19BR9323Q0001_RFQ_Washer Machines.pdf

Page 1 of 13 19BR9323Q0001

COMBINED SYNOPSIS & SOLICITATION

United States Consulate General Sao Paulo, Brazil

Supply and Delivery of Washing Machines

SOLICITATION NO. 19BR9323Q0001

US CONSULATE GENERAL SAO PAULO

Rua Henri Dunant, 700

Chacara Santo Antonio

Sao Paulo/SP

04709-110

Brazil

Tel: (55) 11 3250-5318

E-mail: goncalvesjp@state.gov

March 21, 2023

Page 2 of 13 19BR9323Q0001

Combined Synopsis and Solicitation Solicitation Number 19BR9323Q0001

The American Consulate General Sao Paulo hereby provides the following Combined

Synopsis and Solicitation for:

Supply and delivery of washing machines for the U.S. Consulate General Sao Paulo, Brazil.

All interested sellers shall review the attached pages of this solicitation and offer equipment in accordance with the specification provided in this document.

The evaluation of offers will be based on the Lowest-Priced, Technically Acceptable (LPTA) approach. It is the offeror’s responsibility to prove that the equipment it is offering meets or exceeds the requested specifications.

Synopsis:

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in FAR Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; offers are being requested and a written solicitation will not be issued. The solicitation number is 19BR9323Q0001 and is issued as a Request for Quotations (RFQ), unless otherwise indicated herein. The solicitation document and incorporated provisions and clauses are those in effect through Federal

Acquisition Circular FAC 2020-06, effective May 26, 2022.

Contract Type:

The Government intends to award a single, firm fixed-price contract to the responsible offeror whose offer is evaluated as the lowest-priced and technically acceptable. The total price shall include all labor, equipment, delivery charges, materials, overhead, profit, insurance, customs clearance, and all other expenses necessary to deliver the required supplies. No additional sums will be payable on account of any escalations in the cost of materials, equipment, or labor, or because of the Contractor’s failure to properly estimate or accurately predict the cost or difficulty of achieving the results required by this contract. Nor will the contract price be adjusted on account of fluctuations in currency exchange rates.

Term of Contract:

This ensuing contract shall be effective from the date of the Contracting Officer’s signature and shall remain valid until all items are received and accepted by the Government.

Other Specific Requirements:

All manuals shall be in the English language.

Page 3 of 13 19BR9323Q0001

Basis of Price:

The price of all items shall include their transportation f.o.b. destination to the designated delivery point in accordance with FAR 52.247-34. All quotes should remain valid for 60 days post solicitation deadline.

Delivery:

Delivery shall be made f.o.b. destination as following schedule:

• First third of purchased quantity within 90 days of contract being awarded

• Second third of purchased quantity 30 days after first delivery • Remaining third of purchased quantity 30 days after second delivery

Delivery address:

19BR9323Q0001 SAOPA

SUVI GLOBAL SVCS

11380 NW 34TH ST

DORAL, FL 33178-1828

Partial delivery:

The shipment shall be divided into thirds, with 1/3 of each appliance arriving at a time and with one month between deliveries. – See Attachment 1 Partial Delivery Schedule

Marking:

The cargo must be clearly marked with the requisition and purchase order number (to be advised on award)

Condition of Delivered Equipment:

Only new supplies are authorized, no grey market or refurbished products. All items must be in original packaging, never used, and not altered in any way.

APPLICABLE CLAUSES AND PROVISIONS

The selected Offeror must comply with the following commercial item terms and conditions, which are incorporated herein by reference: FAR 52.212-1, Instructions to Offerors -

Commercial Items applies to this acquisition; FAR 52.212-3 - Offeror Representations and

Certifications - Commercial Items – to be completed with other certifications and submitted with the offer; FAR 52.212-4, Contract Terms and Conditions - Commercial Items, 52.204-7, 52.204-13, 52.204-16, 52.204-18, 52.204-25; 52.209-9, 52.203-18, 52.232-40, 52.246-

2, 52.247-34, 52.225-17, 52.225-12, 52.229-12

DOSARS: 652.225-70; 652.225-71, 652.232-70; 652.242-73; 652.243-70; 652.247-70.

