SF_1449_for_Meso_RFP.doc

DOC document 80 KB Posted Jun 20, 2019

Attached to: Develop Information Collection Tools for Feasibility Study of Mesothelioma Patient Registry
Solicitation number: 75D301-19Q-70489
Issued by: Department of Health and Human Services Centers for Disease Control and Prevention Pittsburgh

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Standard Form 1449 for Responses to 75D301-19Q-70489

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Other files

File	Type	Posted
amendment_00001_75D301-19Q_-70489.pdf	PDF	Jul 1, 2019
Contract_Clauses_and_Solicitation_Provisions.pdf	PDF	Jun 20, 2019
Proposal_instructions_-_70489_-_Meso_Registry.pdf	PDF	Jun 20, 2019
SOW_for_RFP.pdf	PDF	Jun 20, 2019

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PAGE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

2. CONTRACT NO.

3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER

5. SOLICITATION NUMBER

75D301-19Q-70489

6. SOLICITATION

ISSUE DATE

6/20/2019

7. FOR SOLICITATION INFORMATION CALL:

a. NAME

Florence P. Black

b. TELEPHONE NUMBER (No collect calls)

(412) 386-6455

8. OFFER DUE DATE/

LOCAL TIME

07/16/2019

9. ISSUED BY

CODE

436

10. THIS ACQUISITION IS

12. DISCOUNT TERMS

FORMTEXT

Centers for Disease Control and Prevention (CDC)

Office of Acquisition Services (OAS)

626 Cochrans Mill Rd

Pittsburgh, PA 15236-0070

X UNRESTRICTED

SET ASIDE: FOR

SMALL BUSINESS

NAICS: 541990

SIZE STANDARD: $15,000,000

X SEE SCHEDULE

13a. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

X RFQ

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

436

Centers for Disease Control and Prevention (CDC)

Office of Acquisition Services (OAS)

626 Cochrans Mill Rd

Pittsburgh, PA 15236-0070

CODE

18a. PAYMENT WILL BE MADE BY

CODE

434

Centers for Disease Control and Prevention (FMO)

PO Box 15580 404-718-8100

Atlanta, GA 30333-0080

TELEPHONE NO.

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

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

“See Continuation Page”

(Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

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

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

X ARE

28.

CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

29.

AWARD OF CONTRACT: REFERENCE

DATED

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)

Stephanie D Cruz 31c. DATE SIGNED

32a. QUANTITY IN COLUMN 21 HAS BEEN

33. SHIP NUMBER

34. VOUCHER NUMBER

FORMTEXT

RECEIVED

36. PAYMENT

37. CHECK NUMBER

32b. SIGNATURE OF AUTHORIZED GOV’T REPRESENTATIVE 32c. DATE

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

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

38. S/R ACCOUNT NUMBER

39. S/R VOUCHER NUMBER

42a. RECEIVED BY (Print) 42b. RECEIVED AT (Location)

42c. DATE REC’D 42d. TOTAL CONTAINERS

40. PAID BY

AUTHORIZED FOR LOCAL REPRODUCTION

STANDARD FORM 1449 (10-95)

75D301-19Q-70489 Page 2 of 2 There are four attachments to this announcement:

1. Statement of Work

2. Clauses/Provisions applicable to this synopsis/solicitation

3. Proposal Instructions

4. Standard Form 1449 – Blocks 17a and Blocks 30a, 30b, and 30c are to be completed by offeror.

11. DELIVERY FOR FOB

DESTINATION UNLESS

BLOCK IS MARKED

FACILITY CODE

17a. CONTRACTOR/ OFFEROR

IS CHECKED

35. AMOUNT VERIFIED

CORRECT FOR

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED

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