SF-1449.pdf
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- Dental Services
- Solicitation number
- AG-82A7-S-14-0075
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SF-1449
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SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 11. REQUISITIONNUMBER
IPAG~ OF I
OFFEROR TO COMPLETE BLOCKS 12, 17,23,24, & 30 687605 5
2. CONTRACT NO. !J.AWARDI !4.ORDERNUMBER !~. SOLICITATIONNUMBER !~.SOLICITATION
~FF~CTIV~DAT~ AG-S2A7-S-14-0075 ISSUEDATE
08/14/2014
7. FOR SOLICITATION
I~NAME Ib.TELEPHONENUMBER (No collect calls) 18.OFFERDUEDATE/LOCALTIME
INFORMATION GALL: ANTHONY MARTINEZ (303) 275-5416 09/05/2014 1000 MD
9. ISSUEDBY CODE 182A7 10.THISACQUISITIONIS IX] UNRESTRICTEDOR o SETASIDE: % FOR:
JOB CORPS AQM o SMALLBUSINESS WOMEN.OWNEDSMALLBUSINESSo (WOSB)ELIGIBLEUNDERTHEWOMEN·OWNED
USDA FOREST SERVICE o HUBZONESMALL RMAI I RIIRINFRR PRn~RAM NAICS:621210
740 SIMMS STREET BUSINESS OEDWOSB
GOLDEN CO S0401 o SERVICE·DISABLED o 8(A)
SIZESTANDARD: $7.0VETERAN·OWNED
SMALLBUSINESS
11. DELIVERYFORFOBDESTINA· 12.DISCOUNTTERMS 13b.RATING TIONUNLESSBLOCKIS 013a. THISCONTRACTISA MARKED RATEDORDERUNDER 14.METHODOFSOLICITATIONo SEESCHEDULE DPAS(15CFR700)
B(lRFQ DIFB ORFP
15.DELIVERTO CODE 165RA 16.ADMINISTEREDBY CODE IS2A7
PINE RIDGE JCC JOB CORPS AQM
HWY 385-15710
CHADRON NE 69337
17a.CONTRACTORI CODE I FACILITYI 18a.PAYMENTWILLBEMADEBY CODE I
OFFEROR CODE
TELEPHONENO.
017b. CHECKIF REMITIANCEISDIFFERENTANDPUTSUCHADDRESSINOFFER 18b.SUBMITINVOICESTOADDRESSSHOWININ BLOCK18aUNLESSBLOCKBELOW
ISCHECKED OSEE ADDENDUM
19. 20. 21. 22. 23. 24.
ITEMNO. SCHEDULEOFSUPPLIESISERVICES QUANTITY UNIT UNITPRICE AMOUNT
Dental Services for students at Pine Ridge Job
Corps Center. Base Year. 10/1/14 to 9/30/15
Delivery: 07/11/2014
001 Dentist Servicesup to 9 hours per week for 48 weeks per year. Base Year 10/1/14 to 9/30/15
Product/Service Code: Q503
Product/Service Description: MEDICAL- DENTISTRY
Continued ...
(Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA 126.TOTAL AWARD AMOUNT (For Govt. Use Only) o 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212·1, 52.212-4. FAR 52.212·3 AND 52.212·5 ARE ATTACHED. ADDENDA DARE 0 ARE NOT ATTACHED.
o 27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212·4. FAR 52.212-5 IS ATTACHED. ADDENDA 0 ARE 0 ARE NOT ATTACHED
028. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 0 29. AWARD OF CONTRACT: OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER DATED YOUR OFFER ON SOLICITATION (BLOCK 5), ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED. HEREIN. IS ACCEPTED AS TO ITEMS:
30b. NAME AND TITLE OF SIGNER (Type or print) 130C.DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print) 131C.DATE SIGNED
BRIAN N. MCCABE
30a. SIGNATUREOFOFFEROR/CONTRACTOR 31a. UNITEDSTATESOFAMERICA(SIGNATURE OF CONTRACTING OFFICER)
AUTHORIZEO FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE
STANDARD FORM 1449 (REV. 2/2012)
Prescribed by GSA - FAR (48 CFR) 53.212
19. 20. 21. 22. 23. 24
ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
Period of Performance: 10/01/2014 to 09/30/2015
002 Dental Hygienist Services up to 9 hours per week for 48 weeks per year. Base Year 10/01/2014 to 9/30/2015.
Product/Service Code: Q503
Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2014 to 09/30/2015
003 Dental Assistant Services up to 12 hours a week for 48 weeks per year. Base Year 10/01/2014 to 9/30/2015.
Product/Service Code: Q503
Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2014 to 09/30/2015
004 Price per Emergency for the Base Year, 10/01/2014 to 9/30/2015.
Product/Service Code: Q503
Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2014 to 09/30/2015
005 Dentist Services up to 9 hours per week for 48 weeks per year. For Option Year One, 10/01/2015 to 9/30/2016.
Product/Service Code: Q503
Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2015 to 09/30/2016
Continued ...
