75H71026Q00306.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

51CODE 16. ADMINISTERED BYCODE

X

X

339114

SIZE STANDARD:

100.00 % 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

09/23/2026 1200 MD

09/15/2026

STEPHEN SILVERSMITH

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H71026Q00306

5. SOLICITATION NUMBER

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

1 21 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

7.

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 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

1808 W. Aztec Avenue

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 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 (APR 2026

DEVIATION).

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

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

MISTY J. BILLY

. 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.

Delivery: 30 Days After Award

1 The Contractor shall provide DEXIS IXS Digital

Radiograph Sensors in accordance with the

Statement of Work (Attachment A) for the Dental

Department of the Gallup Indian Medical Center in

Gallup, New Mexico.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

21 2 of

Rev. 04/29/2026

SECTION B – CONTINUATION OF SF-1449

THIS PAGE INTENTIONALLY LEFT BLANK

SECTION C – CONTRACT CLAUSES

52.212-4 CONTRACT TERMS AND CONDITIONS –

COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES

NOV 2025

(DEVIATION)

The following Federal Acquisition Regulation clauses also apply:

☐ 52.203-3 GRATUITIES APR 1984

☐ 52.203-6 RESTRICTIONS ON SUBCONTRACTOR SALES TO THE GOVERNMENT Alt I

NOV 2021

☐ 52.203-12 LIMITATION OF PAYMENTS TO INFLUENCE CERTAIN FEDERAL

TRANSACTIONS

JUN 2020

☐ 52.203-13 CONTRACTOR CODE OF BUSINESS ETHICS AND CONDUCT NOV 2021

☐ 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST JUN 2020

☒ 52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS NOV 2023

☒ 52.203-19 PROHIBITION ON REQUIRING CERTAIN INTERNAL CONFIDENTIALITY

AGREEMENTS OR STATEMENTS

JAN 2017

☐ 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL JAN 2011

☒ 52.204-13 SYSTEM FOR AWARD MANAGEMENT MAINTENANCE NOV 2025

(DEVIATION)

☐ 52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS NOV 2025

(DEVIATION)

☐ 52.204-15 SERVICE CONTRACT REPORTING REQUIREMENTS FOR INDEFINITE-

DELIVERY CONTRACTS

NOV 2025

(DEVIATION)

☐ 52.204-91 CONTRACTOR IDENTIFICATION NOV 2025

(DEVIATION)

☒ 52.209-6 PROTECTING THE GOVERNMENT’S INTEREST WHEN

SUBCONTRACTING WITH CONTRACTORS DEBARRED, SUSPENDED, OR

PROPOSED FOR DEBARMENT

NOV 2025

(DEVIATION)

☐ 52.209-9 UPDATES OF PUBLICLY AVAILABLE INFORMATION REGARDING

RESPONSIBILITY MATTERS

NOV 2025

(DEVIATION)

☒ 52.209-10 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC

CORPORATIONS

NOV 2025

(DEVIATION)

☐ 52.213-1 RESERVED

☐ 52.219-3 NOTICE OF HUBZONE SET-ASIDE OR SOLE-SOURCE AWARD NOV 2025

(DEVIATION)

☐ 52.219-6 NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE NOV 2025

(DEVIATION)

☐ 52.219-6 Alt I

NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE, WITH ALTERNATE I NOV 2025

(DEVIATION)

☐ 52.219-7 NOTICE OF PARTIAL SMALL BUSINESS SET-ASIDE NOV 2020

☐ 52.219-7 Alt I

NOTICE OF PARTIAL SMALL BUSINESS SET-ASIDE, WITH ALTERNATE I MAR 2020

☐ 52.219-8 UTILIZATION OF SMALL BUSINESS CONCERNS NOV 2025

(DEVIATION)

☐ 52.219-9 SMALL BUSINESS SUBCONTRACTING PLAN MAR 2026

(DEVIATION)

☐ 52.219-9 Alt I

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE I MAR 2026

(DEVIATION)

☐ 52.219-9 Alt II

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE II MAR 2026

(DEVIATION)

☐ 52.219-9 Alt III

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE III MAR 2026

(DEVIATION)

☐ 52.219-9 Alt IV

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE IV MAR 2026

(DEVIATION)

☐ 52.219-13 NOTICE OF SET-ASIDE OF ORDERS MAR 2020

☐ 52.219-13 Alt I

RESERVED

☐ 52.219-16 LIQUIDATED DAMAGES—SUBCONTRACTING PLAN NOV 2025

(DEVIATION)

