Sol_A15PS00554.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

A07

BIA BUILDING 1

1001 INDIAN SCHOOL RD NW

Contracting Office

DOI, BIA SWRO

0009061837 CODE 16. ADMINISTERED BYCODE

X

X

X

446130

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED ORA07

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

05/28/2015 1700 ET

05/15/2015

505-563-3015Marita Roth (No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

A15PS00554

5. SOLICITATION NUMBER

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

1 9 0040210115OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

Albuquerque NM 87104

TELEPHONE NO.

17a. CONTRACTOR/

ALBUQUERQUE NM 87120

9169 Coors Rd NW

BIE SOUTHWESTERN IND POLY INST

15. DELIVER TO

Albuquerque NM 87104

BIA BUILDING 1

Contracting Office

1001 INDIAN SCHOOL RD NW

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$20.5

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 SWRO 00007

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.

Delivery: 06/15/2015

Optical equipment is needed for Accreditation at the Southwestern Indian Polytechnic Institute (SIPI), Albuquerque, New Mexico.

00010 Topcon Pinnacle Integrated Delivery System - 1 EA

(1) TOP/24450 Topcon Pinnacle Integrated Delivery System - Desk with Triallens drawer, Refractor and Slit lamp arms, OH Lamp, Remote control, Room light wiring kit, Choices, 1 Each;

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

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

Marita Roth

. 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.

(2) TOP/24046 Topcon Manual recline examination chair, (color choice and Height Choice), New, 1

Each;

(3) TOP/13081K1 Topcon CV-5000S with power supply, and KB-50S Controller, New, 1 Each;

(4) TOP/12035K1 Topcon PC-50S 19" LCD Acuity

Chart, for CV-SOOOS with 26' OVI cable to CV, w/wall mount New, Charge w/CV-5000S above;

(5) TOP/28052 Topcon SL-D2 digital slit lamp, (Zeiss style) Galilean-type drum, 1OX, 16X and

25x. (DC-1 digital camera ready), New, 1 Each;

(6) WA/11720 - Welch Allyn Model11720

Ophthalmoscope, Coaxial, 3.5 Volt Head only, 1

Each;

(7) WA/18245 - Welch Allyn Model18245 Streak

Retinoscope, Halogen, 3.5 Volt, Head only, New, 1

Each;

(8) WA/41100 - Welch Allyn 41100

Transilluminator, 3.5v halogen, New, 1 Each;

(9) WA/71670 - Welch Allyn Model71670 Handle -

Halogen 3.5 Volt, well rechargable, New, 3 Each;

(10) KEE/1205-P-2000 Keeler All Pupil II

Slimline Wireless Convertible LED/Halogen BIO w/Charger & 2 Batteries. New, 1 Each;

(11) TOP/10054-CL-300PLN - Topcon CL-300 Auto

Lensmeter with printer, UV, PO, LAN connection, Color Screen, 115V, New, 1 Each;

(12) TOP/15094 Topcon KR-800 Auto Keratometer

Refractometer, New, will connect with existing

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

9 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 9

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

A15PS00554

KR-8900, 1 Each;

(13) TOP/13080 CVTNG Installation and Training on

Topcon CV-5000S Refraction System, (Performed by

Topcon), 1 day, 1 Each;

(14) TOP/13306 Interface Cable, KR, CL,CV, MC, 30', 1 Each;

(15) TOP/13356K Bluetooth connection kit, KR-CL-CV, 1 Each;

(16) Install - Lane Installation, Chair,Pinnacle system, balance of instrumentation, 1 day by GOE

Tech, 1 Each;

(17) Freight.

00020 Finer/Polisher to include Installation/set up and 1 EA training -

(1) OPT/WFPZ OWC Finder/Polisher, easily adjustable strokes; pneumatic lap tables, Dual timer, dual speed, Stainless steel bowl, 16"W, 30"D, 46"H, 420 lbs, 110V, 60Hz, 12A, 2 Each;

(2) Complete installation/set up, and training at

SIPI, 1 Each, Setup;

(3) Freight.

