66III_R1_Exhibit_1.DOC
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- Attached to
- RFP-797-FSS-03-0001-R1: 66III Cost-Per-Test, Clinical Laboratory Analyzer Federal contract opportunity
- Solicitation number
- 797-FSS-03-0001-R1
About this file
This file is Exhibit 1 of RFP-797-FSS-03-0001-R1, containing special instructions for proposal preparation and contract data requirements for a Federal Supply Schedule (FSS) solicitation. The solicitation seeks multiple-award, fixed-price indefinite delivery-indefinite quantity (IDIQ) contracts for Cost-Per-Test Clinical Laboratory Analyzers covering chemistry, hematology, coagulation, urinalysis, microbiology, and immunochemistry capabilities under FSC Group 66, Part III. The Department of Veterans Affairs Veterans Health Administration is the procuring agency, with contract performance lasting five years from the effective date of award. This is an open and continuous solicitation with no closing date; offerors may submit proposals at any time. Proposals must be submitted in a single three-inch, three-ring binder and organized into four exhibits: Contract Data, Technical Proposal (addressing corporate experience, management plan, responsibility/past performance, and general liability insurance for each Special Item Number offered), Price Proposal with detailed pricing attachments, and a Subcontracting Plan for large businesses (those with estimated contract value of $550,000 or more).
Offerors must complete Standard Form 1449, provide current company information and business designations, comply with Central Contractor Registration requirements, and submit representations and certifications per FAR 52.212-3. Manufacturing facilities must be identified with FDA registration numbers, and all products must comply with the Trade Agreements Act. Delivery must be F.O.B. Destination within the 48 contiguous states and the District of Columbia, with optional coverage for Alaska, Hawaii, Puerto Rico, and worldwide delivery. Economic Price Adjustments are permitted in conjunction with contractor commercial practices, and all contracts will include an Industrial Funding Fee. Small Business size standards of 500 employees (including affiliates) apply. Contractors must comply with extensive information security requirements, undergo background investigations for personnel accessing VA information, complete mandatory cyber security and privacy training, and maintain compliance with FISMA, NIST standards, and VA data custodial requirements.
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Solicitation RFP-797-FSS-03-0001-R1 Exhibit 1 (07/2008)
EXHIBIT 1
SPECIAL INSTRUCTIONS FOR PROPOSAL PREPARATION
SUMMARY INSTRUCTIONS
1. Offerors must submit a complete proposal; proposals that are not complete will be returned. There is a checklist contained in the cover pages to this solicitation to assist offerors in verifying that all sections of the offer are completed. Offerors shall complete the check list and submit it with their proposals.
2. The information provided shall be concise, specific and complete, and shall demonstrate a thorough understanding of the requirements described in the Statement of Work section of the solicitation. Proposals are required to clearly demonstrate an offeror’s technical capabilities to perform in accordance with the requirements of this solicitation.
Form of Contract Data, Technical, AND PRICING Proposal REQUIREMENTS
1. Offer shall submit a single original signed and dated offer in a three (3) inch, three (3) ring binder. For your convenience a check list is contained herein to assist you in preparing a complete proposal package (See page CP-6 of the basic solicitation).
2. Offer shall include brochures, literature, and commercial price lists. Elaborate artwork, expensive paper and bindings, and expensive visual and other presentation aids are discouraged.
3. Proposals shall be separated into individually titled exhibits with their corresponding sub-factors and attachments. Each exhibit and sub-factor shall have a table of contents for easy reference:
· Exhibit 1 - Contract Data (Contract Data need only be submitted once)
· Exhibit 2 - Technical Proposal (Submit a response to sub-factors A – Corporate Experience; B – Management Plan; C – Responsibility/Past Performance; D – General Liability Insurance of this exhibit for each Special Item Number)
· Exhibit 3- Price Proposal (Complete Attachments 1a through 3d for each analyzer offered) Attachment 1a - Schedule of Items; Attachment 2a - Commercial Sales Practice Disclosures (CSP); Attachment 2b - CSP Spreadsheet; Attachment 2c - CPT/CPRR Price Analysis Disclosures; Attachment 2d - CSP Spreadsheet (Continued); Attachment 2d - CSP Spreadsheet (Continued); Attachment 3a - CPT/CPRR Proposed Pricing Model ; Attachment 3b - FSS Proposed Pricing Breakdown for CPT/CPRR; Attachment 3c - FSS Proposed Adjustments to CPT/CPRR Pricing ; Attachment 3d - CPT/CPRR Proposed Pricing Model (Sample)
· Exhibit 4 – Subcontracting Plan (For Large Businesses Only)
· Attachment 1 – WorldWide / Overseas Delivery (As applicable)
· Attachment 2 – Price Proposal / WorldWide Delivery (As applicable)
· Attachment 3 – Recovery Purchasing Participation
4. Please see each individual exhibit and attachment for specific instructions.
EXHIBIT 1 - Contract Data - Instructions
Content:
1. A completed signed and dated copy of Contract Data Cover Page. Offeror shall complete this cover page form as the first page of their offer. If necessary to ensure all of the requested information is provided attachments may be included. All information must be recent or current.
2. Compliance confirmation. Provide documentation supporting compliance with the identified requirements if applicable.
3. Standard Form 1449, be sure to complete the following block numbers:
· 12 with any prompt payment terms offered
· 17a with contractor’s legal name, complete address, phone number and Dun and Bradstreet Number
· 17b if remittance address is different from 17a
· 30a signature of offeror/contractor
· 30b typed or printed name of signer in 30a
· 30c date offer signed
4. Complete and return all clauses and provisions in this Exhibit.
Note: If an offeror has completed the annual representations and certifications electronically at https://orca.bpn.gov/, the offeror shall, at a minimum, complete paragraph (b) of the clause, 52.212-3 Offeror Representations and Certifications – Commercial Items (JUN 2008). If, after reviewing the information in the ORCA database, an offeror has determined that there are any additional representations that are necessary for the purposes of this solicitation, the offeror shall comply with the instructions found in paragraph (k)(2) of this clause.