☐ 52.219-27 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO, SERVICE-

DISABLED VETERAN-OWNED SMALL BUSINESS (SDVOSB) CONCERNS

ELIGIBLE UNDER THE SDVOSB PROGRAM

NOV 2025

(DEVIATION)

☒ 52.219-28 POSTAWARD SMALL BUSINESS PROGRAM REREPRESENTATION NOV 2025

(DEVIATION)

☐ 52.219-28 Alt I

POSTAWARD SMALL BUSINESS PROGRAM REREPRESENTATION, WITH

ALTERNATE I

NOV 2025

(DEVIATION)

☐ 52.219-29 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO,

ECONOMICALLY DISADVANTAGED WOMEN-OWNED SMALL BUSINESS

CONCERNS

NOV 2025

(DEVIATION)

☐ 52.219-30 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO, WOMEN-

OWNED SMALL BUSINESS CONCERNS ELIGIBLE UNDER THE WOMEN-

OWNED SMALL BUSINESS PROGRAM

NOV 2025

(DEVIATION)

☐ 52.219-33 NONMANUFACTURER RULE NOV 2025

(DEVIATION)

☒ 52.222-3 CONVICT LABOR NOV 2025

(DEVIATION)

☒ 52.222-19 CHILD LABOR—COOPERATION WITH AUTHORITIES AND REMEDIES NOV 2025

(DEVIATION)

☐ 52.222-35 EQUAL OPPORTUNITY FOR VETERANS NOV 2025

(DEVIATION)

☒ 52.222-36 EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES NOV 2025

(DEVIATION)

☐ 52.222-36

ALT I

EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES, WITH

ALTERNATE I

JUL 2014

☐ 52.222-37 EMPLOYMENT REPORTS ON VETERANS NOV 2025

(DEVIATION)

☐ 52.222-40 NOTIFICATION OF EMPLOYEE RIGHTS UNDER THE NATIONAL LABOR

RELATIONS ACT

NOV 2025

☐ 52.222-41 SERVICE CONTRACT LABOR STANDARDS NOV 2025

(DEVIATION)

☐ 52.222-43 FAIR LABOR STANDARDS ACT AND SERVICE CONTRACT LABOR

STANDARDS-PRICE ADJUSTMENT (MULTIPLE YEAR AND OPTION

CONTRACTS)

NOV 2025

(DEVIATION)

☐ 52.222-44 FAIR LABOR STANDARDS ACT AND SERVICE CONTRACT LABOR

STANDARDS-PRICE ADJUSTMENT

NOV 2025

(DEVIATION)

☒ 52.222-50 COMBATING TRAFFICKING IN PERSONS NOV 2025

(DEVIATION)

☐ 52.222-50 Alt I

COMBATING TRAFFICKING IN PERSONS NOV 2025

(DEVIATION)

☐ 52.222-51 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS TO CONTRACTS FOR MAINTENANCE, CALIBRATION, OR

REPAIR OF CERTAIN EQUIPMENT—REQUIREMENTS

NOV 2025

(DEVIATION)

☐ 52.222-53 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS TO CONTRACTS FOR CERTAIN SERVICES—

REQUIREMENTS

NOV 2025

(DEVIATION)

☐ 52.222-54 EMPLOYMENT ELIGIBILITY VERIFICATION NOV 2025

(DEVIATION)

☐ 52.222-55 MINIMUM WAGES FOR CONTRACTOR WORKERS UNDER EXECUTIVE

ORDER 14026

NOV 2025

(DEVIATION)

☐ 52.222-62 PAID SICK LEAVE UNDER EXECUTIVE ORDER 13706 NOV 2025

(DEVIATION)

☒ 52.222-90 ADDRESSING DEI DISCIMINATION BY FEDERAL CONTRACTORS APR 2026

(DEVIATION)

☐ 52.223-2 REPORTING OF BIOBASED PRODUCTS UNDER SERVICE AND

CONSTRUCTION CONTRACTS

NOV 2025

(DEVIATION)

☐ 52.223-5 POLLUTION PREVENTION AND RIGHT-TO-KNOW INFORMATION MAY 2024

☐ 52.223-11 OZONE-DEPLETING SUBSTANCES NOV 2025

(DEVIATION)

☐ 52.223-12 MAINTENANCE, SERVICE, REPAIR, OR DISPOSAL OF REFRIGERATION

EQUIPMENT AND AIR CONDITIONERS

NOV 2025

(DEVIATION)

