26Q00202_SF1449.pdf

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

167IHSPINERIDGE CODE 16. ADMINISTERED BYCODE

X

X

X

561320

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR167

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

08/18/2026 1200 MT

08/04/2026

PATRICIA THOMPSON

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70626Q00202

5. SOLICITATION NUMBER

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

1 53 IHS1521215OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Pine Ridge SD 57770

Pine Ridge PHS Indian Hospital

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$34

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 SCHEDULEX

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)

Pine Ridge Service Unit WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

PINE RIDGE SD 57770

E. Hwy 18

607 Indian Health Road

PINE RIDGE

Pine Ridge SD 57770

Pine Ridge PHS Indian Hospital

Pine Ridge Service Unit

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

This RFQ is issued as 100% Buy Indian Set-aside.

To establish a multiple option contract with a period of performance commencing upon award. The contract will consist of a base ordering period of twenty-four weeks with 7 option periods consisting of twenty-four weeks each. To provide Up to two (2) Full-Time-Equivalent (FTE) Surgical Nurse services to the Great Plains Area IHS, Pine Ridge Service Unit (PRSU) Hospital located at 607 Indian Health Road, Pine Ridge, South Dakota

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

HEREIN, IS ACCEPTED AS TO ITEMS:

X

DATED

NICHOLE R. LEREW

. 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

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.

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.

57770.

The "Unit Price" is an all-inclusive cost. All

"inclusive cost" is defined as including travel, lodging, per diem, fringe benefits, i.e., life insurance, social security, federal, state, and local taxes, plus all other costs pertinent to the performance of this contract.

1 Base Period: 24 weeks from date of award

Surgical Nurse Services - up to two full-time

Registered Nurses

REGULAR Hours (80 hours per week)

1,920 hours @ $_______________ per hour =

Delivery: 04/03/2027

2 Base Period: 24 weeks from date of award

Surgical Nurse Services - up to two full-time

Registered Nurses

On Call Hours (Rotational)

2,592 hours @ $_______________ per hour =

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

53 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 53

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00202

Delivery: 04/03/2027

3 Base Period: 24 weeks from date of award

Surgical Nurse Services - up to two full-time

Registered Nurses

CALL BACK Hours

384 hours @ $_______________ per hour =

Delivery: 04/03/2027

4 Option Period 1: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

REGULAR Hours (80 hours per week)

1,920 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 09/18/2027

5 Option Period 1: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

ON CALL Hours (Rotational)

2,592 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 09/18/2027

6 Option Period 1: 24 weeks

Continued ...

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

Sponsored by GSA

FAR (48 CFR) 53.110

4 53

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00202

Surgical Nurse Services - up to two full-time

Registered Nurses

CALL BACK Hours

384 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 09/18/2027

7 Option Period 2: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

REGULAR Hours (80 hours per week)

1,920 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 03/04/2028

8 Option Period 2: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

ON CALL Hours (Rotational)

2,592 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 03/04/2028

9 Option Period 2: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

CALL BACK Hours

384 hours @ $_______________ per hour =

Continued ...

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

5 53

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00202

(Option Line Item)

Delivery: 03/04/2028

10 Option Period 3: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

REGULAR Hours (80 hours per week)

1,920 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 08/19/2028

11 Option Period 3: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

ON CALL Hours (Rotational)

2,592 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 08/19/2028

12 Option Period 3: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

CALL BACK Hours

384 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 08/19/2028

Continued ...

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00202

13 Option Period 4: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

REGULAR Hours (80 hours per week)

1,920 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 02/03/2029

14 Option Period 4: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

ON CALL Hours (Rotational)

2,592 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 02/03/2029

15 Option Period 4: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

CALL BACK Hours

384 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 02/03/2029

16 Option Period 5: 24 weeks

Surgical Nurse Services - up to two full-time

Continued ...

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

7 53

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00202

Registered Nurses

REGULAR Hours (80 hours per week)

1,920 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 07/21/2029

17 Option Period 5: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

ON CALL Hours (Rotational)

2,592 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 07/21/2029

18 Option Period 5: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

CALL BACK Hours

384 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 07/21/2029

19 Option Period 6: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

REGULAR Hours (80 hours per week)

1,920 hours @ $_______________ per hour =

Continued ...

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

8 53

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00202

(Option Line Item)

Delivery: 01/05/2030

20 Option Period 6: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

ON CALL Hours (Rotational)

2,592 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 01/05/2030

21 Option Period 6: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

CALL BACK Hours

384 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 01/05/2030

22 Option Period 7: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

REGULAR Hours (80 hours per week)

1,920 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 06/22/2030

Continued ...

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

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00202

23 Option Period 7: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

ON CALL Hours (Rotational)

2,592 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 06/22/2030

24 Option Period 7: 24 weeks

Surgical Nurse Services - up to two full-time

Registered Nurses

CALL BACK Hours

384 hours @ $_______________ per hour =

(Option Line Item)

Delivery: 06/22/2030

Invoice Processing Platform (IPP)

The Indian Health Service (IHS) is in the process of implementing an electronic invoicing system.

In compliance with the Office of Management and

Budget (OMB) M-15-19 memorandum, Improving

Government Efficiency and Saving Taxpayer Dollars

Through Electronic Invoicing, directing Federal agencies to adopt electronic invoicing as the primary means to disburse payment to vendors.

Invoices submitted under any award resulting from this solicitation will be required to utilize the

Invoice Processing Platform (IPP) in accordance with HHSAR 352.232-71, Electronic Submission and

Processing of Payment Requests.

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the

Treasury's Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St.

Continued ...

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00202

Louis (FRSTL). Respondents to this solicitation are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register- however, we encourage you to make sure your organization and designated IPP user accounts are valid and up to date.

The IPP website address is: https://www.ipp.gov

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at (866) 973-3131 (M-F 8AM to 6PM ET), or

IPPCustomerSupport@fiscal.treasury.gov

Should the contractor feel that use of the IPP would be unduly burdensome, their response to this solicitation should include an explanation of this position for a determination by the contracting officer.

The Government reserves the right to accept or reject supplies or services not conforming in all respects to contract requirements.

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