CONTRACT DATA COVER PAGE
| Contractor Name (Include Doing Business As (DBA) if applicable) |
| Tax Identification Number (TIN): |
| Offeror’s Address: (Street/P.O.B., City, State, Zip) |
| Dun & Bradstreet Number (DUNS #): |
| Credit Card Accepted? |
| Yes |
| FORMCHECKBOX |
| No |
| FORMCHECKBOX |
| Affiliate’s Name(s) and Address(es): (if applicable) |
| IT Specialist: |
| Name: |
| Phone: |
| Company Website: |
Name(s) and Titles of Officers, Owners or Partners:
| Business Size/Designation: (Check all that apply) |
| Ordering Information |
| Small Business |
| FORMCHECKBOX |
| HUBZone Small Business |
| FORMCHECKBOX |
| Phone: |
| Woman Owned Small |
| FORMCHECKBOX |
| Veteran Owned Small Business |
| FORMCHECKBOX |
| Fax: |
| Small Disadvantaged |
| FORMCHECKBOX |
| Service Disabled Veteran Owned Small Business |
| FORMCHECKBOX |
Ordering Address:
| 8(a) Small Business |
| FORMCHECKBOX |
| Other than Small Business |
| FORMCHECKBOX |
| (None of the above) |
| FORMCHECKBOX |
| List All Authorized to Sign & Negotiate For This Contract (Include Name/Phone/Fax/E-mail) |
| Payment Address: |
| 1. |
| 2. |
| 3. |
| 24 Hour Emergency Point of Contact: |
| 4. |
| List All Persons Authorized to Administer the Contract for the Company: (Name/Title/Phone/Email) |
| Name: |
| Phone: |
| 1. |
| Fax: |
| 2. |
| Net Worth of Business: |
| Average Annual Sales or Receipts for Preceding 3 Years (indicate which): |
| Date: |
| Amount: |
The above information is current and accurate to the best of my knowledge.
Signature (Sign)
Date
Printed or Typed Name
Phone Number / E-Mail Address
COMPLIANCE CONFIRMATION
This section is mandatory for all offerors. Please confirm that your firm is in compliance with the following requirements of the solicitation as requested below.
1. Clause 52.212-4 CONTRACT TERMS AND CONDITIONS – COMMERCIAL ITEMS, paragraph (t) Central Contractor Registration by providing copies of your registration and/or some other form of documentation indicating compliance.
For additional assistance, reference www.ccr.gov
2. Clause 52.222-37, Employment Reports on Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans by providing a copy of your registration and/or some other form of documentation indicating compliance.
For additional assistance, reference http://vets100.cudenver.edu/vets100.asp Information and Information System Security Requirements
General The Contractor and Contractor personnel shall be subject to the same Federal laws, regulations, standards and VA policies as VA, and VA personnel, regarding information and information system security. Contractor activities and personnel must follow all of the Directives established by VA to include protection of computers and other mobile devices being used to process or transmit sensitive information.
Access to VA Information and VA Information Systems Contractor shall provide access to VA information to employees, subcontractors, and affiliates only to the extent necessary: (1) to perform the services specified in this Contract, (2) to perform necessary maintenance functions for electronic storage or transmission media necessary for performance of this contract, and (3) to individuals who first satisfy the same conditions, requirements and restrictions that comparable VA employees must meet in order to have access to the same VA information. These restrictions include the same level of background investigations, where applicable.
The contractor shall prescreen all personnel who will have access to VA information and information systems to ensure that they maintain U.S. citizenship and are able to read, write, speak and understand the English language.
All contractor employees who require access to the VA’s computer systems or who will have access to sensitive information, in any form, shall be the subject of a background investigation and must receive a favorable adjudication from the VA Security and Law Enforcement Office. The level of background security investigation will be in accordance with VA Directive 0710 and Handbook 0710 which are available at the following website: http://www.va.gov/pubs/asp/edsdirec.asp . Appropriate Background Investigation (BI) forms will be provided upon contract (or task order) award, and are to be completed and returned to the VA Security and Law Enforcement Office within 30 days for processing. If a contractor employee has previously obtained a successful adjudication of a background investigation of the appropriate level by an authorized investigating agency that is still valid, the contractor may submit proof of the successful adjudication rather than a completed VA BI form. VA Security and Law Enforcement Office will notify Contractors when the BI has been completed and adjudicated or when it has verified that the employee has a current successfully adjudicated background investigation at the appropriate level. These requirements are applicable to all subcontractor personnel requiring the same access. If the background investigation and adjudication are not completed prior to the start date of the contract, the employee may, at the discretion of the program office, work on the contract while the background investigation is being processed, but the contractor will be responsible for the actions of those individuals they provide to perform work for the VA. In the event that damage arises from work performed by contractor personnel, under the auspices of the contract, the contractor will be responsible for resources necessary to remedy the incident.
The investigative history for contractor personnel working under this contract must be maintained in the databases of either the Office of Personnel Management (OPM) or the Defense Industrial Security Clearance Organization (DISCO). Should the contractor use a vendor other than OPM or Defense Security Service (DSS) to conduct investigations, the investigative company must be certified by OPM/DSS to conduct contractor investigations.
