Datasets:
unstructuredio
/
SCORE-Bench

Dataset card Data Studio Files
xet
 Community
2
text
stringlengths
0
2.18k
Authorized For Local Reproduction
Previous Edition Is Not Usable
STANDARD FORM 1440 (REV. 10/2023)
Prescribed by GSA-FAR (48 CFR) 53.249(a)(7)
--------------------------------------------------- Unstructured Page Footer End
--------------------------------------------------- Unstructured Plain Text Format 1.0.4
--------------------------------------------------- Unstructured Form Begin
--------------------------------------------------- Unstructured Title Begin
INVOICE 5496-93
--------------------------------------------------- Unstructured Title End
DATE: 9/30/2025
To: Harpent Rentals 839 Oak St Candalier, AZ 28509
Owning Agency: Department of Labor
--------------------------------------------------- Unstructured Table Begin
INVITATION NO: 390-249-1787t5
CONTRACT NO: 9267
APP FUND SYMBOL: ___
STA DEP SYM: ___
TERMS: Net 30
--------------------------------------------------- Unstructured Table End
___
Contracting Officer
--------------------------------------------------- Unstructured Table Begin
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
--------------------------------------------------- Unstructured Table End
Make all checks payable to: General Services Administration
If you have any questions, please call 202-941-4998
TOTAL DUE: $1,177.00
--------------------------------------------------- Unstructured Sub-Title Begin
FOR COLLECTION OFFICER USE ONLY:
--------------------------------------------------- Unstructured Sub-Title Begin
PAID: Check Number: 89437 $ 1,177
Harvey Beverage
--------------------------------------------------- Unstructured Handwriting Begin
Harvey Beverage
--------------------------------------------------- Unstructured Handwriting End
COLLECTION OFFICER
11/4/25 DATE
___ COLLECTION OFFICER ADDRESS
--------------------------------------------------- Unstructured Form End
THANK YOU FOR YOUR BUSINESS!
--------------------------------------------------- Unstructured Page Footer Begin
GENERAL SERVICES ADMINISTRATION GSA 3708 (REV. 9/2014)
--------------------------------------------------- Unstructured Page Footer End
--------------------------------------------------- Unstructured Plain Text Format 1.0.4
--------------------------------------------------- Unstructured Page Header Begin
--------------------------------------------------- Unstructured Image Begin
Reset
Print
--------------------------------------------------- Unstructured Image End
--------------------------------------------------- Unstructured Title Begin
Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
--------------------------------------------------- Unstructured Title End
--------------------------------------------------- Unstructured Title Begin
U.S. Department of Labor
--------------------------------------------------- Unstructured Title End
Office of Workers' Compensation Programs
--------------------------------------------------- Unstructured Image Begin
• DEPARTMENT OF LABOR • UNITED STATES OF AMERICA
--------------------------------------------------- Unstructured Image End
--------------------------------------------------- Unstructured Page Header End
--------------------------------------------------- Unstructured Form Begin
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