75H70626Q00177 RFQ.pdf

PDF 210 KB Posted Jul 22, 2026

Attached to: Firm-Fixed Price, Commercial Item, Purchase Order to provide various meters for the Facility Maintenance Department at Rosebud IHS, Rosebud, South Dakota.
Solicitation number: RFQ-75H70626Q00177
Issued by: Department of Health and Human Services Indian Health Service

About this file

Written by GovTribe AI · Jul 22, 2026

This is a Solicitation/Contract/Order for Commercial Items (Standard Form 1449) issued by the Rosebud Service Unit of the Public Health Service Indian Hospital in Rosebud, South Dakota.

The solicitation is a 100% Small Business Set Aside, Firm Fixed-Price purchase order for various maintenance tools required by Rosebud IHS Hospital. The solicitation number is 75H70626Q00177, with a requisition number of IHS1525690, issued on July 22, 2026, with an offer due date of August 12, 2026 at 12:00 PM Central Time. The period of performance is September 1, 2026 through October 31, 2026, with delivery required by October 31, 2026. The NAICS code is 334515 with a size standard of 750 employees. Jody Keplin (701-477-8416) is the information contact. Payment will be made to Belcourt PHS Indian Hospital in Belcourt, North Dakota, and delivery is to Rosebud PHS Indian Hospital in Rosebud, South Dakota with FOB Destination terms. The contract incorporates FAR clauses 52.212-1, 52.212-3, 52.212-4, and 52.212-5, with discount terms of Net 15-60 Days ARO (After Receipt of Order).

The required items are: (1) 10 each Fluke 117/323 Kit Multimeter Test Kits, (2) 10 each Fluke TL175 Twist Guard Test Leads with 2MM diameter probes, and (3) 2 each Flir TG54-2 Spot IR Thermometers with 20:1 capability. Offerors must provide unit prices and total amounts for each item and be registered in the System of Award Management (SAM) prior to award.

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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

163IHSROSEBUD CODE 16. ADMINISTERED BYCODE

334515

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR171

REQUEST FOR

PROPOSAL

(RFP)

INVITATION

FOR BID (IFB)

10. THIS ACQUISITION ISCODE

REQUEST FOR

QUOTE (RFQ)

14. METHOD OF SOLICITATION

13b. RATING

NORTH AMERICAN INDUSTRY

CLASSIFICATION STANDARD

(NAICS):

SMALL BUSINESS

07/22/2026

701-477-8416JODY KEPLIN

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIME

08/12/2026 1200 CT

b. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70626Q00177

5. SOLICITATION NUMBER

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

1 3 IHS1525690OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Rosebud SD 57570

P.O. Box 400

Rosebud PHS Indian Hospital

9. ISSUED BY

2. CONTRACT NO.

EFFECTIVE DATE

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

ISSUE DATE

DELIVERY FOR FREE ON BOARD

(FOB) DESTINATION UNLESS

BLOCK IS MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS THIS CONTRACT IS A RATED

ORDER UNDER THE DEFENSE

PRIORITIES AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

HUBZONE SMALL

BUSINESS

8(A)

Rosebud Service Unit WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

ROSEBUD SD 57570

800 HOSPITAL DR

ROSEBUD

Belcourt ND 58316

PO Box 160

1300 Hospital Road

Belcourt PHS Indian Hospital

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

100% SB Set Aside, Firm Fixed-Price, Commercial Item, Purchase Order to provide various tools for the maintenance department at Rosebud IHS Hospital, Rosebud, South Dakota. Period of Performance: 9/1/2026-10/31/2026 Delivery: 10/31/2026 Period of Performance: 09/01/2026 to 10/31/2026

1 117 325-KIT MULTIMETER TEST KIT 10 EA

Continued ...

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

WILLIAM C. KOHL

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

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 (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Government Use Only)

OFFER

STANDARD FORM 1449 (REV. 11/2021)

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

29. AWARD OF CONTRACT: REFERENCE

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. 11/2021) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

2 TLI75 TWISTGUARD TEST LEAD 2MM DIAMETER PROBE 10 EA

3 TG54-2 SPOT IR THERMOMETER 20 1 2 EA

The Quoter is hereby notified that they must be registered in the System of Award Management

(SAM) before the Federal Government will issue an award. (You may do this by going to www.sam.gov to register. You are required to update this registration every year prior to the expiration date.)

UEI (Unique Entity ID From Sam)

Federal Tax ID Number:

Email Address:

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

3 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 3

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00177

Net Terms:

15-60 Days ARO

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