-20945.pdf

BPA NO.

PAGE OF PAGES

1. DATE OF ORDER 2. CONTRACT NO. (If any) 6. SHIP TO:

a. NAME OF CONSIGNEE 3. ORDER NO. MODIFICATION NO. 4. REQUISITION/REFERENCE NO.

b. STREET ADDRESS

5. ISSUING OFFICE (Address correspondence to)

c. CITY d. STATE e. ZIP CODE

7. TO: f. SHIP VIA a.NAME OF CONTRACTOR

b. COMPANY NAME

c. STREET ADDRESS

d. CITY e. STATE f. ZIP CODE

DUNS: DUNS+4:

8. TYPE OF ORDER

9. ACCOUNTING AND APPROPRIATION DATA 10. REQUISITIONING OFFICE

11. BUSINESS CLASSIFICATION (Check appropriate box(es)) 12. F.O.B. POINT

14. GOVERNMENT B/L NO. 15. DELIVER TO F.O.B. POINT 16. DISCOUNT TERMS

ON OR BEFORE (Date)

13. PLACE OF

a. INSPECTION b. ACCEPTANCE

17. SCHEDULE (See reverse for Rejections)

a. PURCHASE b. DELIVERY

REFERENCE YOUR ____________________________ Except for billing instructions on the reverse, this Please furnish the following on the terms and delivery order is subject to instructions conditions specified on both sides of this order contained on this side only of this form and is and on the attached sheet, if any, including issued subject to the terms and conditions delivery as indicated. of the above-numbered contract.

a. SMALL b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED e. HUBZone

f. SERVICE-DISABLED

VETERAN-OWNED

g. WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOSB PROGRAM

h. EDWOSB

QUANTITY UNIT QUANTITY

ITEM NO. SUPPLIES OR SERVICES ORDERED UNIT PRICE AMOUNT ACCEPTED

(a) (b) (c) (d) (e) (f) (g)

18. SHIPPING POINT 19. GROSS SHIPPING WEIGHT 20. INVOICE NO.

21. MAIL INVOICE TO:

a. NAME

b. STREET ADDRESS (or P.O. Box) PHONE:

FAX:

c. CITY d. STATE e. ZIP CODE

23. NAME (Typed)

TITLE: CONTRACTING/ORDERING OFFICER

22. UNITED STATES OF AMERICA

BY (Signature)

SEE BILLING

INSTRUCTIONS

ON

REVERSE

AUTHORIZED FOR LOCAL REPRODUCTION (REV. 2/2012) OPTIONAL FORM 347

PREVIOUS EDITION NOT USABLE PRESCRIBED BY GSA/FAR 48 CFR 53.213(f)

IMPORTANT: Mark all packages and papers with contract and/or order numbers.

17(h)

TOTAL

(Cont.

pages)

17(i).

GRAND

TOTAL

ORDER FOR SUPPLIES OR SERVICES

1 3

36C26220P1146 605-20-3-6022-0882

Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite Long Beach CA 90815

Department of Veterans Affairs

4811 Airport Plaza Drive Suite 600

Long Beach CA 90815

079401716

ACIERTO LLC

2053 NORTH 2000 WEST

FARR WEST

UT 84404

X

QUOTE 4/28/2020

See CONTINUATION Page

FMS Facilities Management Svc x

N/A

See CONTINUATION Page

Construction Services for the Department of Veterans Affairs VA Loma L inda Healthcare System (VALLHS) Location: 11201 Benton Street, Loma Linda, CA 92357

Project Title: Installations of Flushing Stations

Contracting POC: Edna Sanchez, edna.sanchez@va.gov 562-766-2265

COR: Victor Nicholson, victor.nicholson@va.gov Phone: (909) 787-5552

Estimated Completion: 120 Calendar Days ARO

**NOTE: PLEASE REFERENCE THE PO/OBLIGATION NUMBER

605C00260 ON ALL INVOICES SUBMITTED ONLINE FOR

PAYMENT

THE SOLICITATION, STATEMENT OF WORK, AMENDMENTS, AND QUOTE

ARE INCORPORATED BY REFERENCE INTO THIS ORDER.

$120,000.00

Department of Veterans Affairs Financial Services Center

SUBMIT INVOICES ONLINE AT:

HTTP://WWW.TUNGSTEN-NETWORK.COM

Harry Seballos

5/6/2020

VHALONSEBALH

Highlight

36C26220P1146

Table of Contents

A.1 OF347 ORDER FOR SUPPLIES OR SERVICES

A.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ACCOUNTING AND APPROPRIATION DATA

A.3 52.217-6 OPTION FOR INCREASED QUANTITY (MAR 1989)

36C26220P1146

CONTINUATION PAGE

A.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Installations of Flushing Station and Valves

1.00 JB $120,000.0000 $120,000.00

This is to bring VA Loma Linda Healthcare System in compliance with Directive 1061 by installing of flushing Stations in Housekeeping Aide closets to provide flushing program. VHALLHCS 11201 Benton Street, Loma Linda, CA. 92354 Loma Linda VA Hospital. Currently FMS does not have the technical knowledge or manpower to support the installation of these 32 flush stations and therefore requires a contractor to perform the installation of flush stations purchased via materials contract.

GRAND TOTAL $120,000.00

ACCOUNTING AND APPROPRIATION DATA

ACRN APPROPRIATION

REQUISITION

NUMBER AMOUNT

1 605-3600162-6022-854100 2543 0100501X3

605-20-3-6022-0882 (P) $120,000.00

A.3 52.217-6 OPTION FOR INCREASED QUANTITY (MAR 1989)

The Government may increase the quantity of supplies called for in the Schedule at the unit price specified. The Contracting Officer may exercise the option by written notice to the Contractor within . Delivery of the added items shall continue at the same rate as the like items called for under the contract, unless the parties otherwise agree.

(End of Clause)

FAR

Number

Title Date

52.211-5 MATERIAL REQUIREMENTS AUG 2000

52.242-17 GOVERNMENT DELAY OF WORK APR 1984

52.243-1 CHANGES—FIXED-PRICE AUG 2018

A.3 52.217-6 OPTION FOR INCREASED QUANTITY (MAR 1989)