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STANDARD FORM 1440 (REV. 10/2023)
Prescribed by GSA-FAR (48 CFR) 53.249(a)(7)
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INVOICE 5496-93
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DATE: 9/30/2025
To: Harpent Rentals 839 Oak St Candalier, AZ 28509
Owning Agency: Department of Labor
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INVITATION NO: 390-249-1787t5
CONTRACT NO: 9267
APP FUND SYMBOL: ___
STA DEP SYM: ___
TERMS: Net 30
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Contracting Officer
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ITEM DESCRIPTION QTY UNIT AVERAGE PRICE AMOUNT
X912 Folding Table 12 ea 23.00 276.00
S912-X Folding Chair White 96 ea 9.00 864.00
P301 Podium 1 ea 37.00 37.00
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Make all checks payable to: General Services Administration
If you have any questions, please call 202-941-4998
TOTAL DUE: $1,177.00
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FOR COLLECTION OFFICER USE ONLY:
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PAID: Check Number: 89437 $ 1,177
Harvey Beverage
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Harvey Beverage
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COLLECTION OFFICER
11/4/25 DATE
___ COLLECTION OFFICER ADDRESS
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THANK YOU FOR YOUR BUSINESS!
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GENERAL SERVICES ADMINISTRATION GSA 3708 (REV. 9/2014)
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Reset
Print
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Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
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U.S. Department of Labor
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Office of Workers' Compensation Programs
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• DEPARTMENT OF LABOR • UNITED STATES OF AMERICA
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1. Name of deceased employee (Last, first, middle)
Trehan Siddharth M
2. Date of Birth (Mo., day, year)
Dec. 29, 1983
3. Date of Injury (Mo., day, year)
Aug. 27, 2025
4. Date of Death (Mo., day, year)
Oct. 9, 2025
5. Social Security Number
443-19-4750
OMB No. 1240-0013
Expires: 06/30/2026
6. Name and address of employing agency (Include ZIP Code)
U.S. Department of Transportation Washington 1200 New Jersey Avenue, SE DC 20590
7. Nature of injury which caused death
Crush injury from renovation materials knocked from scaffolding
8. Name of dependent (Last, first, middle)
Naranjana Trehan