T12 Sol_75H71026Q00033.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

CODE 16. ADMINISTERED BYCODE

X

X

X

339116

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR25

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

12/24/2025 1200 ET

12/09/2025

DAISHA RICHARDS

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H71026Q00033

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 18 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Kayenta AZ 86033 US Highway 160 South Milepost 394.3 Kayenta Health Center

15. DELIVER TO

Kayenta AZ 86033 Highway 160, Mile Post 394.3 PO Box 368 Acquisition Department

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Kayenta Health Center

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

This is a Total Small Business set-aside.

This contract is subject to the electronic payment process by the Department of Treasury.

All invoices complying to the requirements at 52.212-4(g) must be submitted through www.ipp.gov. For additional information, refer to the incorporated clause at 352.232-71 Electronic Submission of Payment Requests (FEB 2022).

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

JERLYN R. BEGAY

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

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

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

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

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

1 Dental Lab Services:

fixed/crowns, & bridge (gold,PFM, all-ceramic including zirconia, and other service available), removable prosthodontist (conventional and immediate complete and partial dentures, flexible partial dentures, interim partial dentures and any other service available at any dental lab) and implant prosthodontics (implant-supported fixed prostheses, implant-retained removable prostheses, and additional services.

Period of Performance: 01/01/2026 to 12/31/2026

2 Shipping & Handling

Period of Performance: 01/01/2026 to 12/31/2026

3 Option Year 1:

Dental Lab Services:

fixed/crowns, & bridge (gold,PFM, all-ceramic including zirconia, and other service available), removable prosthodontist (conventional and immediate complete and partial dentures, flexible partial dentures, interim partial dentures and any other service available at any dental lab) and implant prosthodontics (implant-supported fixed prostheses, implant-retained removable prostheses, and additional services.

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

18 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 18

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H71026Q00033

(Option Line Item)

01/01/2027

Period of Performance: 01/01/2027 to 12/31/2027

4 Option Year 1:

Shipping & Handling

(Option Line Item)

01/01/2027

Period of Performance: 01/01/2027 to 12/31/2027

5 Option Year 2:

Dental Lab Services:

fixed/crowns, & bridge (gold,PFM, all-ceramic including zirconia, and other service available), removable prosthodontist (conventional and immediate complete and partial dentures, flexible partial dentures, interim partial dentures and any other service available at any dental lab) and implant prosthodontics (implant-supported fixed prostheses, implant-retained removable prostheses, and additional services.

(Option Line Item)

01/01/2028

Period of Performance: 01/01/2028 to 12/31/2028

6 Option Year 2:

Shipping & Handling

(Option Line Item)

01/01/2028

Period of Performance: 01/01/2028 to 12/31/2028

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

Sponsored by GSA

FAR (48 CFR) 53.110

Rev. 11/30/2025

SECTION C – CONTRACT CLAUSES

52.212-4 CONTRACT TERMS AND CONDITIONS –

COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES

NOV 2025

(DEVIATION)

The following Federal Acquisition Regulation clauses also apply:

☐ 52.203-3 GRATUITIES APR 1984

☐ 52.203-6 RESTRICTIONS ON SUBCONTRACTOR SALES TO THE GOVERNMENT Alt I

NOV 2021

☐ 52.203-12 LIMITATION OF PAYMENTS TO INFLUENCE CERTAIN FEDERAL

TRANSACTIONS

JUN 2020

☐ 52.203-13 CONTRACTOR CODE OF BUSINESS ETHICS AND CONDUCT NOV 2021

☐ 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST JUN 2020

☒ 52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS NOV 2023

☐ 52.203-19 PROHIBITION ON REQUIRING CERTAIN INTERNAL CONFIDENTIALITY

AGREEMENTS OR STATEMENTS

JAN 2017

☐ 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL JAN 2011

☒ 52.204-13 SYSTEM FOR AWARD MANAGEMENT MAINTENANCE NOV 2025

(DEVIATION)

☐ 52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS NOV 2025

(DEVIATION)

☐ 52.204-15 SERVICE CONTRACT REPORTING REQUIREMENTS FOR INDEFINITE-

DELIVERY CONTRACTS

NOV 2025

(DEVIATION)

☐ 52.204-91 CONTRACTOR IDENTIFICATION NOV 2025

(DEVIATION)

