ATTACHMENT NO. 3 - STANDARD FORM 18.pdf

75H71323Q00050

1. REQUEST NO.

5a. ISSUED BY

NAME

a. NAME

c. STREET ADDRESS

d. CITY

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK 5a ON

OR BEFORE CLOSE OF BUSINESS (Date)

2. DATE ISSUED 3. REQUISITION/PURCHASE REQUEST NO. 4. CERT. FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG.1

RATING

6. DELIVERY BY (Date)

7. DELIVERY

9. DESTINATION

a. NAME OF CONSIGNEE

b. STREET ADDRESS

PAGE OF PAGES

5b. FOR INFORMATION CALL: (No collect calls)

TELEPHONE NUMBER

AREA CODE NUMBER

8. TO:

b. COMPANY

e. STATE f. ZIP CODE

c. CITY

d. STATE e. ZIP CODE

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 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)

THIS RFQ

REQUEST FOR QUOTATION

(THIS IS NOT AN ORDER)

IS IS NOT A SMALL BUSINESS SET ASIDEX

03/24/2023

1 2

Portland Area Indian Health Service 1414 N.W. Northrup, Suite 800 Portland OR 97209

IHS-NEW-PORTLAND

Multiple

WESTERN OREGON SERVICE UNIT

CHEMAWA INDIAN HEATLH CTR

3750 Chemawa Rd, NE

Salem OR 97305-1198

Salem

OR 97305-1198

503 304-7661ALLAN GAERLAN

03/28/2023 1700 PS

FOB DESTINATION

OTHER

(See Schedule)X

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

Period of Performance: 07/01/2023 to 06/30/2024

1 BASE PERIOD |YEAR ONE (1) - HEALTH EDUCATION 1 YR

NETWORK SUBSCRIPTION

2 OPTION PERIOD ONE (1) |YEAR TWO (2) - HEALTH 1 YR

EDUCATION NETWORK SUBSCRIPTION

(Option Line Item)

Period of Performance: 07/01/2024 to 06/30/2025

3 OPTION PERIOD TWO (2) |YEAR THREE (3) - HEALTH 1 YR

EDUCATION NETWORK SUBSCRIPTION

(Option Line Item)

Continued ...

12. DISCOUNT FOR PROMPT PAYMENT

a. 10 CALENDAR DAYS (%) b. 20 CALENDAR DAYS (%) c. 30 CALENDAR DAYS (%) d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations

13. NAME AND ADDRESS OF QUOTER

b. STREET ADDRESS

c. COUNTY

d. CITY e. STATE f. ZIP CODE

14. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

16. SIGNER

a. NAME (Type or print)

c. TITLE (Type or print)

a. NAME OF QUOTER

AREA CODE

NUMBER

15. DATE OF QUOTATION

b. TELEPHONE are are not attached

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable

STANDARD FORM 18 (REV. 6-95)

Prescribed by GSA - FAR (48 CFR) 53.215-1(a)

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 2

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H71323Q00050

Period of Performance: 07/01/2025 to 06/30/2026

4 OPTION PERIOD THREE (3) |YEAR FOUR (4) - HEALTH 1 YR

EDUCATION NETWORK SUBSCRIPTION

(Option Line Item)

Period of Performance: 07/01/2026 to 06/30/2027

5 OPTION PERIOD FOUR (4) |YEAR FIVE (5) - HEALTH 1 YR

EDUCATION NETWORK SUBSCRIPTION

(Option Line Item)

Period of Performance: 07/01/2027 to 06/30/2028

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