover AFB, DE 19902
POLAND
Flighteye Model K8-1 Drone System
EA
$40500.00
1,620,000
Flighteye Model K8-2 Drone System
EA
$36900.00
3,247,200
Seal
S/Ns
CRT 1: BOX 1A: 2615082 CRT 5: BOX 5A: 2615100 BOX 1B: 2615085 BOX 5B: 2615099
:unselected:
CRT 2: BOX 2A: 2615084 CRT 6: BOX 6A: 2615095 BOX 2B: 2615083 BOX 6B: 2615092
:unselected:
CRT 3: BOX 3A: 2615091 CRT 7: BOX 7A: 2615089 BOX 3B: 2615088 BOX 7B: 2615094
:unselected:
CRT 4: BOX 4A: 2615093 CRT 8: BOX 8A: 2615133 BOX 4B: 2615097 BOX 8B: 2615131
:unselected:
a. ORIGIN :unselected: CQA :selected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
RAMSEY.COLLIN.LYLE.159529 Digitally signedby
RAMSEY COLLIN L.YLE. 1505295714
Tute: 2023.12/08 16:45:21 -0500
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:Collin Ramsey
TITLE:
Mechanical Engineer
MAILING ADDRESS:
NSWC Crane, BLDG 3395, 300 HWY 361
Crane, IN 47522-5001
COMMERCIAL
TELEPHONE NUMBER:
812-854-1303
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
RAMSEY,COLLIN.LYLE.159529 Digitally signed by
RAMSEY COLLINLYLE 1595298714
Dute: 2023.12:08 16:46:08-05:007
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:Collin Ramsey
TITLE:
Mechanical Engineer
MAILING ADDRESS:
NSWC Crane, BLDG 3395, 300 HWY 361
Crane, IN 47522-5001
COMMERCIAL
TELEPHONE NUMBER:
812-854-1303
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
of
OMB No. 0704-0248 OMB approval expires: 20240131
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
BPC CASE NW-P-LDA / GS00Q140ADU109
TDL1-023
TCN PNWA9432056002CXX
SPRING, TX
CODE :
CODE :
HII 12730 FAIR LAKES CIR. FAIRFAX, VA 22033
FEDSIM / DMATS CONTRACT #:
GS00Q140ADU109
CODE : FOB:
CODE :
CYBERLUX CORPORATION 21631 Rhodes Rd. Suite A 105 Spring TX 77388
FAIRFAX, VA 22033
CODE :
CODE :
Dover Air Force Base - FY9125 436 APS/TRTCI 550 Atlantic Street, Dover AFB, DE 19902
POLAND
Flighteye Model K8-1 Drone System
EA
$40500.00
972,000
Flighteye Model K8-2 Drone System
EA
$36900.00
1,771,200
Seal
S/Ns
CRT 1: BOX 1A: 2615150 CRT 5: BOX 5A: 2615146 CRT 9: BOX 9A: BOX 1B: 2615001 BOX 5B: 2615147 BOX 9B:
CRT 2: BOX 2A: 2615004 CRT 6: BOX 6A: 1238563 BOX 2B: 2615010 BOX 6B: 1238564
:unselected:
CRT 3: BOX 3A: 2615013 CRT 7: BOX 7A: 2615003 BOX 3B: 2615007 BOX 7B: 2615002
:unselected:
CRT 4: BOX 4A: 2615148 CRT 8: BOX 8A: 2615011 BOX 4B: 2615149 BOX 8B: 2615005
:unselected:
a. ORIGIN :unselected: CQA :selected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
RAMSEY.COLLIN.LYLE.159529 Digitally signedby
RAMSEY COLLIN LYLE. 1505295714
Thute: 2023.12. 12 16:58:28-0500
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:Collin Ramsey
TITLE:
Mechanical Engineer
MAILING ADDRESS:
NSWC Crane, BLDG 3395, 300 HWY 361
Crane, IN 47522-5001
COMMERCIAL
TELEPHONE NUMBER:
812-854-1303
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
RAMSEY.COLLIN.LYLE.159529 Digitally signed by
RAMSEY COLLIN LYLE 1595295714
Dute: 2023.12.12 16:58:40-05:00
DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:Collin Ramsey
TITLE:
Mechanical Engineer
MAILING ADDRESS:
NSWC Crane, BLDG 3395, 300 HWY 361
Crane, IN 47522-5001
COMMERCIAL
TELEPHONE NUMBER:
812-854-1303
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
of
CYBERLU X® ®
Harnessing the Future
Buyer:
HII Mission Technologies Corp.
