FA8212-23-Q-0806.pdf

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (REV.2/2012)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

FD20202300806 01

5. SOLICITATION NUMBER

FA8212-23-Q-0806

6. SOLICITATION ISSUE DATE

30 AUG 2023

b. TELEPHONE NUMBER (No collect calls) (801 ) 564 -4132 ext.

2. CONTRACT NO.

7. FOR SOLICITATION

INFORMATION CALL

3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

a. NAME Justin M Raleigh

8. OFFER DUE DATE/LOCAL

TIME

8SEP2023

12. DISCOUNT TERMS11. DELIVERY FOR FOB DEST.

UNLESS BLOCK IS MARKED

SEE SCHEDULE

10. THIS ACQUISITION IS UNRESTRICTED SET ASIDE: % FOR:

SMALL BUSINESS WOMEN-OWNED SMALL BUSINESS

HUBZONE SMALL (WOSB)ELIGIBLE UNDER THE WOMEN-OWNED

BUSINESS SMALL BUSINESS PROGRAM

NAICS CODE:

SERVICE-DISABLED EDWOSB 541715

VETERAN-OWNED SIZE STANDARD

SMALL BUSINESS 8 (A) 1,000 :

13a. THIS CONTRACT IS A

RATED ORDER

UNDER DPAS

(15 CFR 700)

13b. RATING

DO: A1 52.211-14, 52.211-15

14. METHOD OF SOLICITATION

RFQ IFB RFP

9. ISSUED BY CODE

DEPARTMENT OF THE AIR FORCE, DIRECTORATE OF CONTRACTING

AFSC PZABA

6050 GUM LANE BLDG 1215

HILL AIR FORCE BASE UT 84056-5825

BUYER: Justin M Raleigh/PZABA justin.raleigh.1@us.af.mil Phone: (801) 564- 4132 Fax: (000) 000-0000 No Collect Calls

15. DELIVER TO CODE

SEE LINE ITEM SCHEDULE

16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR FACILITY

CODE CODE

18a. PAYMENT WILL BE MADE BY CODE

(SEE ESP CLAUSE 252.232-7003.)

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED. SEE ELECTRONIC SUBMISSION OF PAYMENT REQUESTS, CLAUSE 252.232-7003.

FA8212

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

FMS REQUIREMENT

ROUTINE

Subject to the terms and conditions stated herein, the Contractor agrees to hold its offered prices firm for 30 days.

THIS IS AN FMS REQUIREMENT AWARD CANNOT BE MADE TO OFFSHORE VENDOR WITHOUTPRIOR APPROVAL OF BUY MANAGER.

COUNTERFEIT PREVENTION DOES NOT APPLY. IUID NOT REQUIRED.

SEE LINE ITEM SCHEDULE

(Attach Additional Sheets as Necessary)

26. AWARD AMOUNT (For Gov’t use only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE 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 HEREIN.

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 CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

X

X X

X X

X

25. ACCOUNTING AND APPROPRIATION DATA SEE FUNDS SCHEDULE

X

SCD:B

EFT:T

Total

STANDARD FORM 1449 (REV. 2/2012) BACK

COMPUTER GENERATED 8/30/2023, 9:25 AM

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32b. SIGNATURE OF AUTHORIZED GOV’T REPRESENTATIVE

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

32c. DATE

41c. DATE

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

PARTIAL FINAL

37. CHECK NUMBER36. PAYMENT

COMPLETE PARTIAL FINAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC’D (YY/MM/DD) 42d. TOTAL CONTAINERS

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

SEE LINE ITEM SCHEDULE

(Attach Additional Sheets as Necessary)

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

FA8212-23-Q-0806

SUPPLIES OR SERVICES AND PRICES/COSTS

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

2 EA

CLIN ACRN ACRN Total

0001 AA

Part Number 07-110-3850 7-3850 Line Item(s)

NSN: 6130-21-913-4033 WF

ANALYZER-CHARGER,BA

INU Battery Adapter Aluminium Manufacturer 43678 43678 Associated Document(s)

FD20202300806 01

Priority: R

Inspection: Origin Acceptance: Origin Quality Assurance: Standard Inspection Foreign Military Sales :FMS Case:PT-D-QAV