Page 4 of 13 19BR9323Q0001

FAR 52.212-5, Contract Terms and Conditions Required to Implement Statutes or Executive

Orders-Commercial Items - the applicable clauses under paragraph (b) are: 52.203-6;

52.203-13, 52.204-10; 52.209-6; 52.222-19; 52.222-21; 52.222-26; 52.222-35; 52.222-37, 52.222-50;

52.223-15, 52.223-18; 52.225-5; 52.225-13; 52.232-33.

Addendum to FAR 52.212-4 Contract Terms and Conditions – Commercial Items (Deviation

2017-02)

The whistleblower protection of 41 U.S.C 4712 has been removed from paragraph (r) of

FAR clause 52.212-4. The following revised paragraph applies:

(r) Compliance with laws unique to Government contracts. The Contractor agrees to comply with 31 U.S.C. 1352 relating to limitations on the use of appropriated funds to influence certain Federal contracts; 18 U.S.C. 431 relating to officials not to benefit; 40 U.S.C. chapter

37, Contract Work Hours and Safety Standards; 41 U.S.C. chapter 87, Kickbacks; 10 U.S.C.

2409 relating to whistleblower protections; 49 U.S.C. 40118, Fly American; and 41 U.S.C.

chapter 21 relating to procurement integrity.

(End of Clause)

The full text of the referenced FAR and DOSAR clauses may be accessed electronically at https://www.acquisition.gov/content/regulations.

The following and provision(s) are provided in full text:

Addendum to 52.212-2 Evaluation – Commercial Items (Nov 2021)

The Government will award a contract resulting from this solicitation to the responsible offeror (as determined within the meaning of FAR Part 9, paragraph 9.104), whose offer conforms to the solicitation and is determined to be the most advantageous solution to the

Government, price and other factors considered. Evaluation will be based on offeror’s submission and the provision at FAR 52.212-2, as provided in this solicitation.

The Government reserves the right to award without any discussions. The following factors shall be used to evaluate offers:

(a) The following factors shall be used to evaluate offers:

(i) Price

The price will be evaluated by the lowest aggregate sum of the items including any delivery charges, custom clearance, handling charge, Value Added Tax (if applicable) etc.

(ii) Offer equipment in accordance with the specification provided in this document

(b) A written notice of award or acceptance of an offer mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a https://www.acquisition.gov/content/regulations https://www.acquisition.gov/content/regulations

Page 5 of 13 19BR9323Q0001 binding contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of provision)

52.204-24 - Representation Regarding Certain Telecommunications and Video Surveillance

Services or Equipment (Nov 2021)

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the

Offeror has represented that it “does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument” in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Items.

(a)

Definitions. As used in this provision—

Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on

Contracting for Certain Telecommunications and Video Surveillance Services or

Equipment. (b) Prohibition.

(1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for

Fiscal

Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August

13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system.

Nothing in the prohibition shall be construed to—

(i)Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii)Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for

Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after

August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered

Page 6 of 13 19BR9323Q0001 telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract.

Nothing in the prohibition shall be construed to—

(i)Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii)Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(c) Procedures. The Offeror shall review the list of excluded parties in the

System for Award Management (SAM) (https://www.sam.gov) for entities excluded from receiving federal awards for “covered telecommunications equipment or services”.

(d) Representation. The Offeror represents that—

(1)It □ will, □ will not provide covered telecommunications equipment or services to the Government in the performance of any contract, subcontract or other contractual instrument resulting from this solicitation. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds

“will” in paragraph (d)(1) of this section; and

(2)After conducting a reasonable inquiry, for purposes of this representation, the

Offeror represents that—

It □ does, □ does not use covered telecommunications equipment or services, or use any equipment, system, or service that uses covered telecommunications equipment or services. The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds “does” in paragraph (d)(2) of this section. (e) Disclosures.

