AMENDED ATTACHMENT NO 1 - 75H71324Q00006_SF18.pdf

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Attached to
AMENDED 75H71324Q00006 - Lighting Panels
Solicitation number
75H71324Q00006
Issued by

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This is a combined synopsis/solicitation from the Department of Health and Human Services Indian Health Service seeking quotes for lighting panels to be delivered to a health clinic in Toppenish, Washington. Quotes are requested for various sized lighting panels on a firm fixed price basis, with delivery required within 30 days. The solicitation will be set aside first for Small Business Indian Firms, then to other small businesses if less than two reasonably priced quotes are received from SBIFs. The NAICS code is 335139 and small business size standard is 1250 employees. Quotes are due by the date specified and must be submitted electronically through the SF-18 form and completed representation form included as attachments. Award will be made to the responsible offeror providing the most advantageous quote to the government considering price and past performance.

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ATTACHMENT NO. 1 - 75H71324Q00006_SF-18.pdf PDF
ATTACHMENT NO. 2 - BUY INDIAN FIRM REPRESENTATION FORM.pdf PDF

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REQUEST FOR QUOTATION

(THIS IS NOT AN ORDER)

THIS RFQ IS IS NOT A SMALL BUSINESS SET-ASIDE

15. DATE OF QUOTATION

16. SIGNER

a. NAME (Type or print)

c. TITLE (Type or print)

b. TELEPHONE

AREA CODE

NUMBER

STANDARD FORM 18 (REV. 6/1995)

Prescribed by GSA-FAR (48 CFR) 53.215-1(a)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable

8. TO:

b. COMPANYa. NAME

c. STREET ADDRESS

d. CITY e. STATE f. ZIP CODE

9. DESTINATION

a. NAME OF CONSIGNEE

b. STREET ADDRESS

c. CITY

d. STATE e. ZIP CODE

7. DELIVERY

FOB DESTINATION

OTHER

(See Schedule)

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS (Date)

IMPORTANT: This is a request for information and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or service. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotation must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State and local taxes)

ITEM NUMBER

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

12. DISCOUNT FOR PROMPT PAYMENT

a. 10 CALENDAR DAYS (%) b. 20 CALENDAR DAYS (%) c. 30 CALENDAR DAYS (%) d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

b. STREET ADDRESS

c. COUNTY

d. CITY e. STATE f. ZIP CODE

14. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

PAGE OF PAGES

1. REQUEST NUMBER 2. DATE ISSUED 3. REQUISITION/PURCHASE REQUEST NUMBER 4. CERT. FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG. 1

RATING

5a. ISSUED BY 6. DELIVER BY (Date)

5b. FOR INFORMATION CALL (NO COLLECT CALLS)

NAME TELEPHONE NUMBER

AREA CODE NUMBER

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REQUEST FOR QUOTATION(THIS IS NOT AN ORDER)

THIS RFQ

IS

IS NOT A SMALL BUSINESS SET-ASIDE

15. DATE OF QUOTATION

16. SIGNER

a. NAME (Type or print)

c. TITLE (Type or print)

b. TELEPHONE

AREA CODE

NUMBER

STANDARD FORM 18 (REV. 6/1995)

Prescribed by GSA-FAR (48 CFR) 53.215-1(a) AUTHORIZED FOR LOCAL REPRODUCTION Previous edition not usable

8. TO:

b. COMPANY

a. NAME

c. STREET ADDRESS

d. CITY

e. STATE

f. ZIP CODE

9. DESTINATION

a. NAME OF CONSIGNEE

b. STREET ADDRESS

c. CITY

d. STATE

e. ZIP CODE

7. DELIVERY

FOB DESTINATION

OTHER (See Schedule)

10. PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS (Date) IMPORTANT: This is a request for information and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or service. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotation must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State and local taxes)