☒ 52.223-23 SUSTAINABLE PRODUCTS NOV 2025

(DEVIATION)

☐ 52.224-1 PRIVACY ACT NOTIFICATION APR 1984

☐ 52.224-2 PRIVACY ACT APR 1984

☐ 52.224-3 PRIVACY TRAINING JAN 2017

☐ 52.224-3

ALT I

PRIVACY TRAINING, WITH ALTERNATE I JAN 2017

☒ 52.225-1 BUY AMERICAN-SUPPLIES NOV 2025

(DEVIATION)

☐ 52.225-1 Alt I

BUY AMERICAN-SUPPLIES, WITH ALTERNATE I OCT 2022

☐ 52.225-3 BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT NOV 2025

52.225-3

ALT I

RESERVED

☐ 52.225-3 Alt II

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE II

NOV 2025

(DEVIATION)

☐ 52.225-3 Alt III

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE III

NOV 2025

(DEVIATION)

☐ 52.225-3 Alt IV

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE IV

NOV 2025

(DEVIATION)

☐ 52.225-5 TRADE AGREEMENTS NOV 2023

☐ 52.225-14 INCONSISTENCY BETWEEN ENGLISH VERSION AND TRANSLATION OF

CONTRACT

FEB 2000

☐ 52.225-19 CONTRACTOR PERSONNEL IN A DESIGNATED OPERATIONAL AREA OR

SUPPORTING A DIPLOMATIC OR CONSULAR MISSION OUTSIDE THE

UNITED STATES

MAY 2020

☐ 52.225-26 CONTRACTORS PERFORMING PRIVATE SECURITY FUNCTIONS

OUTSIDE THE UNITED STATES

OCT 2016

☐ 52.226-1 UTILIZATION OF INDIAN ORGANIZATIONS AND INDIAN-OWNED

ECONOMIC ENTERPRISES

NOV 2025

(DEVIATION)

☐ 52.226-5 RESTRICTIONS ON SUBCONTRACTING OUTSIDE DISASTER OR

EMERGENCY AREA

NOV 2025

(DEVIATION)

☐ 52.226-6 PROMOTING EXCESS FOOD DONATION TO NONPROFIT

ORGANIZATIONS

NOV 2025

(DEVIATION)

☐ 52.226-7 DRUG-FREE WORKPLACE MAY 2024

☒ 52.226-8 ENCOURAGING CONTRACTOR POLICIES TO BAN TEXT MESSAGING

WHILE DRIVING

MAY 2024

☐ 52.229-12 TAX ON CERTAIN FOREIGN PROCUREMENTS AUG 2025

(DEVIATION)

☐ 52.232-3 PAYMENTS UNDER PERSONAL SERVICES CONTRACTS NOV 2025

(DEVIATION)

☐ 52.232-18 AVAILABILITY OF FUNDS APR 1984

☐ 52.232-29 TERMS FOR FINANCING OF COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2021

☐ 52.232-30 INSTALLMENT PAYMENTS OF COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2021

☒ 52.232-33 PAYMENT BY ELECTRONIC FUNDS TRANSFER—SYSTEM FOR AWARD

MANAGEMENT

OCT 2018

☐ 52.232-34 PAYMENT BY ELECTRONIC FUNDS TRANSFER—OTHER THAN SYSTEM

FOR AWARD MANAGEMENT

JUL 2013

☐ 52.232-36 PAYMENT BY THIRD PARTY NOV 2025

(DEVIATION)

☒ 52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS

MAR 2023

☐ 52.232-90 FAST PAYMENT PROCEDURE NOV 2025

(DEVIATION)

☒ 52.233-3 PROTEST AFTER AWARD NOV 2025

☒ 52.233-4 APPLICABLE LAW FOR BREACH OF CONTRACT CLAIM NOV 2025

(DEVIATION)

☐ 52.237-2 PROTECTION OF GOVERNMENT BUILDING, EQUIPMENT, AND

VEGETATION

APR 1984

☐ 52.237-3 CONTINUITY OF SERVICES JAN 1991

☒ 52.240-91 SECURITY PROHIBITIONS AND EXCLUSIONS NOV 2025

(DEVIATION)

☐ 52.240-91 Alt I

SECURITY PROHIBITIONS AND EXCLUSIONS, WITH ALTERNATE I NOV 2025

(DEVIATION)

