75H71125P00058 draft po.pdf
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- Solicitation number
- 75H71125P00058
About this file
This is an Order for Supplies or Services (Optional Form 347) issued by the Oklahoma City Area Indian Health Service to Ohlsen Right of Way and Maintenance Inc. on February 3, 2025, with order number 75H71125P00058.
The contractor shall furnish and install sanitary utility sewerage piping, shower kit, up-flush toilet, grab bar and appurtenances for N Bear, with a total award amount of $11,500.00. The period of performance is February 3, 2025 to April 8, 2025. The contractor is classified as a small business. The work includes Davis Bacon wage requirements (Decision OK20240030). Project oversight will be provided by Jim Shane as Engineering Technician, with Jeffrey Earnest serving as Contract Specialist. Invoices can be submitted electronically to okcapinvoices@ihs.gov or mailed to the Oklahoma City Area Indian Health Service office, with NET 30P payment terms.
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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)
02/03/2025
75H71125P00058 IHS1506195
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
04/08/2025
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 sanitary utility sewerage piping, shower kit, up flush toilet, grab bar and appurtenances.
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
$11,500.00
22. UNITED STATES OF
AMERICA BY (Signature)
23. NAME (Typed)
TITLE: CONTRACTING/ORDERING OFFICER
EDSON W. YELLOWFISH
$11,500.00
OPTIONAL FORM 347 (Rev. 2/2012)
Prescribed by GSA/FAR 48 CFR 53.213(f)
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE
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
02/03/2025 75H71125P00058
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: 02/03/2025 to
04/08/2025
1 Contractor shall furnish and install 11500 J3 1.00 11,500.00 sanitary utility sewerage piping, shower kit, up-flush toilet, grab bar and appurtenances for N Bear in accordance with the Statement of Work and Drawings.
Project Data:
127809.3.HGFK0000000-OKLAHOMA AREA
IHS.25235-ALL OTR SVCS.12/08/2024
Accounting Info:
2025.J5002IH.25235 Appr. Yr.: 2025
CAN: J5002IH Object Class: 25235
Funded: $11,500.00
Additional Provisions and Conditions (10 pages; 4-13 are attached hereto)
Scope of Work includes: Statement of Work
(3 pages), bid sheet (1 page) drawing (1 page) (attached).
Davis Bacon General Wage Decision
OK20240030 Dated 08/05/2024 is hereby incorporated, (attached)
FAR Clause 52.213-4 attached FAR Clause
52.204-7 applies
Oversite Monitor: Jim Shane, Engineering
Technician
Office Phone: 785-364-2309
Cell: 580-678-6535
E-mail: donald.shane@ihs.gov
Contract Specialist (C): Jeffrey Earnest, (IHS/OKC) 405-951-3740
E-mail jeffrey.earnest@ihs.gov
Complete invoices and supporting documentation shall be sent either
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)) $11,500.00
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
02/03/2025 75H71125P00058
PAGE NO
(a) (b) (c) (d) (e) (f) (g) electronically via e-mail or by regular postal mail to the paying office (Bill To) below:
Bill To:
E-mail Invoice to: okcapinvoices@ihs.gov
Or mail invoices to:
Oklahoma City Area Indian Health Service
Attention Finance Department
701 Market Drive
Oklahoma City, OK 73114
Accounts Payable POC is Alicia Kinney
Phone 405-951-3924
E-mail alicia.kenney@ihs.gov
Please Note: Email a copy of the invoice to the Contract Specialist and Oversite
Monitor so that they can verify work is complete and make sure it is received in the system.
The total amount of award: $11,500.00. 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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