☒ 52.209-6 PROTECTING THE GOVERNMENT’S INTEREST WHEN

SUBCONTRACTING WITH CONTRACTORS DEBARRED, SUSPENDED, OR

PROPOSED FOR DEBARMENT

NOV 2025

(DEVIATION)

☐ 52.209-9 UPDATES OF PUBLICLY AVAILABLE INFORMATION REGARDING

RESPONSIBILITY MATTERS

NOV 2025

(DEVIATION)

☒ 52.209-10 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC

CORPORATIONS

NOV 2025

(DEVIATION)

☐ 52.213-1 RESERVED

☐ 52.219-3 NOTICE OF HUBZONE SET-ASIDE OR SOLE-SOURCE AWARD NOV 2025

(DEVIATION)

☒ 52.219-6 NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE NOV 2025

(DEVIATION)

☐ 52.219-6 Alt I

NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE, WITH ALTERNATE I NOV 2025

☐ 52.219-7 NOTICE OF PARTIAL SMALL BUSINESS SET-ASIDE NOV 2020

☐ 52.219-7 Alt I

NOTICE OF PARTIAL SMALL BUSINESS SET-ASIDE, WITH ALTERNATE I MAR 2020

☐ 52.219-8 UTILIZATION OF SMALL BUSINESS CONCERNS NOV 2025

(DEVIATION)

☐ 52.219-9 SMALL BUSINESS SUBCONTRACTING PLAN NOV 2025

(DEVIATION)

☐ 52.219-9 Alt I

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE I NOV 2025

(DEVIATION)

☐ 52.219-9 Alt II

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE II NOV 2025

(DEVIATION)

☐ 52.219-9 Alt III

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE III NOV 2025

(DEVIATION)

☐ 52.219-9 Alt IV

SMALL BUSINESS SUBCONTRACTING PLAN, WITH ALTERNATE IV NOV 2025

(DEVIATION)

☐ 52.219-13 NOTICE OF SET-ASIDE OF ORDERS MAR 2020

☐ 52.219-13 Alt I

RESERVED

☐ 52.219-16 LIQUIDATED DAMAGES—SUBCONTRACTING PLAN NOV 2025

(DEVIATION)

☐ 52.219-27 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO, SERVICE-

DISABLED VETERAN-OWNED SMALL BUSINESS (SDVOSB) CONCERNS

ELIGIBLE UNDER THE SDVOSB PROGRAM

NOV 2025

(DEVIATION)

☒ 52.219-28 POSTAWARD SMALL BUSINESS PROGRAM REREPRESENTATION NOV 2025

(DEVIATION)

☐ 52.219-28 Alt I

POSTAWARD SMALL BUSINESS PROGRAM REREPRESENTATION, WITH

ALTERNATE I

NOV 2025

(DEVIATION)

☐ 52.219-29 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO,

ECONOMICALLY DISADVANTAGED WOMEN-OWNED SMALL BUSINESS

CONCERNS

NOV 2025

(DEVIATION)

☐ 52.219-30 NOTICE OF SET-ASIDE FOR, OR SOLE-SOURCE AWARD TO, WOMEN-

OWNED SMALL BUSINESS CONCERNS ELIGIBLE UNDER THE WOMEN-

OWNED SMALL BUSINESS PROGRAM

NOV 2025

(DEVIATION)

☐ 52.219-32 ORDERS ISSUED DIRECTLY UNDER SMALL BUSINESS RESERVES MAR 2020

☐ 52.219-33 NONMANUFACTURER RULE NOV 2025

(DEVIATION)

☒ 52.222-3 CONVICT LABOR NOV 2025

(DEVIATION)

☒ 52.222-19 CHILD LABOR—COOPERATION WITH AUTHORITIES AND REMEDIES NOV 2025

(DEVIATION)

☐ 52.222-35 EQUAL OPPORTUNITY FOR VETERANS NOV 2025

(DEVIATION)

☒ 52.222-36 EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES NOV 2025

(DEVIATION)

☐ 52.222-36

ALT I

EQUAL OPPORTUNITY FOR WORKERS WITH DISABILITIES, WITH

ALTERNATE I

JUL 2014

☐ 52.222-37 EMPLOYMENT REPORTS ON VETERANS NOV 2025

(DEVIATION)

