HT0011-13-P-0004.pdf

6 . ISSUE D BY CODE

HT0011-13-P-0004

1 . CO N TRA CT/P U RCH . O RD E R/

A G RE E M E N T N O .

H T0011

2 . D E L IVE RY O RD E R/ CA L L N O .

10P AGE 1 OF

5 . P RIO RITY

CODE

8 . DEL IVERY FOB

DEST INAT IONX

OT HE R

(See Sch edule if o t h er)

OR D ER FOR SUPPLIES OR SER VICES

3 . D A TE O F O RD E R/CA L L

2012 Dec 01

4 . RE Q ./ P U RCH . RE Q U E ST N O .

SEE IT EM 6

TR IC AR E MAN AGEMEN T AC TIVITY

14501 GEOR GE C AR TER W AY

SU ITE 105

C H AN TILLY VA 20151

7 . ADM INIST E RE D BY (if o th er th a n 6 )

( YYYYM M M D D )

1 0 . D E L IVE R TO FO B P O IN T BY (D ate)

( YYYYM M M D D )

H EALTH C AR E IN F OR MATION & MAN AGEMEN T SY ST

AN N A H AR R IS

230 E OH IO ST, STE 500

C H IC AGO IL 60611-3270

CODE 35KX79 . CONT RACT OR FACIL IT Y

SEE SCHEDULE

1 2 . D ISCO U N T TE RM S

N et 30 D ays

M A RK IF BU SIN E SS IS1 1 .

SM A L L

SM A L L

D ISA D VA N TA G E D

W O M E N -O W N E D

1 3 . M AIL INVOICE S T O T HE ADDRESS IN BLOCK

See Item 15

2 5 . T OT AL $300,000.00

TR IC AR E MAN AGEMEN T AC TIVITY

KAR EN SAD D OR IS

IN F OR MATION ASSU R AN C E- IA

D H H Q BU ILD IN G

7700 AR LIN GTON BLVD , SU ITE 5101

F ALLS C H U R C H VA 22042-5101

1 7 . ACCOUNT ING AND AP P ROP RIAT ION DAT A/ L OCAL USE

CODE

1 8 . IT E M NO. 1 9 . SCHEDUL E OF SUP P LIE S/ SERVICE S

* If q u a n t i ty a ccep ted b y th e G o ver n m en t is s a m e a s q u a n t i ty a ccep ted b elo w q u a n t i ty o r d er ed a n d en cir cle.

DE L IVE RY/1 6 .

1 4 . SHIP T O

Se e Sche dule

H T0003 H Q0649

MARK ALL

P AC KAG ES AND

P AP ERS W ITH

IDENTIFIC ATIO N

NUMB ERS IN

B LO C KS 1 AND 2 .

2 3 . AM OUNT

1 5 . P AYM ENT W IL L BE M ADE BY CODE

D F AS IN VP D AI TMA

8899 EAST 56TH STR EET

IN D IAN APOLIS IN 46249-1505

Th is d el iv ery o rd er/cal l i s i s s u ed o n an o th er G o v ern men t ag en cy o r in acco rd an ce w i th an d s u b ject to terms an d co n d i t io n s o f ab o v e n u mb ered co n tract .

T YP E CAL L

OF P URCHASE X

ORDE R

SEE SCHEDULE

24. UNITED STATES OF AMERICA

TEL: 703-681-0361

EMAIL: millie.mitchell@tma.osd.mil

CONTRACTING / ORDERING OFFICER

q u a n t i ty o r d er ed , in d ica te b y X . If d i f f er en t , en ter a ctu a l

BY: Millie A. Mitchell

If t h is bo x is m ark ed, sup p lier m ust sign Accep t an ce an d ret urn t h e fo llo win g n um ber o f co p ies:

NAM E OF CONT RACT OR SIGNAT URE T YP E D NAM E AND T IT L E

( YYYYM M M D D )

DAT E SIGNE D

ACCE P T ANCE. T HE CONT RACT OR HE REBY ACCE P T S T HE OFFE R REP RESE NT ED BY T HE NUM BE RED P URCHASE ORDE R AS IT M AY P REVIOUSL Y HAVE BEE N OR IS NOW M ODIFIE D, SUBJE CT T O AL L OF T HE T E RM S

AND CONDIT IONS SE T FORT H, AND AGRE ES T O P ERFORM T HE SAM E.

