1449 COVER SHEET.pdf

FOR OFFICIAL USE ONLYNESSS V 1.14

12. DISCOUNT TERMS11. DELIVERY FOR FOB

DESTINATION UNLESS

BLOCK IS MARKED

21Q49006B00

AUSTIN ADAMSON

SURFACE FORCES LOGISTICS CTR

BALTIMORE, MD 21226

2401 HAWKINS POINT ROAD

SFLC-CPD-C&P2-SAP, BLDG. 3, 2ND FLOOR

UNITED STATES COAST GUARD (SFLC)

AUSTIN ADAMSON AUSTIN.J.ADAMSON@USCG.MIL

X

25. ACCOUNTING AND APPROPRIATION DATA $

OF1PAGE

NET 30

12/11/2021

14. METHOD OF SOLICITATION

6. SOLICITATION ISSUE DATE

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

SET ASIDE: __100_____ % FOR

SIZE STANDARD:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

7. FOR SOLICITATION

INFORMATION CALL

2. CONTRACT NO. 3. AWARD/

EFFECTIVE DATE

4. ORDER NUMBER

8. NAME 8. OFFER DUE DATE/LOCAL TIME

9. ISSUED BY 10. THIS ACQUISITION IS

NAICS:

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

RFQ IFB RFP

16. ADMINISTERED BY

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

OFFER

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

26. TOTAL AWARD AMOUNT (For Gov't Use Only)

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

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

ARE ARE NOT ATTACHED

ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

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

ADDITIONAL SHEETS SUBLECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFER

.YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

29.

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)

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (REV. 3/2011)

Prescribed by GSA - FAR (48 CFR) 53.212

SOLICITATION/CONTRACT/ORDER FOR COMMERICAL ITEMS

CODE

CODE

CODE

TELEPHONE NO.

CODE FACILITY

CODE

CODE17a. CONTRACTOR/

OFFEROR

31c. DATE SIGNED

8 (A)

SEE SCHEDULE

SEE SCHEDULE

18a. PAYMENT WILL BE MADE BY

b. TELEPHONE NUMBER (No

PREVIOUS EDITION IS NOT USABLE

DATED

AWARD OF CONTRACT: REF.

SEE SCHEDULE

15. DELIVER TO

UNRESTRICTED OR

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL BUSINESS

(EDWOSB)

410-762-6696 12/28/2020 1200EST

X

336611

X

32a. QUANTITY IN COLUMN 21 HAS BEEN

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

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

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

PARTIAL FINAL

36. PAYMENT

COMPLETE PARTIAL FINAL

37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

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

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT,EXCEPTED AS NOTED:

32c. DATE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE32c. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

STANDARD FORM 1449 (REV. 1/2011) BACK

ITEM

NO

(A)

SUPPLIES OR SERVICES

(B)

QUANTITY

(C)

UNIT

(D)

UNIT

PRICE

(E)

AMOUNT

(F)

OF4PAGE

PLEASE SEE ATTACHED PACKAGE

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 25) $

OBLIGATION/CONTRACT/ORDER FOR

COMMERCIAL ITEMS - CONTINUATION

CONTRACT NO.AWARD/EFFECTIVE DATE

ITEM

NO

(A)

SUPPLIES OR SERVICES

(B)

QUANTITY

(C)

UNIT

(D)

UNIT

PRICE

(E)

AMOUNT

(F)

OF5PAGE

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 25) $

OBLIGATION/CONTRACT/ORDER FOR

COMMERCIAL ITEMS - CONTINUATION

CONTRACT NO.AWARD/EFFECTIVE DATE

DELIVER TO

DESTINATION

OF6PAGE

PLEASE SEE ATTACHED PACKAGE

PROCUREMENT REQUEST NO. :

LINE NO. QTY PDD