Attn: Accounts Payable
Virginia Beach, VA 23462
Seller:
Cyberlux Corporation 800 Park Offices Drive, Suite 3209 Research Triangle Park NC 27709
POC:
Aaron Goodman
agoodman@cyberlux.com
subcontract-consultant-invoices@hii-tsd.com
914-414-1884
Via email to:
Invoice Date:
April 25, 2025
Invoice #:
20230829-HII-1014
Purpose:
Shipment 1
Date of Shipment:
4/25/25
Attachments:
Payment Due: In accordance with Modification No. 4
Amount Due
Truck 1 - April 25, 2025
DD250 #
Crate #
Category #
Model #
# of Units
Price/Unit
Price/Crate
47QFCA51127001
A
K8-1
$ 40,444.00
$ 323,552.00
47QFCA51127002
A
K8-1
$ 40,444.00
$ 161,776.00
47QFCA51127002
A
K8-2
$ 36,819.00
$ 147,276.00
47QFCA51127003
A
K8-2
$ 36,819.00
$ 294,552.00
47QFCA51127004
A
K8-2
$ 36,819.00
$ 294,552.00
47QFCA51127005
A
K8-2
$ 36,819.00
$ 184,095.00
47QFCA51127005
B
K8-1
$ 40,441.71
$ 121,325.13
47QFCA51127006
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127007
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127008
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127009
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127010
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127011
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127012
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127013
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127014
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127015
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127016
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127017
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127018
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127019
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127020
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127021
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127022
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127023
B
K8-2
$ 36,807.22
$ 294,457.76
47QFCA51127024
B
K8-2
$ 36,807.22
$ 294,457.76
Total
$ 7,121,825.57
Against Initial Payment Made at Award IAW Modification No. 4, Attachment A
$5,127,714.41
$1,994,111.16
$1,994,111.16
In accordance with Modification No. 4, Section 5, Cyberlux hereby certifies as follows: 1. Cyberlux has delivered the goods identified in the invoice in compliance with this Agreement; and 2. Cyberlux's Termination Settlement Proposal of February 15, 2025 and all statements made in support of that proposal are made in good faith; the supporting data are accurate and complete to the best of Cyberlux's knowledge and belief; and the amount claimed accurately reflects the amount that Cyberlux believes it is entitled to receive under the Subcontract; and
Aaron Goodman Chief Of Staff
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127001
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (CAT A)
EA
$40444.00
323,552
:unselected:
EA
Seal
S/Ns
CRT 1: BOX 1A: 2615199 BOX 1B: 2615187
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
DATE (YYYYMMDD)
SIENATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TITLE:
MAILING ADDRESS:
TYPED NAME:
TYPED NAME: Douglas Ferm
TITLE:
Proposta Administrador
TITLE:
MAILING ADDRESS:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
COMMERCIAL TELEPHONE NUMBER:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
of
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Antikde
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127002
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007,-1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (CAT A)
EA
$40444.00
161,776
Flighteye Model K8-2 Drone System (CAT A)
EA
$36819.00
147,276
Seal
S/Ns
CRT 2: BOX 1A: 2615152 BOX 1B: 2615151
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents
Del Milan
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Douglas Form
TITLE:
Property Administrator
MAILING ADDRESS:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
*If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
of
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information if It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127003
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (CAT A)
EA
$36819.00
294,552
:unselected:
Seal
S/Ns
CRT 3: BOX 1A: 2615170 BOX 1B: 2615169
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents
de Mica
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Form,
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS: COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127004
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (CAT A)
EA
$36819.00
294,552
:unselected:
Seal
S/Ns
CRT 4: BOX 1A: 2615168 BOX 1B: 2615167
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
2025/04/ 24
between
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Daglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
Document 178-1 Filed 04/15/26
Page 40 of 135 PageID#
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127005
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category A)
EA
$36819.00
$184,0950.00 00
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
121.334.13 $121,322.13
Seal
S/Ns
CRT 5: BOX 1A: 2615166 BOX 1B: 2615165
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents 26250424
PostHl Dan
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information if It does not display a currently valid OMS control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127006
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003,23,010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 6: BOX 1A: 2615164 BOX IB: 2615163
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. De Mon 2025 0424
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Raporty Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs. mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information if It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127007
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 7: BOX 1A: 2615162 BOX 1B: 2615161
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
Das MyDear
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information if It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127008
Spring, TX
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 8: BOX 1A: 2615188 BOX 1B: 2615186
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents De Alcan
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
(SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information if it does not display a currently valli OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127009
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
J
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 9: BOX IA: 2815185 BOX 1B: 2615184
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. BeMba
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Daglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS;
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS: COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127010
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 10: BOX 1A: 2815183 BOX 1B: 2615178
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Real M Dear
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Form
TITLE:
Property Administrator
MAILING ADDRESS; C
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270011
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 11: BOX 1A: 2615179 BOX 1B: 2615180
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. AllOur
DATE (YYYYMMDD)
SI NATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Propfity HominisTaler
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
€
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270012
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 12: BOX 1A: 2615181 BOX 1B: 2615182
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein of on supporting documents Deg M. Den
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270013
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 13: BOX 1A: 2615197 BOX 1B: 2615195
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
Dan M.Our
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dagles Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS: COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270014
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 14: BOX 1A: 2615196 BOX 1B: 2615192
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TITLE:
MAILING ADDRESS:
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
COMMERCIAL TELEPHONE NUMBER:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TYPED NAME: Daglas Farm
TITLE:
Property Administrator
MAILING ADDRESS:
De M. Brun
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information If it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270015
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 15: BOX 1A: 2615194 BOX 1B: 2615193
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. De Milan 2025 04 24 DATE (YYYYMMDD) SICAKTURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Daglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS."
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270016
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 16: BOX 1A: 2615191 BOX 1B: 2615190
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents
De Mi Jeom
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dougles Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information if It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270017
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
15, ITEM NO.
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 17: BOX 1A: 2615198 BOX 1B: 2615189
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Dsl Modem
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Daglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION, SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270018
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 18: BOX 1A: 2615171 BOX 1B: 2615172
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents,
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents Des Mœur
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Douglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270019
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003,23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 19: BOX 1A: 2615158 BOX 1B: 2615173
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
Det 1. Den
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Property Administração
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270020
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 20: BOX 1A: 2615174 BOX 1B: 2615154
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Det MitTem
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Form
TITLE:
Property Administrator
MAILING ADDRESS: I
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270021
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
13, SHIPPED TO
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 21: BOX 1A: 2615153 BOX 1B: 2615155
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DegliDer
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Daglas Ferm
TITLE:
Raporty Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein of on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS: COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270022
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 22: BOX 1A: 2615156 BOX 1B: 2615157
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. DoMeu
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dades Ferm
TITLE:
Property Alministrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270023.
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers; 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 23: BOX 1A: 2615175 BOX 1B: 2615176
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Desde
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Douglas Form
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs. mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA511270024
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 24: BOX 1A: 2615177 BOX 1B: 2615159
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
Das Maken
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Daglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS: COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
CYBERLU Harnessing the Future
X ®
Buyer:
HII Mission Technologies Corp.