(1) Disclosure for the representation in paragraph (d)(1) of this provision. If the Offeror has responded “will” in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer:

(i)For covered equipment—

(A)The entity that produced the covered telecommunications equipment

(include entity name, unique entity identifier, CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known);

(B)A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C)Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(ii)For covered services—

(A)If the service is related to item maintenance: A description of all covered

Page 7 of 13 19BR9323Q0001 telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B)If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(2) Disclosure for the representation in paragraph (d)(2) of this provision. If the

Offeror has responded “does” in the representation in paragraph (d)(2) of this provision, the

Offeror shall provide the following information as part of the offer:

(i)For covered equipment—

(A)The entity that produced the covered telecommunications equipment

(include entity name, unique entity identifier, CAGE code, and whether the entity was the OEM or a distributor, if known);

(B)A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C)Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(ii)For covered services—

(A)If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B)If not associated with maintenance, the PSC of the service being provided;

and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph

(b)(2) of this provision.

(End of provision)

52.214-34 Submission of Offers in the English Language (Apr 1991)

Offers submitted in response to this solicitation shall be in the English language. Offers received in other than English shall be rejected.

(End of Provision)

52.225-17 Evaluation of Foreign Currency Offers (Feb 2000)

If the Government receives offers in more than one currency, the Government will evaluate offers by converting the foreign currency to United States currency using [Contracting

Officer to insert source of rate] in effect as follows:

(a) For acquisitions conducted using sealed bidding procedures, on the date of bid opening.

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(b) For acquisitions conducted using negotiation procedures-

(1) On the date specified for receipt of offers, if award is based on initial offers;

otherwise (2) On the date specified for receipt of proposal revisions.

(End of provision)

Addendum to FAR 52.212-1 Instruction to Offerors – Commercial Items (Nov 2021)

Pursuant to FAR 12.302(d), the provision at FAR 52.212-1, Instruction to Offerors –

Commercial Items (Nov 2021) is augmented as follows:

1) The period of acceptance of offers is herewith changed to sixty (60) calendar days.

2) Preparation of Offers - Offerors shall prepare and submit its offer in two (2) volumes as set forth below.

VOLUME I:

1. PRICING

The offeror shall complete the tables below.

Please note that there are multiple acceptable models. Only submit an offer for the lowest priced option you can provide.

Line

Item

Description Unit of

Issue

Quantity Unit Cost Total Cost

001 Washer Model Whirpool

WFW5620H

WFW5605MW

WFW560CH

Each 228

002 Value Added Tax

(if applicable)

Lot 1

003 Delivery Charges F.O.B Lot 1

TOTAL - FIRM FIXED PRICE

CURRENCY

(i) 52.212-3 Offeror Representations and Certifications—Commercial Items (May 2022)

Offeror Representations and Certifications - Commercial Items - the selected offeror must submit a completed copy of the listed representations and certifications. A completed copy of these provisions MUST be included on the System for Award Management (SAM) web site located at https://www.sam.gov/portal. If the Offeror has not completed the annual

Page 9 of 13 19BR9323Q0001 representations and certifications electronically, the Offeror shall complete only paragraphs

(c) through (u) of this provision.

(ii) 52.225-6 Trade Agreements Certificate (Feb 2021)

FAR clause 52.225-5 Trade Agreements applies and the offeror shall submit the following certification as part of their Volume I:

a)The offeror certifies that each end product, except those listed in paragraph (b) of this provision, is a U.S.-made or designated country end product, as defined in the clause of this solicitation entitled “Trade Agreements.”

(b)The offeror shall list as other end products those supplies that are not U.S.-made or designated country end products. Other End Products:

Line item no. Country of Origin

List as necessary

(c)The Government will evaluate offers in accordance with the policies and procedures of part 25 of the Federal Acquisition Regulation. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American statute. The Government will consider for award only offers of U.S.-made or designated country end products unless the

Contracting Officer determines that there are no offers for such products or that the offers for those products are insufficient to fulfill the requirements of this solicitation.

