SF-18_SOL-00081.pdf

18-239-SOL-00081

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

05/31/2018 IHS1356701

1 21

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

Indian Health Service 06/18/2018

WHITE EARTH HEALTH CENTER

Indian Health Service

40520 CO HWY 34

OGEMA

MN 56569

218 444-0537CATHY BIRD

06/18/2018 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 combined synopsis/solicitation for commercial items prepared in accordance with the format in FAR Part 13, and 25 U.S.C 47 the Buy Indian Act, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation;

quotations are being requested and a written solicitation will not be issued. FAC Number/Effective Date:2005-96/11-06-2017

NAICS: 384206

This is set aside 100% Buy Indian This is restricted to small business IEE firms in order to meet small business goals.

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 21

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

18-239-SOL-00081

Basis for Award:

Lowest Price

Brand Name or Equal items

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. Multiple awards are not anticipated.

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, Woman-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:

06/18/2018, 2:00pm CT.

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

Quote must be legible in order to be considere

FEDERAL ACQUISITION REGULATION (FAR)

This is a request for quote.

Prospective vendor shall not propose items that are on backorder. Vendor is responsible for verifying product availability prior to submitting a quote.

Period of Performance: 05/31/2018 to 06/18/2018

1 PT OT SUPPLIES

Delivery: 06/18/2018

SUBMIT WITH QUOTE:

(1) Direct contact information including e-mail.

(2) Complete pricing for items listed.

(3) Dunn & Bradstreet Number.

(4) Small Business status.

(5) IEE Certification

(6) Delivery time frame ARO.

Continued ...

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

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 21

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

18-239-SOL-00081

INVOICE INSTRUCTIONS:

Contractor shall mail all invoices to -

Indian Health Service

522 Minnesota Ave NW

Bemidji, MN 56601

ATTN: FINANCE

At a minimum, a properly prepared invoice shall include:

1) Name and address of the Contractor.

2) Invoice date and invoice number. (The

Contractor should date invoices as close as possible to the date of the mailing or transmission.)

3) IHS Contract No.

4) Description, quantity, unit of measure, unit price, and extended price of supplies delivered or services performed.

5) Shipping and payment terms (e.g., shipment number and date of shipment, discount for prompt payment terms). Bill of lading number and weight of shipment will be shown for shipments on

Government bills of lading.

6) Name and address of Contractor official to whom payment is to be sent (must be the same as that in the contract or in a proper notice of assignment).

7) Name (where practicable), title, phone number, and mailing address of person to notify in the event of a defective invoice.

8) Contractor Taxpayer Identification Number

(TIN).

9) Contractor Dun & Bradstreet Number (DUNS).

Improperly prepared invoices or statements shall be returned to the contractor and may delay payment.

PACKING SLIPS:

All vendor packing slips shall clearly identify the IHS contract number for tracking purposes.

Failure to list this number may result in payment delays.

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