28321322D00060012 - SF1449.pdf

PDF 129 KB Posted Apr 7, 2022

Attached to: Acquire single unit kiosks for the field offices to facilitate Visitor Intake Process (VIPr) functions
Solicitation number: 28321322D00060012
Issued by: Social Security Administration

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LEVEL 1C= AIS LOW RISK/NON-SENSITIVE

HDQTRS

Baltimore MD 21235-0047 Post Office Box 47 Office of Finance Social Security Administration

4106903000104

3A6P3

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

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

OFFEROR

AOUEDRAOGO

410-965-4301 Alassane Ouedraogo

CODE 16. ADMINISTERED BYCODE

334118

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR283213

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

03/23/2021

410-965-4301ALASSANE OUEDRAOGO

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

28321321R00000021

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 72 3365-22-1112OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

Baltimore MD 21202 204 South High St Attn: Julie Zuramski

RELIASOURCE, INC.

17a. CONTRACTOR/

Refer to Statement of Work

15. DELIVER TO

00000 Office of Acquisition and Grants

9. ISSUED BY

28321322D00060012

2. CONTRACT NO.

EFFECTIVE DATE

1,000

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

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

Net 30 THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Social Security Administration

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

DUNS Number: 118231880

CAGE: 3A6P3

This is an Indefinite Delivery-Indefinite Quantity (IDIQ) Contract with ReliaSource Inc. to support the Social Security Administration's request for VIPr Kiosks in accordance with the contract terms and conditions and attached statement of work.

(Use Reverse and/or Attach Additional Sheets as Necessary)

$100,000.00

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

KATHLEEN COONEY 04/06/2022

All

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

28321321R00000021 1

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

31c. DATE SIGNED

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

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDEND

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

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

4003365/2022/3124/028228704/3365-22-1112/R170170D0

05/07/2021

29. AWARD OF CONTRACT:

REF.

Contractor Signature Received

04/06/2022

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

0001 Base Year - Hardware 100,000.00

Period of Performance: April 06, 2022 - April 05, 0002 Option Year 1 - Hardware, Maintenance, and Support

Period of Performance: April 06, 2023 - April 05, Amount: $485,552.00(Option Line Item)

0003 Option Year 2 - Maintenance and Support

Period of Performance: April 06, 2024 - April 05, Amount: $495,264.00(Option Line Item)

0004 Option Year 3 - Maintenance and Support

Period of Performance: April 06, 2025 - April 05, Amount: $505,168.00(Option Line Item)

0005 Option Year 4 - Maintenance and Support

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

72 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 72

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

RELIASOURCE, INC.

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

28321322D00060012

Period of Performance: April 06, 2026 - April 05, Amount: $515,280.00(Option Line Item)

0006 Option Year 5 - Maintenance and Support

Period of Performance: April 06, 2027 - April 05, Amount: $525,584.00(Option Line Item)

0007 Option Year 6 - Maintenance and Support

Period of Performance: April 06, 2028 - April 05, Amount: $536,096.00(Option Line Item)

0008 Option Year 7 - Maintenance and Support

Period of Performance: April 06, 2029 - April 05, Amount: $546,816.00(Option Line Item)

0009 Option Year 8 - Maintenance and Support

Period of Performance: April 06, 2030 - April 05, Amount: $557,760.00(Option Line Item)

0010 Option Year 9 - Maintenance and Support

Period of Performance: April 06, 2031 - April 05, Amount: $568,896.00(Option Line Item)

0011 Option to Extend Services

(May be exercised any timeframe within contract ordering period for up to 6-months of services)

Period of Performance: April 06, 2032 - October

05, 2032

Continued ...

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