☐ 52.240-92 SECURITY REQUIREMENTS NOV 2025

(DEVIATION)

☐ 52.240-92 Alt II

SECURITY REQUIREMENTS WITH ALTERNATE II NOV 2025

(DEVIATION)

☐ 52.240-93 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS

NOV 2025

(DEVIATION)

☐ 52.242-5 PAYMENTS TO SMAL BUSINESS SUBCONTRACTORS JAN 2017

☐ 52.242-13 BANKRUPTCY JUL 1995

☐ 52.244-2 SUBCONTRACTS JUN 2020

☒ 52.244-6 SUBCONTRACTS FOR COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES

NOV 2025

(DEVIATION)

☐ 52.245-1 GOVERNMENT PROPERTY SEP 2021

☐ 52.245-2 GOVERNMENT PROPERTY INSTALLATION OPERATION SERVICES APR 2012

☐ 52.245-9 USE AND CHARGES APR 2012

☐ 52.247-64 PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS

NOV 2025

(DEVIATION)

☐ 52.247-64 Alt I

PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS, WITH ALTERNATE I

APR 2003

☐ 52.247-64 Alt II

PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS, WITH ALTERNATE II

NOV 2021

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 this/these address(es):

Revolutionary FAR Overhaul - FAR Overhaul - FAR Part Deviation Guidance | Acquisition.GOV

Federal Acquisition Regulation - https://www.acquisition.gov/browse/index/far

Department of Health and Human Services Acquisition Regulation – https://www.acquisition.gov/hhsar https://www.acquisition.gov/far-overhaul/far-part-deviation-guide https://www.acquisition.gov/browse/index/far https://www.acquisition.gov/hhsar

(End of clause)

52.252-6 AUTHORIZED DEVIATIONS IN CLAUSES NOV 2020

(a)The use in this solicitation or contract of any Federal Acquisition Regulation (48 CFR Chapter 1) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the date of the clause.

(b)The use in this solicitation or contract of any Department of Health and Human Services (48 CFR Chapter 3) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation.

(End of clause)

The following Department of Health and Human Services Acquisition Regulation clauses also apply:

☐ 352.203-70 ANTI-LOBBYING DEC 2015

☐ 352.208-70 PRINTING AND DUPLICATION DEC 2015

☐ 352.211-3 PAPERWORK REDUCTION ACT DEC 2015

☐ 352.219-71 MENTOR-PROTÉGÉ PROGRAM REPORTING REQUIREMENTS JAN 2010

☐ 352.223-70 SAFETY AND HEALTH DEC 2015

☐ 352.224-70 PRIVACY ACT DEC 2015

☒ 352.226-6 INDIAN ECONOMIC ENTERPRISE SUBCONTRACTING

LIMITATIONS

MAR 2022

☐ 352.227-70 PUBLICATIONS AND PUBLICITY DEC 2015

☐ 352.231-70 SALARY RATE LIMITATION DEC 2015

☐ 352.237-70 PRO-CHILDREN ACT DEC 2015

☐ 352.237-71 CRIME CONTROL ACT – REPORTING OF CHILD ABUSE DEC 2015

☐ 352.237-72 CRIME CONTROL ACT – REQUIREMENTS FOR BACKGROUND

CHECKS

DEC 2015

☐ 352.237-73 INDIAN CHILD PROTECTION AND FAMILY VIOLENCE ACT DEC 2015

352.232-71 ELECTRONIC SUBMISSION OF PAYMENT

REQUESTS

APR 2026

(a) Definitions. As used in this clause –

Payment request means a bill, voucher, invoice, or request for contract financing payment with associated supporting documentation. The payment request must comply with the requirements in FAR 32.905(b) and the applicable payment clause included in this contract.

(b) Submission instructions. Except as provided in paragraph (c) of this clause, the Contractor must submit payment requests electronically using the Department of Treasury Invoice Processing Platform (IPP) or successor system. Information regarding IPP, including IPP Customer Support contact information, is available at www.ipp.gov or any successor site.

http://www.ipp.gov/

(c) Alternate submission procedures. The Contractor may submit payment requests using other than IPP only when the Contracting Officer authorizes alternate procedures in writing.

(d) Submission of alternate payment procedures authorization. If alternate payment procedures are authorized, the Contractor shall include a copy of the Contracting Officer’s written authorization with each payment request.