☐ 52.222-40 NOTIFICATION OF EMPLOYEE RIGHTS UNDER THE NATIONAL LABOR

RELATIONS ACT

NOV 2025

(DEVIATION)

☐ 52.222-41 SERVICE CONTRACT LABOR STANDARDS NOV 2025

(DEVIATION)

☐ 52.222-43 FAIR LABOR STANDARDS ACT AND SERVICE CONTRACT LABOR

STANDARDS-PRICE ADJUSTMENT (MULTIPLE YEAR AND OPTION

CONTRACTS)

NOV 2025

(DEVIATION)

☐ 52.222-44 FAIR LABOR STANDARDS ACT AND SERVICE CONTRACT LABOR

STANDARDS-PRICE ADJUSTMENT

NOV 2025

(DEVIATION)

☒ 52.222-50 COMBATING TRAFFICKING IN PERSONS NOV 2025

(DEVIATION)

☐ 52.222-50 Alt I

COMBATING TRAFFICKING IN PERSONS NOV 2025

(DEVIATION)

☐ 52.222-51 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS TO CONTRACTS FOR MAINTENANCE, CALIBRATION, OR

REPAIR OF CERTAIN EQUIPMENT—REQUIREMENTS

NOV 2025

(DEVIATION)

☐ 52.222-53 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS TO CONTRACTS FOR CERTAIN SERVICES—

REQUIREMENTS

NOV 2025

(DEVIATION)

☐ 52.222-54 EMPLOYMENT ELIGIBILITY VERIFICATION NOV 2025

(DEVIATION)

☐ 52.222-55 MINIMUM WAGES FOR CONTRACTOR WORKERS UNDER EXECUTIVE

ORDER 14026

NOV 2025

(DEVIATION)

☐ 52.222-62 PAID SICK LEAVE UNDER EXECUTIVE ORDER 13706 NOV 2025

(DEVIATION)

☐ 52.223-2 REPORTING OF BIOBASED PRODUCTS UNDER SERVICE AND

CONSTRUCTION CONTRACTS

NOV 2025

(DEVIATION)

☐ 52.223-5 POLLUTION PREVENTION AND RIGHT-TO-KNOW INFORMATION MAY 2024

☐ 52.223-11 OZONE-DEPLETING SUBSTANCES NOV 2025

(DEVIATION)

☐ 52.223-12 MAINTENANCE, SERVICE, REPAIR, OR DISPOSAL OF REFRIGERATION

EQUIPMENT AND AIR CONDITIONERS

NOV 2025

(DEVIATION)

☐ 52.223-23 SUSTAINABLE PRODUCTS NOV 2025

(DEVIATION)

☐ 52.224-1 PRIVACY ACT NOTIFICATION APR 1984

☐ 52.224-2 PRIVACY ACT APR 1984

☐ 52.224-3 PRIVACY TRAINING JAN 2017

☐ 52.224-3

ALT I

PRIVACY TRAINING, ITH ALTERNATE I JAN 2017

☐ 52.225-1 BUY AMERICAN-SUPPLIES NOV 2025

(DEVIATION)

☐ 52.225-1 Alt I

BUY AMERICAN-SUPPLIES, WITH ALTERNATE I OCT 2022

☒ 52.225-3 BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT NOV 2025

(DEVIATION)

52.225-3

ALT I

RESERVED

☐ 52.225-3 Alt II

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE II

NOV 2025

(DEVIATION)

☐ 52.225-3 Alt III

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE III

NOV 2025

(DEVIATION)

☐ 52.225-3 Alt IV

BUY AMERICAN-FREE TRADE AGREEMENTS-ISRAELI TRADE ACT,

WITH ALTERNATE IV

NOV 2025

(DEVIATION)

☐ 52.225-5 TRADE AGREEMENTS NOV 2023

☐ 52.225-14 INCONSISTENCY BETWEEN ENGLISH VERSION AND TRANSLATION OF

CONTRACT

FEB 2000

☐ 52.225-19 CONTRACTOR PERSONNEL IN A DESIGNATED OPERATIONAL AREA OR

SUPPORTING A DIPLOMATIC OR CONSULAR MISSION OUTSIDE THE

UNITED STATES

MAY 2020

☐ 52.225-26 CONTRACTORS PERFORMING PRIVATE SECURITY FUNCTIONS

OUTSIDE THE UNITED STATES

OCT 2016

☐ 52.226-1 UTILIZATION OF INDIAN ORGANIZATIONS AND INDIAN-OWNED

ECONOMIC ENTERPRISES

NOV 2025

(DEVIATION)