ITEM NUMBER

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

12. DISCOUNT FOR PROMPT PAYMENT

a. 10 CALENDAR DAYS (%)

b. 20 CALENDAR DAYS (%)

c. 30 CALENDAR DAYS (%)

d. CALENDAR DAYS

NUMBER

PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

b. STREET ADDRESS

c. COUNTY

d. CITY

e. STATE

f. ZIP CODE

14. SIGNATURE OF PERSON AUTHORIZED TO SIGN QUOTATION

PAGE

OF

PAGES

1. REQUEST NUMBER

2. DATE ISSUED

3. REQUISITION/PURCHASE REQUEST NUMBER

4. CERT. FOR NAT. DEF. UNDER BDSA REG. 2 AND/OR DMS REG. 1

RATING

5a. ISSUED BY

6. DELIVER BY (Date) 5b. FOR INFORMATION CALL (NO COLLECT CALLS)

NAME

TELEPHONE NUMBER

AREA CODE

NUMBER

THIS RFQ IS A SMALL BUSINESS SET-ASIDE.: 0
7. DELIVERY. FOB DESTINATION: 0
NOTE: Additional provisions and representations are attached.: 0
NOTE: Additional provisions and representations are not attached.: 0
7. DELIVERY. OTHER (See Schedule): 0
THIS RFQ IS NOT A SMALL BUSINESS SET-ASIDE.: 0
PAGE OF:
4. CERT. FOR NAT. DEF. UNDER BDSA REG. 2 AND/OR DMS REG. 1. RATING:
3. REQUISITION/PURCHASE REQUEST NUMBER:
1. REQUEST NUMBER:
5a. ISSUED BY:
5b. FOR INFORMATION CALL (NO COLLECT CALLS). NAME:
8. TO. a. NAME:
13. NAME AND ADDRESS OF QUOTER. f. ZIP CODE:
16. SIGNER. a. NAME (Type or print):
16. SIGNER. b. TELEPHONE. AREA CODE:
16. SIGNER. b. TELEPHONE. NUMBER:
16. SIGNER. c. TITLE (Type or print):
13. NAME AND ADDRESS OF QUOTER. e. STATE:
13. NAME AND ADDRESS OF QUOTER. d. CITY:
13. NAME AND ADDRESS OF QUOTER. b. STREET ADDRESS:
13. NAME AND ADDRESS OF QUOTER. c. COUNTRY:
13. NAME AND ADDRESS OF QUOTER. a. NAME OF QUOTER:
8. TO. c. STREET ADDRESS:
8. TO. d. CITY:
11. SCHEDULE (Include applicable Federal, State and local taxes). ITEM NUMBER. COLUMN A. Line 18 of 18:
11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT. COLUMN D.:
8. TO. e. STATE:
8. TO. f. ZIP CODE:
5b. FOR INFORMATION CALL (NO COLLECT CALLS). TELEPHONE NUMBER. AREA CODE:
8. TO. b. COMPANY:
5b. FOR INFORMATION CALL (NO COLLECT CALLS). TELEPHONE NUMBER. NUMBER:
9. DESTINATION. a. NAME OF CONSIGNEE:
9. DESTINATION. b. STREET ADDRESS:
9. DESTINATION. c. CITY:
9. DESTINATION. e. ZIP CODE:
9. DESTINATION. d. STATE:
PAGES:
2. DATE ISSUED. Enter 2 digit month, 2 digit day and 4 digit year.:
10. PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS (Date). Enter 2 digit month, 2 digit day and 4 digit year.:
15. DATE OF QUOTATION. Enter 2 digit month, 2 digit day and 4 digit year.:
6. DELIVER BY (Date). Enter 2 digit month, 2 digit day and 4 digit year.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:
12. DISCOUNT FOR PROMPT PAYMENT. a. 10 CALENDAR DAYS (%):
12. DISCOUNT FOR PROMPT PAYMENT. b. 20 CALENDAR DAYS (%):
12. DISCOUNT FOR PROMPT PAYMENT. c. 30 CALENDAR DAYS (%):
12. DISCOUNT FOR PROMPT PAYMENT. d. CALENDAR DAYS. NUMBER:
12. DISCOUNT FOR PROMPT PAYMENT. d. CALENDAR DAYS. PERCENTAGE:
14. SIGNATURE OF PERSON AUTHORIZED TO SIGN QUOTATION. Click to Sign. :

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