(End of provision)

(iii) 52.229-11 Tax on Certain Foreign Procurements-Notice and Representation (Jun 2020)

(a) Definitions. As used in this provision—

Foreign person means any person other than a United States person.

Specified Federal procurement payment means any payment made pursuant to a contract with a foreign contracting party that is for goods, manufactured or produced, or services provided in a foreign country that is not a party to an international procurement agreement with the United States. For purposes of the prior sentence, a foreign country does not include an outlying area.

United States person as defined in 26 U.S.C. 7701(a)(30) means

(1) A citizen or resident of the United States;

(2) A domestic partnership;

(3) A domestic corporation;

19BR9323Q0001

(4) Any estate (other than a foreign estate, within the meaning of 26

U.S.C. 701(a)(31)); and

(5) Any trust if–

(i) A court within the United States is able to exercise primary supervision over the administration of the trust; and

(ii) One or more United States persons have the authority to control all substantial decisions of the trust.

(b) Unless exempted, there is a 2 percent tax of the amount of a specified

Federalprocurement payment on any foreign person receiving such payment. See 26 U.S.C.

5000C and its implementing regulations at 26 CFR 1.5000C-1 through 1.5000C-7.

(c) Exemptions from withholding under this provision are described at 26 CFR

1.5000C1(d)(5) through (7). The Offeror would claim an exemption from the withholding by using the

Department of the Treasury Internal Revenue Service Form W-14, Certificate of Foreign

Contracting Party Receiving Federal Procurement Payments, available via the internet at www.irs.gov/w14. Any exemption claimed and self-certified on the IRS Form W-14 is subject to audit by the IRS. Any disputes regarding the imposition and collection of the 26 U.S.C.

5000C tax are adjudicated by the IRS as the 26 U.S.C. 5000C tax is a tax matter, not a contract issue.

The IRS Form W-14 is provided to the acquiring agency rather than to the IRS.

(d) For purposes of withholding under 26 U.S.C. 5000C, the Offeror represents that

(1) It [_] is [_] is not a foreign person; and

(2) If the Offeror indicates “is” in paragraph (d)(1) of this provision, then the

Offeror represents that—I am claiming on the IRS Form W-14 [__] a full exemption, or [__] partial or no exemption [Offeror shall select one] from the excise tax.

(e) If the Offeror represents it is a foreign person in paragraph (d)(1) of this provision, then—

(1) The clause at FAR 52.229-12, Tax on Certain Foreign Procurements, will be included in any resulting contract; and

(2) The Offeror shall submit with its offer the IRS Form W-14. If the IRS

Form W-14 is not submitted with the offer, exemptions will not be applied to any resulting contract and the Government will withhold a full 2 percent of each payment.

(f) If the Offeror selects “is” in paragraph (d)(1) and “partial or no exemption” in paragraph(d)(2) of this provision, the Offeror will be subject to withholding in accordance with the clause at FAR 52.229-12, Tax on Certain Foreign Procurements, in any resulting contract.

(g) A taxpayer may, for a fee, seek advice from the Internal Revenue Service (IRS) as to theproper tax treatment of a transaction. This is called a private letter ruling. Also, the

IRS may publish a revenue ruling, which is an official interpretation by the IRS of the

Internal Revenue Code, related statutes, tax treaties, and regulations. A revenue ruling is the conclusion of the IRS on how the law is applied to a specific set of facts. For questions relating to the interpretation of the IRS regulations go to https://www.irs.gov/help/tax-law-questions.

19BR9323Q0001

(End of provision)

VOLUME II:

1. TECHNICAL CAPABILITY

The proposed supplies shall meet all of the minimum technical specifications and the delivery terms contained herein. In addition, the offeror shall provide:

(A) A delivery confirmation providing delivery as requested in Attachment 1 within ninety (90) calendar days of award to SUVI GLOBAL.