Attn: Accounts Payable
Virginia Beach, VA 23462
Seller:
yberlux Corporation
Research Triangle Park NC 27709
Point of Contact Aaron Goodman
agoodman@cyberlux.com
Via email to: subcontract-consultant-invoices@hii-tsd.com
914-414-1884
Invoice Date:
April 29, 2025
Invoice #:
20230829-HII-1015
Purpose:
Shipment 2
Date of Shipment:
4/28/25
Attachments:
Payment Due: In accordance with Modification No. 4
Amount Due
Truck 1 - April 28, 2025
DD250 #
Crate #
Category #
Model #
# of Units
Price/Unit
Price/Crate
47QFCA511270025
B
K8-2
$36,807.22
$294,457.76
47QFCA511270026
B
K8-2
$36,807.22
$294,457.76
47QFCA511270027
B
K8-2
$36,807.22
$294,457.76
47QFCA511270028
B
K8-2
$36,807.22
$294,457.76
47QFCA511270029
B
K8-2
$36,807.22
$294,457.76
47QFCA511270030
B
K8-2
$36,807.22
$294,457.76
47QFCA511270031
B
K8-2
$36,807.22
$294,457.76
47QFCA511270032
B
K8-2
$36,807.22
$294,457.76
47QFCA511270033
B
K8-2
$36,807.22
$294,457.76
47QFCA511270034
B
K8-2
$36,807.22
$294,457.76
47QFCA511270035
B
K8-2
$36,807.22
$294,457.76
47QFCA511270036
B
K8-2
$36,807.22
$294,457.76
47QFCA511270037
B
K8-2
$36,807.22
$294,457.76
47QFCA511270038
B
K8-2
$36,807.22
$294,457.76
47QFCA511270039
B
K8-2
$36,807.22
$294,457.76
47QFCA511270040
B
K8-2
$36,807.22
$294,457.76
47QFCA511270041
B
K8-2
$36,807.22
$294,457.76
47QFCA511270042
B
K8-2
$36,807.22
$294,457.76
47QFCA511270043
B
K8-2
$36,807.22
$294,457.76
47QFCA511270044
B
K8-2
$36,807.22
$294,457.76
47QFCA511270045
B
K8-2
$36,807.22
$294,457.76
47QFCA511270046
B
K8-2
$36,807.22
$294,457.76
47QFCA511270047
B
K8-2
$36,807.22
$294,457.76
47QFCA511270048
B
K8-2
$36,807.22
$294,457.76
$7,066,986.24
Amount Credited (72% of Total Price for Crates 1-24) against initial payment made at award IAW Modification No. 4, Attachment A
$5,088,230.09
$1,978,756.15
In accordance with Modification No. 4, Section 5, Cyberlux hereby certifies as follows: 1. Cyberlux has delivered the goods identified in the invoice in compliance with this Agreement; and 2. Cyberlux's Termination Settlement Proposal of February 15, 2025 and all statements made in support of that proposal are made in good faith; the supporting data are accurate and complete to the best of Cyberlux's knowledge and belief; and the amount claimed accurately reflects the amount that Cyberlux believes it is entitled to receive under the Subcontract; and 3. All goods delivered by Cyberlux are free and clear of any third-party liens, claims, or encumbrances of any kind
Aaron Goodman Chief Operating Office
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-elex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127025
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Scal
S/Ns
CRT I: BOX A: 2615160 BOX B: 2615023
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
2025/04 28
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Balea DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Sand comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127026
OF
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Scal
S/Ns
CRT 2: BOX A: 2615020 BOX B: 2615021
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of ilsted Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of IIsted Items
has been made by me or under my supervision and they conform to contract, except as noted herejmor on supporting documents. 2025 0428
De Hablar
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter :selected: actual quantity received below quantity shipped and encircle.
Pago of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127027
OF
Spring, TX
CODE :
CODE :
HIII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 3: BOX A: 2615016 BOX B: 2615022
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Da Max
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric; if different, enter :selected: actual quantity received below quantity shipped and encircle.
Pago of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127028
OF
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 4: BOX A: 2615017 BOX B: 2615018
:unselected:
:unselected:
:unselected:
:unselected:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herain or on supporting documents. 2925 028
Les Mer
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparant good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment Is the same as quantity shipped, Indicate by (X) maric; If different, enter actual quantity received below quantity shipped and encircle.
Page
of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections @mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number,
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127029
OF
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 5: BOX A: 2615019 BOX B: 2615200
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and thay conform to contract, except as noted herein or on supporting documents. 20250426
doy lea
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mhx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127030
OF
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 6: BOX A: 2615028 BOX B: 2615030
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. PMSeu
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) mark; if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127031
OF
CODE :
CODE :
HIT 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 7: BOX 1A: 2615031 BOX 1B: 2615033
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except es noted harain or on supporting documents.
Porselen
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mll. Respondents should be aware that notwithstanding any other provision of law, ho person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127032
OF
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 8: BOX A: 2615032 BOX B: 2615029
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herafh or on supporting documents. 2025 0428
PostAler
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark, If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMS control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127033
Spring, TX
HIT
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Scal
S/Ns
CRT 9: BOX A: 2615034 BOX B: 2615035
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Ma Mpu
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Govemment is the same as quantity shipped, Indicate by (X) maric If different, enter actual quantity received below quantity shipped and encircle.
Pago of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127034
Spring, TX
FIT
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
I
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 10: BOX A: 2615036 BOX B: 2615037
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of IIsted Items
has been made by ma or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. MaluQuan
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric if different, enter :selected: actual quantity received below quantity shipped and encircle.
Pago
of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127035
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 11: BOX A: 2615038 BOX B: 2615039
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Par Mleven 2025 04 28
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) markc; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127036
OF
Spring, TX
HI
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 12: BOX A: 2615044 BOX B: 2615026
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 20250428
DATE (YYYYMMDD)
Do Meu SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of IIsted Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Govemment Is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
Pago of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-elex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127037
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 13: BOX A: 2615040 BOX B: 2615042
:selected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 2225 0428
Royalbleu
DATE (YYYYMMDD) :selected:
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME!
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown in column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127038
Spring, TX
HIE
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
I
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 14: BOX A: 2615041 BOX B: 2615027
:selected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
has been made by me or under my supervision and thay conform to contract, except as noted herein or on supporting documents. basil@eu
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantitles shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment Is the same as quantity shipped, Indicate by (X) mark; If different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections @mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127039
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End
Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
CODE :
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 15: BOX A: 2615050 BOX B: 2615049
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Isted Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 2025 04 25
Desuden
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, indicate by (X) maric; if different, enter actual quantity received below quantity shipped and encircle.
