75H71022P00578 - Nations Gas Technologies.pdf

IHSNAVAJO

WINDOW ROCK AZ 86515

P.O. BOX 9020

IHSNAVAJO

329186

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

Highway 160, Mile Post 394.3 PO Box 368 Acquisition Department Kayenta Health Center

25 CODE 16. ADMINISTERED BYCODE

X

X

324110

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR25

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

928-697-4027SHEILA DENNY

75H71022P00578

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION 5. SOLICITATION NUMBER

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

1 5 IHS1439203OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

Kayenta AZ 86033

TELEPHONE NO.

NAVAJO NM 873280356

NAVAJO ROUTE 12 MILL ROAD

NATIONS GAS TECHNOLOGIES, INC.

NATIONS GAS TECHNOLOGIES, INC. 329186

17a. CONTRACTOR/

Kayenta AZ 86033 HWY 160, South Milepost 394.3 Kayenta Health Center

15. DELIVER TO

Kayenta AZ 86033 Highway 160, Mile Post 394.3 PO Box 368 Acquisition Department

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

1,500

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 SCHEDULEX

12. DISCOUNT TERMS

HHS NET 15P THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

X

Kayenta Health Center

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.

The contractor shall provide the following Propane Service on an "As Needed Basis" on behalf the Kayenta Health Center Quarters Department in Kayenta, AZ. Service will be in accordance with Statement of Work.

******************NOTE TO VENDOR*****************

PLEASE REFERENCE THE PURCHASE ORDER NUMBER LISTED

IN BLOCK #4 ON ALL INVOICES AND PACKING SLIPS

ASSOCIATED WITH THIS ORDER.

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

$22,896.00

HEREIN, IS ACCEPTED AS TO ITEMS:

X

X X

DATED

ROXANNE R. FRANKLIN 01/26/2022

. 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 FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

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.

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

2022.J54E9QT.23322

29. AWARD OF CONTRACT:

REF.

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.

INVOICE SUBMISSION INSTRUCTIONS: The Contractor shall submit invoices in accordance with FAR

Clause 52.212-4(g) by regular postal mail to:

Shall submit invoices in format stated in

52.212-4(g) and email to the following individuals:

Kayenta Health Center

ATTN: Financial Management Team

P.O. Box 1276

Kayenta, AZ 86033

KSU Finance Department: Lucy.Todacheene@ihs.gov.

Acquisition Buyer, Contract Specialist:

Sheila.Denny@ihs.gov.

Delivery: 12/31/2022

Appr. Yr.: 2022 CAN: J54E9QT Object Class: 23322

Period of Performance: 01/26/2022 to 12/31/2022

1 DELIVERY OF PROPANE - KHC OLD QUARTERS SERVICES 21,600.00

ON AN "AS NEEDED BASIS"

$2.25 PER GALLON

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

5 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 5

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

NATIONS GAS TECHNOLOGIES, INC. 329186

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

75H71022P00578

2 NAVAJO NATION TAX - KHC OLD QUARTERS 1,296.00

$1,296.00

Contracting Officer (CO): Sheila Denny, Contract

Specialist, Telephone: (928) 697-4027, Sheila.Denny@ihs.gov.

Contracting Officer (CO): is the only individual to authorize modifications to the purchase order and/or terms and conditions.

Per FAR Subpart 1.602-2(d), the Contracting

Officer (CO) determines that this order does not requires a Contracting Officer Representative

(COR).

Supervisory Point of Contact (SPOC): Letina

Tsosie, KHC Supervisor Housing Specialist, Telephone: (928) 697-5018, Letina.Tsosie@ihs.gov.

**INVOICE SUBMISSION**:

The Contractor shall submit invoices once in accordance with FAR Clause 52.212-4(g) by regular postal mail to:

Kayenta Health Center

ATTN: Financial Management Team

P.O. Box 1276

Kayenta, AZ 86033

The Contractor is required to mail invoices, but in addition the Contractor may also email invoices to the following address:

Lucy.Todacheene@ihs.gov. Questions regarding payments, contact Finance at (928) 697-4386/4389.

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

Continued ...

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

Sponsored by GSA

FAR (48 CFR) 53.110

4 5

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

NATIONS GAS TECHNOLOGIES, INC. 329186

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

75H71022P00578 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.

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

Continued ...

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

5 5

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

NATIONS GAS TECHNOLOGIES, INC. 329186

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

75H71022P00578

System for Award Management.

Questions regarding Payment contact Finance at

928.697.4386.

Additional Applicable Federal Acquisition Clauses:

52.204-7 System for Award Management (Oct 2018)

52.204-9 Personnel Identity Verification of

Contractor Personnel (Jan 2011)

52.212-4 Contract Terms and Conditions-Commercial

Items (Oct 2018)

52.229-3 Federal, State, and Local Taxes (Feb

2013)

52.232-33 Payment by Electronic Funds

Transfer-Systems for Award Management (Oct 2018)

52.232-40 Providing Accelerated Payments to Small

Business Subcontractors (Dec 2013)

52.237-2 Protection of Government Buildings, Equipment, and Vegetation (APR 1984)

52.237-3 Continuity of Services (Jan 1991)

The total amount of award: $22,896.00. The obligation for this award is shown in box 26.

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