(B) Technical Compliance Matrix confirming that your offer reflects one of the specified acceptable models.

Brand Name Only:

REQURED SPECIFICATION Model Quantity OFFERERED

SPECIFICATIONS (TO

BE COMPLETED BY

OFFERORS)

Washer

Whirlpool

WFW5620H or

WFW5605MW or

WFW560CH

Refer to attached document for specs

19BR9323Q0001_Washers_Model Specs

SUBMISSION OF OFFERS:

The complete offer submission shall include:

(1) Price Offer and Representations and Certifications – Volume I

(2) Technical Capability and Delivery Confirmation – Volume II

(3) Filled out SF-1449 form

Interested parties may submit their offers not later than 5 p.m Brazilian Time Zone (BRT) on

April 14, 2023 via email to Ms. Juliana Goncalves at goncalvesjp@state.gov and

ProcurementSP@state.gov. If you have any questions, please contact to Ms. Juliana Goncalves at goncalvesjp@state.gov as early as possible to allow ample time for a response.

The email subject line must read “Solicitation 19BR9323Q0001”. The size shall not exceed

20MB and the email shall not include any zipped files (.zip/.rar).

Late submissions shall not be considered.

Applicable laws and regulations: Solicitation and award will be subject to laws and regulations of the United States of America.

Kimberly Nau

Contracting Officer

{END OF SOLICITATION}

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

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

. REQUISITION NUMBER 1

PR11374972

PAGE 1 OF PAGES

2 . CONTRACT NO. 3 . AWARD/ EFFECTIVE

DATE

4 . ORDER NUMBER . SOLICITATION NUMBER 5

19BR9323Q0001

6 . SOLICITATION ISSUE

DATE

7 . FOR SOLICITATION

INFORMATION CALL:

a. NAME Juliana P. Goncalves

b. TELEPHONE NUMBER ( No collect calls) 8 . OFFER DUE DATE/

LOCAL TIME

. ISSUED BY 9 CODE BR930 . THIS ACQUISITION IS 10 x UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

ESS WOMEN-OWNED SMALL BUSIN

HUBZONE SMALL

BUSINESS

(WOSB) ELLIGIBLE UNDER THE WOMEN-OWNED

AM NAICS: SMALL BUSINESS PROGR

NG SMALL BUSINESS EMERGI EDWOSB

AMERICAN CONSULATE GENERAL SAO PAULO

RUA HENRI DUNANT, 700, ATTN: GSO/PROCUREMENT

SAO PAULO 04709110

BRAZIL

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS (A 8

) SIZE STANDARD:

b. RATING 13 - 11 . DELIVERY FOR FOB DESTINAT

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

. DISCOUNT TERMS 12 13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

14 . METHOD OF SOLICITATIO N

x RFQ

IFB

R FP

15 . DELIVER TO CODE 16 . ADMINISTERED BY CODE

AMERICAN CONSULATE GENERAL SAO

PAULO

RUA HENRI DUNANT, 700, ATTN:

RECEIVING UNIT

SAO PAULO 04709110

BRAZIL

AMERICAN CONSULATE GENERAL SAO PAULO

RUA HENRI DUNANT, 700, ATTN: GSO/PROCUREMENT

SAO PAULO 04709110

BRAZIL

CODE FACILITY

CODE

17 a. CONTRACTOR/

OFFERER

TELEPHONE NO.

18 a. PAYMENT WILL BE MADE BY

AMERICAN CONSULATE GENERAL SAO PAULO

RUA HENRI DUNANT, 700, ATTN: RECEIVING UNIT

SAO PAULO 04709110

BRAZIL

CODE

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

OFFER

18 b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLE SS 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 ( )

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

ARE

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

ITEM NO. 20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23. UNIT

PRICE

24.

AMOUNT

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

STANDARD FORM 1449 (REV. 2/2012) BACK