(End of clause)

The following local Indian Health Service, Navajo Area terms also apply:

NAIHS-ACQ-09 UNAUTHORIZED COMMITMENTS NOV 2025

(a) Definitions.

Contracting Officer means a person with the authority to enter into, administer, and/or terminate contracts and make related determination and findings.

Ratification means the act of approving an unauthorized commitment by an official who has the authority to do so.

Unauthorized Commitment (UAC) means an agreement that is not binding solely because the Government representative who made it lacked the authority to enter into that agreement on behalf of the Government.

(b) Policy.

The Government is not bound by agreements with, or contractual commitments made to, prospective contractors by individuals who do not have delegated contracting authority. Unauthorized commitments do not follow the appropriate process for the expenditure of Government funds. Consequently, the Government may not be able to ratify certain actions, putting a contractor at risk for taking direction from a Federal official other than the contracting officer (see FAR 1.403-2). Government employees responsible for unauthorized commitments are subject to disciplinary action. Contractors perform at their own risk when accepting direction from unauthorized officials. Failure to follow statutory and regulatory processes for the expenditure of Government funds is a very serious matter.

(c) Procedure.

Any agreement, modification, or change to a contractual agreement made by a government personnel who lack authority will be deemed an unauthorized commitment. The Government is not liable to the Contractor or under the terms of the contract, financially or otherwise – unless the unauthorized commitment successfully passes the ratification process.

The ratification process does not have any lead time, nor does the Government make any promise that an unauthorized commitment will be ratified and, therefore, the Contractor would be paid. The Contractor proceeds at its own risk if any of the terms of the contract are altered, changed, or modified without the written concurrence by a Contracting Officer.

(End of Clause)

SECTION D – DOCUMENTS, EXHIBITS, ATTACHMENTS, ETC.

Attachment A – Statement of Work

Attachment B – Fully-Approved Brand Name Justification

Attachment C– Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form

STATEMENT OF WORK

GALLUP INDIAN MEDICAL CENTER: DEXIS IXS DIGITAL RADIOGRAPH SENSORS (SIZE 2)

PURPOSE OF CONTRACT: Gallup Indian Medical Center (GIMC) is part of the Navajo Area Indian Health Servicies (NAIHS) located in Gallup, New Mexico. The GIMC Dental Department has a need for digital radiograph sensors in Size 2.

GENERAL: Contractor shall furnish all necessary equipment and tools for the successful delivery of new equipment, attachments, and accessories required by the Dental Department.

Background: IHS is an agency within the U.S. Department of Health and Human Services, and is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally-recognized tribe grew out of the special government to government relationship between the federal government and Indian Tribes. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally-recognized tribes in 34 states.

Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 201,583 members of the Navajo Nation. The Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

Gallup Indian Medical Center (GIMC) is a 75-bed hospital in Gallup, New Mexico, on the border of the Navajo Reservation. Clinical specialties at GIMC includes Internal Medicine, Cardiology, Anesthesia, OB/GYN, General Surgery, Orthopedics, Ophthalmology, ENT, Radiology, Pathology, Pediatrics, Psychiatry, Emergency Medicine, and Urology. The workload at Gallup is one of the largest in the Indian Health Service with 380,000 outpatient encounters and 3,300 inpatient admissions annually. GIMC has the largest staff of all Navajo Area IHS facilities.

STATEMENT OF WORK: The vendor shall provide the following new equipment, attachments, and accessories to meet the specifications and the successful delivery.

Attachment A

STATEMENT OF WORK

GALLUP INDIAN MEDICAL CENTER: DEXIS IXS DIGITAL RADIOGRAPH SENSORS (SIZE 2)

Specifications:

GIMC Dental Department needs fourteen (14) DEXIS IXS Size 2 sensors. The DEXIS IXS Size 2 sensor must be the next-generation intraoral digital sensor built on the Gendex GXS-700 platform. The sensor is to be a digital intraoral sensor (CMOS-based) and able to capture sharp images at low doses. Durability should be three times more resistant to damage or functional failure than Gendex GXS-700.

Sensors should have thermoplastic resin housing with a dome surface design to protect the internal components. The cable to the sensor needs to be durable, not requiring replacement under normal use.

The USB connector for direct plug-in must be able to integrate with our DEXIS imaging software and communicate with our practice software platform, DENTRIX.

Auto-calibration capabilities are needed for files stored in the sensor and be able to auto-download when connected. Additionally, we should be able to move the sensor between operatories without a need for re-calibration.