32a. QUANTITY IN COLUMN 21 HAS BEEN
[J RECEIVED o INSPECTED U ACCEPTED AND CONFORMS TO THE CONTRACT EXCEPT AS NOTED'
32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE I 32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 321. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE
32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE
33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED 36. PAYMENT 37. CHECK NUMBER
CORRECT FOR
o COMPLETE o PARTIAL o FINAL
D'PARTIAL U FINAL
38. SIR ACCOUNT NUMBER 39. SIR 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 (YYIMMIOO) 142d. TOTAL CONTAINERS
STANDARD FORM 1449 (REV. 2/2012) BACK
REFERENCE NO OF DOCUMENT BEING CONTINUED
CONTINUATION SHEET AG-8/,A7-:::;-] 4-007.')
NAME OF OFFEROR OR CONTRACTOR
OF
ITEM NO.
(A)
SUPPLIES/SERVICES
(B)
AMOUNT
(F)
006 Dental Hysienist Services up to 9 hours per week for 48 weeks per year. Option Year One, 10/01/2015 to 9/30/2016.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2015 to 09/30/2016
007 Dental Assistant Services up to 12 hours per week for 48 weeks per year. Option Year One, 10/01/2015 to 9/30/2016.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2015 to 09/30/2016
008 Price per Emergency for Option year One, 10/01/2015 to 9/30/2016.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2015 to 09/30/2016
009 Dentist Services up to 9 hours per week for 48 weeks per year. Option Year Two, 10/01/2016 to 9/30/2017.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2016 to 09/30/2017
010 Dental Hygienist Services up to 9 hours per week for 48 weeks per year. Option Year Two, 10/01/2016 to 9/30/2017.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2016 to 09/30/2017
011 Dental Assistant Services up to 12 hours per week for 48 weeks per year. Option Year Two, 10/01/2016 to 9/30/2017.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2016 to 09/30/2017
012 Price per Emergency for Option Year Two, 10/01/2016 to 9/30/2017.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2016 to 09/30/2017 Continued ...
QUANTITY UNIT
(C) (D)
UNIT PRICE
(E)
NSN 7540-01-152-8067
OPTIONAL FORM 336 (4-86)
Sponsored by GSA
FAR (48 CFR) 53.110
CONTINUATION SHEET G-82A7-S-14-0075 5
REFERENC~ NO. OF DOCUMENT BEING CONTINUED
NAME OF OFFEROR OR CONTRACTOR
ITEM NO.
(A)
SUPPLIES/SERVICES
(B)
AMOUNT
(F)
013 Dentist Services up to 9 hours per week for 48 weeks per year. Option Year Three, 10/01/2017 to 9/30/2018.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2017 to 09/30/2018
014 Dental Hygienist Services up to 9 hours per week for 48 weeks per year. Option Year Three, 10/01/2017 to 9/30/2018.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2017 to 09/30/2018
015 Dental Assistant Services up to 12 hours per week for 48 weeks per year. Option Year Three, 10/01/2017 to 9/30/2018.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2017 to 09/30/2018
016 Price per Emergency for Option Year Three, 10/01/2017 to 9/30/2018.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2017 to 09/30/2018
017 Dentist Services up to 9 hours per week for 48 weeks per year. Option Year Four, 10/91/2018 to 9/30/2019.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2018 to 09/30/2019
018 Dental Hygienist Services up to 9 hours per week for 48 weeks per year. Option Year Four, 10/01/2018 to 9/30/2019.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Period of Performance: 10/01/2018 to 09/30/2019
019 Dental Assistant Services up to 12 hours per week for 48 weeks per year. Option Year Four, 10/01/2018 to 9/30/2019.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY Continued ...
QUANTITY UNIT
(C) (D)
UNIT PRICE
(E)
NSN 7540-01-152 8067
OPTIONAL FORM 336 (4-86)
REFERENCE NO. OF DOCUMENT BEING CONTINUED
CONTINUATION SHEET AG-82A7-S-14-007S
NAME OF OFFEROR OR CONTRACTOR
ITEM NO.
(A)
SUPPLIES/SERVICES
(B)
AMOUNT
(F)
I QUANTITY IUNIT I
\ (C) (D)
UNIT PRICE
(E)
Period of Performance: 10/01/2018 to 09/30/2019
020 Price per Emergency for Option Year Four, 10/01/2018 to 9/30/2019.
Product/Service Code: Q503 Product/Service Description: MEDICAL- DENTISTRY
NSN 7540-01-1528067
OPTIONAL FORM 336 (4-86)
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