PO_75H71124P00419.pdf
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- Solicitation number
- 75H71124P00419
About this file
This document is an Order for Supplies or Services related to a federal contract opportunity. The contract number is 75H71124P00419, awarded to HORIZON UNDERGROUND LLC to furnish and install a water service line for S Horton in Sand Springs, Oklahoma. The total contract value is $7,400.00, with a period of performance from September 3, 2024 to November 4, 2024. The work will be performed in accordance with the provided Statement of Work and drawing. The contracting agency is the Department of Health and Human Services, Indian Health Service. Key points of contact include the Supervisory Civil Engineer, Contract Specialist, and Finance Office.
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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)
09/03/2024
75H71124P00419 IHS1496390
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
MATT
HORIZON UNDERGROUND LLC 856176
HORIZON UNDERGROUND LLC 4205 B
4205 BEELINO RD
BEGGS OK 74421
See Schedule
12. F.O.B. POINT
11/04/2024
OKLAHOMA CITY AREA OFFICE
701 MARKET DRIVE
OKLAHOMA CITY OK 73114
OKLAHOMA CITY OK 73114
RFQ 246-24-Q-0132
ORACLE
ITEM NO.
(a)
SUPPLIES OR SERVICES
(b)
QUANTITY
ORDERED
(c)
UNIT
(d)
UNIT
PRICE
(e)
AMOUNT
(f)
QUANTITY
ACCEPTED
(g)
XX
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: MN1NZAEAMNF8
CONTRACTOR SHALL FURNISH AND INSTALL A
WATER SERVICE LINE FOR S HORTON IN SAND
SPRINGS, OK (CREEK, CO.) IN ACCORDANCE WITH
THE STATEMENT OF WORK AND DRAWING PROVIDED.
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
$7,400.00
22. UNITED STATES OF
AMERICA BY (Signature)
23. NAME (Typed)
TITLE: CONTRACTING/ORDERING OFFICER
EDSON W. YELLOWFISH
$7,400.00
OPTIONAL FORM 347 (Rev. 2/2012)
Prescribed by GSA/FAR 48 CFR 53.213(f)
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE
09/05/2024
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
09/03/2024 75H71124P00419
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: 09/03/2024 to
11/04/2024
1 CONTRACTOR SHALL FURNISH AND INSTALL A 7400 J3 1.00 7,400.00
WATER SERVICE LINE FOR S HORTON IN SAND
SPRINGS, OK (CREEK,CO.) IN ACCORDANCE WITH
THE STATEMENT OF WORK AND DRAWING PROVIDED.
ADDITIONAL PROVISIONS AND CONDITIONS (10
PAGES; 3-13 ARE ATTACHED HERETO)
SCOPE OF WORK INCLUDES STATEMENT OF WORK (4
PAGES), DRAWING (2 PAGE ATTACHED).
DAVIS BACON GENERAL WAGE DECISION
OK20240030 04.05.24 IS HEREBY INCORPORATED,
(ATTACHED).
FAR CLAUSE 52.203-4 ATTACHED.
FAR CLAUSE 52.204-7 APPLIES.
Project Data:
134465.3.HGFK0000000-OKLAHOMA AREA
IHS.25235-ALL OTR SVCS.05/24/2024
Accounting Info:
2024.J5002IH.25235 Appr. Yr.: 2024
CAN: J5002IH Object Class: 25235
Funded: $7,400.00
OVERSIGHT/MONITOR: ANDREW BANTA,
SUPERVISORY CIVIL ENGINEER, OFFICE:
918.586.8410. CELL: 918.752.9191.
ANDREW.BANTA@IHS.GOV.
CONTRACT ADMINISTRATOR: NOLEEN POWELL,
CONTRACT SPECIALIST, OFFICE: 405.951.3975.
NOLEEN.POWELL@IHS.GOV.
OCAO FINANCE CONTACT: ALICIA KINNEY, OFFICE
OF FINANCE AND ACCOUNTING, 405.951.3924,
SEND ORIGINAL INVOICES TO OKLAHOMA AREA
INDIAN HEALTH SERVICE ATTN: FINANCE
701 MARKET DRIVE, OKLAHOMA CITY, OK 73114.
OR EMAIL TO OKCAPInvoice@ihs.gov.
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)) $7,400.00
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
09/03/2024 75H71124P00419
PAGE NO
(a) (b) (c) (d) (e) (f) (g)
The total amount of award: $7,400.00. 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)) $0.00
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