Pago of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127040
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 16: BOX A: 2615048 BOX B: 2615046
:unselected:
:unselected:
:unselected:
:unselected:
has been made by me or under my supervision and they conform to contract, except as noted harein or on supporting documents. 2025 0428
Boulder
DATE (YYYYMMDD)
SI FUTURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantitles shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric If different, enter actual quantity received below quantity shipped and encircle.
Pago of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-elex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127041
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense 1800 F St. NW
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23,008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End
Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
CODE :
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 17: BOX A: 136801 BOX B: 136802
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted hereln of on supporting documents. 2225028
Ball. Dece
DATE (YYYYMMDD)
SIG RATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at why.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127042
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End
Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
CODE :
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 18: BOX A: 136803 BOX B: 136804
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 202504 25
Bestill Que
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment is the same as quantity shipped, Indicate by (X) maric If different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires" 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mali.mll. Respondents should be aware that notwithstanding any other provision of law, ho person shall be subject to any penalty for falling to comply with a collection of Information If it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127043
OF
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 19: BOX A: 136805 BOX B: 136806
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 2025 0426
Poslou
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127044
OF
Spring, TX
CODE :
CODE :
HII
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 20: BOX A: 136807 BOX B: 136808
:unselected:
:unselected:
:unselected:
:unselected:
&. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Ilsted Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listad Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DSM Du
DATE (YYYYMMDD)
SIGN! DIRE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Govemment Is the same as quantity shipped, indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127045
Spring, TX
CODE :
CODE :
HII
General Services Administration
AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End
Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
CODE :
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 21: BOX A: 136809 BOX B: 136810
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision end they conform to contract, except as noted herein or on supporting documents. 2025 0428
Das Mileu
DATE (YYYYMMDD)
SIG TATI'RE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment Is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127046
OF
Spring, TX
CODE :
CODE :
HII
General Services Administration
AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 22: BOX A: 2615043 BOX B: 2615024
:unselected:
:unselected:
:unselected:
:unselected:
a ORIGIN :selected: CQA :unselected: ACCEPTANCE of ilstad Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 2025 0428
Boys Mella
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127047
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 23: BOX A: 2615025 BOX B: 2615047
:unselected:
:unselected:
:unselected:
:unselected:
has been made by me or under my supervision and they conform to contract, except as noted herejn or on supporting documents. 2025 0425
Mal Malen
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of IIsted Items
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantitles shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127048
Spring, TX
CODE :
CODE :
HI
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
:unselected:
Seal
S/Ns
CRT 24: BOX A: 136811 BOX B: 2615045
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Ilsted Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
Destill Den
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric; if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at why.mc-alex.esd.mbx.dd-dod-Information-collactions@mall.mill. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127049
Spring, TX
CODE :
CODE :
HIT 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CYBERLUX
Spring, TX 77388
FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23,011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Scal
S/Ns
CRT 1: BOX 1A: 136821 BOX IB: 136831
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted harain or on supporting documents Dayfull Dea
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferme
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD) TYPED NAME:
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were recalved in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric If different, enter actual quantity received below quantity shipped and encimale.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mbx.dd-dod-information-collections @mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for faling to comply with a collection of Information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127050
Spring, TX
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
CODE :
FOB:
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Blicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807,22
294,457.76
Scal
S/Ns
CRT 2: BOX 2A: 136845 BOX 2B: 136844
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a, ORIGIN :selected: CQA :unselected: ACCEPTANCE of Ilstad Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Pas dela
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Roberty Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment is the same as quantity shipped, Indicate by (X) mark If different, enter :selected: actual quantity received below quantity shipped and encircle.
Paga of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Sand comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valli OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127051
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003,23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 3: BOX 3A: 136832 BOX 3B: 136833
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
B. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except es noted herein or on supporting documents. Basil deur
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGN! TURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
Laulas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantitias shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; If different, enter actual quantily received below quantity shipped and ancircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires" 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.asd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127052
Spring, TX
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
CODE :
FOB:
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 4: BOX 4A: 136843 BOX 4B: 136842
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
& ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of ilsted Items
has been made by me or under my supervision and they conform to contract, exceptas noted herein or on supporting documents Basilea
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dagles Ferm
TITLE:
Agata Administrado
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment is the same as quantity shipped, Indicate by (X) mark; If different, enter :selected: actual quantity received below quantity shipped and encircle.
Paga of
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections @mail.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127053
Spring, TX
CODE :
CODE :
HIE 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 5: BOX SA: 136834 BOX 5B: 136835
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
& ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by ma or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Day Malar
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Doudas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment Is the same as quantity shipped, Indicate by (X) maric If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per responsa, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections @mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127054
Spring, TX
CODE :
CODE:
HI 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
.
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Scal
S/Ns
CRT 6: BOX 6A: 136841 BOX 6B: 136840
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herelp or on supporting documents. Pas Mour
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Form
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public raporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mali.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127055
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 7: BOX 7A: 136836 BOX 7B: 136837
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Pourleur DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@hnall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127056
OF
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration
AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
I
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Scal
S/Ns
CRT 8: BOX 8A: 136838 BOX 8B: 136839
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 2025 0429 Pauloeur DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Property Adminizacion
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity racelved by the Government Is the same as quantity shipped, Indicate by (X) maric; if different, enter :selected: actual quantity received below quantity shipped and endrcle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-elex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127057
OF
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
Washington, DC 20405
CODE :
FOB:
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23,011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
I
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
147,228.88
Seal
S/Ns
CRT 9: BOX 9A: 136819
:unselected:
Flighteye Model K8-1 Drone System (Category B)
$40440.71
161,762.84
Scal
S/Ns
CRT 9: BOX 9B: 136818
:unselected:
:unselected:
:unselected:
& ORIGIN :selected: COA :unselected: ACCEPTANCE of Ilsted Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except es noted herein or on supporting documents.
has been made by ma or under my supervision and they conform to contract, except as noted hereln or on supporting documents. Das Meer
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME!
