Amendment 2.pdf

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ IS A SMALL BUSINESS SET-ASIDE

PAGE OF PAGES

1. REQUEST NO.

CRHC-21-55

2. DATE ISSUED

9/1/2021

3. REQUISITION/PURCHASE REQUEST NO.

Amendment No. 2

4. CERT.FOR NAT. DEF.

UNDER BDSA REG.2

AND/OR DMS REG. 1

RATING

5A. ISSUED BY

Eagle Butte Indian Health Service, Cheyenne River Service Unit 24276 166th St, PO Box 1012, Eagle Butte, SD 57625

6. DELIVER BY (Date)

10/31/2022

5b. FOR INFORMATION CALL (NO COLLECT CALLS) 7. DELIVERY OTHER

FOB DESTINATION (See Schedule)

NAME

Paige Kerstiens paige.kerstiens@ihs.gov

TELEPHONE NUMBER 9. DESTINATION

AREA CODE

NUMBER

964-1565

a. NAME OF CONSIGNEE

Cheyenne River Service Unit

8. TO: b. STREET ADDRESS

24276 166th St, PO Box 1012

a. NAME

b. COMPANY

c. CITY

Eagle Butte

c. STREET ADDRESS

d. CITY

e. STATE

f. ZIP CODE

d. STATE

SD

e. ZIP CODE

57625

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK

5a ON OR BY 1:00 PM MST ON (Date)

September 3, 2021

IMPORTANT: This is a request for information, and quotations furnished are not offiers. 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)

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

Amendment No. Two(2) hereby authorizes the following:

1) Extend closing date of solicitation from 9/1/2021 to 9/3/2021.

2) All else remains the same.

There are no other changes by reason of this amendment.

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 are are not attached.

13. NAME AND ADDRESS OF QUOTER 15. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

15. DATE OF

QUOTATION a. NAME OF QUOTER

b. STREET ADDRESS

c. COUNTY 16. SIGNER

a. NAME (Type of print)

b. TELEPHONE

AREA CODE

d. CITY e. STATE f. ZIP CODE

c. TITLE (type or print) NUMBER

AUTHORIZED FOR LOCAL REPRODUCTION FormFlow/Delrina Inc. STANDARD FORM 18 (REV 6-95) Previous edition not usable Prescribed by GSA-FAR (48 CFR) 53-215-1(a) mailto:paige.kerstiens@ihs.gov

ITEM

NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

DUNS & Bradstreet Number:

(The Duns & Bradstreet number is required.

Provided you do not have it, you may call 866-705-

5711 and obtain one.) You will need a DUNS &

Bradstreet NUMBER to be awarded the purchase order and registered with the System for Award

Management; you can register at www.sam.gov

The quoter is hereby notified that they must be registered in the System for Award Management

(SAM) before the Government will issue an award. You may do this by going to www.sam.gov to register and you are required to update this registration every year prior to the expiration date.

No contract award shall be made to a vendor listed on the OIG Exclusion List

(http://exlusions.oig.hhs.gov) throughout the duration of the contract.

Federal Tax ID Number:

Email Address:

Net Terms:

http://www.sam.gov/ http://exlusions.oig.hhs.gov/