☐ 52.226-5 RESTRICTIONS ON SUBCONTRACTING OUTSIDE DISASTER OR

EMERGENCY AREA

NOV 2025

(DEVIATION)

☐ 52.226-6 PROMOTING EXCESS FOOD DONATION TO NONPROFIT

ORGANIZATIONS

NOV 2025

(DEVIATION)

☒ 52.226-8 ENCOURAGING CONTRACTOR POLICIES TO BAN TEXT MESSAGING

WHILE DRIVING

MAY 2024

☐ 52.229-12 TAX ON CERTAIN FOREIGN PROCUREMENTS AUG 2025

(DEVIATION)

☐ 52.232-18 AVAILABILITY OF FUNDS APR 1984

☐ 52.232-29 TERMS FOR FINANCING OF COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2021

☐ 52.232-30 INSTALLMENT PAYMENTS OF COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2021

☒ 52.232-33 PAYMENT BY ELECTRONIC FUNDS TRANSFER—SYSTEM FOR AWARD

MANAGEMENT

OCT 2018

☐ 52.232-34 PAYMENT BY ELECTRONIC FUNDS TRANSFER—OTHER THAN SYSTEM

FOR AWARD MANAGEMENT

JUL 2013

☐ 52.232-36 PAYMENT BY THIRD PARTY NOV 2025

(DEVIATION)

☒ 52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS

MAR 2023

☐ 52.232-90 FAST PAYMENT PROCEDURE NOV 2025

(DEVIATION)

☒ 52.233-3 PROTEST AFTER AWARD NOV 2025

(DEVIATION)

☒ 52.233-4 APPLICABLE LAW FOR BREACH OF CONTRACT CLAIM NOV 2025

☐ 52.237-2 PROTECTION OF GOVERNMENT BUILDING, EQUIPMENT, AND

VEGETATION

APR 1984

☒ 52.237-3 CONTINUITY OF SERVICES JAN 1991

☒ 52.240-91 SECURITY PROHIBITIONS AND EXCLUSIONS NOV 2025

(DEVIATION)

☐ 52.240-91 Alt I

SECURITY PROHIBITIONS AND EXCLUSIONS, WITH ALTERNATE I NOV 2025

(DEVIATION)

☐ 52.240-92 SECURITY REQUIREMENTS NOV 2025

(DEVIATION)

☐ 52.240-92 Alt II

SECURITY REQUIREMENTS WITH ALTERNATE II NOV 2025

(DEVIATION)

☐ 52.240-93 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION

SYSTEMS

NOV 2025

(DEVIATION)

☐ 52.242-5 PAYMENTS TO SMAL BUSINESS SUBCONTRACTORS JAN 2017

☐ 52.242-13 BANKRUPTCY JUL 1995

☐ 52.244-2 SUBCONTRACTS JUN 2020

☒ 52.244-6 SUBCONTRACTS FOR COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES

NOV 2025

(DEVIATION)

☐ 52.245-1 GOVERNMENT PROPERTY SEP 2021

☐ 52.245-2 GOVERNMENT PROPERTY INSTALLATION OPERATION SERVICES APR 2012

☐ 52.245-9 USE AND CHARGES APR 2012

☐ 52.247-64 PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS

NOV 2025

(DEVIATION)

☐ 52.247-64 Alt I

PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS, WITH ALTERNATE I

APR 2003

☐ 52.247-64 Alt II

PREFERENCE FOR PRIVATELY OWNED U.S.-FLAG COMMERCIAL

VESSELS, WITH ALTERNATE II

NOV 2021

52.217-8 OPTION TO EXTEND SERVICES NOV 1999

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 45 days before the contract expires.

(End of clause)

52.217-9 OPTION TO EXTEND THE TERM OF THE

CONTRACT MAR 2000

(a)The Government may extend the term of this contract by written notice to the Contractor within 10 days before the contract expires; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 10 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b)If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c)The total duration of this contract, including the exercise of any options under this clause, shall not exceed 12/31/2028.