00030 Essilor Neksia Tracer/Blocker system to include 1 EA installation set-up and training -

(1) ESS/M25175 - Essilor Neksia Patternless

Edger, P/P/P, All plastics, polish, safety bevel and groove, 115V, 1 year warranty, New, 1 Each;

(2) ESS/L20012 - Essilor Neksia Tracer/Blocker, with shape modification software, 115V, 1 year warranty, New, 1 Each;

(3) MISC/PARTS - Pump, Tank, water control solenoids, Hoses, barcode readers, line conditioner, 1 Each;

(4) Complete installation/set up, and training at

SIPI, 1 Each;

(5) Freight.

Continued ...

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

Sponsored by GSA

FAR (48 CFR) 53.110

4 9

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

A15PS00554

00040 Essilor Mr. Orange/ Mr. Blue system - 1 EA

(1) ESS/M22175 - Essilor Mr. Orange, Cuts all plastics, 30 degree Drilling, Rimless Groove, All plastics Polishing, 115V, 60 Hz, 1 Each;

(2) ESS/L14042 - Essilor Mr. Blue 2.0 Tracer

Blocker, Auto, 115V, 1 Each;

(3) Setup. Complete installation/set up, and training at SIPI, 1 Each;

(4) Freight.

00050 Topcon OC-2200 Examination Chair System - 1 EA

(1) TOP/24046 Topcon OC-2200 Manual recline examination chair, (color choice and Height

Choice), New, 1 Each:

(2) TOP/23055 Topcon IS-2500 Instrument Stand, (w/o 3rd arm), New, 1 Each;

(3) TOP/VT10 Topcon VT-10 Phoropter, -cyls.

w/reading card and rod, 1 Each;

(4) TOP/28052 Topcon SL-D2 digital slit lamp, (Zeiss style) Galilean-type drum, 10X, 16X and

25x. (DC-1 digital camera ready), New, 1 Each;

(5) GOENC1701L GOE VC1701L Digital Acuity System, full featured system w/remote control, (wall mount included) 17" LED LCD, 1 year warranty, New, 1 Each;

(6) KEE/1205-P-2000 - Keeler All Pupil II

Slimline Wireless Convertible LED/Halogen BIO w/Charger & 2 Batteries, New, 1 Each;

(7) WN11720 - Welch Allyn Model 11720

Ophthalmoscope. Coaxial, 3.5 Volt. Head only, 1

Each;

(8) WN18245 - Welch Allyn Model 18245 Streak

Retinoscope, Halogen, 3.5 Volt, Head only, New, 1

Each;

(9) WN41100 - Welch Allyn 41100 Transilluminator, 3.5v halogen, New, 1 Each;

(10) WA/71670 - Welch Allyn Model 71670 Handle, Halogen 3.5 Volt, well rechargeable, New, 3 Each;

(11) Install - Lane Installation, 1 Each.

00060 Topcon OC-2200 Examination Chair System - 1 EA

Continued ...

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

5 9

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

A15PS00554

(1) TOP/24046 Topcon OC-2200 Manual recline examination chair, (color choice and Height

Choice), New, 1 Each;

(2) TOP/23055 Topcon IS-2500 Instrument Stand, (w/o 3rd arm), New, 1 Each;

(3) TOP/VT10 Topcon VT-10 Phoropter, -cyls.

w/reading card and rod, 1 Each;

(4) TOP/28052 Topcon SL-D2 digital slit lamp, (Zeiss style) Galilean-type drum, 10X, 16X and

25x, (DC-1 digital camera ready), New, 1 Each;

(5) GOENC1701L GOE VC1701L Digital Acuity System, full featured system w/remote control, (wall mount included) 17" LED LCD, 1 year warranty, New, 1 Each;

(6) KEE/1205-P-2000 - Keeler All Pupil II

Slimline Wireless Convertible LED/Halogen BIO w/Charger & 2 Batteries, New, 1 Each;

(7) WN11720 - Welch Allyn Model 11720

Ophthalmoscope, Coaxial, 3.5 Volt, Head only, 1

Each;

(8) WN18245 - Welch Allyn Model 18245 Streak

Retinoscope, Halogen, 3.5 Volt, Head only, New, 1

Each;

(9) WN41100 - Welch Allyn 41100 Transilluminator, 3.5v halogen, list $110 (6/13), New, 1 Each;

(10) WA/71670 - Welch Allyn Model 71670 Handle, Halogen 3.5 Volt, well rechargeable, New, 3 Each;

(11) Install - Lane Installation, 1 Each.

00070 Topcon OC-2200 Examination Chair System - 1 EA

(1) TOP/24046 Topcon OC-2200 Manual recline examination chair, (color choice and Height

Choice), New, 1 Each;

(2) TOP/23055 Topcon IS-2500 Instrument Stand, (w/o 3rd arm), New, 1 Each;

(3) TOP/VT10 Topcon VT-10 Phoropter, -cyls.

w/reading card and rod, 1 Each;

(4) TOP/28052 Topcon SL-D2 digital slit lamp, (Zeiss style) Galilean-type drum 10X, 16X and

25x, (DC-1 digital camera ready), New, 1 Each;

(5) GOENC1701L GOE VC1701L Digital Acuity System, full featured system w/remote control, (wall mount included) 17" LED LCD, 1 year warranty, New, 1 Each;

Continued ...

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

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

A15PS00554

(6) KEE/1205-P-2000 - Keeler All Pupil II

Slimline Wireless Convertible LED/Halogen BIO w/Charger & 2 Batteries, New, 1 Each;

(7) WN11720 - Welch Allyn Model 11720

Ophthalmoscope, Coaxial, 3.5 Volt, Head only, 1

Each;

(8) WN18245 - Welch Allyn Model 18245 Streak

Retinoscope, Halogen, 3.5 Volt, Head only, New, 1

Each;

(9) WN41100 - Welch Allyn 41100 Transilluminator, 3.5v halogen, New, 1 Each;

(10) WA/71670 - Welch Allyn Model 71670 Handle.

Halogen 3.5 Volt, well rechargeable, New, 3 Each;

(11) Install - Lane Installation, 1 each.

00080 Topcon OC-2200 Examination Chair System - 1 EA

(1) TOP/24046 Topcon OC-2200 Manual recline examination chair, (color choice and Height

Choice), New, 1 Each;

(2) TOP/23055 Topcon IS-2500 Instrument Stand, (w/o 3rd arm), New, 1 Each;

(3) TOP/VT10 Topcon VT-10 Phoropter, -cyls.

w/reading card and rod, 1 Each;

(4) TOP/28052 Topcon SL-D2 digital slit lamp, (Zeiss style) Galilean-type drum 10X, 16X and

25x, (DC-1 digital camera ready), New, 1 Each;

(5) GOENC1701L GOE VC1701L Digital Acuity System, full featured system w/remote control, (wall mount included) 17" LED LCD, 1 year warranty, New, 1 Each;

(6) KEE/1205-P-2000 - Keeler All Pupil II

Slimline Wireless Convertible LED/Halogen BIO w/Charger & 2 Batteries, New, 1 Each;

(7) WN11720 - Welch Allyn Model 11720

Ophthalmoscope. Coaxial, 3.5 Volt, Head only, 1

Each;

(8) WN18245 - Welch Allyn Model 18245 Streak

Retinoscope, Halogen, 3.5 Volt, Head only, New, 1

Each;

(9) WN41100 - Welch Allyn 41100 Transilluminator, 3.5v halogen, New, 1 Each;

(10) WA/71670 - Welch Allyn Model 71670 Handle, Halogen 3.5 Volt, well rechargeable, New, 3 Each;

(11) Install - Lane Installation, 1 Each.

Continued ...

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

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

A15PS00554

00090 Topcon OC-2200 Examination Chair System - 1 EA

(1) TOP/24046 Topcon OC-2200 Manual recline examination chair, (color choice and Height

Choice), New, 1 Each;

(2) TOP/23055 Topcon IS-2500 Instrument Stand, (w/o 3rd arm), New, 1 Each;

(3) TOP/VT10 Topcon VT-10 Phoropter, -cyls.

w/reading card and rod, 1 Each;

(4) TOP/28052 Topcon SL-D2 digital slit lamp, (Zeiss style) Galilean-type drum, 10X, 16X and

25x. (DC-1 digital camera ready), New, 1 Each;

(5) GOENC1701L GOE VC1701L Digital Acuity System, full featured system w/remote control, (wall mount included) 17" LED LCD, 1 year warranty, New, 1 Each;

(6) KEE/1205-P-2000 - Keeler All Pupil II

Slimline Wireless Convertible LED/Halogen BIO w/Charger & 2 Batteries, New, 1 Each;

(7) WN11720 - Welch Allyn Model 11720

Ophthalmoscope, Coaxial, 3.5 Volt, Head only, 1

Each;

(8) WN18245 - Welch Allyn Model 18245 Streak

Retinoscope, Halogen, 3.5 Volt, Head only, New, 1

Each;

(9) WN41100 - Welch Allyn 41100 Transilluminator, 3.5v halogen, list $110 (6/13), New, 1 Each;

(10) WA/71670 - Welch Allyn Model 71670 Handle, Halogen 3.5 Volt, well rechargeable, New, 3 Each;

(11) Install - Lane Installation, 1 each.

00110 Topcon OC-2200 Examination Chair System - 1 EA

(1) TOP/24046 Topcon OC-2200 Manual recline examination chair, (color choice and Height

Choice), New, 1 Each;

(2) TOP/23055 Topcon IS-2500 Instrument Stand, (w/o 3rd arm), New, 1 Each;

(3) TOP/VT10 Topcon VT-10 Phoropter, -cyls.

w/reading card and rod, 1 Each;

(4) TOP/28052 Topcon SL-D2 digital slit lamp, (Zeiss style) Galilean-type drum, 10X, 16X and

Continued ...

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

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A15PS00554

25x. (DC-1 digital camera ready), New, 1 Each;

(5) GOENC1701L GOE VC1701L Digital Acuity System, full featured system w/remote control, (wall mount included) 17" LED LCD, 1 year warranty, New, 1 Each;

(6) KEE/1205-P-2000 - Keeler All Pupil II

Slimline Wireless Convertible LED/Halogen BIO w/Charger & 2 Batteries, New, 1 Each;

(7) WN11720 - Welch Allyn Model 11720

Ophthalmoscope, Coaxial, 3.5 Volt, Head only, 1

Each;

(8) WN18245 - Welch Allyn Model 18245 Streak

Retinoscope, Halogen, 3.5 Volt, Head only, New, 1

Each;

(9) WN41100 - Welch Allyn 41100 Transilluminator, 3.5v halogen, New, 1 Each;

(10) WA/71670 - Welch Allyn Model 71670 Handle, Halogen 3.5 Volt, well rechargeable, New, 3 Each;

(11) Install - Lane Installation, 1 each.

00120 Essilor Mr. Blue Edging System - 1 EA

(1) ESS/M24145 - Essilor Mr. Blue Edger, 2.0 Cuts all plastics, Milling function, 30 degree

Drilling, Rimless Groove, All plastics Polishing, 115V, 1 Each;

(2) ESS/L14042 - Essilor Mr. Blue 2.0 Tracer

Blocker, Auto, 115V, 1 Each;

(3) ESS/ACC_Mr.Blue_DW Complete Accessory Kit for Mr. Blue Edging System. Essibox PC (no monitor, keyboard or mouse), Router, Bar Code readers, Line Conditioner, Direct water kit;

(4) MISC./Parts 19.5" LCD Monitor, keyboard and mouse, for use with the Essibox PC;

(5) ESS/06901961 - Essilor 5yr Remote Maintenance

Extended Service Plan;

(6) ESS/MET001 - Essilor Meye Touch Software, Optional Upgrade used in conjunction with EssiBox system. Allows custom milled shapes and more, 1

Each;

(7) Setup - Complete installation/setup, and training at SIPI, 1 Each.

Continued ...

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

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A15PS00554

00130 Professional Exam Stools - 7 EA

(1) Professional Exam Stool, 15"x4" round vinyl seat, 18-24" pneumatic height adjustable, swivel casters, no back (specify color);

(2) Freight.

00140 Professional Exam Stools - 7 EA

(1) Professional Exam Stool, 15"x4" round vinyl seat, 20-26" pneumatic height adjustable, swivel casters, no back (specify color);

(2) Freight.

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