Physical dimensions are 30.4 x 42.3mm; USB Port: USB 2.0/USB 3.x; Resolution: theoretical 25.6 lp/mm, visible 20+ lp/mm; Cable length: 2.5m; Cable material: ultra-durable; Driver: DEXIS IO Sensor Driver 3.0 or higher; Sensor technology: enhanced Csl Scintillator + Optical fibers; IoT connectivity: device health monitoring and automatic software updates.

Shipping and handling for all quoted items are included in the price.

The vendor shall provide a return policy allowing the customer to return any sensors within an agreed-upon number of days after purchase and delivery, permitting exchanges or a full refund if the sensors or packing are unsatisfactory or non-operational.

This product is also listed on our approved FY2026 annual acquisition plan as 2026-AAP-GSU-IT-0004.

PERIOD OF PERFORMANCE: Delivery of equipment, attachments, and accessories shall be within 30 days after date of award.

mailto:Dezbaa.damon-mallette@ihs.gov

Solicitation Number: 75H71026Q00306 Page 1 of 2

Rev. 09/30/2025

JUSTIFICATION TO RESTRICT COMPETITION (below SAT) Pursuant to Revolutionary FAR Overhaul (RFO) 12.102, for acquisitions valued at or below the simplified acquisition threshold (SAT) using RFO 12.201-1 Simplified Procedures for commercial products and services, the Contracting Officer (CO) hereby documents the decision that only one source is reasonably available.

1. Agency and Contracting Activity.

U.S. Department of Health and Human Services Indian Health Service, Navajo Area Gallup Indian Medical Center Division of Acquisition Management & Contracts

2. Name and Address of Only Source.

DEXIS IXS Digital Radiograph Sensors

3. Description of Supplies/Services and Estimated Cost.

***THIS ONLY JUSTIFIES THE BRAND NAME DESCRIBED AS FOLLOWS.***

The Gallup Indian Medical Center (GIMC) Dental Department requires DEXIS IXS Digital Radiograph Sensors. GIMC currently utilizes DEXIS IXS Digital Radiograph Sensors as part of its standardized dental operations, and Dental Department employees are trained in the proper use of these products.

4. Description of Circumstances, including why only one source is reasonably available.

IAW RFO 11.204(a)(1), specific characteristics of the DEXIS IXS Digital Radiograph Sensors that limit the availability to only one source are compatibility with established software programs and support maintenance. Only this suggested source can furnish the requirements, to the exclusion of other sources, because the sensors are compatible with the existing imaging platforms for capturing, downloading, and storing radiographs. These sensors also integrate seamlessly with the dental practice management system, DENTRIX.

Furthermore, the sensors are also supported by an existing IT support contract for maintenance service.

5. Description of Market Research.

A Sources Sought Notice was posted to SAM.gov under Notice ID IHS1528810. The notice received interest from a large business firm and two ISBEE firms. The department found all three firms capable of providing the required instruments to meet the SOW. Based on the rule of two, as applicable to the Buy Indian Act, the solicitation will be issued as a 100% ISBEE set-aside.

Attachment B

Solicitation Number: 75H71026Q00306 Page 2 of 2

Rev. 09/30/2025

SIGNATURES

PREPARED BY:

Name: Stephen Silversmith, Contract Specialist

Date:

CONTRACTING OFFICER (CO) (RFO 6.104-1(a)(12)):

Name: Misty Billy, Contracting Officer

Date:

X

X

DEPARTMENT OF HEALTH & HUMAN SERVICES

Indian Health Service

Office of Management Services Division of Acquisition Policy (DAP)

5600 Fishers Lane Rockville, MD 20857

INDIAN HEALTH SERVICE

BUY INDIAN ACT

INDIAN ECONOMIC ENTERPRISE

REPRESENTATION FORM

SOLICITATION/SOURCES SOUGHT/RFI #: _________________________________________________

PROJECT TITLE: ________________________________________________________

DATE: ___________________________________________________________________

In accordance with 25 U.S.C. 47 the Buy Indian Act, the signature below constitutes self-certification that the Offeror meets the definition of an “Indian Economic Enterprise” (HHSAR 326.601) in response to this Sources Sought Notice, Request for Information (RFI) or Solicitation and resultant contract.

The enterprise must meet the definition of “Indian Economic Enterprise” throughout the following time periods:

(1) At the time an offer is made in response to this solicitation;

(2) At the time of contract award; and

(3) During the full term of the contract performance period. At any point during these periods, if the Contractor no longer meets the eligibility requirements, the contractor must provide immediate written notification to the Contracting Officer.