Douglas Ferme
TITLE:
Property Administração
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric if different, enter :selected: actual quantity received below quantity shipped and encircle.
Paga of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whe.mc-alex.esd.mbx.dd-dod-information-collections@mail.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127058
OF
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Blicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 10: BOX 10A: 136816 BOX 10B: 136815
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: COA :unselected: ACCEPTANCE of Ilsted Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Bestiller
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Daplas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apperant good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information, Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mo-alex.esd.mbx.dd-dod-information-collectionstimal.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127059
Spring, TX
CODE :
CODE :
HEI 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 11: BOX 11A: 136814 BOX 11B: 136820
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a, ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents basil deur DATE (YYYYMMDD) SIG12 TURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Paralas Ferm
TITLE:
Agente Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD) TYPED NAME:
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparant good condition except es noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The publle reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127060
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23,010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 12: BOX 12A: 136813 BOX 12B: 136817
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Ilsted Items
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. DansMilu
has been made by ma or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas, Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER!
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information la estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.ead.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for faling to comply with a collection of information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127061
OF
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003,23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 13: BOX 13A: 136824 BOX 13B: 136825
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents Silden
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferme
TITLE:
Proper Heministrabe
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127062
OF
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 14: BOX 14A: 136826 BOX 14B: 136827
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: COA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Portal.de DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
2025/04/29
TYPED NAME: Dudas Ferme
TITLE: Profesion Administração
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric If different, enter actual quantity received below quantity shipped and encircle.
Paga of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes par response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.asd.mbx.dd-dod-information-collections @mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to ary penalty for falling to comply with a collection of Information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127063
OF
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23,010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 15: BOX 15A: 136828 BOX 15B: 136829
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: COA :unselected: ACCEPTANCE of Ilsted Items
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of Isted Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted høfeln or on supporting documents Byl Mellem DATE (YYYYMMDO) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Form
TITLE:
Freaty Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantitles shown in column 17 were received In apparent good condition except es noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
" If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric If different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valid OMB control number,
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127064
Spring, TX
CODE :
CODE :
FII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 16: BOX 16A: 136830 BOX 16B: 136812
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Isted Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted heralmor on supporting documents. PourMaden
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Refeita Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE [YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127065
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003,23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 17: BOX 17A: 136952 BOX 17B: 136958
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents. Profil deun
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD) SIBELSURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
" If quantity received by the Goverment is the same as quantity shipped, Indicate by (X) maric If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127066
Spring, TX
CODE :
CODE :
HIFI 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 18: BOX 18A: 136850 BOX 18B: 136849
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
& ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Dansleeu DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dadas Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Sand comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.esd.mhx.dd-dod-information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127067
Spring, TX
CODE :
CODE :
FILE 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Blicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Scal
S/Na
CRT 19: BOX 19A: 136846 BOX 19B: 136953
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted herain or on supporting documents. Roussel Dem
has been made by me or under my supervision and they conform to contract, except as noted harein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Deudas Ferm
TITLE: Reparto Administrada
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127068
Spring, TX
CODE :
CODE :
ни 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 20: BOX 20A: 136956 BOX 20B: 136955
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: COA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted harein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted heteln or on supporting documents bouillon
DATE (YYYYMMDD)
SIG JATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Form
TITLE:
Property Administração
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
" If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127069
OF
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Scal
S/Ns
CRT 21: BOX 21A: 136847 BOX 21B: 136960
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
B. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as tooted heren or on supporting documents. 2025 0429
Mail.de
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Raporty Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by ma or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS: COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATÉ (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment is the same as quantity shipped, Indicate by (X) maric If different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for raviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, et wha.me-alex.esd.mbx.dd-dod-information-collections @mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127070
OF
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Blicker 717-332-0830
Flighteye Model K8-I Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 22: BOX 2ZA: 136848 BOX 22B: 136951
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted hareln or on supporting documents. 2025 0429
Desuden
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
BIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Ferm
TITLE:
Honey Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
" If quantity received by the Goverment Is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-elax.end.mbx.dd-dod-Information-collections@mall.mil, Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127071
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Scal
S/Ns
CRT 23: BOX 23A: 136957 BOX 23B: 136954
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Ilsted Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted harain or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. De 1.Jem DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Douglas Form
TITLE:
Roberty Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
*If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric; If different, enter :selected: actual quantity received below quantity shipped and encircle.
Page
of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.and.mbx.dd-dod-Information-collections@mail.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127072
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 24: BOX 24A: 136959 BOX 24B: 136823
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
B. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Do Meu
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Pagas Ferm
TITLE:
Fresate Hommestrao
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and thay conform to contract, except as noted harain or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were recelvad In apparant good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment Is the same as quantity shipped, Indicate by (X) mark; If different, entar actual quantity received below quantity shipped and encircle.