The contractor shall bear the expense of obtaining background investigations. If the investigation is conducted by the Office of Personnel Management (OPM) through the VA, the contractor shall reimburse the VA within 30 calendar days.
Background investigations from investigating agencies other than OPM are permitted if the agencies possess an OPM and Defense Security Service certification. The Vendor Cage Code number must be provided to the Office of Security and Law Enforcement, which will verify the information and advise the contracting officer whether the contractor employee is authorized access to VA information and information systems for purposes of performing this contract .
The contractor, when notified of an unfavorable background determination by the Government, shall immediately withdraw the employee from performing work under the contract, and from access to VA information and information systems.
Failure to comply with the contractor personnel security requirements of this contract is grounds for termination of the contract for default.
Information and Information System Security Requirements (Continued)
Access to VA Information and VA Information Systems (Continued) Further, the contractor will be responsible for the actions of all individuals provided to work for the VA under this contract. In the event that damages arise from work performed by contractor-provided personnel under the auspices of this contract, the contractor will be responsible for all resources necessary to remedy the incident.
The position sensitivity for VA information and information systems that must be used or accessed to perform this contract has been designated as (insert level of sensitivity such as Low Risk) and the level of background investigation is a (insert level of investigation, such as NACI).
VA Data Custodial Requirements
All information and records provided to Contractor by VA, in whatever medium, as well as all information and documents, including drafts, emails, back-up copies, hand-written notes and copies that contain such information and records gathered or created by Contractor (collectively referred to as “VA information”) in the performance of this contract, regardless of storage media, are the exclusive property of VA. Contractor does not retain any property interest in these materials, and will not use them for any purpose other than performance of this contract.
Upon completion or termination of the contract, Contractor will either provide all copies of all VA information to VA or certify that it has destroyed all copies of all VA information as required by VA in a method specified by VA, at VA’s option. The Contractor will not retain any copies of VA information. Where immediate return or destruction of the information is not practicable, Contractor will return or properly destroy the information within 30 days of completion or termination of the contract. All provisions of this contract concerning the security and protection of the VA information that is the subject of this contract will continue to apply to the VA information for as long as the Contractor retains it, regardless of whether the contract has been completed or terminated.
Prior to termination or completion of this contract, Contractor will not destroy VA information received from VA or gathered or created by Contractor in the course of performing this contract without prior written approval by the VA contracting officer.
Contractor will receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of this contract and applicable federal and VA information confidentiality and security laws, regulations and policies. Applicable federal information security regulations include all applicable Federal information Processing Standards (FIPS) and Special Publications (SPs) issued by the National Institute of Standards and Technology (NIST). If federal or VA information confidentiality and security laws, regulations and policies become applicable to the VA information or information systems after execution of this contract, or if NIST issues or updates an applicable FIPS or SP after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations and policies, including FIPS or SP, in this contract.
The Contractor shall not make copies of VA information except as necessary to perform this agreement or to preserve electronic information stored on Contractor electronic storage media for restoration in case any electronic equipment or data used by the Contractor needs to be restored to an operating state.
A determination by VA that the Contractor has violated any of the information confidentiality and security provisions of this contract, including a violation of any applicable FIPS or SP, shall be sufficient grounds for VA to terminate the contract for default.
Contractor will store, transport or transmit VA information only in an encrypted form, using an encryption application that meets the requirements of FIPS 140-2, or is approved for use by VA.
The contractor’s firewall and web server, if applicable, shall meet or exceed NIST’s minimum requirements for security.
Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor may use and disclose VA information only in two other situations: (i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA’s prior written authorization. The contractor will refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA Contracting Officer for response.
Information and Information System Security Requirements (Continued)
VA Data Custodial Requirements (Continued) The contractor shall not release information protected by either 38 USC 5705 or 7332 in response to a court order, and shall immediately refer such court orders to VA for response.
Information System Design and Development
Information systems which are designed or developed for VA or on behalf of VA at non-VA facilities, shall comply with all Federal Information Security Management Act (FISMA), National Institute of Standards and Technology (NIST) Federal Information Processing Standard (FIPS) 200 and related VA security control requirements commensurate with the FIPS 199 system security categorization.
The system security categorization level is [Contracting Officer must insert Low, Moderate or High, as provided by the VA-approved ISO] Impact
The minimum security controls to be integrated into the system design or development are contained in the VA-approved (Contracting Officer must insert Low, Moderate or High AND attach a copy of the applicable security controls baseline to the RFP, RFQ, SOO, SOW, etc) security controls baseline.
The security controls must be designed, developed and implemented in accordance with the provisions of a VA-approved system development life cycle Information System Hosting, Operation, Maintenance or Use
For information systems which are hosted, operated, maintained, or used on behalf of VA at non-VA facilities, contractors are fully responsible and accountable for ensuring compliance with all Federal Information Security Management Act (FISMA), National Institute of Standards and Technology (NIST) Federal Information Processing Standard (FIPS) 200 and related VA security control requirements. The contractor security control procedures must be identical, not equivalent, to those procedures used to secure VA systems. For example, risk assessments, security plans, control testing, contingency planning, and certification and accreditation must, at a minimum, be based on risk and explicitly meet guidance from the National Institute of Standards and Technology (NIST).
The system security categorization level is [Contracting Officer must insert Low, Moderate or High] Impact
The minimum security controls implemented at the non-VA facility are contained in the VA-approved [Contracting Officer must insert Low, Moderate or High (same as above) AND attach a copy of the applicable security controls baseline to the RFP, RFQ, SOO, SOW, etc] security controls baseline.
The security controls must be in place prior to hosting, operation, maintenance, or use of the information system, or systems by or on behalf of VA.
