1282A718Q0006.pdf

PDF 109 KB Posted Nov 14, 2017

Attached to: Off-Site Dental Services; Collbran Job Corps Center; Collbran
Solicitation number: 1282A718Q0006
Issued by: Department of Agriculture Forest Service Job Corps

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Solicitation Schedule of Service Quoter's Questionnaire

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Solicitation.pdf	PDF	Jan 2, 2018

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SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

82A7

LAKEWOOD CO 80401

1617 COLE BLVD

USDA FOREST SERVICE

JOB CORPS AQM

82E6 CODE 16. ADMINISTERED BYCODE

621210

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR82A7

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

01/02/2018 1200 MT

11/14/2017

(303)275-5781JENNIFER ROCKMAN

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

1282A718Q0006

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 25 885287OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

COLLBRAN CO 81624

57608 HIGHWAY 330

COLLBRAN JOB CORPS

USDA FOREST SERVICE

15. DELIVER TO

LAKEWOOD CO 80401

1617 COLE BLVD

USDA FOREST SERVICE

9. ISSUED BY

2. CONTRACT NO.

EFFECTIVE DATE

$7.50

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

JOB CORPS AQM

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Collbran Job Corps Center, in Collbran, CO has a requirement for OFF-SITE Dental Services for a six-month base period, four (4) one-year option years, and a six-month option period five to be exercised at the sole discretion of the Government. Wage Determination WD 15-5423 (Rev.-3) applies to this acquisition and is incorporated as Attachment 1. A single, firm-fixed price award is anticipated as a result of this Request for Quote. The Contractor shall be required to provide services as detailed in

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

MARK E. MENG

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

this solicitation.

***Any questions should be submitted IN WRITING, via email, to jrockman@fs.fed.us.

Period of Performance: 01/15/2018 to 07/31/2018

001 Dentist Services 150 HR

Base Period

Anticipated Award Type: Firm-fixed-price

Product/Service Code: Q503

Product/Service Description: MEDICAL- DENTISTRY

002 Dental Hygienist Services 150 HR

Base Period

Anticipated Award Type: Firm-fixed-price

Product/Service Code: Q503

Product/Service Description: MEDICAL- DENTISTRY

003 Dental Assistant Services 200 HR

Base Period

Anticipated Award Type: Firm-fixed-price

Product/Service Code: Q503

Product/Service Description: MEDICAL- DENTISTRY

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

25 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 25

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

1282A718Q0006

101 Dentist Services 300 HR

Option Year One

Anticipated Award Type: Firm-fixed-price

(Option Line Item)

Period of Performance: 08/01/2018 to 07/31/2019

102 Dental Hygienist Services 300 HR

Option Year One

Anticipated Award Type: Firm-fixed-price

(Option Line Item)

Period of Performance: 08/01/2018 to 07/31/2019

103 Dental Assistant Services 400 HR

Option Year One

Anticipated Award Type: Firm-fixed-price

(Option Line Item)

Period of Performance: 08/01/2018 to 07/31/2019

201 Dentist Services 300 HR

Option Year Two

Anticipated Award Type: Firm-fixed-price

(Option Line Item)

Period of Performance: 08/01/2019 to 07/31/2020

202 Dental Hygienist Services 300 HR

Option Year Two

Anticipated Award Type: Firm-fixed-price

(Option Line Item)

Period of Performance: 08/01/2019 to 07/31/2020

203 Dental Assistant Services 400 HR

Option Year Two

Anticipated Award Type: Firm-fixed-price

(Option Line Item)

Period of Performance: 08/01/2019 to 07/31/2020

301 Dentist Services 300 HR

Option Year Three

Anticipated Award Type: Firm-fixed-price

(Option Line Item)

Period of Performance: 08/01/2020 to 07/31/2021

302 Dental Hygienist Services 300 HR

Option Year Three

Continued ...

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