Sol_A15PS00267.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

A04

DOI Building Contracting Office 2021 4tTH AVENUE NORTH

BIA RMRO 00004

CODE 16. ADMINISTERED BYCODE

X

X

X

423710

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED ORA04

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

03/20/2015 1500 MT

03/09/2015

208-387-5566Michelle Cruzsalum (No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

A15PS00267

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 3 0040199001OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

BILLINGS MT 59101-1461

TELEPHONE NO.

17a. CONTRACTOR/

Multiple Destinations

15. DELIVER TO

BILLINGS MT 59101-1461

DOI Building Contracting Office 2021 4tTH AVENUE NORTH

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

BIA RMRO 00004

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

**100% Small Business Buy Indian Set Aside Buy**

The Bureau of Indian Affairs, National Interagency Fire Center intends to purchase hose reels. Contractor shall furnish all materials to include mounting brackets and spool assemblies, and transportation.

Vendor DUNS Number:___________________________ Suggested COR: SSMART Continued ...

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

Michelle Cruzsalum

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Delivery: 07/30/2015

00010 BIA-28-19-LT Hannay Reel Assembly 7 EA

Delivery Location Code: 0009061909

BIA NIFC: Susan Smart

2010 North Willow Street

EAGLE BUTTE SD 57625 US

00020 Freight to Eagle Butte Center

Delivery Location Code: 0009061909

BIA NIFC: Susan Smart

2010 North Willow Street

EAGLE BUTTE SD 57625 US

Period of Performance: 03/09/2015 to 07/30/2015

Delivery Date: Buyer requires seller to deliver on or before delivery date.

00030 HAN-SBEPF 27.5-19-21LT Alum Reel Assembl 11 EA

Delivery Location Code: 0009061982

BIA NIFC: Chester Gladstone

5785 Highway 10 West

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

3 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 3

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

A15PS00267

MISSOULA MT 59808 US

00040 Freight to Missoula, Montana

Delivery Location Code: 0009061982

BIA NIFC: Chester Gladstone

5785 Highway 10 West

MISSOULA MT 59808 US

Period of Performance: 03/09/2015 to 07/30/2015

Delivery Date: Buyer requires seller to deliver on or before delivery date.

00050 HAN-SBEPF 27.5-19-21LT Alum Reel Assembl 2 EA

Delivery Location Code: 0009061904

BIA NIFC: Bernadette Lucero

37 Hillside Drive

DULCE NM 87528 US

00060 Freight to Dulce, NM

Delivery Location Code: 0009061909

BIA NIFC: Susan Smart

2010 North Willow Street

EAGLE BUTTE SD 57625 US

Period of Performance: 03/09/2015 to 07/30/2015

Delivery Date: Buyer requires seller to deliver on or before delivery date.

Please Total Line Item Numbers 00010 to 00060.

Grand Total $___________________________________

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110