17-242-SOL-00084,_ZSU_Low_Level_Laser_Therapy_System.pdf

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

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225 Albuquerque Indian Health Service

CODE 16. ADMINISTERED BYCODE

X

X

X

334510

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR203

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

09/06/2017 1200 MD

08/30/2017

505-256-6752ERIC WRIGHT

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

17-242-SOL-00084

5. SOLICITATION NUMBER

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

1 4 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

1,250

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)

Albuquerque Indian Health Service

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.

The contractor shall provide a BRAND NAME OR EQUAL TO FX 635 Low Level Laser Therapy System and FFS-EC Lunula Laser Low Level Therapy System to the following Albuquerque Area Indian Health Service Facility:

Zuni Service Unit Attn: Ambulatory Care Department Route 301 North B Street Zuni, New Mexico 87327

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

ERIC K. WRIGHT

. 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

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.

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.

Acquisition will be for a one time purchase.

1 FX 635, FX 635 Low Level Laser Therapy System, Qty of 1.

2 FFS-EC Lunula Laser Low Level Therapy System, Qty of 1.

The contractor shall be in accordance with all

Federal, State, Local, Tribal and IHS regulations and shall be made with minimal divergence from the schedule established and with minimum disturbance and maximum protection of government personnel, property and general public.

Offers will be accepted for a Brand Name or Equal

To item listed below with the following specifications:

1. Item# FX 635 Low Level Laser Therapy System

Qty: 1

Specifications:

- Configuration: (3) Class 2 17.25mW Line

Generating Diodes

- Wavelength: 635nm

- Modulation: Variable

- Weight: 65lbs (29.48 kg)

- Height: 70in (177.8 cm) (Average - Adjustable)

- Two Independent Adjustable Arms For Desired

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

4 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 4

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

17-242-SOL-00084

Laser Concentration

- 4 Locking Anti-Static Casters

- Display: Full Color Touch Screen Control

- Power Source: 100-240VAC 50-60Hz

- Chassis: Powder Coated Aircraft Aluminum

- Housing & Covers: Non-Allergenic Material, Spray Finished

- Accessories: 2-Keys, Power Cord, Laser Safety

Glasses

- Compliant to: ISO 13485 Medical Device Quality, IEC 60825-1 Laser Safety, IEC 60601-1-2 EMC, IEC

60601-1 Safety, CE Mark, CB Certified

- FDA Laser Class 2 / FDA Device Class ll / EU

Device Class IIa, Laser Class II

2. Item# FFS-EC Lunula Laser Low Level Therapy

System

Qty: 1

Specifications:

- Configuration: (2) line generated class 2 laser diode modules

- Wavelength: 635nm & 405nm

- Modulation: Constant Wave (CW)

- Display: Full Color TFT Touch Screen Control

Center

- Power Source: 100-240VAC 50-60Hz

- Chassis: Powder Coated Aircraft Aluminum

- Treatment Area: 304 Stainless Steel for

Anti-Microbial Properties

- Housing: Injection Molded Process with

Non-Allergen Material/Plastic

- Weight: 23lbs (10.43 kg)

- Accessories: 2-Keys, Power Cord & Laser Safety

Glasses

- Compliant to: IS0 13485 Medical Device

Quality; IEC 60825-1 Laser Safety; IEC 60601-1-2

EMC; IEC 60601-1 MEE Safety; CE Mark; CB Cert;

CMDCSA

- Laser Class 2: Device Class: II (USA); 2a (EU)

DELIVERY LOCATION

A BRAND NAME OR EQUAL TO FX 635 Low Level Laser

Therapy System and FFS-EC Lunula Laser Low Level

Therapy System will be provided to the following

Albuquerque Area Indian Health Service Facility:

Zuni Service Unit

Continued ...

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

Sponsored by GSA

FAR (48 CFR) 53.110

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

4 4

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

17-242-SOL-00084

Attn: Ambulatory Care Department

Route 301 North B Street

Zuni, New Mexico 87327

SDVOSB CASCADING SET-ASIDE:

Offers will be solicited from Service Disabled

Veteran-Owned small business concerns. If we do not receive enough competition and/or reasonably priced offers from the SDVOSB set-aside, we will then evaluate quotes and consider for award to other small business concerns. Any acquisition resulting from this cascading set-aside will be from such a concern as follows: First Tier:

Service Disabled Veteran-Owned Business and

Second Tier: Hub Zone and Third Tier: all other

Small Business Concerns. Offers received from enterprises that are not one of these small business concerns will not be considered.

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

Sponsored by GSA

FAR (48 CFR) 53.110