Referen ce y o u r q u o te d ated

Fu rn is h th e fo l lo w in g o n terms s p eci fied h erein . REF :

2 0 . QUANT IT Y

ORDERE D/

ACCE P T ED*

2 1 . UNIT 2 2 . UNIT P RICE

D IFFE RE N CE S

2 6 .

INSP E CT E D RE CE IVED ACCEP T E D, AND CONFORM S T O T HE

CONT RACT EXCEP T AS NOT E D

2 7 a. QUANT IT Y IN COL UM N 2 0 HAS BE E N

( YYYYM M M D D )

c. DAT E d. P RINT E D NAM E AND T IT L E OF AUT HORIZ ED

GOVERNM E NT RE P RE SENT AT IVE

b. SIGNAT URE OF AUT HORIZ E D GOVE RNM E NT RE P RE SENT AT IVE

e. M AIL ING ADDRE SS OF AUT HORIZ ED GOVE RNM ENT REP RESE NT AT IVE

36. I ce r tify th is account is cor re ct and prope r for paym e nt.

g. E -M AIL ADDRESSf. T EL EP HONE NUM BE R

a. DAT E

( YYYYM M M D D )

b. SIGNAT URE AND T IT LE OF CE RT IFYING OFFICE R

2 8 . SHIP NO. 2 9 . DO VOUCHER NO. 3 0 .

INIT IAL S

3 2 . P AID BY 3 3 . AM OUNT VE RIFIED

CORRE CT FOR

3 5 . BIL L OF LADING NO.

3 4 . CHE CK NUM BE R

3 7 . RE CEIVED AT 3 8 . RECE IVE D BY

( YYYYM M M D D )

3 1 . P AYM E NT

COM P L ET E

P ART IAL

FINAL

P ART IAL

FINAL

DD For m 1155, DEC 2001 P RE VIOUS EDIT ION IS OBSOL ET E .

3 9 . DAT E RE CE IVED 4 0 . T OT AL

CONT AINERS

4 1 . S/R ACCOUNT NO. 4 2 . S/R VOUCHE R NO.

AD D R ESS

AN D

N AME

Section B - Supplies or Services and Prices

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Years $300,000.00 $300,000.00 HIMSS Organizational Affiliate Program

FFP

FOB: Destination

NET AMT $300,000.00

000101 $0.00 Funding for CLIN 0001

NET AMT $0.00

ACRN AA

CIN: HT000323344066000101

$75,000.00

000102 $0.00 Funding for CLIN 0001

ACRN AB

CIN: HT000323344082000102

000103 $0.00 Funding for CLIN 0001

ACRN AC

CIN: HT000323344079000103

000104 $0.00 Funding for CLIN 0001

ACRN AD

CIN: HT000323344081000104

Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government 000101 N/A N/A N/A Government 000102 N/A N/A N/A Government 000103 N/A N/A N/A Government 000104 N/A N/A N/A Government

