SAMPLE_CALL_ORDER_-__NARCAN_(Naloxone_Hcl)corrected_v2.pdf

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER

5. SOLICITATION NUMBER2. CONTRACT NO. 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION INFORMATION

CALL:

a. NAME Teresa Delgado teresa.a.roshau-delgado@usdoj.gov

b. TELEPHONE NUMBER (No collect calls) 8. OFFER DUE DATE / LOCAL

TIME

CODE 15DDFA

DEA

Attn: Office of Acq & Relo Mgmt (FA) 8701 Morrissette Drive Springfield, VA 22152

9. ISSUED BY UNRESTRICTED OR X SET ASIDE: % FOR

X SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS: 446110

SIZE STANDARD: $27,500,000

10. THE ACQUISITION IS

SEE

SCHEDULE

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED

NET 30

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER DPAS

(15 CFR 700)

13b. RATING

X RFQ IFB RFP

14. METHOD OF SOLICITATION

15DDSSCODE15. DELIVER TO

DEA

Attn: Office of Forensic Sciences (SS) 8701 Morrissette Drive Springfield, VA 22152

CODE 15DDFA16. ADMINISTERED BY

DEA

Attn: Office of Acq & Relo Mgmt (FA) 8701 Morrissette Drive Springfield, VA 22152

FACILITY

CODE

CODE

TELEPHONE NO.

17a. CONTRACTOR/

OFFEROR

D-HQCODE18a. PAYMENT WILL BE MADE BY

SAMPLE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

Please provide pricing to the sample order for evaluation purposes only

See Continuation Sheet(s) (Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE X ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ____ COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. _____________________________ OFFER

DATED _________________ . YOUR OFFER ON SOLICITATION (BLOCK 5)

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN,

IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR PRINT)

Nanaesi Amoo

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

DJD-17-Q-0147 Page 1 of 2

Section 2 - Commodity or Services Schedule

SCHEDULE OF SUPPLIES/SERVICES

CONTINUATION SHEET

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 400.000000 EA $____________ $___________________

0002 400.000000 EA $____________ $___________________

0003 400.000000 EA $____________ $___________________

0004 400.000000 EA $____________ $___________________

NARCAN (Naloxone Hcl) 4mg Nasal Spray - 2pk

Line Period of Performance: 09/30/2017 - 09/29/2018

NARCAN (Naloxone Hcl) 2mg Nasal Spray - 2pk

Line Period of Performance: 09/30/2017 - 09/29/2018

NARCAN (Naloxone Hcl) 2mg Pre-Filled Syringe- 1ea

Line Period of Performance: 09/30/2017 - 09/29/2018

NARCAN (Naloxone Hcl) KIT Kit Contains:

*Qty: 1 -Neoprene Accessory Pouch, black, zipper closure and carabineer clip. 5"W x 3"H *Qty: 2 - IMS3369/ Naloxone l mg/ mL 2mL Needleless PFS (Narcan) *Qty: 2 - WTMAD300/ Nasal Atomization Device w/o 3cc Syringe

*Qty: 1 - MDI70-150/ Shield CPR Microshield *Qty: 1 - RU123128/ Nasal Airway 28FR *Qty: 1 - 837168/ Surgical Lubricant Packet *Qty: 1 - KC55083/ Purple Nitrile Gloves, Large, pair

Line Period of Performance: 09/30/2017 - 09/29/2018