75H71124P00353 signed PO.pdf
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- Attached to
- Install a Water Service Line, Delia, KS
- Solicitation number
- 75H71124P00353
About this file
This document is an Order for Supplies or Services related to a federal contract opportunity. The key details are:
The order was issued on 07/24/2024 under Contract #75H71124P00353 to OHLSEN RIGHT OF WAY & MAINTENANCE, INC. for the installation of a water service line in accordance with the Statement of Work and drawing. The total award amount is $6,912.50 with a period of performance from 07/24/2024 to 09/27/2024. The work will be performed for the Indian Health Service, a civilian agency within the Department of Health and Human Services. The contractor is identified as a small business. Key contract oversight will be provided by the Contracting Officer, the Senior Field Engineer, and the Contract Specialist.
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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)
07/24/2024
75H71124P00353 IHS1498101
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
BRETT OHLSEN
OHLSEN RIGHT OF WAY AND MAINTENANCE INC 1499028
OHLSEN RIGHT OF WAY & MAINTENANCE,
892 US HIGHWAY 36
SENECA KS 66538
See Schedule
12. F.O.B. POINT
09/27/2024
OKLAHOMA CITY AREA OFFICE
701 MARKET DRIVE
OKLAHOMA CITY OK 73114
OKLAHOMA CITY OK 73114
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: NC6QLTJS6151
Contractor shall furnish and install a water service line 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
$6,912.50
22. UNITED STATES OF
AMERICA BY (Signature)
23. NAME (Typed)
TITLE: CONTRACTING/ORDERING OFFICER
EDSON W. YELLOWFISH
$6,912.50
OPTIONAL FORM 347 (Rev. 2/2012)
Prescribed by GSA/FAR 48 CFR 53.213(f)
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE
07/24/2024
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
07/24/2024 75H71124P00353
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: 07/24/2024 to
09/27/2024
1 Contractor shall furnish and install a 6912.5 J3 1.00 6,912.50 water service line for S LeCompte in accordance with the statement of work and drawing.
Project Data:
131016.3.HGFK0000000-OKLAHOMA AREA
IHS.25235-ALL OTR SVCS.06/25/2024
Accounting Info:
2024.J5002IH.25235 Appr. Yr.: 2024
CAN: J5002IH Object Class: 25235
Funded: $6,912.50
Additional Provisions and Conditions (10 pages; 3/12 are attached hereto)
Scope of Work includes: Statement of Work
(3 pages), drawing (1 page) (attached).
Davis Bacon General Wage Decision
KS20240152 Dated 04/05/2024 is hereby incorporated, (attached)
FAR Clause 52.213-4 attached FAR Clause
52.204-7 applies
Oversite Monitor: Ted Schuleter, P.E.
Senior Field Engineer
Office Phone: 785-364-4164
Cell: 785-851-4411
E-mail: ted.schlueter@ihs.gov
Contract Specialist (C): Jeffrey Earnest, (IHS/OKC) 405-951-3740
E-mail:jeffrey.earnest@ihs.gov
The total amount of award: $6,912.50. The obligation for this award is shown in box
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)) $6,912.50
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
07/24/2024 75H71124P00353
PAGE NO
(a) (b) (c) (d) (e) (f) (g)
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)) $0.00
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