FA851724Q0003.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 J

1. REQUISITION NUMBER

23-32382 / 24-31118

5. SOLICITATION NUMBER

FA8517-24-Q-0003

6. SOLICITATION ISSUE DATE

b. TELEPHONE NUMBER (No collect calls) (478 ) 222 -1088 ext.

2. CONTRACT NO.

7. FOR SOLICITATION

INFORMATION CALL

3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

a. NAME Courtney R. Haynes

8. OFFER DUE DATE/LOCAL

TIME

12. DISCOUNT TERMS11. DELIVERY FOR FOB DEST.

UNLESS BLOCK IS MARKED

SEE SCHEDULE

10. THIS ACQUISITION IS UNRESTRICTED SET ASIDE: 100 % FOR:

SMALL BUSINESS WOMEN-OWNED SMALL BUSINESS

HUBZONE SMALL (WOSB)ELIGIBLE UNDER THE WOMEN-OWNED

BUSINESS SMALL BUSINESS PROGRAM

NAICS CODE:

SERVICE-DISABLED EDWOSB 334515

VETERAN-OWNED SIZE STANDARD

SMALL BUSINESS 8 (A) 750 :

13a. THIS CONTRACT IS A

RATED ORDER

UNDER DPAS

(15 CFR 700)

13b. RATING

DO: A7 52.211-14, 52.211-15

14. METHOD OF SOLICITATION

RFQ IFB RFP

9. ISSUED BY CODE

SUPPORT EQUIPMENT - AUTOMATIC TEST, AFSC/PZAAC

235 BYRON ST BLDG 300 STE 19A

BLDG 300 CML PHN 478 926 7204

ROBINS AFB GA 31098-1670

BUYER: Courtney R. Haynes/PZAAC courtney.haynes.1@us.af.mil Phone: (478) 222- 1088

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.

FA8517

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

FMS REQUIREMENT

ROUTINE

THIS IS A TOTAL SMALL BUSINESS SET-ASIDE.

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

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 1 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:C

EFT:T

Total

STANDARD FORM 1449 (REV. 2/2012) BACK

COMPUTER GENERATED 1/18/2024, 9:21 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

FA8517-24-Q-0003

SUPPLIES OR SERVICES AND PRICES/COSTS

This is an FMS & NonFMS commercial requirement for the buy of the Signal Generator, NSN:

6625016277720, PN: E8663D Option HE3. This effort is a 100% total Small Business SetAside and will result in a (1) one year Purchase Order. The requirement will be for a combined quantity of (2) two each and the evaluation factors will be Price/Cost.

All quotes shall be in whole dollar amounts.

FMS BUY OF THE SIGNAL GENERATOR

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0001 AA

NSN: 6625016277720 RH

GENERATOR,SIGNAL

FMS

Manufacturer Part Number

1LQK8 E8663D OPTION HE3

Associated Document(s) Line Item(s)

FD20602332382 0001

Priority: R ROUTINE

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Commercial Item Inspection Foreign Military Sales :FMS Case:IQDQBZ

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

* DIQ00X DESTINATION

Type / Ship To PACRN Mark For

* DIQ00X PAB DIQT00

Type / Ship To Quantity (U/I) *ARO Purchase

Order _ Req No / Pri

Required Delivery

* DIQ00X 1 EA *180 Calendar Days DIQT7Z22345601 / PRI: 05

Proposed Delivery

* DIQ00X 1 EA

NONFMS BUY OF THE SIGNAL GENERATOR

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0002 AB

NSN: 6625016277720 RH

GENERATOR,SIGNAL

Manufacturer Part Number

1LQK8 E8663D OPTION HE3

Associated Document(s) Line Item(s)

FD20602431118 0001

Priority: R ROUTINE

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Commercial Item Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A FY4541 DESTINATION

Type / Ship To PACRN Mark For

A FY4541 PAA YXX610

Type / Ship To Quantity (U/I) *ARO Purchase

Order _ Req No / Pri

Required Delivery

A FY4541 1 EA *180 Calendar Days FE206722440016 / PRI: 15

Proposed Delivery

A FY4541 1 EA

SHIP TO / PLACE OF PERFORMANCE

TYPE/CODE: A FY4541

802d MXSS/MXDXA 180 Cochran St. BLDG. 162 Robins AFB GA 31098

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

AWARD NUMBER:

