12.06.22 W56HZV-20-D-0104 - DO W56HZV-23-F-0074.pdf

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

Offeror To Complete Block 12, 17, 23, 24, & 30

1. Requisition Number Page Of

2. Contract No. 3. Award/Effective Date 4. Order Number 5. Solicitation Number 6. Solicitation Issue Date

7. For Solicitation Information Call:

A. Name B. Telephone Number (No Collect Calls) 8. Offer Due Date/Local Time

9. Issued By Code 10. This Acquisition is Unrestricted OR Set Aside: % For:

Small Business Women-Owned Small Business (WOSB) Eligible Under the Women-Owned Small Business Program

Hubzone Small Business EDWOSB

Service-Disabled Veteran-Owned Small Business NAICS:

Email: 8(A) Size Standard:

11. Delivery For FOB Destination Unless Block Is Marked

12. Discount Terms 13a. This Contract Is A Rated Order Under DPAS (15 CFR 700) 13b. Rating

See Schedule 14. Method Of Solicitation RFQ IFB RFP

15. Deliver To Code 16. Administered By Code

Telephone No.

17a. Contractor/Offeror Code Facility 18a. Payment Will Be Made By Code

Telephone No.

17b. Check If Remittance Is Different And Put Such Address In Offer

18b. Submit Invoices To Address Shown In Block 18a Unless Block Below Is Checked See Addendum

19.

Item No.

20.

Schedule Of Supplies/Services

21.

Quantity

22.

Unit

23.

Unit Price

24.

Amount

(Use Reverse and/or Attach Additional Sheets As Necessary)

25. Accounting And Appropriation Data 26. Total Award Amount (For Govt. Use Only)

27a.Solicitation Incorporates By Reference FAR 52.212-1, 52.212-4. FAR 52.212-3 And 52.212-5 Are Attached. Addenda Are Are Not Attached.

27b.Contract/Purchase Order Incorporates By Reference FAR 52.212-4. FAR 52.212-5 Is Attached. Addenda Are Are Not Attached.

28. Contractor Is Required To Sign This Document And Return _________ 29. Award Of Contract: Ref. Offer Copies to Issuing Office. Contractor Agrees To Furnish And Deliver All Items Set Forth Or Otherwise Identified Above And On Any Additional Sheets Subject To The Terms And Conditions Specified.

Dated . Your Offer On Solicitation (Block 5), Including Any Additions Or Changes Which Are Set Forth Herein, Is Accepted As To Items:

30a. Signature Of Offeror/Contractor 31a. United States Of America (Signature Of Contracting Officer)

30b. Name And Title Of Signer (Type Or Print) 30c. Date Signed 31b. Name Of Contracting Officer (Type Or Print) 31c. Date Signed

Authorized For Local Reproduction Previous Edition Is Not Usable

Standard Form 1449 (Rev. 2/2012) Prescribed By GSA-FAR (48 CFR) 53.212

SEE SCHEDULE

W56HZV-20-D-0104 2022DEC06 W56HZV23F0074

MUKTI DEB (586)282-6938

MUKTI.DEB.CIV@ARMY.MIL

W56HZV

ACC-DTA

6501 E. 11 MILE RD.

DETROIT ARSENAL, MI 48397-5000

X

X 100

326299

X DOA4

W25G1U

SEE SCHEDULE

S4801A

DCMA SEATTLE

188 106TH AVE NE

SUITE 660

BELLEVUE WA 98004-8019

7JSM8

ISLAND TARP & CONTAINMENT LLC

26292 TWELVE TRESS LN NW BLDG 2

POULSBO, WA 98370-1200

HQ0339

DFAS - COLUMBUS CENTER

WEST ENTITLEMENT OPERATIONS

P O BOX 182317

COLUMBUS OH 43218-2317

SEE SCHEDULE

SEE CONTRACT ADMINISTRATION DATA $107,712.00

X X

X 2

/SIGNED/

VALENCIA LANE

VALENCIA.D.LANE.CIV@ARMY.MIL (586)282-3531 2022DEC06

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19.

Item No.

20.

Schedule Of Supplies/Services

21.

Quantity

22.

Unit

23.

Unit Price

24.

Amount

32a. Quantity In Column 21 Has Been

Received Inspected Accepted, And Conforms To The Contract, Except As Noted: _________________________________________________

32b. Signature Of Authorized Government Representative 32c. Date 32d. Printed Name and Title of Authorized Government Representative

32e. Mailing Address of Authorized Government Representative 32f. Telephone Number of Authorized Government Representative

32g. E-Mail of Authorized Government Representative

33. Ship Number 34. Voucher Number 35. Amount Verified 36. Payment 37. Check Number Correct For Partial Final Complete Partial Final

38. S/R Account No. 39. S/R Voucher Number 40. Paid By

41a. I Certify This Account Is Correct And Proper For Payment 42a. Received By (Print) 41b. Signature And Title Of Certifying Officer 41c. Date 42b. Received At (Location)

42c. Date Rec’d (YY/MM/DD) 42d. Total Containers

Standard Form 1449 (Rev. 2/2012) Back

CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SUPPLEMENTAL INFORMATION

Buyer Name: MUKTI DEB

Buyer Office Symbol/Telephone Number: CCTA-APS-C/(586)282-6938

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

Type of Business: Small Disadvantaged Business Performing in U.S.

