18-239-sol-00067.pdf

18-239-SOL-00067

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

04/25/2018 IHS1349951

1 26

522 Minnesota Ave NW Beverly Bailey 218-444-0473 Bemidji MN 56601

Indian Health Service 06/04/2018

INDIAN HEALTH SERVICE

425 7TH STREET NW

CASS LAKE

MN 56633

218 335-3345BEVERLY BAILEY

05/04/2018 1400 CT

FOB DESTINATION

OTHER

(See Schedule)X

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

This is a request for quote conducted under Simplified Acquisition Procedures pursuant to the authority of FAR Subpart 13 and 25 USC 47 the Buy Indian Act.

This announcement constitutes the only solicitation and offers are being requested. The solicitation documents & incorporated provisions & clauses are those in effect through Federal Acquisition Circular 2005-96/11-06-2017.

There will only be one (1) contract awarded from this solicitation

Set-Aside:

This is set-aside 100% for Indian Economic Enterprise 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

2 26

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

18-239-SOL-00067

small business vendors only pursuant to

25 USC 47, the Buy Indian Act.

Contract Type:

The Indian Health Service (IHS) intends to issue a firm-fixed price purchase order resulting from this solicitation. Prospective vendor shall submit a firm-fixed price offer.

Substitutes:

The item in this solicitation may be brand name or equal.

Basis for Award:

Lowest price technically acceptable.

Tax Exempt:

IHS is a tax exempt Federal agency.

Delivery: FOB Destination

Identify delivery date ARO in the quotation.

NAICS: 339112

************ABILITYONE:

http://www.abilityone.gov/

Prospective vendors shall propose

AbilityOne products when available.

Items offered shall be clearly identified as AbilityOne.**********

Prospective vendors shall be properly registered in www.sam.gov. This includes proper registration as a small business IEE firm as well as any subcategory claimed such as (HUBZone, 8(a), Service Disabled Veteran Owned, Veteran Owned, Women-Owned, Small Disadvantaged)in order for IHS to issue an award and claim procurement actions with eligible IEE small business vendors.

RESPONSE NO LATER THAN:

05/04/2018, 2:00pm CT.

Quote must be received on or before the closing date and time.

Quote must be legible in order to be considered.

1 Item G5-3 G5 Bottler Unit with Cartridges 1 EA

(including a 3000 liter Stage 5 USEPA Microbial

Continued ...

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

3 26

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

18-239-SOL-00067

Cartridge Part BP3)

Delivery: 06/04/2018

2 Item SS-BT14 14 Gal Bladder Tank - Drinking Water

Delivery: 06/04/2018

3 Item FNP3033WE Faucet White long reach for sterisil system

Delivery: 06/04/2018

4 Item SS-RFBA Bracket Faucet remote autoclave quantity of 2

Delivery: 06/04/2018

5 Item SS-RFBD Bracket Faucet remote Dental water

Delivery: 06/04/2018

6 Item PE-08-BI-0500F-W Tubing White 1 4" quantity of 25'

Delivery: 06/04/2018

FEDERAL ACQUISITION REGULATION (FAR)

52.252-2 Clauses Incorporated by Reference.

This contract incorporates 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:

www.acquisition.gov

52.204-13: System for Award Management

Maintenance.

52.204-19: Incorporation by Reference of

Continued ...

4 26

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

18-239-SOL-00067

Representations and Certifications

52.213-4: Terms and Conditions-Simplified

Acquisitions (Other Than Commercial Items).

52.223-15 Energy Efficiency in Energy-Consuming

Products

52.232-18 Availability of Funds

52.243-1: Changes-Fixed Price

52.247-34: FOB Destination

52.216-24 Limitation of Government Liability.

(a) In performing this contract, the Contractor is not authorized to make expenditures or incur obligations exceeding the award amount in dollars.

(b) The maximum amount for which the Government shall be liable if this contract is terminated is for services or supplies received and accepted in dollars.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ACQUISITION REGULATION

(HHSAR) (48 CFR CHAPTER 3) CLAUSES:,

This contract incorporates 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.hhs.gov/policies/hhsar/subpart301-1.htm l

352.227-70 Publications and Publicity

352.231-71 Pricing of Adjustments

352.270-2 Indian Preference

352.270-3 Indian Preference Program