At the beginning of the contract, and annually thereafter, the contractor will provide the results of an independent assessment and verification of security controls. The independent assessment and verification must apply the same standards that VA applies in the certification and accreditation of its information systems. Any deficiencies noted during this assessment must be provided to the COTR for entry into the VA’s Plan of Action and Milestone (POA&M) management process. The contractor will follow the VA’s POA&M process to document planned remedial actions to address any deficiencies in information security policies, procedures, and practices, and the completion of those activities. Security deficiencies must be corrected within the timeframes approved by the COTR. Contractor procedures will be subject to periodic, unannounced assessments by VA officials. The physical aspects associated with contractor activities will also be subject to such assessments.
All electronic storage media used on non-VA leased or owned IT equipment that is used to store, process, or access VA sensitive information must have all VA sensitive information removed, cleared, sanitized, or destroyed in accordance with VA policies and procedures upon the earlier of: (1) completion or termination of the contract or (2) disposal or return of the IT equipment by the contractor or any person acting on behalf of the contractor.
Information and Information System Security Requirements (Continued) Security Incident Investigation
The term “security incident” means an event that has, or could have, resulted in loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor shall immediately (within one hour) notify the COTR and simultaneously, the VA Network Security Operations Center (vasoc@va.gov) of any known or suspected security incident, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor has access.
To the extent known by the Contractor, the Contractor’s notice to VA will identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information was placed at risk or compromised), and any other information that the contractor considers relevant.
Contractor will simultaneously report the incident to the appropriate law enforcement entity(ies) of jurisdiction. The Contractor, its employees, and its subcontractors and their employees will cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The Contractor also will cooperate with VA in any civil litigation to recover VA information, to obtain monetary or other compensation from a third party for damages arising from any incident, or to obtain injunctive relief against any third party arising from, or related to, the incident.
To the extent practicable, Contractor shall mitigate any harmful effects on individuals whose VA information was accessed or disclosed in a security incident. In the event of a data breach with respect to any sensitive personal information processed or maintained by the contractor or subcontractor under the contract, the contractor is responsible for liquidated damages to be paid to the VA and for remediation to potentially harmed individuals (such as offering and paying for credit monitoring).
Security Controls Compliance Testing On a periodic basis, the VA, including the VA Office of Inspector General, may choose to evaluate any or all of the security controls implemented by the contractor under these clauses. With ten working-day’s notice, at the request of the Government, the contractor will fully cooperate and facilitate in a Government-sponsored security control assessment at each location wherein VA information is processed or stored, or information systems are developed, operated, maintained, or used on behalf of VA, including those initiated by the Office of the Inspector General. The government may conduct a security control assessment on shorter notice (to include unannounced assessments) determined by VA in the event of a security incident or at any other time.
Training
All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA networks:
(1) sign and acknowledge understanding of, and responsibilities for compliance with, the attached National Rules of Behavior relating to access to VA information systems;
(2) successfully complete VA Cyber Security Awareness training, and annual refresher training, as required;
(3) successfully complete VA General Privacy training, and annual refresher training, as required; and
(4) successfully complete any additional cyber security or privacy training as VA personnel with equivalent information system access, as required [to be defined by the VA Program Official and provided to the Contracting Officer for inclusion in the solicitation document – e.g., any Role-Based Information Security Training required in accordance with NIST Special Publication 800-16, Information Technology Security Training Requirements.] The contractor shall provide to the Contracting Officer a copy of the training certificates for each applicable employee within one week of completion of the training and annually thereafter, as required. These online courses are located at the following web site:
https://www.ees-learning.net/.
Failure to complete this mandatory training within the timeframe required will be grounds for suspension or termination of all physical and/or electronic access privileges and removal from work on the contract until such time as the training is completed.
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30
1. REQUISITION NUMBER
2. CONTRACT NO.
3. AWARD/EFFECTIVE
DATE
4. ORDER NO.
5. SOLICITATION NO.
RFP-797-FSS-03-0001-R1
6. SOLICITATION ISSUE DATE 07-01-2008
7. FOR SOLICITATION
INFORMATION CALL
a. NAME
HELPDESK,FSS621I@VA.GOV
b. TELEPHONE NUMBER (No collect calls) (708) 786-7722
8. OFFER DUE DATE/
Open and Continuous
9. ISSUED BY
CODE
10. THIS ACQUISITION IS
VA National Acquisition Center Federal Supply Schedule Service (049A2-2)
P.O. Box 76, Bldg 37, Hines IL 60141 Overnight deliveries should be mailed or hand delivered to the address located in block 16
FORMCHECKBOX
UNRESTRICTED OR
FORMCHECKBOX
SET ASIDE:
% FOR:
FORMCHECKBOX
SMALL BUSINESS
FORMCHECKBOX
EMERGING SMALL BUSINESS
FORMCHECKBOX
HUBZONE SMALL BUSINESS
NAICS: 334516 FORMCHECKBOX
SERVICE DISABLED VETERAN
FORMCHECKBOX
8(A)
SIZE STANDARD : 500 EMPLOYEES
11. DELIVERY FOR FOB DESTINA-
TION UNLESS BLOCK IS
MARKED
FORMCHECKBOX
SEE SCHEDULE
12. DISCOUNT TERMS
FORMCHECKBOX
13a.
THIS CONTRACT IS A
RATED ORDER UNDER
DPAS (15 CFR 700)
13b. RATING
14. METHOD OF SOLICITATION
RFQ
FORMCHECKBOX
IFB
FORMCHECKBOX
RFP
15. DELIVER TO
16. ADMINISTERED BY
| TO BE SHOWN ON INDIVIDUAL DELIVERY ORDER |
| VA National Acquisition Center |
Federal Supply Schedule Service (049A2-2)
1st Avenue, 1 Block North of 22nd Street Bldg 37
Hines IL 60141
17a. CONTRACTOR/
OFFEROR
FACILITY
18a. PAYMENT WILL BE MADE BY
TO BE SHOWN ON INDIVIDUAL DELIVERY ORDER
FORMCHECKBOX
17b.
CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN
OFFER
18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK
BELOW IS CHECKED FORMCHECKBOX
SEE ADDENDUM
19.
ITEM NO.
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
FSC
CLASS (ES)
FEDERAL SUPPLY SCHEDULE
FSC GROUP 66, PART III, COST PER TEST
CLINICAL LABORATORY ANALYZER: Chemistry
Hematology, Coagulation, Urinalysis, Microbiology
And Immunochemistry
(Attach Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA
26. TOTAL AWARD AMOUNT (For Govt. Use Only)
Estimated $
FORMCHECKBOX
27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA
FORMCHECKBOX
ARE
FORMCHECKBOX
ARE NOT ATTACHED.
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA
ARE
FORMCHECKBOX
ARE NOT ATTACHED.
FORMCHECKBOX
28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN __1 _ COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.
FORMCHECKBOX
29. AWARD OF CONTRACT: REFERENCE FPR OFFER
DATED . YOUR OFFER ON SOLICITATION
(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:
SEE SUMMARY OF AWARD DOCUMENTS
| 30a. SIGNATURE OF OFFEROR/CONTRACTOR |
| 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) |
30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT)
| 30c. DATE SIGNED |
| 31b. NAME OF CONTRACTING OFFICER (Type or print) |
31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE
STANDARD FORM 1449 (REV. 3/2005)
Prescribed by GSA - FAR (48 CFR) 53.212
STANDARD FORM 1449 (REV. 3/2005) BACK
19.
ITEM NO.
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
32a. QUANTITY IN COLUMN 21 HAS BEEN
RECEIVED
FORMCHECKBOX
INSPECTED
ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:
32b. SIGNATURE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE
| 32c. DATE |
| 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT |
REPRESENTATIVE
| 32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE |
| 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE |
32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE
| 33. SHIP NUMBER |
| 34. VOUVHER NUMBER |
| 35. AMOUNT VERIFIED |
CORRECT FOR
36. PAYMENT
FORMCHECKBOX
COMPLETE
FORMCHECKBOX
PARTIAL
FORMCHECKBOX
FINAL
37. NUMBER
PARTIAL
FINAL
| 38. S/R ACCOUNT NO. |
| 39. S/R VOUCHER NUMBER |
| 40. PAID BY |
| 41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT |
| 42a. RECEIVED BY (Print) |
| 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER |
| 41c. DATE |
42b. RECEIVED AT (Location)
| 42c. DATE REC’D (YY/MM/DD) |
| 42d. TOTAL CONTAINERS |
STANDARD FORM 1449 (REV. 3/2005) BACK
| ACH VENDOR / MISCELLANEOUS PAYMENT |
| OMB No. 1510-0056 |
ENROLLMENT FORM
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment-related information processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the
Treasury Department to transmit payment data, by electronic means to vendor's financial institution. Failure to provide the requested information may delay or prevent the receipt of payments thru the Automated Clearing House Payment System.
FEDERAL PROGRAM AGENCY
VA Finance Center
AGENCY IDENTIFIER:
| AGENCY LOCATION CODE (ALC) |
| ACH FORMAT: |
| xxxxxxxxxxxxxxxxxx |
| xxxxxxxxxxxxxxxxxxxxx |
| ( CCD |
( CTX
ADDRESS
P. O. Box 149970
Austin, Texas 78714
CONTACT PERSON NAME:
TELEPHONE NUMBER
ATTN: VENDORIZING UNIT
( 512 ) 460-5049
ADDITIONAL INFORMATION:
| FAX # (512) |
| 460-5221 |
PAYEE / COMPANY INFORMATION
NAME
SSN NO. OR TAXPAYER ID NO.
ADDRESS
CONTACT PERSON NAME:
TELEPHONE NUMBER:
FINANCIAL INSTITUTION INFORMATION
NAME
ADDRESS
ACH COORDINATOR NAME:
TELEPHONE NUMBER:
NINE-DIGIT ROUTING TRANSIT NUMBER:
DEPOSITOR ACCOUNT TITLE:
DEPOSITOR ACCOUNT NUMBER:
TYPE OF ACCOUNT
| ( CHECKING |
| ( SAVINGS |
( LOCKBOX
SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL:
TELEPHONE NUMBER:
(Could be the same as ACH Coordinator)
SF 3881 (Rev 12/90) deliveries or performance
AS216 MANUFACTURING FACILITIES/PLACE OF PERFORMANCE (MARCH 1997)
1. Offeror must indicate in the space below and/or by attachment, if additional space is needed, (a) exact product(s) Offeror desires to furnish to the Government (b) whether the Offeror manufactures FORMCHECKBOX the product(s) and/or if he/she is a distributor FORMCHECKBOX of the product(s) manufactured by another firm, indicate in the appropriate space.
SIN
FACILITY LOCATION (NAME, ADDRESS, CITY, CONTY, STATE AND ZIP CODE)
FACILITY’S FDA REGISTRATION NUMBER
PERSON TO BE CONTACTED INCLUDING PHONE NUMBER
Notes:
A. If the product(s) are to be manufactured at more than one location, each location should be identified and product(s) manufactured at the facility should be identified. Also list the names and locations of (packager, labelers, etc.,) who participate in the production of product(s) to be furnished to the Government.
