SF1449 HSCG40-12-Q-FZ036.docx

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Amplifier-Power (1KW) PA-2220A (13499
Solicitation number
HSCG40-12-Q-FZ036
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SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

2112402b4200fz036

2. CONTRACT NO.

3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER

5. SOLICITATION NUMBER

HSCG40-12-Q-FZ036

6. SOLICITATION

ISSUE DATE

8/6/12

7. FOR SOLICITATION INFORMATION CALL:
a. NAME

Dennis S. Kokoskie

b. TELEPHONE NUMBER (no collect calls)

410-762-6097

8. OFFER DUE DATE/ LOCAL TIME

8/28/12 2:00PM

9. ISSUED BY CODE 75174

USCG Surface Forces Logistics Center Attn: Dennis.S.Kokoskie@uscg.mil CPD-C&P3/Shared Services Division 2401 Hawkins Point Rd., Bldg. 3, 1st Floor Baltimore, MD 21226-5000

E-mail: Dennis.S.Kokoskie@uscg.mil

10. THIS ACQUISITION IS

|X| UNRESTRICTED OR |_| SET ASIDE 100% FOR:

SMALL BUSINESS|_| EMERGING SMALL|_| HUBZONE SMALLBUSINESS
BUSINESS
|_| SERVICE DISABLED VETERAN-|_| 8(A)
OWNED SMALL BUSINESS

NAICS: 334511

SIZE STANDARD 750

11. DELIVERY FOR FOB DESTINATION UNLESS BLOCK IS MARKED

|_| SEE SCHEDULE

12. DISCOUNT

TERMS

|_| 13a. THIS CONTRACT IS A RATED ORDER UNDER DPAS (15 CFR 700)
13b. RATING

14. METHOD OF SOLICITATION

|_| RFQ |_| IFB |X| RFP

15. DELIVER TO CODE

See Description of Supplies/Services

16. ADMINISTERED BY CODE

Same as block 9

17a. CONTRACTOR/ CAGE CODE FACILITY

OFFEROR CODE

DUNS No.

TELEPHONE NO:

FAX NO:

18a. PAYMENT WILL BE MADE BY CODE

USCG Finance Center 1430A Kristina Way Chesapeake, VA 23326

|_| 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 |X| SEE ADDENDUM

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

NSN 01-504-8373

AMPLIFIER-POWER (1KW)

REPL#373059

PART_NBR: 270-2695-020

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 & 52.212-5 ARE ATTACHED. ADDENDA |X| 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.

|X| 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN ONE (1) COPY 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: REFERENCE

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 (SINGATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER

30c. DATE SIGNED

31b. NAME OF CONTRACTING OFFICER

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTIONSTANDARD FORM 1449 (Rev. 3/2005)
PREVIOUS EDITION IS NOT USABLEPrescribed by GSA – FAR (48 CFR) 53.212

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

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

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE

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

33. SHIP NUMBER

34. VOUCHER NUMBER

35. AMOUNT VERIFIED CORRECT FOR

36. PAYMENT

|_| COMPLETE|_| PARTIAL|_| FINAL
37. CHECK NUMBER

|_| PARTIAL |_| FINAL

38. S/R ACCOUNT NUMBER

39. S/R VOUCHER NUMBER

40. PAID BY

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

42 a. RECEIVED BY (Print)

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER
41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC’D (YY/MM/DD)

42d. TOTAL CONTAINERS

STANDARD FROM 1449 (REV. 3/2005) BACK

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