19BR8220Q0001 - SF1449 Cover Page.pdf

AUTORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (REV. 02/2012)

PREVIOUS EDITION IS NOT USABLE Computer Generated Prescribed by GSA - FAR (48 CFR) 53.212

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

PR9100488-0001

PAGE 1 OF PAGES

2. CONTRACT NO.

3. AWARD/ EFFECTIVE

DATE

4. ORDER NUMBER 5. SOLICITATION NUMBER

19BR8220Q0001

6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME Monique B Borring

b. TELEPHONE NUMBER(No collect calls)

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY CODE BR820 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS WOMEN-OWNED SMALL BUSINESS

HUBZONE SMALL

BUSINESS

(WOSB) ELLIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM NAICS:

EDWOSB EMERGING SMALL BUSINESS

AMERICAN CONSULATE GENERAL RIO DE JANEIRO

AV. PRESIDENTE WILSON, 147 - CENTRO, ATTN:

GSO/PROCUREMENT

RIO DE JANEIRO 20030020

BRAZIL

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS 8 (A) SIZE STANDARD:

13b. RATING11. DELIVERY FOR FOB DESTINAT-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

AMERICAN CONSULATE GENERAL RIO

DE JANEIRO

3090 RIO DE JANEIRO PLACE, ATTN:

GSO/PROCUREMENT

WASHINGTON DC 20521

UNITED STATES

AMERICAN CONSULATE GENERAL RIO DE JANEIRO

AV. PRESIDENTE WILSON, 147 - CENTRO, ATTN: GSO/PROCUREMENT

RIO DE JANEIRO DC 20521

BRAZIL

CODE FACILITY

CODE

17a. CONTRACTOR/

OFFERER

TELEPHONE NO.

18a. PAYMENT WILL BE MADE BY

AMERICAN CONSULATE GENERAL RIO DE JANEIRO

AV. PRESIDENTE WILSON, 147 - CENTRO, ATTN:

CONSULADO AMERICANO DO RIO DE JANEIRO

RIO DE JANEIRO 20030020

BRAZIL

CODE

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

OFFER

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

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)

25. ACCOUNTING AND APPROPRIATION DATA

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

27a.SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED

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

SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED HEREIN.

29. AWARD OF CONTRACT: REF. _ _______________ OFFER DATED

_ __________. YOUR OFFER ON SOLICITATION (BLOCK 5), INCLUDING ANY

ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN, IS ACCEPTED AS

TO ITEMS:

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)

31c. DATE SIGNED

Clin 001 100 % Design Documents - 20% of the total cost 1 ea Clin 002 100% Material Delivery - 40% of the total cost 1 ea Clin 003 50% Installation Complete - 20% of the total cost 1 ea Clin 004 100% Installation (To include punch list and 1 ea close out material) - 20% of the total cost

X X

X

ITEM NO. 20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

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

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

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

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

CORRECT FOR

36. PAYMENT 37. CHECK NUMBER

PARTIAL FINAL COMPLETE PARTIAL FINAL

38. S/R ACCOUNT NO. 39. S/R VOUCHER NO. 40. PAID BY

41.a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print) 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41C. DATE

42b. RECEIVED AT (Location)

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

STANDARD FORM 1449 (REV. 2/2012) BACK