B. Products can be identified by Special Item Number as listed on Attachment 1a of Exhibit 3.
C. Where items of foreign origin are involved, it is essential that the countries in which the items are produced or manufactured be identified.
2. When more than one manufacturing facility is involved for any manufacturing or processing or more than one component is included under the SIN, the names, locations and ownership of all facilities must be shown. The names and locations of the manufacturing facilities, where manufacture of the time offered herein will be performed are:
A. COMPONENT MATERIAL
| Components manufactured by |
| in the facilities located at |
| FDA Reg. No. |
| which are owned by |
Note:
Component information necessary only when component is a finished device used in a kit.
B. STERILIZATION
| Sterilization performed by |
| in the facilities located at |
| FDA Reg. No. |
| which are owned by |
AS216 MANUFACTURING FACILITIES/PLACE OF PERFORMANCE (MARCH 1997) (CONTINUED)
3. Irrespective of whether plants are owned or leased by the offeror, the contracting officer may require offerors to furnish evidence of ownership of leasing of such plant(s) for performance of contract bid upon, together with a statement signed by all parties certifying that no agreements or understandings exist between the parties other than those specified in the documents furnished.
4. The performance of any of the work contracted for in any place other than that named in the offer and any resulting contract is prohibited unless the same is specifically approved in advance by the contracting officer. Full responsibility for fulfillment of the contract will remain with the contractor.
5. In the event of facility listed above is not owned or leased by the offeror, offeror shall make available to the contracting officer, within five days of a request therefore by the contracting officer, written evidence of a commitment by the owner or leasee of such facility that the described materials or components will be supplied by owner/leasee and/or any described manufacturing, processing or packing and packaging will be performed by owner/leasee. Evidence of the commitment at the lease shall be in the form of a firm offer which indicates the stipulated time for acceptance thereof.
6. CAUTION:
(i) No change in the place of performance shall be permitted between the opening/closing date of offer and the award except where time permits and then only upon receipt of the contracting officers written approval.
(ii) Offeror agrees to inform the Department of Veterans Affairs, National Acquisition Center (049A1F2), P.O. Box 76, Hines, IL 60141, immediately of any relocation of this prime facility or the relocation of any subcontractors facility and;
(iii) If at any time during the life of the contract, the contractors facility, or the source from which the contractor obtains any of the item(s) listed under this contract, fails to meet Good Manufacturing Practice Regulations (GMPRs) (Public Law 94-295), the contract may be subject to termination, in whole or in part, without liability to the Government, plus;
(iv) Any products manufactured during this period of GMPRs deficiencies will not be shipped, and that material which has been received, shall be returned as rejected goods.
F-FSS-202-G DELIVERY PRICES (JAN 1994) (DOMESTIC COVERAGE ONLY)
(a) Prices offered must cover delivery as provided below to destinations located within the 48 contiguous States and the District of Columbia.
(1) Delivery to the door of the specified Government activity by freight or express common carriers on articles for which store-door delivery is provided, free or subject to a charge, pursuant to regularly published tariffs duly filed with the Federal and/or State regulatory bodies governing such carrier; or, at the option of the Contractor, by parcel post on mailable articles, or by the Contractor's vehicle. Where store-door delivery is subject to a charge, the Contractor shall (a) place the notation "Delivery Service Requested" on bills of lading covering such shipments, and (b) pay such charge and add the actual cost thereof as a separate item to his invoice.
(2) Delivery to siding at destinations when specified by the ordering office, if delivery is not covered under paragraph (a)(1), above.
(3) Delivery to the freight station nearest destination when delivery is not covered under paragraph (a)(1) or (a)(2), above.
F-FSS-202-G DELIVERY PRICES (JAN 1994) (DOMESTIC COVERAGE ONLY) (CONTINUED)
(b) The offeror is requested to indicate below whether or not prices submitted cover delivery f.o.b. destination in Alaska, Hawaii, and the Commonwealth of Puerto Rico.
(Yes)
(No)
| Alaska |
| Hawaii |
| Puerto Rico |
(c) When deliveries are made to destinations outside the contiguous 48 States; i.e., Alaska, Hawaii, and the Commonwealth of Puerto Rico, and are not covered by paragraph (b), above, the following conditions will apply:
(1) Delivery will be f.o.b. inland carrier, point of exportation (FAR 52.247-38), with the transportation charges to be paid by the Government from point of exportation to destination in Alaska, Hawaii, or the Commonwealth of Puerto Rico, as designated by the ordering office. The Contractor shall add the actual cost of transportation to destination from the point of exportation in the 48 contiguous States nearest to the designated destination. Such costs will, in all cases, be based upon the lowest regularly established rates on file with the Interstate Commerce Commission, the U.S. Maritime Commission (if shipped by water), or any State regulatory body, or those published by the U.S. Postal Service; and must be supported by paid freight or express receipt or by a statement of parcel post charges including weight of shipment.
(2) The right is reserved to ordering agencies to furnish Government bills of lading.
(d) Ordering offices will be required to pay differential between freight charges and express charges where express deliveries are desired by the Government.
