RFQ_NO._DTFH7116Q00051.pdf

DTFH7116Q00051

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

08/24/2016

1 2

Eastern Federal Lands Highway Div.

Acquisitions Office/JAN BEAVER 21400 Ridgetop Circle

Federal Highway Administration

703-404-6216 Sterling VA 20166-6511

Federal Highway Administration

Eastern Federal Lands Highway Div.

21400 Ridgetop Circle

Sterling

VA 20166-6511

703 404-6216Jan Beaver

09/06/2016 1200 ET

FOB DESTINATION

OTHER

(See Schedule)X

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

***THIS SOLICITATION IS PREPARED IN ACCORDANCE

WITH FEDERAL ACQUISITION REGULATION PART 13,

SIMPLIFIED ACQUISITION PROCEDURES.***

THIS WILL BE A FIRM, FIXED PRICE CONTRACT.

PROVIDE PRICING FOR THE FOLLOWING:

00001 iCOR MEASUREMENT UNIT TO INCLUDE: TABLET WITH 1 EA

HANDS-FREE CARRYING SUPPORT, DATA ANALYSIS APP.,

CHARGING CABLE, TABLET USB CABLE, USB CHARGER, 18

PIECES OF CONTACT SPONGE, ELECTRODE STORAGE

SOLUTION, CARRYING CASE, CONDUCTIVE GEL, AND USER

MANUAL, PART NO. 900101.

QUANTITY: 1 EACH

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)

DTFH7116Q00051

00007 ESTIMATED SHIPPING AND HANDLING FEE. 1 EA

PLEASE PROVIDE THE FOLLOWING INFORMATION WITH

YOUR QUOTATION:

DUN & BRADSTREET (DUNS) NUMBER:

FEDERAL TAX ID NUMBER:

ESTIMATED DELIVERY TIME:

IMPORTANT PAYMENT REQUIREMENT: IN ACCORDANCE

WITH FEDERAL ACQUISITION REGULATION (FAR) SUBPART

4.1102, PROSPECTIVE CONTRACTORS SHALL BE

REGISTERED IN THE SYSTEM FOR AWARD MANAGEMENT

(SAM) DATABASE PRIOR TO AWARD OF A CONTRACT. FAR

CLAUSE 52.232-33 REQUIRES SAM REGISTRATION FOR

PAYMENT. IN ADDITION, WHEN SETTING UP VENDOR

INFORMATION IN THE SAM DATABASE, THE D&B LEGAL

NAME SHOULD BE THE SAME AS THE IRS CONSENT NAME.

SAM REGISTRATION IS AVAILABLE ONLINE AT

WWW.SAM.GOV.

RESPONSES TO REQUEST FOR QUOTATION WILL BE

ACCEPTED VIA FAX NUMBER 571-434-1551, EMAIL:

JAN.BEAVER@DOT.GOV, OR MAIL TO THE ADDRESS IN

BLOCK NO. 9, AND MUST BE RECEIVED BY 12:00 PM,

EST, TUESDAY, SEPTEMBER 6, 2016.

***PLEASE NOTE: QUESTION SUBMISSION: INTERESTED

OFFERORS MUST SUBMIT ANY QUESTIONS CONCERNING THE

SOLICITATION AT THE EARLIEST TIME POSSIBLE TO

ENABLE THE BUYER TO RESPOND. QUESTIONS NOT

RECEIVED WITHIN A REASONABLE TIME PRIOR TO CLOSE

OF THE SOLICITATION MAY NOT BE CONSIDERED.***

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