SF 18 12-250-SOL-00107.pdf

12-250-SOL-00107

1. REQUEST NO.

5a. ISSUED BY

NAME

a. NAME

c. STREET ADDRESS

d. CITY

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK 5a ON

OR BEFORE CLOSE OF BUSINESS (Date)

2. DATE ISSUED 3. REQUISITION/PURCHASE REQUEST NO. 4. CERT. FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG.1

RATING

6. DELIVERY BY (Date)

7. DELIVERY

9. DESTINATION

a. NAME OF CONSIGNEE

b. STREET ADDRESS

PAGE OF PAGES

5b. FOR INFORMATION CALL: (No collect calls)

TELEPHONE NUMBER

AREA CODE NUMBER

8. TO:

b. COMPANY

e. STATE f. ZIP CODE

c. CITY

d. STATE e. ZIP CODE

IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State and local taxes)

THIS RFQ

REQUEST FOR QUOTATION

(THIS IS NOT AN ORDER)

IS IS NOT A SMALL BUSINESS SET ASIDEX

05/15/2012 HRS88862

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Office of Acquisition Management and Policy 5600 Fishers Lane, Rm 13A-43

HHS/HRSA/OO/OAMP

Rockville MD 20857

15 Days After Award

Health Resources and Services Admin

Health Resources and Services Admin 5600 Fishers Lane

Rockville

MD 20852

301 443-5131CHRIS HAGER

05/30/2012 1130 ES

FOB DESTINATION

OTHER

(See Schedule)X

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

National Poison Control Center Help Hotline After Hours Support

Delivery: 15 Days After Award Period of Performance: 06/18/2012 to 06/17/2013

The Period of Performance will be one 12 month Base Period with two 12 month each Option Periods. This RFQ asks for a Firm Fixed Price for each 12 month period.

Refer to the Letter of Instruction and Attachment A (Statement of Work) for complete instructions Continued ...

12. DISCOUNT FOR PROMPT PAYMENT

a. 10 CALENDAR DAYS (%) b. 20 CALENDAR DAYS (%) c. 30 CALENDAR DAYS (%) d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations

13. NAME AND ADDRESS OF QUOTER

b. STREET ADDRESS

c. COUNTY

d. CITY e. STATE f. ZIP CODE

14. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

16. SIGNER

a. NAME (Type or print)

c. TITLE (Type or print)

a. NAME OF QUOTER

AREA CODE

NUMBER

15. DATE OF QUOTATION

b. TELEPHONE are are not attached

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable

STANDARD FORM 18 (REV. 6-95)

Prescribed by GSA - FAR (48 CFR) 53.215-1(a)

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

12-250-SOL-00107

to prepare your quote.

SUBMISSION OF INVOICES AND PLACE OF PAYMENT

1. The Contactor shall submit monthly invoices/vouchers, equal to 1/12 of the 12 month

Firm Fixed Price, in original and two (2) copies as follows:

Send one copy to the COR

Send one original and one copy to:

Department of Health and Human Services

Health Resources and Services Administration

OAMP

Parklawn Building, Room 13A-19

5600 Fishers Lane

Rockville, Maryland 20857

Attn: Contract Specialist

2. For inquiries regarding payment, call Accounts Payable Section at 301-443-3020.

3. For inquiries regarding receiving, inspection and acceptance, rejections, or technical issues call your COR.

4. The Contractor agrees to include the following information on its invoice/voucher:

a. contractor's name, invoice/voucher number, and date;

b. contract number;

c. description, price, and quantity of services/products delivered;

d. date of services;

e. payment terms;

f. tax identification number;

g. contractor's complete remittance address;

h. signature of an authorized official certifying that the invoice is correct and proper for payment; and

i. invoice/voucher to be submitted in a format in which total number of hours, funds used and remaining are shown.

5. Payment shall be made by:

Program Support Center/HHS

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

12-250-SOL-00107

DFO Accounting Operations

Suite 200

12501 Ardennes Avenue

Rockville, MD 20857

Telephone: 301-443-3020

Fax: 301-443-0562

ELECTRONIC FUNDS TRANSFER

In accordance with FAR 52.204-7 Central

Contractor Registration (APR 2008), the

Contractor shall designate a financial institution for receipt of electronic funds transfer payments. This designation shall be submitted in writing to the finance office set forth in above.

EVALUATION OF CONTRACTOR'S PERFORMANCE

Final evaluation of Contractor performance shall be conducted on this contract in Interim and final evaluation of Contractor performance shall be conducted on this contract in accordance with the Office of Federal Procurement Policy (OFPP)

Policy Letter 92-5 issued January 11, 1993, FAR

Subpart 42.15 and HHSAR 342.7001(c)(2)(iv). Upon contract competition, a final evaluation of the

Contractor's performance shall be completed by the Government.

949 INVOICE INFORMATION/CLAUSES INCORPORATED

BY REFERENCE

1. Clauses incorporated by reference (FAR

52.252-2) (Feb 1998)

This contract incorporated one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the

Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://www.acqnet.gov/far

Federal Acquisition Regulation (48 CFR Chapter 1)

Clauses

FAR 52.204-7 Central Contractor Registration (Apr

2008)

Continued ...

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

12-250-SOL-00107

FAR 52.213-4 Terms and Conditions Simplified

Acquisitions (Other than Commercial Items) (Feb

2008)

FAR 52.227-14 Rights in Data - General (Dec 2007)

FAR 52.232-33 Payment by Electronic Funds

Transfer Central Contractor Registration (Oct

2003)

FAR 52.243-1 Changes Fixed Price (Aug 1987)

Alternate I (Apr 1984)