552.211-78 COMMERCIAL DELIVERY SCHEDULE (MULTIPLE AWARD SCHEDULE) (FEB 1996) (DOMESTIC DELIVERY)
(a) Time of Delivery. The Contractor shall deliver to destination within the number of calendar days after receipt of order (ARO) in the case of F.O.B. Destination prices; or to place of shipment in transit in the case of F.O.B. Origin prices, as set forth below. Offerors shall insert the “Time of Delivery (days of ARO)” column in the schedule of Items a definite number of calendar days within which delivery will be made. In no case shall the offered delivery time exceed the Contractor’s normal commercial practice. The Government requires the Contractor’s normal commercial delivery time, as long as it is less than the “stated” delivery time(s) shown below. If the Offeror does not insert a delivery time in the schedule of Items, the Offeror will be deemed to offer delivery in accordance with the Government’s stated delivery time, as stated below:
Items or group of items (special item No. or nomenclature)
| Government’s stated deliver time (days ARO) |
| Contractor’s normal commercial delivery time |
| Proposed delivery time to the Government |
ALL SINS
552.211-78 COMMERCIAL DELIVERY SCHEDULE (MULTIPLE AWARD SCHEDULE) (FEB 1996) (DOMESTIC DELIVERY) (CONTINUED)
(b) Expedited Delivery Times. For those items that can be delivered quicker than the delivery times in paragraph (a), above, the offeror is requested to insert below, a time (hours/days ARO) that delivery can be made when expedited delivery is requested.
Items or group of items (Special Item No. or nomenclature)
Expedited delivery time (hours/days ARO))
(c) Overnight and 2-Day Delivery Times. Ordering activities may required overnight or 2-day delivery. The Offeror is requested to annotate its price list or by separate attachment identify the items that can be delivered overnight or within 2 days. Contractors offering such delivery services will be required to state in the cover sheet to its FSS price list details concerning this service.
CONTRACT ADMINISTRATION DATA
K-FSS-1 AUTHORIZED NEGOTIATORS (MAR 1998) (VARIATION)
The offeror shall, in the spaces below, fill in the names of all persons authorized to negotiate and sign offers and contracts in the company name with the Government in connection with this request for proposals or quotations: (List the names, titles, and telephone numbers and electronic mail address of the authorized negotiators)
G-FSS-900-C CONTACT FOR CONTRACT ADMINISTRATION (JUL 2003)
Offerors should complete paragraphs (a) and (b) if providing both domestic and overseas delivery. Complete paragraph (a) if providing domestic delivery only. Complete paragraph (b) if providing overseas delivery only.
The Contractor shall designate a person to serve as the contract administrator for the contract both domestically and overseas. The contract administrator is responsible for overall compliance with contract terms and conditions. The contract administrator is also the responsible official for issues concerning 552.238-74, Industrial Funding Fee and Sales Reporting (JUL 2003), including reviews of contractor records. The Contractor’s designation of representatives to handle certain functions under this contract does not relieve the contract administrator of responsibility for contract compliance. Any changes to the designated individual must be provided to the Contracting Officer in writing, with the proposed effective date of the change.
G-FSS-900-C CONTACT FOR CONTRACT ADMINISTRATION (JUL 2003) (CONTINUED)
(a) Domestic:
| NAME |
| TITLE |
| ADDRESS |
| ZIP CODE |
| TELEPHONE NO |
| FAX NO. |
| E-MAIL ADDRESS |
(b) Overseas: Overseas contact points are mandatory for local assistance with the resolution of any delivery, performance, or quality complaint from customer agencies. (Also, see the requirement in I‑FSS‑594, Parts and Service.) At a minimum, a contact point must be furnished for each area in which deliveries are contemplated, e.g., Europe, South America, Far East, etc.
| NAME |
| TITLE |
| ADDRESS |
| ZIP CODE |
| TELEPHONE NO |
| FAX NO. |
| E-MAIL ADDRESS |
552.216-73 ORDERING INFORMATION (SEP 1999) (ALTERNATE II—SEP 1999)
(a) In accordance with the Placement of Orders clause of this solicitation, the offeror elects to receive orders placed by GSA's Federal Supply Service (FSS) by either FORMCHECKBOX facsimile transmission or FORMCHECKBOX computer-to-computer Electronic Data Interchange (EDI).
(b) An offeror electing to receive computer-to-computer EDI is requested to indicate below the name, address, and telephone number of the representative to be contacted regarding establishment of an EDI interface.
552.216-73 ORDERING INFORMATION (SEP 1999) (ALTERNATE II—SEP 1999) (CONTINUED)
(c) An offeror electing to receive orders by facsimile transmission is requested to indicate below the telephone number(s) for facsimile transmission equipment where orders should be forwarded.
(d) For mailed orders, the offeror is requested to include the postal mailing address(es) where paper form orders should be mailed.
(e) Offerors marketing through dealers are requested to indicate below whether those dealers will be participating in the proposed contract.
YES FORMCHECKBOX
NO FORMCHECKBOX
If "yes" is checked, ordering information to be inserted above shall reflect that in addition to offeror's name, address, and facsimile transmission telephone number, orders can be addressed to the offeror's name, c/o nearest local dealer. In this event, two copies of a list of participating dealers shall accompany this offer, and shall also be included in Contractor's Federal Supply Schedule pricelist.
52.223-3 HAZARDOUS MATERIAL IDENTIFICATION AND MATERIAL SAFETY DATA (JAN 1997) -- ALTERNATE I (JUL 1995)
(a) “Hazardous material,” as used in this clause, includes any material defined as hazardous under the latest version of Federal Standard No. 313 (including revisions adopted during the term of the contract).
(b) The offeror must list any hazardous material, as defined in paragraph (a) of this clause, to be delivered under this contract. The hazardous material shall be properly identified and include any applicable identification number, such as National Stock Number or Special Item Number. This information shall also be included on the Material Safety Data Sheet submitted under this contract.
MATERIAL
(If none, insert “None”)
Identification No.
52.223-3 HAZARDOUS MATERIAL IDENTIFICATION AND MATERIAL SAFETY DATA (JAN 1997) -- ALTERNATE I (JUL 1995) (CONTINUED)
(c) This list must be updated during performance of the contract whenever the Contractor determines that any other material to be delivered under this contract is hazardous.