Paga of
Document 178-1 Filed 04/15/26
Page 109 of 135 PageID#
CYBERLU Harnessing the Future
®)
Buyer: HII Mission Technologies Corp. Attn: Accounts Payable 5701 Cleveland Street Suite 400 Virginia Beach, VA 23462
Seller:
Cyberlux Corporation
Research Triangle Park NC 27709
Point of Contact:
Aaron Goodman
agoodman@cyberlux.com
Via email to: subcontract-consultant-invoices@hii-tsd.com
914-414-1884
Invoice Date:
May 6, 2025
Invoice #:
20230829-HII-1016
Purpose:
Shipment 3
Date of Shipment:
May 2, 2025
Attachments:
Payment Due:
In accordance with Modification No. 4
Amount Due
Truck 3 - May 2, 2025
DD250 #
Crate #
Category #
Model #
# of Units
Price/Unit
Price/Crate
47QFCA511270049
B
K8-2
$36,807.22
$294,457.76
47QFCA511270050
B
K8-2
$36,807.22
$294,457.76
47QFCA511270051
B
K8-2
$36,807.22
$294,457.76
47QFCA511270052
B
K8-2
$36,807.22
$294,457.76
47QFCA511270053
B
K8-2
$36,807.22
$294,457.76
47QFCA511270054
B
K8-2
$36,807.22
$294,457.76
47QFCA511270055
B
K8-2
$36,807.22
$294,457.76
47QFCA511270056
B
K8-2
$36,807.22
$294,457.76
47QFCA511270057
B
K8-2
$36,807.22
$147,228.88
47QFCA511270057
B
K8-1
$40,440.71
$161,762.84
47QFCA511270058
B
K8-1
$40,440.71
$323,525.68
47QFCA511270059
B
K8-1
$40,440.71
$323,525.68
47QFCA511270060
B
K8-1
$40,440.71
$323,525.68
47QFCA511270061
B
K8-1
$40,440.71
$323,525.68
47QFCA511270062
B
K8-1
$40,440.71
$323,525.68
47QFCA511270063
B
K8-1
$40,440.71
$323,525.68
47QFCA511270064
B
K8-1
$40,440.71
$323,525.68
47QFCA511270065
B
K8-1
$40,440.71
$323,525.68
47QFCA511270066
B
K8-1
$40,440.71
$323,525.68
47QFCA511270067
B
K8-1
$40,440.71
$323,525.68
47QFCA511270068
B
K8-1
$40,440.71
$323,525.68
47QFCA511270069
B
K8-1
$40,440.71
$323,525.68
47QFCA511270070
B
K8-1
$40,440.71
$323,525.68
47QFCA511270071
B
K8-1
$40,440.71
$323,525.68
47QFCA511270072
B
K8-1
$40,440.71
$323,525.68
$7,517,539.00
Amount Credited (72% of Total Price for Crates 1- 24) against initial payment made at award IAW Modification No. 4, Attachment A
$5,412,628.08
$2,104,910.92
In accordance with Modification No. 4, Section 5, Cyberlux hereby certifies as follows: 1. Cyberlux has delivered the goods identified in the invoice in compliance with this Agreement; and 2. Cyberlux's Termination Settlement Proposal of February 15, 2025 and all statements made in support of that proposal are made in good faith; the supporting data are accurate and complete to the best of Cyberlux's knowledge and belief; and the amount claimed accurately reflects the amount that Cyberlux believes it is entitled to receive under the Subcontract; and 3. All goods delivered by Cyberlux are free and clear of any third-party liens, claims, or encumbrances of any kind.
Ranson by Sely
Larson Isely Chief Operating Officer
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.esd.mbx.dd-dod-Information-collections @mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127073
Spring, TX
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
CODE : FOB:
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Scal
S/Ns
CRT 1: BOX 1A: 136966 BOX 1B: 136965
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Matilda
has been made by ma or under my supervision and they conform to contract, except es noted herein or on supporting documents.
2025/05/05
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
DagFerm
TITLE:
Property Administrati
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
" If quantity received by the Government Is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity recalvad below quantity shipped and encircle.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data heeded, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127074
CODE :
CODE :
HEI 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Scal
S/Ns
CRT 2: BOX 2A: 136964 BOX 2B: 136963
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
post all den
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Daug Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The publle reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127075
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End
Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 3: BOX 3A: 136962 BOX 3B: 136961
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents Dal/ Que
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Doux Ferm
TITLE:
Sporty Administrator
MAILING ADDRESS
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching wodsting data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-elex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondants should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401,
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127076
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE:
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 4: BOX 4A: 136967 BOX 4B: 136968
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
Matilda
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Doug Ferme
TITLE:
Raportas Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted harein ar on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and endrcle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching exlating data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at wha.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for faling to comply with a collection of information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127077
B. ACCEPTANCE POINT
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration
AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE:
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 5: BOX 5A: 136969 BOX 5B: 136970
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted hameln or on supporting documents. Delillere
DATE (YYYYMMDD)
S GNNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Doug Ferm
TITLE:
Property Administrador
MAILING ADDRESSA
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching axlating data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.esd.mbx.dd-dod-information-collections@mall.mil. Respondents should be aware that notwithstanding any other provialon of law, no person shall be subject to any penalty for falling to comply with a collection of information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127078
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23,007, 1003.23.008, 1003.23.009, 1003.23,010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 6: BOX 6A: 136971 BOX 6B: 136972
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has baan made by me or under my supervision and they conform to contract, except as noted hereln or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents Logos Mover
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Doug Form
TITLE:
Property Administrator
MAILING ADDRESS:"
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
" If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per responsa, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whe.mo-alex.esd.mhx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127079
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE !
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 7: BOX 7A: 136973 BOX 7B: 136974
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents 2025 05 05
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dag Ferme
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric if different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information la estimated to average 3 minutes per response, Including the time for reviewing Instructions, ssarching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.asd.mbx.dd-dod-Information-collections@mail.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information If it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127080
Spring, TX
ДН
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE :
FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23,011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End
Mechanicsburg, PA 17055
Mechanicsburg PA POC Scott Elicker 717-332-0830
CODE :
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 8: BOX 8A: 136975 BOX 8B: 136976
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Isted Items
has been made by me or under my supervision and they conform to contract, except as noted herein or an supporting documents 20250505
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Daug Ferm
TITLE:
Property Administraties
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of Ilsted Items has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
" If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127081
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 9: BOX 9A: 136822 BOX 9B: 136998
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except es noted herein or on supporting documents. Paul. De
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Das Ferra
TITLE:
Roparty Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of listed Itams
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric; If different, enter actual quantity received below quantity shipped and encircle:
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127082
OF
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003,23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 10: BOX IOA: 136984 BOX 10B: 136983
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mill. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127083
Spring, TX
HIT
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 11: BOX 11A: 136985 BOX 11B: 136989
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: COA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents Pago Melu
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Pag Fame
TITLE:
Procity Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric; If different, enter actual quantity received below quantity shipped and encircle.
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires" 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutaa per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127084
Spring, TX
HI
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 12: BOX 12A: 136988 BOX 12B: 136993
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Ilstad Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Sevilladem DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Long Feu
TITLE:
Pocity Administrator
MAILING ADDRESS
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except es noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) marc If different, enter actual quantity received below quantity shipped and encircle.