Surveillance Criticality Designator: C

Weapon System: Water Supply and Water Purification Equi

*** End of Narrative A0000 ***

Contract: W56HZV-20-D-0104

Delivery Order: W56HZV-23-F-0074

Value of this action: $107,712.00

1. Delivery order W56HZV-23-F-0074 is issued bilaterally pursuant to the Indefinite Delivery Indefinite Quantity (IDIQ) contract W56HZV-

20-D-0104 for the following:

CLIN ITEM NSN QTY ______ ___________________ ________________ _____

0013AA TANK,FABRIC,COLLAPS 5430-01-485-8341 11 EA

2. This award is processed against the Third Ordering Period.

3. The maximum quantity listed in the base contract W56HZV-20-D-0104 is 90 EA. Including this award, the total quantity ordered is 47

EA. The remaining total quantity deliverable is 43 EA. The minimum guaranteed quantity of 18 EA has been satisfied in the first delivery order.

4. The Place of Performance is changed from:

23010 RYEN DR NW STE C

POULSBO, WA 98370-6406

to

26292 TWELVE TRESS LN NW BLDG 2

POULSBO, WA 98370-1200

5. As a result of this action, the total amount of this delivery order is $107,712.00.

6. Early delivery is authorized at no additional cost to the Government.

7. All other terms and conditions of contract W56HZV-20-D-0104, except those addressed by this delivery order W56HZV-23-F-0074 remain unchanged and in full force and effect.

*** END OF NARRATIVE A0001 ***

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W56HZV-20-D-0104/W56HZV23F0074

ISLAND TARP & CONTAINMENT LLC

PIIN/SIIN

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

SUPPLIES OR SERVICES AND PRICES/COSTS

0013 TANK,FABRIC,COLLAPS

NSN: 5430-01-485-8341

Mfr CAGE: 97403

Mfr Part Number: 20K WATER ASSY

0013AA THIRD ORDERING PERIOD-PRODUCTION QUANTITY 11 EA $ 9,792.00000 $ 107,712.00 _________________________________________ ______________ __________________

COMMODITY NAME: TANK,FABRIC,COLLAPS

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: EH3S0017EH PRON AMD: 03 ACRN: AA

AMS CD: SM2B1100000

PSC: 5430

Packaging and Marking _____________________

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

REL CD MILSTRIP ADDR SIG CD MARK FOR TP CD ______ ________ ______ ______ ________ _____

001 W56HZV2286W000 W25G1U J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 11 03-AUG-2023

FOB POINT: Destination

SHIP TO:

(W25G1U) SU W1A8 DLA DISTRIBUTION

DDSP NEW CUMBERLAND FACILITY

2001 NORMANDY DRIVE DOOR 113 TO 134

NEW CUMBERLAND,PA,17070-5002

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-20-D-0104/W56HZV23F0074

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Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

CONTRACT ADMINISTRATION DATA

PRON/ PRON/

AMS CD/ AMS CD/

LINE MIPR/ OBLG JO NO/ OBLIGATEDLINE MIPR/ OBLG JO NO/ OBLIGATED

ITEM GFEBS ATA STAT ACCT ASSIGN ACRN AMOUNTITEM GFEBS ATA STAT ACCT ASSIGN ACRN AMOUNT_____ _________ _____ ___________ ____ _______________ _________ _____ ___________ ____ __________

0013AA EH3S0017EH 2 AA $ 107,712.00

SM2B1100000

TOTAL $ 107,712.00

OBLIGATED OBLIGATED

ACRN ACCOUNTING CLASSIFICATION AMOUNTACRN ACCOUNTING CLASSIFICATION AMOUNT____ _________________________ ______________ _________________________ __________

AA 97 X4930AC9D 6D 26FB S20113 W56HZV $ 107,712.00 __________________

TOTAL $ 107,712.00

LINELINE

ITEM ACRN EDI/SFIS ACCOUNTING CLASSIFICATIONITEM ACRN EDI/SFIS ACCOUNTING CLASSIFICATION_____ ____ _______________________________________ ____ __________________________________

0013AA AA 97 0X0X4930AC9D S20113 6D0000SM2B110000026FB S20113 W56HZV

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