75H71124P00339 signed PO.pdf
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- Solicitation number
- 75H71124P00339
About this file
This document is an Order for Supplies or Services for contract 75H71124P00339, awarded by the Department of Health and Human Services Indian Health Service to CRUTCHO CREEK FARMS LLC on 2024-07-16 for $8,050.00. The contract is for the installation of a sewer service line from a home to the main sewer line in Oklahoma City, OK, in accordance with the attached Statement of Work and Drawing. The period of performance is from 2024-07-16 to 2024-09-16. The contract sets aside the work for small businesses and includes applicable Davis-Bacon Act wage rates. The Statement of Work and drawing are attached, along with additional contract provisions and clauses.
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Text version
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)
07/16/2024
75H71124P00339 IHS1496540
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
RAY WILLIAMS
CRUTCHO CREEK FARMS LLC 1596239
CRUTCHO CREEK FARMS LLC 6625 N
6625 NE 10TH ST
OKLAHOMA CITY OK 73110
See Schedule
12. F.O.B. POINT
09/16/2024
SHAWNEE
703 E. Independence
SHAWNEE OK 74804
SHAWNEE OK 74804
ORACLE
ITEM NO.
(a)
SUPPLIES OR SERVICES
(b)
QUANTITY
ORDERED
(c)
UNIT
(d)
UNIT
PRICE
(e)
AMOUNT
(f)
QUANTITY
ACCEPTED
(g)
X
X
Destination Destination HHS NET 30P
f. SERVICE-DISABLED
VETERAN-OWNED
e. HUBZone
g. WOMEN-OWNED SMALL BUSINESS (WOSB)
ELIGIBLE UNDER THE WOSB PROGRAM
h. EDWOSB
UEI: DR5DXNMV8B33
Contractor shall install sewer service line from home to main for L Taylor in accordance with the Statement of Work and Drawing.
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
$8,050.00
22. UNITED STATES OF
AMERICA BY (Signature)
23. NAME (Typed)
TITLE: CONTRACTING/ORDERING OFFICER
EDSON W. YELLOWFISH
$8,050.00
OPTIONAL FORM 347 (Rev. 2/2012)
Prescribed by GSA/FAR 48 CFR 53.213(f)
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE
07/17/2024
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
Oklahoma City OK 73114
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
07/16/2024 75H71124P00339
PAGE NO
(a) (b) (c) (d) (e) (f) (g)
Admin Office:
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
Period of Performance: 07/16/2024 to
09/16/2024
1 Contractor shall install a sewer service 8050 J3 1.00 8,050.00 line from home to main for L Taylor in accordance with the Statement of Work ad
Drawing.
Project Data:
131331.3.HGFK0000000-OKLAHOMA AREA
IHS.25235-ALL OTR SVCS.05/29/2024
Accounting Info:
2024.J5002IR.25235 Appr. Yr.: 2024
CAN: J5002IR Object Class: 25235
Funded: $8,050.00
Additional Provisions and Conditions (10 pages; 3-12 are attached hereto)
Scope of Work includes Statement of Work (2 pages), drawing (1 page) (attached).
Davis Bacon General Wage Decision
OK20240026 Dated 04/05/2024 is hereby incorporated, (attached)
FAR Clause 52.213-4 attached FAR Clause
52.204-7 applies
The total amount of award: $8,050.00. 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
PREVIOUS EDITION NOT USABLE
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $8,050.00
File details come from the government source that posted it. Updated .