Attachment A - SF1449.pdf
PDF 107 KB Posted
- Attached to
- National Maternal Mental Health Hotline
- Solicitation number
- 75R60223Q00222
About this file
This solicitation package includes a Standard Form 1449 for a commercial items contract along with a statement of work and optional tasks. The Department of Health and Human Services Health Resources and Services Administration seeks proposals to operate a National Maternal Mental Health Hotline for a base period of 12 months plus one 7-month option period. The hotline services will include counseling and referrals to address mental health issues for pregnant and postpartum women. Offerors are also invited to propose on optional tasks such as counselor training, community presentations, and transition planning. Proposals are due by July 14, 2023 and the period of performance for the base period will start upon award.
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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
OAMP
5600 Fishers Lane, Rm 14W26B Management and Policy Office of Acquisition
HHS/HRSA/OO/OAMP
CODE 16. ADMINISTERED BYCODE
X
X
624190
SIZE STANDARD:
% FOR:SET ASIDE:UNRESTRICTED OROAMP
RFPIFB
10. THIS ACQUISITION ISCODE
RFQ
14. METHOD OF SOLICITATION
13b. RATING
NAICS:
SMALL BUSINESS
08/07/2023 1700 ES
07/14/2023
(301) 287-0169RYAN MACDONALD
(No collect calls)
INFORMATION CALL:
FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME
4. ORDER NUMBER3. AWARD/ 6. SOLICITATION
75R60223Q00222
5. SOLICITATION NUMBER
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF
1 4 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30
Rockville MD 20857
TELEPHONE NO.
17a. CONTRACTOR/
15. DELIVER TO
Rockville MD 20857 5600 Fishers Lane, Rm 14W26B Management and Policy Office of Acquisition
9. ISSUED BY
7.
2. CONTRACT NO.
EFFECTIVE DATE
$16
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 SCHEDULEX
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)
HHS/HRSA/OO/OAMP
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.
PLEASE COMPLETE THIS FORM, PROVIDE A QUOTE IN
ACCORDANCE WITH THE SOLICITATION AND PROVIDE THE
FOLLOWING INFORMATION:
1. CONTACT NAME, PHONE & FAX NUMBER:__________
2. E-MAIL: _________________________
3. UEI NUMBER: _____________________
4. TAX IDENTIFICATION NUMBER: ______
Please provide your quote for a base period of 12 (Use Reverse and/or Attach Additional Sheets as Necessary)
HEREIN, IS ACCEPTED AS TO ITEMS:
X
XX
DATED
KWASI B. ANTWI
. 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.
(twelve) months plus one (1) 7-month option period in accordance with the attached
Instructions, Conditions and Notices to Offerors included in the Cover Letter.
1 Base Period: National Maternal Mental Health
Hotline (see Statement of Work)
Period of Performance: 12 months
2 Base Period - Optional Task 1 (Counselor Training)
(Option Line Item)
3 Base Period - Optional Task 1 (Counselor Training)
(Option Line Item)
4 Base Period - Optional Task 1 (Counselor Training)
(Option Line Item)
5 Base Period - Optional Task 2 (Presentations)
Continued ...
32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE
32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
4 2 of
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
NAME OF OFFEROR OR CONTRACTOR
3 4
CONTINUATION SHEET
REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF
(A) (B) (C) (D) (E) (F)
75R60223Q00222
(Option Line Item)
6 Base Period - Optional Task 2 (Presentations)
(Option Line Item)
7 Base Period - Optional Task 2 (Presentations)
(Option Line Item)
8 Base Period - Optional Task 3 (Hotline Transition
Plan)
(Option Line Item)
9 Option Period 1: National Maternal Mental Health
Hotline (see Statement of Work)
Period of Performance: 7 months
(Option Line Item)
10 Option Period 1 - Optional Task 1 (Counselor
Training)
(Option Line Item)
11 Option Period 1 - Optional Task 1 (Counselor
Training)
(Option Line Item)
12 Option Period 1 - Optional Task 1 (Counselor
Training)
(Option Line Item)
13 Option Period 1 - Optional Task 2 (Presentations)
Continued ...
NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)
Sponsored by GSA
FAR (48 CFR) 53.110
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
NAME OF OFFEROR OR CONTRACTOR
4 4
CONTINUATION SHEET
REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF
(A) (B) (C) (D) (E) (F)
75R60223Q00222
(Option Line Item)
14 Option Period 1 - Optional Task 2 (Presentations)
(Option Line Item)
15 Option Period 1 - Optional Task 2 (Presentations)
(Option Line Item)
16 Option Period 1 - Optional Task 3 (Hotline
Transition Plan)
(Option Line Item)
NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)
Sponsored by GSA
FAR (48 CFR) 53.110
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