(d) The apparently successful offeror agrees to submit, for each item as required prior to award, a Material Safety Data Sheet, meeting the requirements of 29 CFR 1910.1200(g) and the latest version of Federal Standard No. 313, for all hazardous material identified in paragraph (b) of this clause. Data shall be submitted in accordance with Federal Standard No. 313, whether or not the apparently successful offeror is the actual manufacturer of these items. Failure to submit the Material Safety Data Sheet prior to award may result in the apparently successful offeror being considered nonresponsible and ineligible for award.
(e) If, after award, there is a change in the composition of the item(s) or a revision to Federal Standard No. 313, which renders incomplete or inaccurate the data submitted under paragraph (d) of this clause, the Contractor shall promptly notify the Contracting Officer and resubmit the data.
(f) Neither the requirements of this clause nor any act or failure to act by the Government shall relieve the Contractor of any responsibility or liability for the safety of Government, Contractor, or subcontractor personnel or property.
(g) Nothing contained in this clause shall relieve the Contractor from complying with applicable Federal, State, and local laws, codes, ordinances, and regulations (including the obtaining of licenses and permits) in connection with hazardous material.
(h) The Government’s rights in data furnished under this contract with respect to hazardous material are as follows:
(1) To use, duplicate and disclose any data to which this clause is applicable. The purposes of this right are to -
(i) Apprise personnel of the hazards to which they may be exposed in using, handling, packaging, transporting, or disposing of hazardous materials;
(ii) Obtain medical treatment for those affected by the material; and
(iii) Have others use, duplicate, and disclose the data for the Government for these purposes.
(2) To use, duplicate, and disclose data furnished under this clause, in accordance with subparagraph (h)(1) of this clause, in precedence over any other clause of this contract providing for rights in data.
(3) The Government is not precluded from using similar or identical data acquired from other sources.
(i) Except as provided in paragraph (i)(2), the Contractor shall prepare and submit a sufficient number of Material Safety Data Sheets (MSDS’s), meeting the requirements of 29 CFR 1910.1200(g) and the latest version of Federal Standard No. 313, for all hazardous materials identified in paragraph (b) of this clause.
(1) For items shipped to consignees, the Contractor shall include a copy of the MSDS’s with the packing list or other suitable shipping document which accompanies each shipment. Alternatively, the Contractor is permitted to transmit MSDS’s to consignees in advance of receipt of shipments by consignees, if authorized in writing by the Contracting Officer.
52.223-3 HAZARDOUS MATERIAL IDENTIFICATION AND MATERIAL SAFETY DATA (JAN 1997) -- ALTERNATE I (JUL 1995) (CONTINUED)
(2) For items shipped to consignees identified by mailing address as agency depots, distribution centers or customer supply centers, the Contractor shall provide one copy of the MSDS’s in or on each shipping container. If affixed to the outside of each container, the MSDS’s must be placed in a weather resistant envelope.
C-FSS-411 FIRE OR CASUALTY HAZARDS, OR SAFETY OR HEALTH REQUIREMENTS (OCT 1992)
(a) Items in this solicitation which involve fire or casualty hazards (e.g., items containing electrical components), or safety or health requirements, shall conform to the safety standards (if any) for such products issued by a nationally recognized standards developing organization. The offeror shall identify in the spaces below whether any such standards are applicable to the products offered, and if so, which standard(s) applies. (Check one).
1.
There are no nationally recognized safety standards which are applicable to any of the products offered under this solicitation.
2.
The safety standard(s) identified below are applicable to the following products offered under this solicitation:
PRODUCT
STANDARD
There are no nationally recognized safety standards which are applicable to the other products offered (if any).
(b) The offeror must furnish proof, satisfactory to the Government, that the products offered will conform with the requirements of the published safety standards. Acceptable proof of conformance includes a labeling, listing, or acceptance of the product by an organization approved by the Occupational Safety and Health Administration (OSHA) as a "Nationally Recognized Testing Laboratory" (NRTL). This conformance requirement must be maintained with respect to all applicable products furnished under resultant contracts.
(c) Information regarding currently-approved NRTL's may be obtained by writing to the following:
NRTL Recognition Program Office of Variance Determination Occupational Safety and Health Administration U.S. Department of Labor 200 Constitution Avenue, N.W.
Room N-3653 Washington, DC 20210
(202) 219-7193
C-FSS-411 FIRE OR CASUALTY HAZARDS, OR SAFETY OR HEALTH REQUIREMENTS (OCT 1992) (CONTINUED) Note: A listing of organizations currently recognized by OSHA as NRTLs can be obtained via the web at www.osha-slc.gov/dts/otpca/nrtl/index.html
552.232-82 CONTRACTOR’S REMITTANCE (PAYMENT) ADDRESS (MAY 2003)
(a) Payment by electronic funds transfer (EFT) is the preferred method of payment. However, under certain conditions, the ordering activity may elect to make payment by check. The offeror shall indicate below the payment address to which checks should be mailed for payment of proper invoices submitted under a resultant contract.
PAYMENT ADDRESS:
(b) Offeror shall furnish by attachment to this solicitation, the remittance (payment) addresses of all authorized participating dealers receiving orders and accepting payment by check in the name of the Contractor in care of the dealer, if different from their ordering address(es) specified elsewhere in this solicitation. If a dealer's ordering and remittance address differ, both must be furnished and identified as such.
552.232-82 CONTRACTOR’S REMITTANCE (PAYMENT) ADDRESS (MAY 2003)
(c) All offerors are cautioned that if the remittance (payment) address shown on an actual invoice differs from that shown in paragraph (b) of this provision or on the attachment, the remittance address(es) in paragraph (b) of this provision or attached will govern.
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