75H71020P01294Casale Technology GroupLLC.pdf

ORDER FOR SUPPLIES OR SERVICES

3. ORDER NO. 4. REQUISITION/REFERENCE NO.

PAGE OF PAGES

5. ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS

IMPORTANT: Mark all packages and papers with contract and/or order numbers. 1

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

a. NAME OF CONSIGNEE

c. CITY d. STATE e. ZIP CODE

7. TO:

a. NAME OF CONTRACTOR

f. SHIP VIA

8. TYPE OF ORDER

b. COMPANY NAME

c. STREET ADDRESS

d. CITY e. STATE f. ZIP CODE

9. ACCOUNTING AND APPROPRIATION DATA

a. PURCHASE b. DELIVERY

REFERENCE YOUR:

Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.

Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of this form and is issued subject to the terms and conditions of the above-numbered contract.

10. REQUISITIONING OFFICE

11. BUSINESS CLASSIFICATION (Check appropriate box(es))

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

13. PLACE OF

a. INSPECTION b. ACCEPTANCE

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

ON OR BEFORE (Date)

16. DISCOUNT TERMS

17. SCHEDULE (See reverse for Rejections)

05/11/2020

75H71020P01294 See Schedule

Northern Navajo Medical CTR

US Hwy 491 North

Shiprock NM 87420

ANGELITA J CASALE

ANGELITA YVETTE CASALE 1542332

CASALE TECHNOLOGY GROUP LLC

2021 E WESTCHESTER DR

CHANDLER AZ 85249-4683

See Schedule

12. F.O.B. POINT

09/30/2020

Northern Navajo Medical Center

PO Box 160 Shiprock NM 87420

Shiprock NM 87420

Quote No.: IHS1402871/IHS1402878-CTG

BEGAY BEULAH (IHS)

ITEM NO.

(a)

SUPPLIES OR SERVICES

(b)

QUANTITY

ORDERED

(c)

UNIT

(d)

UNIT

PRICE

(e)

AMOUNT

(f)

QUANTITY

ACCEPTED

(g)

XX X

X

Destination Destination IHS NET 15P

f. SERVICE-DISABLED

VETERAN-OWNED

e. HUBZone

g. WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOSB PROGRAM

h. EDWOSB

**This is a Small Entity**

Equipment to be delivered to MIS Department located at Northern Navajo Medical Center, Shiprock, New Mexico.

Continued ...

19. GROSS SHIPPING WEIGHT18. SHIPPING POINT 20. INVOICE NO.

21. MAIL INVOICE TO:

a. NAME

b. STREET ADDRESS

(or P.O. Box)

c. CITY d. STATE e. ZIP CODE

SEE BILLING

INSTRUCTIONS

ON REVERSE

17(h)

TOTAL

(Cont.

pages)

17(i)

GRAND

TOTAL

$137,641.00

22. UNITED STATES OF

AMERICA BY (Signature)

23. NAME (Typed)

TITLE: CONTRACTING/ORDERING OFFICER

MARGARET J. SHIRLEY-DAMON

$137,641.00

OPTIONAL FORM 347 (Rev. 2/2012)

Prescribed by GSA/FAR 48 CFR 53.213(f)

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION NOT USABLE

05/12/2020

Northern Navajo Medical CTR

PO Box 3790

Shiprock NM 87420-0160

Shiprock NM 87420-0160

If desired, this order (or a copy thereof) may be used by the Contractor as the Contractor's invoice, instead of a separate invoice, provided the following statement, (signed and dated) is on (or attached to) the order: "Payment is requested in the amount of $ ___________. No other invoice will be submitted." However, if the Contractor wishes to submit an invoice, the following information must be provided:

contract number (if any), order number, item number(s), description of supplies or service, sizes, quantities, unit prices, and extended totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs exceed $10 (except for parcel post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an ordering activity during the same billing period, consolidated periodic billings are encouraged.

RECEIVING REPORT

Quantity in the "Quantity Accepted" column on the face of this order has been: inspected, accepted, received by me and conforms to contract. Items listed below have been rejected for the reasons indicated.