Individual Contracting Officers may require documentation of eligibility before awarding a set-aside or sole source contracts under the Buy Indian Act and awards may be subject to protest if the eligibility of the successful Offeror is in question. In addition to the self-certification requirements, successful Offerors must also be registered with the System of Award Management (SAM).

Any false or misleading information submitted by an enterprise when submitting an offer in consideration of an award set-aside under the authority of the Buy Indian Act is a violation of the law and punishable under 18 U.S.C. 1001.

False claims submitted as part of contract performance are subject to the penalties enumerated in 31 U.S.C. 3729 to 3731 and 18 U.S.C. 287.

REPRESENTATION

The Offeror represents as part of its offer that it does _____, does not _____ meet the definition of an “Indian Economic Enterprise” with “Indian Ownership” under the authority of the Buy Indian Act.

Name of the 51% owner of IEE Firm

Certifying Signature

Print Name

Name of Federally Recognized Tribal Entity

Business Name

DUNS Number

Attachment C

SECTION E – SOLICITATION PROVISIONS

52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES

The following instructions will supplement the requirements at 52.212-1(a).

To facilitate evaluation of your quotation, please provide the following information:

1. Price Quotation

• Submit a detailed quotation that clearly demonstrates compliance with all requirements and specifications outlined in the Statement of Work (Attachment A).

2. Capability Statement

• Provide a brief capability statement describing your firm's experience, qualifications, and ability to provide the requested services listed in the Statement of Work (Attachment A).

• Include any other supporting documentation necessary to verify conformance with the stated requirements.

Please ensure your quotation addresses all requirements contained in the Statement of Work. Failure to provide the requested documentation above may affect the Government's ability to evaluate your quotation.

Please email your quotation package to Mr. Stephen Silversmith, Contract Specialist, at Stephen.Silversmith@ihs.gov. Please include “RFQ 75H71026Q00306” in the subject line of your email.

52.212-2 EVALUATION – COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2025

(DEVIATION)

(a) Evaluation factors. The Government will award a contract resulting from this solicitation to the responsible Offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

Technical capability to provide the requested services per the Statement of Work requirements

Price

The award will be made to the lowest-priced, technically acceptable quote.

(b) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).

(c) Notice of award. A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of provision) mailto:Stephen.Silversmith@ihs.gov

The following Federal Acquisition Regulations provisions incorporated by reference also apply:

☐ 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO

INFLUENCE CERTAIN FEDERAL TRANSACTIONS

SEP 2024

52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE

CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS OR

STATEMENTS-REPRESENTATION

JAN 2017

☒ 52.204-7

SYSTEM FOR AWARD MANAGEMENT - REGISTRATION

NOV 2025

(DEVIATION)

☐ 52.204-7 Alt I

SYSTEM FOR AWARD MANAGEMENT—REGISTRATION, WITH

ALTERNATE I

NOV 2025

(DEVIATION)

52.207-6 SOLICITATION OF OFFERS FROM SMALL BUSINESS CONCERNS AND

SMALL BUSINESS TEAMING ARRANGEMENTS OR JOINT VENTURES

(MULTIPLE-AWARD CONTRACTS)

AUG 2024

☐ 52.209-12 CERTIFICATION REGARDING TAX MATTERS OCT 2025

☐ 52.216-31 TIME-AND-MATERIALS/LABOR-HOUR PROPOSAL REQUIREMENTS –

COMMERCIAL ACQUISITION

NOV 2021

☐ 52.219-4 NOTICE OF PRICE EVALUATION PREFERENCE FOR HUBZONE SMALL

BUSINESS CONCERNS

NOV 2025

(DEVIATION)

☐ 52.219-31 NOTICE OF SMALL BUSINESS RESERVE MAR 2020

☐ 52.222-18 CERTIFICATION REGARDING KNOWLEDGE OF CHILD LABOR FOR

LISTED END PRODUCTS

FEB 2021

52.222-48 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS FOR MAINTENANCE, CALIBRATION, OR REPAIR OF

CERTAIN EQUIPMENT–CERTIFICATION

MAY 2014

☐ 52.222-52 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS FOR CERTAIN SERVICES-CERTIFICATION

MAY 2014

☐ 52.222-56 CERTIFICATION REGARDING TRAFFICKING IN PERSONS COMPLIANCE

PLAN

OCT 2020

☐ 52.223-1

BIOBASED PRODUCT CERTIFICATION

MAY 2024

☐ 52.223-4

RECOVERED MATERIAL CERTIFICATION

MAY 2008

☐ 52.237-1

SITE VISIT

APR 1984

☒ 52.240-90 SECURITY PROHIBITIONS AND EXCLUSIONS REPRESENTATIONS AND

CERTIFICATIONS

52.209-2 PROHIBITION ON CONTRACTING WITH

INVERTED DOMESTIC CORPORATIONS –

REPRESENTATION

(a) Definitions. As used in this clause—

Inverted domestic corporation means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c).