Paga of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127085
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525,68
Seal
S/Ns
CRT 13: BOX 13A: 136991 BOX 13B: 136990
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Ilsted Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents, Davidla
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
Das Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and thay conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and ancircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail .mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127086
OF
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525.68
Seal
S/Ns
CRT 14: BOX 14A: 136995 BOX 14B: 136999
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
& ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted harain or on supporting documents. PostMeden
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Doug Ferm
TITLE:
Papaty Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL
TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
Page
of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and raviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127087
Spring, TX
CODE :
HI
CODE :
FOB:
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
323,525,68
Seal
S/Ns
CRT 15: BOX 15A: 136987 BOX 15B: 136996
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and thay conform to contract, except as noted herein or on supporting documents. Pas Mo Deu
DATE (YYYYMMDD)
FIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Daug Forme
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: COA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and thay conform to contract, except as noted harain or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantitias shown In column 17 were received in apparant good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.
:
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burdan for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information If It does not display a currently valld QMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039 :unselected:
TDL 023
TCN 47QFCA51127088
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FO8:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-1 Drone System (Category B)
EA
$40440.71
161,762.84
Scal
S/Ns
CRT 16: BOX 16A: 137000
:unselected:
Flighteye Model K8-2 Drone System (Category B)
$36807.22
147,228.88
Seal
S/Ns
CRT 16: BOX 16B: 136994
:unselected:
:unselected:
:unselected:
& ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and
they conform to contract, except as noted herein or
on supporting documents.
Dentiden
DATE (YYYYMMDD)
SIONATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
has been made by me or under my supervision and thay conform to contract, except as noted harain or on supporting documents.
TYPED NAME:
Dag Ferm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantitles shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) markc; if different, enter actual quantity received below quantity shipped and encircle.
Paga of
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
OMB approval expires:
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whis.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondants should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127089
Spring, TX
HIT
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23,011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Scal
S/Ns
CRT 17: BOX 17A: 136901 BOX 17B: 136902
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: COA :unselected: ACCEPTANCE of Ilsted Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Dyslelar
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dag Form
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.ssd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADUI09-47QFCA22F0039
TDL 023
TCN 47QFCA51127090
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 18: BOX 18A: 136903 BOX 18B: 136904
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
has been made by me or under my supervision and they conform to contract, except as noted herain or on supporting documents.
DATE (YYYYMMDD)
BIG TADIRE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dogg Ferme
TITLE:
Experts Administração
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government Is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received balow quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutas par response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.esd.mbx.dd-dod-Information-collections@mall.mill. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information if it does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127091
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Blicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 19: BOX 19A: 136905 BOX 19B: 136906
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of Ilstad Items
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 2025 05 05
RogelioDer
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Daug Ferme
TITLE:
Rosty Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantify received by the Government Is the same as quantity shipped, indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127092
Spring, TX
CODE :
CODE :
HUI 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003,23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Blicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 20: BOX 20A: 136907 BOX 20B: 136908
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and thay conform to contract, except as noted herein or on supporting documents. 20250505 Andelen DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME: Doug Form
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown in column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching exdating data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-elex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127093
Spring, TX
CODE :
CODE :
HII 12730 Fair Lakes CIR
General Services Administration AAS Defense
FAIRFAX, VA 22033
Washington, DC 20405
CYBERLUX
Spring, TX 77388
CODE : FOB:
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Scal
S/Ns
CRT 21: BOX 21A: 136909 BOX 21B: 136910
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 20250505
bestill-dia
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
De Fer
TITLE:
Remeto Administrator
MAILING ADDRESS.
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantitles shown in column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
" If quantity received by the Government is the same as quantity shipped, Indicate by (X) mark; If different, enter actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of information Is estimated to average 3 minutes per response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-Information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently vald OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127094
Spring, TX
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
CODE :
FOB:
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Blicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 22: BOX 22A: 136911 BOX 22B: 136912
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 20250505 Dans l'elec DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dug form
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted heraln or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received in apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Goverment is the same as quantity shipped, Indicate by (X) maric; If different, enter :selected: actual quantity received below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes per responsa, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, Including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mo-alex.esd.mbx.dd-dod-Information-collections@mall.mll. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for falling to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO.
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127095
Spring, TX
HII
FAIRFAX, VA 22033
CODE :
General Services Administration
AAS Defense
Washington, DC 20405
CODE :
CYBERLUX
Spring, TX 77388
CODE : FOB:
CODE :
Request to Initiate Purchase numbers:
1003.23.007, 1003.23.008, 1003.23.009, 1003.23.010, & 1003.23.011
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 23: BOX 23A: 136913 BOX 23B: 136914
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
a. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. 20250505 Basil Don
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted harein or on supporting documents.
DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Daug Farm
TITLE:
Property Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 ware received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
* If quantity received by the Government is the same as quantity shipped, Indicate by (X) mark; If different, enter :selected: actual quantity recalved below quantity shipped and encircle.
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248 OMB approval expires: 20270131
The public reporting burden for this collection of Information is estimated to average 3 minutes par response, Including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of Information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.ssd.mbx.dd-dod-Information-collections@mall.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of Information If It does not display a currently valld OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
ORDER NO. :unselected:
GS00Q140ADU109-47QFCA22F0039
TDL 023
TCN 47QFCA51127096
CODE :
CODE :
HII 12730 Fair Lakes CIR FAIRFAX, VA 22033
General Services Administration AAS Defense 1800 F St. NW Washington, DC 20405
CODE : FOB:
CODE :
CYBERLUX 21631 Rhodes Rd. BLDG F Spring, TX 77388
Request to Initiate Purchase numbers: 1003.23.007, 1003.23.008, 1003.23.009,
1003.23.010, & 1003.23.011
CODE :
CODE :
NAVSUP WSS NOFX 5450 Carlie Pike BLDG 107 South End Mechanicsburg, PA 17055 Mechanicsburg PA POC Scott Elicker 717-332-0830
Flighteye Model K8-2 Drone System (Category B)
EA
$36807.22
294,457.76
Seal
S/Ns
CRT 24: BOX 24A: 136915 BOX 24B: 136916
:unselected:
:unselected:
:unselected:
:unselected:
:unselected:
&. ORIGIN :selected: CQA :unselected: ACCEPTANCE of listed items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents. Del file 20250505 DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
Dagferie
TITLE:
Hopedy Administrator
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
b. DESTINATION :unselected: CQA :unselected: ACCEPTANCE of listed Items
has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE!
MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
Quantities shown In column 17 were received In apparent good condition except as noted.
DATE (YYYYMMDD)
SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE: MAILING ADDRESS:
COMMERCIAL TELEPHONE NUMBER:
" If quantity received by the Government Is the same as quantity shipped, Indicate by (X) maric if different, enter actual quantity received below quantity shipped and encircle.
Document 178-1 Filed 04/15/26 3749
Page 134 of 135 PageID#
YBERLU ®
Harnessing the Future
Buyer: HIT MISSION Technologies Corp. Attn: Accounts Payable 5701 Cleveland Street Suite 400 Virginia Beach, VA 23462
Seller:
Cyberlux Corporation
Research Triangle Park NC 27709
Point of Contact:
Aaron Goodman
agoodman@cyberlux.com
914-414-1884
Via email to:
subcontract-consultant-invoices@hii-tsd.com
Invoice Date:
May 6, 2025
Invoice #:
20230829-HII-1016
Purpose:
Shipment 4
Date of Shipment:
May 5, 2025
Attachments:
Payment Due:
In accordance with Modification No. 4
Amount Due
Truck 4 - May 5, 2025
DD250 #
Crate #
Category #
Model #
# of Units
Price/Unit
Price/Crate
47QFCA511270073
B
K8-1
$40,440.71
$323,525.68
47QFCA511270074
B
K8-1
$40,440.71
$323,525.68
47QFCA511270075
B
K8-1
$40,440.71
$323,525.68
47QFCA511270076
B
K8-1
$40,440.71
$323,525.68
47QFCA511270077
B
K8-1
$40,440.71
$323,525.68
47QFCA511270078
B
K8-1
$40,440.71
$323,525.68
47QFCA511270079
B
K8-1
$40,440.71
$323,525.68
47QFCA511270080
B
K8-1
$40,440.71
$323,525.68
47QFCA511270081
B
K8-1
$40,440.71
$323,525.68
47QFCA511270082
B
K8-1
$40,440.71
$323,525.68
47QFCA511270083
B
K8-1
$40,440.71
$323,525.68
47QFCA511270084
B
K8-1
$40,440.71
$323,525.68
47QFCA511270085
B
K8-1
$40,440.71
$323,525.68
47QFCA511270086
B
K8-1
$40,440.71
$323,525.68
47QFCA511270087
B
K8-1
$40,440.71
$323,525.68
47QFCA511270088
B
K8-1
$40,440.71
$161,762.84
47QFCA511270088
B
K8-2
$36,807.22
$147,228.88
47QFCA511270089
B
K8-2
$36,807.22
$294,457.76
47QFCA511270090
B
K8-2
$36,807.22
$294,457.76
47QFCA511270091
B
K8-2
$36,807.22
$294,457.76
47QFCA511270092
B
K8-2
$36,807.22
$294,457.76
47QFCA511270093
B
K8-2
$36,807.22
$294,457.76
47QFCA511270094
B
K8-2
$36,807.22
$294,457.76
47QFCA511270095
B
K8-2
$36,807.22
$294,457.76
47QFCA511270096
B
K8-2
$36,807.22
$294,457.76
$7,517,539.00
Amount Credited (72% of Total Price for Crates 1-24) against initial payment made at award IAW Modification No. 4, Attachment A
$5,412,628.08
$2,104,910.92
In accordance with Modification No. 4, Section 5, Cyberlux hereby certifies as follows: 1. Cyberlux has delivered the goods identified in the invoice in compliance with this Agreement; and 2. Cyberlux's Termination Settlement Proposal of February 15, 2025 and all statements made in support of that proposal are made in good faith; the supporting data are accurate and complete to the best of Cyberlux's knowledge and belief; and the amount claimed accurately reflects the amount that Cyberlux believes it is entitled to receive under the Subcontract; and 3. All goods delivered by Cyberlux are free and clear of any third-party liens, claims, or encumbrances of any kind.
Ranson by Jely
Larson Isely Chief Operating Officer
Document 178-1 Filed 04/15/26 3750
FAIRWINDS TECHNOLOGIES
Fairwinds Technologies LLC 6165 Guardian Gateway, Ste J Aberdeen Proving Ground, MD 21005 Duns: 080308420 UEI# R3G6PWHQRAY5
Bill to:
Cyberlux Corporation
Research Triangle, NC 27709
Invoice #:
CYBLUX-1001B
Invoice Date:
7/9/2025
Email: Kyle.kolwicz@Fairwinds-tech.com
Invoice Terms:
NET30
Please accept this invoice for payment under Strategic Business Development, Service and Supply Teaming Agreement between Fairwinds Technologies, LLC and Cyberlux Corporation executed on June 7th, 2023.
Invoice Period of Performance:
Jul-25
Invoice Description
Contract Value of 1,000 K-8 Variants
Due to Fairwinds (8%)
8% Fee of first 1,000 K-8 variant drones sold and delivered
$ 29,356,780.00
$ 2,348,542.40
INVOICE TOTAL
$2,348,542.40
Please send payment via electronic transfer to:
Sandy Spring Bank, 17801 Georgia Avenue, Olney, Maryland 20832
Account Number: 1616740306; Routing Number: 055001096 If paying by check, please mail to: Fairwinds Technologies LLC, 920 Melvin Rd, Annapolis, MD 21403
Regards,
Kyle Kolwicz
Kyle Kolwicz Chief Operating Officer
Original source file
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- ip-hii-edva-00483-doc-0178-exhibit-1.pdf
- Source UID
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- Full SHA-256
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