SHIPMENT

NUMBER

PARTIAL

FINAL

DATE RECEIVED SIGNATURE OF AUTHORIZED U.S. GOV'T REP. DATE

REPORT OF REJECTIONS

TOTAL CONTAINERS GROSS WEIGHT RECEIVED AT TITLE

ITEM NO. SUPPLIES OR SERVICES UNIT QUANTITY

REJECTED

REASON FOR REJECTION

SUPPLEMENTAL INVOICING INFORMATION

OPTIONAL FORM 347 (Rev. 2/2012) (BACK)

PAGE 2 OF 8 CONTRACT NO. (if any)

DATE OF ORDER

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

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

ORDER NO.

QUANTITY

ACCEPTED

05/11/2020 75H71020P01294

PAGE NO

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

Vendor's POC: Angel Casale, (480)

758-1602, angel@casaletech.com

Government's POC: Tina Nelson, (505)

368-6195, tina.nelson@ihs.gov

Contract Specialist: Felecia Chavez, (505)

368-6086, Felecia.chavez@ihs.gov

Admin Office:

Northern Navajo Medical CTR

US Hwy 491 North

Shiprock NM 87420

1 Fee Schedule: 115,188.00

K0Q22A#BGJ: HP LaserJet M609x - Printer -

Monochrome - Laser Duplex, Laser, A4/Legal, 1200 x 1200 dpi, up to 75 ppm

57 @ $1,600.00 ea./qty = $91,200.00

B5L47A#BGJ: HP Color LaserJet ENT MFP M577F

Printer, Color, Laser, Legal (8.5in x

14in),(Original)A4/Legal(Media) up to 40 ppm (copying), Up to 40 ppm(Printing), 650 sheets

12 @ $1,405.00 ea./qty = $16,860.00

U8TH7E: HP 3y 9x5 NBD w/ DMR CLJ M57x MFP

On-Site Service

12 @ $594.00 ea./qty = $7,128.00

Total: $115,188.00

PRIORITY CODE: 20-3007-4YLC

Requisition No: IHS1402871

Accounting Info:

2020.J54F289.31033 Appr. Yr.: 2020

CAN: J54F289 Object Class: 31033

Funded: $115,188.00

2 Fee Schedule: 11,799.00

Continued ...

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION

PREVIOUS EDITION NOT USABLE

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $126,987.00

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

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

ORDER NO.

QUANTITY

ACCEPTED

05/11/2020 75H71020P01294

PAGE NO

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

U9MZ0E: HP 3y 9x5 NBD a/ DMR LJ Ent M609

M612 On-Site Service

57 @ $207.00 ea./qty = $11,799.00

Requisition No: IHS1402871

Accounting Info:

2020.J54F289.25723 Appr. Yr.: 2020

CAN: J54F289 Object Class: 25723

Funded: $11,799.00

3 Fee Schedule: 8,575.00

J8A04A#BGJ: HP Color LaserJet Enterprise

M653dn - Printer - Color - Laser Duplex, Laser, A4/Legal, 1200 x 1200 dpi, up to 60 ppm

7 @ $1,225.00 ea./qty = $8,575.00

PRIORITY CODE: 20-3009-4YLC

Requisition No: IHS1402878

Accounting Info:

2020.J54F280.31033 Appr. Yr.: 2020

CAN: J54F280 Object Class: 31033

Funded: $8,575.00

4 Fee Schedule: 2,079.00

U9NZ6E: HP 3y 9x5 NBD w/ DMR CLJ Ent M65x

On-Site Service

7 @ 297.00 ea./qty = $2,079.00

Requisition No: IHS1402878

Accounting Info:

2020.J54F280.25723 Appr. Yr.: 2020

CAN: J54F280 Object Class: 25723

Funded: $2,079.00

INDIAN HEALTH SERVICE

INVOICE SUBMISSION INSTRUCTIONS

The Contractor shall submit invoice(s) in

Continued ...

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $10,654.00

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

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

ORDER NO.