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

* DPT006 ORIGIN

Type / Ship To PACRN Mark For

* DPT006 PAB DPTM00

Type / Ship To Quantity (U/I) On or Before Req No / Pri

Required Delivery

* DPT006 2 EA 20 FEB 2025 DPTM5431565100 / PRI:

Proposed Delivery

* DPT006 2 EA

TAC: DFMS

SHIP TO / PLACE OF PERFORMANCE

TYPE/CODE: + CNOTE

MARK FOR: (See Individual Line Item) REQUISITION NUMBER: (See Individual Line Item) REQUISITION PRIORITY: (See Individual Line Item)

AWARD NUMBER:

IAW the DD Form 1423

SHIP TO (FOREIGN MILITARY SALES)

TYPE/CODE: * DPT006

SUPPLEMENTAL ADDRESS CODE: DA6QAV

FMS CASE CODE/LOA: PT-D-QAV/008

MAPAC SHIP TO CODE: DPT006

MAPAC MARK FOR: DPTM00

REQUISITION NUMBER: (See Individual Line Item) REQUISITION PRIORITY: (See Individual Line Item)

AWARD NUMBER:

ADDENDUM TO CLAUSE 52.212-4

52.232-39 UNENFORCEABILITY OF UNAUTHORIZED OBLIGATIONS (JUN 2013)

(IAW FAR 32.706-3)

252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (JAN 2023)

(IAW DFARS 232.7004(b), PGI 232.7004(b)(1), DFARS 212.301(f)(liii))

(f) WAWF payment instructions. The Contractor must use the following information when submitting payment requests and receiving reports in WAWF for this contract/order:

(1) Document type. The Contractor shall use the following document type(s).

(Contracting Officer: Insert applicable document type(s).

Note: If a “Combo” document type is identified but not supportable by the Contractor’s business systems, an “Invoice” (stand-alone) and “Receiving Report” (stand-alone) document type may be used instead.)

(2) Inspection/acceptance location. The Contractor shall select the following inspection/acceptance location(s) in WAWF, as specified by the contracting officer.

(Contracting Officer: Insert inspection and acceptance locations or “Not applicable.”)

(3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system.

Routing Data Table* Field Name in WAWF Data to be entered in WAWF Pay Official DoDAAC Issue By DoDAAC Admin DoDAAC Inspect By DoDAAC Ship To Code Ship From Code Mark For Code Service Approver (DoDAAC) Service Acceptor (DoDAAC)

Accept at Other DoDAAC LPO DoDAAC DCAA Auditor DoDAAC Other DoDAAC(s) (*Contracting Officer: Insert applicable DoDAAC information or “See schedule” if multiple ship to/acceptance locations apply, or “Not applicable.”)

(4) Payment request and supporting documentation. The Contractor shall ensure a payment request includes appropriate contract line item and subline item descriptions of the work performed or supplies delivered, unit price/cost per unit, fee (if applicable), and all relevant back-up documentation, as defined in DFARS Appendix F, (e.g. timesheets) in support of each payment request.

(5) WAWF email notifications. The Contractor shall enter the e-mail address identified below in the “Send Additional Email Notifications” field of WAWF once a document is submitted in the system.

(Contracting Officer: Insert applicable email addresses or “Not applicable.”)

(g) WAWF point of contact.

(1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity’s WAWF point of contact.

(Contracting Officer: Insert applicable information or “Not applicable.”)

(2) For technical WAWF help, contact the WAWF helpdesk at 866-618-5988.

ACCOUNTING AND APPROPRIATION DATA (AUG 1998)

Accounting and Appropriation Chargeable ACRN Funds Citation Amount Chargeable

AA 9711X8242 0002 4F X LC SH CQAVPT 000000 00000 008000 503000 F03000 $0.00

PSR: 372461 FSR: 045783 DSR: 232163 CIN: F2DCCW3228A1030000AA

ACRN TOTAL $ 0.00

LIST OF DOCUMENTS, EXHIBITS OR ATTACHMENTS

Form Number Description/File Name Date Number of Pages

ITEM_DESCRIPTION 17AUG2023 1

ADDENDUM TO PROVISION 52.212-1

52.204-7 SYSTEM FOR AWARD MANAGEMENT (OCT 2018)

(IAW FAR 4.1105(a)(1))