SHIP TO (FOREIGN MILITARY SALES)

TYPE/CODE: * DIQ00X

SUPPLEMENTAL ADDRESS CODE: DXXQBZ

FMS CASE CODE/LOA: IQDQBZ/008

MAPAC SHIP TO CODE: DIQ00X

MAPAC MARK FOR: DIQT00

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

AWARD NUMBER:

ADDENDUM TO CLAUSE 52.2124

ACCOUNTING AND APPROPRIATION DATA (AUG 1998)

Accounting and Appropriation Chargeable ACRN Funds Citation Amount Chargeable

AA 9711X8242.0002 4FX LCRN CQBZIQ 20M5A9 63800 008000 503000 F03000 $0.00

PSR: 387850 FSR: 049026 DSR: 156398

AB 97X4930 FA29 6Z4 47E8 55639K MU2400 92095 MDSPX0 503000 DMAPS JON:X56396630000 F03000

$0.00

PSR: K33327 FSR: 018110 DSR: 357493

REFERENCE:

AA PR: FD20602332382

CIN: F3QCDJ3206A0010000AA

AB PR: FD20602431118

CIN:F3QCCM3332G0010000AA

ACRN TOTAL $ 0.00

F.O.B. ORIGIN, FIRST DESTINATION TRANSPORTATION (FDT)

The Long Line of Accounting (LOA) listed below shall be used to pay for FDT to their point of usage, storage, or embarkation on the CLINs/SubCLINs listed below. The Miscellaneous Obligation Reimbursement Document (MORD) Number associated with this LOA shall be entered into Power Track to fund the FDT charges needed to transport the item.

CLIN/SubCLIN: 0002

Long Line of Accounting (LOA): 97X4930 FA29 6Z4 47E8 55639K MU2400 92095 MDSPX0 503000

DMAPS JON:X56396630000 F03000

MORD Number: F3QCBK2280NP011

NOTE TO CONTRACTOR: FOREIGN MILITARY SALES

1015 DAYS PRIOR TO SHIPMENT, CONTACT THE DCMA/ACO TRANSPORTATION OFFICE FOR SHIPPING ADDRESS /

INSTRUCTIONS.

EVIDENCE OF SHIPMENT ON FOREIGN MILITARY SALES (FMS) CONTRACTS

(DEC 2003) The contractor shall provide to the payment office evidence of shipment that will consist of both a DD Form 250, Material Inspection and Receiving Report, and the carrier s receipt (e.g., the Commercial Bill of Lading, the Government Bill of Lading, the United States Postal Parcel Service receipt, the United Parcel Service pickup record, or other carrier pickup document). The contractor need not submit a DDForm 250, if one is not otherwise required under the contract.

TRANSPORTATION APPROPRIATION CHARGEABLE

The Transportation Allotment Identification (TAI) relates directly to the above ACRN(s). For example the TAI "TAA" is for the same line item(s) as ACRN "AA".

FMS TRANSPORTATION ALLOTMENT SHALL BE USED ONLY WHEN SHIPMENT ON GOVERNMENT BILL OF LADING IS

AUTHORIZED

Insert 3 if movement via surface mode or 2 if movement via airlift in place of any "#" shown.

Insert last digit of current fiscal year in place of any asterisk "*" shown when material is shipped.

CLIN ATAC FMS ALLOTMENT/ NOTE

0001 D625

0002 F6RS

LIST OF DOCUMENTS, EXHIBITS OR ATTACHMENTS

Form Number Description/File Name Date Number of Pages Market Research.pdf 19MAY2023 6

158 2332382 Packaging FMS 19JUL2023 2

158 2431118 Packaging NONFMS 13DEC2023 2

1653 2332382 Transportation FMS 19JUL2023 3

1653 2431118 Transportation NONFMS 13DEC2023 3

Item Description.pdf 02NOV2022 1