QUANTITY

ACCEPTED

05/11/2020 75H71020P01294

PAGE NO

(a) (b) (c) (d) (e) (f) (g) accordance with FAR subpart 52.212-4(g) with the following addendum:

1. Email to: Shawn Morgan, Finance Manager, shawn.morgan@ihs.gov

2. Email to: Felecia Chavez, Contract Specialist, Felecia.chavez@ihs.gov

* No other non-invoice related documents

(i.e. deliverables, reports, balance statements) shall be sent to the CS, COR or

Finance Office. Failure to submit directly to the offices listed above will delay prompt payment of your invoice.

Additionally, the Contractor is required to include its Data Universal Numbering System

(DUNS) number on each invoice. For additional information about the Dun &

Bradstreet (D&B) DUNS number, please visit http://fedgov.dnb.com/webform.

Invoices shall be submitted in accordance with the contract terms, i.e. payment schedule, progress payments, partial payments, deliverables, etc.

All information set forth in FAR Clause

52.212-4(g), Invoice, must be included in all invoices for it to constitute a proper invoice.

FAR 52.212-4(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include:

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, contract line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

Continued ...

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $0.00

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

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

ORDER NO.

QUANTITY

ACCEPTED

05/11/2020 75H71020P01294

PAGE NO

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

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi)Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN).

The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the

Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by

Electronic Funds Transfer/Central

Contractor Registration, or 52.232-34, Payment by Electronic Funds Transfer/Other

Than Central Contractor Registration), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C.

3903) and Office of Management and Budget

(OMB) prompt payment regulations at 5 CFR

Part 1315.

In accordance with OMB Memorandum, M-11-32, Agencies shall make payments to small

Continued ...

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

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

ORDER NO.

QUANTITY

ACCEPTED

05/11/2020 75H71020P01294

PAGE NO

(a) (b) (c) (d) (e) (f) (g) businesses as soon as practicable, with the goal of making payments within 15 days of receipt of a proper invoice. If a small business contractor is not paid within this

(15 day) accelerated period, the contractor will not be given a late-payment interest penalty. Interest penalties, as prescribed by the Prompt Payment Act, remain unchanged by means of this memorandum. All small businesses shall label all invoices as

"Small Business."

Additionally, in accordance with OMB

Memorandum, M-12-16, all prime contractors are encouraged to disburse funds received from the Federal Government to their small business subcontractors in a prompt manner.

To assist prime contractors in expediting contractor payments to small business subcontractors, Agencies shall, to the full extent permitted by law, temporarily establish an earlier, accelerated date for making agency payments to all prime contractors. Consistent with OMB Memorandum

M-11-32 above, Agencies shall have a goal of paying all prime contractors within 15 days of receiving proper documentation. In an effort to support small business growth, drive economic activity and job creation, the Contractor is encouraged to accelerate payments to their small business subcontractors.

In accordance with the requirements of the

Debt Collection Improvement Act of 1996, all payments under this order will be made by electronic funds transfer (EFT). The

Contractor shall provide financial institution information to the Finance

Office designated above in accordance with

FAR 52.232-33 Payment by Electronic Funds

Transfer - Central Contractor Registration.

C3. Any questions related to payment must be directed to the Finance Department at

(505) 368-6080.

Continued ...

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

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

ORDER NO.

QUANTITY

ACCEPTED

05/11/2020 75H71020P01294

PAGE NO

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

52.252-2 CLAUSES INCORPORATED BY REFERENCE

(Feb 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text upon request the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at the address:

http://www.arnet.gov/far/

FAR 52.212-4 Contract Terms and

Conditions--Commercial Items (OCT 2018)

52.204-7 System for Award Management (OCT

2018)

52.223-1 Biobased Product Certification

(MAY 2012)

52-229-3 Federal, State and Local Taxes

(FEB 2013)

52.232-33 Payment by Electronic Funds

Transfer-System for Award Management (OCT

2018)

52.232-40 Providing Accelerated payments to Small Business Subcontractor (DEC 2013)

52.249-1 Termination for Convenience of the Government (Fixed-Price) (Short Form)

(APR 1984)

52-249-8 Default (Fixed-Price Supply and

Service) (APR 1984)

The total amount of award: $137,641.00. The obligation for this award is shown in box

17(i).

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION