AG-569R-S-16-0023.rtf

Construction RFQ

AG-24H8-S-10-XXXX

Project Description

REQUEST FOR QUOTATION

PAGE OF PAGES

(THIS IS NOT AN ORDER)

THIS RFQ

IS

IS NOT A SMALL BUSINESS SET- ASIDE

1. REQUEST NO.

2. DATE ISSUED

3. REQUISITION/PURCHASE REQUEST NO.

4. CERT. FOR NAT.DEF.

RATING

AG-569R-S-16-0023

05/20/2016

UNDER BDSA REG. 2

AND/OR DMS REG. 1

5a. ISSUED BY

6. DELIVER BY (Date) Lake States Acquisition Team See Section F 5b. FOR INFORMATION CALL (NO COLLECT CALLS)

7. DELIVERY

FOB DESTINATION

NAME

TELEPHONE NUMBER

OTHER (See Schedule)

AREA CODE

NUMBER

9. DESTINATION

Shawn M. Lacina 362-1347

a. NAME OF CONSIGNEE

8. TO:

a. NAME

b. COMPANY

b. STREET ADDRESS

c. STREET ADDRESS

c. CITY

d. CITY

e. STATE

f. ZIP CODE

d. STATE

e. ZIP CODE

10. PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5A ON OR BEFORE CLOSE OF BUSINESS 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 June 20, 2016, 2:00PM Central submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

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

ITEM NO.

SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(a) (b) (c) (d) (e) (f) North Branch Peshtigo River at Forest Road 2174 Culvert Replacement

Enter pricing on schedule of items in section B See Section B for the Schedule of Items This project is 100% set-aside for Hubzone small businesses Mailed quotes should reference “AG-569R-S-16-0023” on outer mailing envelope. Quotes may also be emailed to slacina@fs.fed.us and include AG-569R-S-16-0023 in the subject line. No fax quotes will be accepted.

a. 10 CALENDAR DAYS (%)

b. 20 CALENDAR DAYS (%)

c. 30 CALENDAR DAYS (%)

d. CALENDAR DAYS

12. DISCOUNT FOR PROMPT PAYMENT

NUMBER

PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

14. SIGNATURE OF PERSON AUTHORIZED TO

15. DATE OF

a. NAME OF QUOTER

SIGN QUOTATION

QUOTATION

b. STREET ADDRESS

16. SIGNER

a. NAME (Type or print)

b. TELEPHONE

c. COUNTY

AREA CODE

d. CITY

e. STATE

f. ZIP CODE

c. TITLE (Type or Print)

NUMBER

NSN 7540-01-152-8084

Previous edition not usable 18-121 STANDARD FORM 18 (Rev. 6-95) Prescribed by GSA-FAR (48 CFR) 53.215-1(a) Chequamegon-Nicolet National Forest North Branch Peshtigo River Culvert Replacement

AG-569R-S-16-0023

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