Section F - Deliveries or Performance

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS UIC

0001 POP 01-DEC-2012 TO

30-NOV-2013

N/A TRICARE MANAGEMENT ACTIVITY

KAREN SADDORIS

INFORMATION ASSURANCE- IA

DHHQ BUILDING

7700 ARLINGTON BLVD, SUITE 5101

FALLS CHURCH VA 22042-5101

HT0003

000101 N/A N/A N/A N/A

000102 N/A N/A N/A N/A

000103 N/A N/A N/A N/A

000104 N/A N/A N/A N/A

Section G - Contract Administration Data

ACCOUNTING AND APPROPRIATION DATA

AA: 970130.1313D-2013 0101010400807781-1884 252.30 044226 PRC34066

AMOUNT: $75,000.00

CIN HT000323344066000101: $75,000.00

AB: 970130.1313D-2013 0101010400807783-1884 252.30 044226 PRC34082

AMOUNT: $75,000.00

CIN HT000323344082000102: $75,000.00

AC: 970130.1313D-2013 0101010400807781-1884 252.30 044226 PRC34079

AMOUNT: $75,000.00

CIN HT000323344079000103: $75,000.00

AD: 970130.1313D-2013 0101010400807781-1884 252.30 044226 PRC34081

AMOUNT: $75,000.00

CIN HT000323344081000104: $75,000.00

PAYMENT INSTRUCTIONS

Invoicing and Receiving Report Instructions

The Contractor is responsible for submitting invoices and initiating receiving reports electronically through Wide Area Work Flow – Receipt and Acceptance (WAWF) for goods and services rendered under this Contract. For fixed price contracts, the WAWF 2 IN 1 format (for services), and the COMBO format (only for supplies or equipment), are the preferred methods of processing electronic invoices and receiving reports within TMA. Back up documentation (such as timesheets, etc.) can be included and attached to WAWF documents as requested by the responsible COR. Attachments created in any Microsoft Office product are attachable to the invoice in WAWF.

Contractor personnel (WAWF Vendor role) shall self-register at the web site:

https://wawf.eb.mil/, and be activated by the Contractor’s designated Electronic Business Point of Contact. WAWF training is available on the internet at http://wawftraining.com.

The Contractor shall submit invoices for payment and initiate receiving reports every month.

The Government shall process invoices for payment and associated receiving reports every month.

Prior to submitting the first WAWF-RA electronic form for a given task order, Contractors should first coordinate with the assigned TMA COR.

252.232-7003 Electronic Submission of Payment Requests and Receiving Reports.

As prescribed in 232.7004, use the following clause:

ELECTRONIC SUBMISSION OF PAYMENT REQUESTS AND RECEIVING REPORTS (MAR

2008)

(a) Definitions. As used in this clause—

(1) “Contract financing payment” and “invoice payment” have the meanings given in section

32.001 of the Federal Acquisition Regulation.

(2) “Electronic form” means any automated system that transmits information electronically from the initiating system to all affected systems. Facsimile, e-mail, and scanned documents are not acceptable electronic forms for submission of payment requests.

However, scanned documents are acceptable when they are part of a submission of a payment request made using Wide Area WorkFlow (WAWF) or another electronic form authorized by the Contracting Officer.

(3) “Payment request” means any request for contract financing payment or invoice payment submitted by the Contractor under this contract.

(b) Definitions. Important to the WAWF Process

(1) Acceptor: The organization or person designated in block 15 of the SF 1449 (cover page of the purchase request) who accepts the products or services tendered. The acceptor has a unique DoDAAC (Department of Defense Activity Address Code) shown in the upper right had box of block 15 that must be used to notify the acceptor that an electronic invoice is pending.

(2) DoDAAC: As stated above, an acronym for Department of Defense Activity Address Code. This code unique to each organization in the Department of Defense. Knowledge of what DoDAAC codes must be input into WAWF electronic invoices is crucial to the payment process as it alerts the acceptor that an invoice is pending for acceptance and alerts the payment office that a completed action is ready to process for payment.

(3) Payment Office: The location of the Defense Finance and Accounting Service (DFAS) office shown in block 18a of the SF 1449 that will process your electronic invoices. The payment office also has a unique DoDAAC.

(c) Options within WAWF include a "combo" for supply items, a 2-in-1 invoice for service contracts and a "stand-alone" invoice. It is recommended that the use of, stand-alone invoices be avoided. The matching of "stand-alone" invoices by DFAS offices requires invoices and receiving reports be separately or individually submitted by the vendor and the receiving activity and can routinely cause lengthy delays and possible rejection because they do not appear together and therefore must be individually matched and then verified. The use of the "combo" or "2-in-1" does not present this problem and avoids the attendant delays associated with matching. Detailed instructions on how to create an invoice, as well as other topical issues, can be found at the WAWF training website at http://www.wawftraining.com.

