Sol_75H71026Q00122.pdf

PDF 115 KB Posted Mar 26, 2026

Attached to: Gallup Service Unit: Non-Personal Healthcare Services – General Internist Outpatient Physician Services and Infectious Disease Physician Services
Solicitation number: 75H71026Q00122
Issued by: Department of Health and Human Services Indian Health Service

About this file

Written by GovTribe AI · Mar 26, 2026

This is a Solicitation/Contract/Order for Commercial Items (Standard Form 1449) issued by Gallup Indian Medical Center for physician services at their facility in Gallup, New Mexico 87301.

The solicitation number is 75H71026Q00122, issued on March 26, 2026, with an offer due date of April 9, 2026 at 1000 MD. The acquisition is a 100% Indian-Owned Small Business Economic Enterprise (ISBEE) set-aside under NAICS code 621111 (Offices of Physicians). The contracting officer is Jerlyn R. Begay, with Adrian Segay serving as the information contact. The contract utilizes labor-hour CLINs with estimated values, and invoices must be submitted through www.ipp.gov per the electronic payment process. Payment will be made through the Department of Treasury.

The contract comprises 12 line items for physician services spanning a base period from October 1, 2026, to September 30, 2028, with four option periods. Line items 1-4 cover General Internist Outpatient Physician Services with 2 full-time positions at 540 estimated hours each, while line items 5-8 cover Infectious Disease Physician Services with 1 full-time position at 1,040 estimated hours each. Line items 9-12 cover part-time Infectious Disease Physician Services with 1 part-time position at 156 estimated hours each. Services are to be provided in accordance with attached Performance Work Statements (Attachments A and B) to the Internal Medicine Department. All line items are designated as labor-hour CLINs where contractor estimates exceed at the contractor's own risk.

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Other files

File	Type	Posted
ATTACHMENT B - Performance Work Statement_Infectious Disease.pdf	PDF	Mar 26, 2026
ATTACHMENT D - IHS IEE Representation Form_Jan 2022_508 Compliant.pdf	PDF	Mar 26, 2026
ATTACHMENT A - Performance Work Statement General Internist.pdf	PDF	Mar 26, 2026
ATTACHMENT C - IHSBusinessAssociateAgreement.pdf	PDF	Mar 26, 2026
Combined Synopsis-Solicitation 75H71026Q00122.pdf	PDF	Mar 26, 2026

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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

51CODE 16. ADMINISTERED BYCODE

621111

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR51

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

04/09/2026 1000 MD

03/26/2026

505-339-9474ADRIAN SEGAY

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H71026Q00122

5. SOLICITATION NUMBER

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

1 6 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Gallup NM 87301

1808 W. Aztec Avenue

Acquisition Department

9. ISSUED BY

2. CONTRACT NO.

EFFECTIVE DATE

$16

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)

Gallup Indian Medical Center WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

Gallup NM 87301

516 E. Nizhoni Blvd.

Gallup Indian Medical Center

Gallup NM 87301

1808 W. Aztec Avenue

Acquisition Department

Gallup Indian Medical Center

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

This is a 100% Indian-Owned Small Business Economic Enterprise (ISBEE) set-aside

This contract is subject to the electronic payment process by the Department of Treasury.

All invoices complying to the requirements at 52.212-4(g) must be submitted through www.ipp.gov. For additional information, refer to the incorporated clause at 352.232-71 Electronic Submission of Payment Requests (FEB 2022).

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

JERLYN R. BEGAY

. 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.

Period of Performance: 10/01/2026 to 09/30/2028

1 Base Period:

Contractor shall provide General Internist

Outpatient Physician Services IAW Attachment A -

Performance Work Statement to the Internal

Medicine Department at Gallup Indian Medical

Center in Gallup, New Mexico 87301.

Qty: 2 Full-Time

Hours: 540 each (Estimated)

This is a Labor-Hour CLIN. Values are estimated that the Contractor exceeds at its own risk.

Period of Performance: 10/01/2026 to 03/31/2027

2 Option Period One:

Contractor shall provide General Internist

Outpatient Physician Services IAW Attachment A -

Performance Work Statement to the Internal

Medicine Department at Gallup Indian Medical

Center in Gallup, New Mexico 87301.

Qty: 2 Full-Time

Hours: 540 each (Estimated)

This is a Labor-Hour CLIN. Values are estimated that the Contractor exceeds at its own risk.

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

6 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 6

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H71026Q00122

(Option Line Item)

04/01/2027

Period of Performance: 04/01/2027 to 09/30/2027

3 Option Period Two:

Contractor shall provide General Internist

Outpatient Physician Services IAW Attachment A -

Performance Work Statement to the Internal

Medicine Department at Gallup Indian Medical

Center in Gallup, New Mexico 87301.

Qty: 2 Full-Time

Hours: 540 each (Estimated)

This is a Labor-Hour CLIN. Values are estimated that the Contractor exceeds at its own risk.

(Option Line Item)

10/01/2027

Period of Performance: 10/01/2027 to 03/31/2028

4 Option Period Three:

Contractor shall provide General Internist

Outpatient Physician Services IAW Attachment A -

Performance Work Statement to the Internal

Medicine Department at Gallup Indian Medical

Center in Gallup, New Mexico 87301.

Qty: 2 Full-Time

Hours: 540 each (Estimated)

This is a Labor-Hour CLIN. Values are estimated that the Contractor exceeds at its own risk.

(Option Line Item)

04/01/2028

Period of Performance: 04/01/2028 to 09/30/2028

5 Base Period:

Contractor shall provide Infectious Disease

Physician Services IAW Attachment B - Performance

Work Statement to the Internal Medicine

Department at Gallup Indian Medical Center in

Gallup, New Mexico 87301.

Qty: 1 Full-Time

Continued ...

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