Subsidiary means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

(b) Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation, or a subsidiary of an inverted domestic corporation, unless the exception at 9.108-3(b) applies or the requirement is waived in accordance with the procedures at 9.108-5.

(c) Representation. The Offeror represents that-

(1) It □ is, □ is not an inverted domestic corporation; and

(2) It □ is, □ is not a subsidiary of an inverted domestic corporation.

52.209-11 REPRESENTATION BY CORPORATIONS

REGARDING DELINQUENT TAX LIABILITY OR A

FELONY CONVICTION UNDER ANY FEDERAL

LAW

(a) The Government will not enter into a contract with any corporation that—

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that–

(1) It is □ is not □ a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is □ is not □ a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

52.225-2 BUY AMERICAN CERTIFICATE OCT 2022

(a) (1) The Offeror certifies that each end product, except those listed in paragraph (b) of this provision, is a domestic end product and that each domestic end product listed in paragraph (c) of this provision contains a critical component.

(2) The Offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products. For those foreign end products that do not consist wholly or predominantly of iron or steel or a combination of both, the Offeror shall also indicate whether these foreign end products exceed 55 percent domestic content, except for those that are COTS items. If the percentage of the domestic content is unknown, select “no”.

(3) The Offeror shall separately list the line item numbers of domestic end products that contain a critical component (see FAR 25.105).

(4) The terms “commercially available off-the-shelf (COTS) item,” “critical component,” "domestic end product," "end product," and "foreign end product" are defined in the clause of this solicitation entitled "Buy American-Supplies."

(b)Foreign End Products:

Line Item No. Country of Origin Exceeds 55% domestic content (yes/no)

(b)[List as necessary]

(c) Domestic end products containing a critical component:

Line Item No. ___

[List as necessary]

(d) The Government will evaluate offers in accordance with the policies and procedures of part 25 of the Federal Acquisition Regulation.

(End of provision)

52.252-1 SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE

FEB 1998

This solicitation incorporates one or more solicitation provisions 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. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es):

Revolutionary FAR Overhaul - FAR Overhaul - FAR Part Deviation Guidance | Acquisition.GOV

Federal Acquisition Regulation - https://www.acquisition.gov/browse/index/far

Department of Health and Human Services Acquisition Regulation – https://www.acquisition.gov/hhsar

(End of Provision)

52.252-5 AUTHORIZED DEVIATIONS IN PROVISIONS NOV 2020

(a)The use in this solicitation of any Federal Acquisition Regulation (48 CFR Chapter 1) provision with an authorized deviation is indicated by the addition of "(DEVIATION)" after the date of the clause.

https://www.acquisition.gov/far/part-25#FAR_25_105 https://www.acquisition.gov/far/part-25#FAR_Part_25 https://www.acquisition.gov/far-overhaul/far-part-deviation-guide https://www.acquisition.gov/browse/index/far https://www.acquisition.gov/hhsar

(b)The use in this solicitation of any Department of Health and Human Services (48 CFR Chapter 3) provision with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation.

(End of Provision)

The following Department of Health and Human Services Acquisition Regulation provisions also apply:

☐ 352.219-70 MENTOR-PROTÉGÉ PROGRAM DEC 2015

☐ 352.223-71 INSTRUCTIONS TO OFFERORS – SUSTAINABLE ACQUISITION DEC 2015

☒ 352.226-4 NOTICE OF INDIAN SMALL BUSINESS ECONOMIC ENTERPRISE SET

ASIDE

MAR 2022

☐ 352.226-5 NOTICE OF INDIAN ECONOMIC ENTERPRISE SET ASIDE MAR 2022

☒ 352.226-7 INDIAN ECONOMIC ENTERPRISE REPRESENTATION MAR 2022

☐ 352.239-73 ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY

NOTICE

DEC 2015