(d) A key, important, and imperative step for vendors to take is to e-mail notification to the acceptor identified in the contract in block 15 by clicking on the "Send More E-Mail Notifications" link in WAWF upon submission of the electronic invoice instrument (combo or 2-in1). This step provides notice to the acceptor of your pending invoice. Except as provided in paragraph (c) of this clause, the Contractor shall submit payment requests and receiving reports using WAWF, in one of the following electronic formats that WAWF accepts: Electronic Data Interchange, Secure File Transfer Protocol, or World Wide Web input. Information regarding WAWF is available on the Internet at https://wawf.eb.mil/.

(e) The Contractor may submit a payment request and receiving report using other than WAWF only when—

(1) The Contracting Officer authorizes use of another electronic form. With such an authorization, the Contractor and the Contracting Officer shall agree to a plan, which shall include a timeline, specifying when the Contractor will transfer to WAWF;

(2) DoD is unable to receive a payment request or provide acceptance in electronic form;

(3) The Contracting Officer administering the contract for payment has determined, in writing, that electronic submission would be unduly burdensome to the Contractor. In such cases, the Contractor shall include a copy of the Contracting Officer’s determination with each request for payment; or

(4) DoD makes payment for commercial transportation services provided under a Government rate tender or a contract for transportation services using a DoD-approved electronic third party payment system or other exempted vendor payment/invoicing system (e.g., PowerTrack, Transportation Financial Management System, and Cargo and Billing System).

(f) The Contractor shall submit any non-electronic payment requests using the method or methods specified in Section G of the contract.

(g) In addition to the requirements of this clause, the Contractor shall meet the requirements of the appropriate payment clauses in this contract when submitting payment requests.

(h) The Contractor is responsible for submitting invoices and initiating receiving reports electronically through Wide Area Work Flow – Receipt and Acceptance (WAWF) for goods and services rendered under this Contract. Contractors should use the WAWF cost voucher format to bill on cost-reimbursement contracts, including Time and Materials and Labor Hour (T&M and LH) contracts. For cost-reimbursement, T&M and LH contracts, the DCAA has sole authority for verifying claimed costs and approving interim payment requests, and the Contracting Officer has the sole authority for approving final payment requests. Information on completing a WAWF Cost Voucher is available on the internet at http://wawftraining.com. WAWF documents are routed using specific location codes. To insure proper routing the following WAWF location codes are provided for this contract:

Pay DoDAAC: HQ0649

Service Acceptor DoDAAC: HT0003

Service Approver / Ext.:

Karen Saddoris| FTICAM

Self registration for the use of WAWF can be accomplished at https://wawf.eb.mil/index.html.

For assistance in registering contact:

1-866-618-5988

COMMERCIAL: 801-605-7095

CSCASSIG@CSD.DISA.MIL

Helpful training on the use of WAWF for the submission of invoices is available on line at http://www.wawftraining.com.

(i) Questions concerning payments:

(1) DFAS Indianapolis at 1-888-332-7366. You will need to have the delivery/purchase/contract number ready when calling about payments.

(2) Payment and receipt information can be accessed at the DFAS website https://myinvoice.csd.disa.mil/.You will need to have the delivery/purchase/contract number or invoice number to inquire about the payment.

When initiating documents within WAWF, Contractors must use the appropriate two-part TMA location code to include BOTH the Government Acceptor DoDAAC / Extension (Ext) fields and the Local Processing Office (LPO) DoDAAC / Extension fields as displayed within the WAWF application and illustrated below:

Section I - Contract Clauses

CLAUSES INCORPORATED BY REFERENCE

52.212-4 Contract Terms and Conditions--Commercial Items FEB 2012 52.225-13 Restrictions on Certain Foreign Purchases JUN 2008 52.233-3 Protest After Award AUG 1996 52.233-4 Applicable Law for Breach of Contract Claim OCT 2004