(End of clause)

52.252-2 CLAUSES INCORPORATED BY REFERENCE FEB 1998

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

Revolutionary FAR Overhaul - FAR Overhaul - FAR Part Deviation Guidance | Acquisition.GOV

Federal Acquisition Regulation - https://www.acquisition.gov/browse/index/far

Department of Health and Human Services Acquisition Regulation – https://www.acquisition.gov/hhsar

(End of clause)

52.252-6 AUTHORIZED DEVIATIONS IN CLAUSES NOV 2020

(a)The use in this solicitation or contract of any Federal Acquisition Regulation (48 CFR Chapter 1) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the date of the clause.

(b)The use in this solicitation or contract of any Department of Health and Human Services (48 CFR Chapter 3) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation.

(End of clause)

The following Department of Health and Human Services Acquisition Regulation clauses also apply:

☐ 352.203-70 ANTI-LOBBYING DEC 2015

☐ 352.208-70 PRINTING AND DUPLICATION DEC 2015

☐ 352.211-3 PAPERWORK REDUCTION ACT DEC 2015

☐ 352.219-71 MENTOR-PROTÉGÉ PROGRAM REPORTING REQUIREMENTS JAN 2010

☐ 352.223-70 SAFETY AND HEALTH DEC 2015

☒ 352.224-70 PRIVACY ACT DEC 2015

☐ 352.226-6 INDIAN ECONOMIC ENTERPRISE SUBCONTRACTING

LIMITATIONS

MAR 2022

☐ 352.227-70 PUBLICATIONS AND PUBLICITY DEC 2015

☐ 352.231-70 SALARY RATE LIMITATION DEC 2015

☐ 352.237-70 PRO-CHILDREN ACT DEC 2015

☐ 352.237-71 CRIME CONTROL ACT – REPORTING OF CHILD ABUSE DEC 2015

☐ 352.237-72 CRIME CONTROL ACT – REQUIREMENTS FOR BACKGROUND

CHECKS

DEC 2015

☐ 352.237-73 INDIAN CHILD PROTECTION AND FAMILY VIOLENCE ACT DEC 2015

352.232-71 ELECTRONIC SUBMISSION OF PAYMENT

REQUESTS

FEB 2022

(a) Definitions. As used in this clause –

Payment request means a bill, voucher, invoice, or request for contract financing payment with associated supporting documentation. The payment request must comply with the requirements identified in FAR 32.905(b), “Content of Invoices” and the applicable Payment clause included in this contract.

(b) Except as provided in paragraph (c) of this clause, the Contractor shall submit payment requests electronically using the Department of Treasury Invoice Processing Platform (IPP) or successor system. Information regarding IPP, including IPP Customer Support contact information, is available at www.ipp.gov or any successor site.

(c) The Contractor may submit payment requests using other than IPP only when the Contracting Officer authorizes alternate procedures in writing in accordance with HHS procedures.

(d) If alternate payment procedures are authorized, the Contractor shall include a copy of the Contracting Officer’s written authorization with each payment request.

(End of Clause)

The following local Indian Health Service, Navajo Area terms also apply:

NAIHS-ACQ-09 UNAUTHORIZED COMMITMENTS NOV 2025

(a) Definitions.

Contracting Officer means a person with the authority to enter into, administer, and/or terminate contracts and make related determination and findings.

Ratification means the act of approving an unauthorized commitment by an official who has the authority to do so.

Unauthorized Commitment (UAC) means an agreement that is not binding solely because the Government representative who made it lacked the authority to enter into that agreement on behalf of the Government.

(b) Policy.

The Government is not bound by agreements with, or contractual commitments made to, prospective contractors by individuals who do not have delegated contracting authority. Unauthorized commitments do not follow the appropriate process for the expenditure of Government funds. Consequently, the Government may not be able to ratify certain actions, putting a contractor at risk for taking direction from a Federal official other than the contracting officer (see FAR 1.403-2) Government employees responsible for unauthorized commitments are subject to disciplinary action. Contractors perform at their own risk when accepting direction from unauthorized officials. Failure to follow statutory and regulatory processes for the expenditure of Government funds is a very serious matter.

(c) Procedure.

Any agreement, modification, or change to a contractual agreement made by a government personnel who lack authority will be deemed an unauthorized commitment. The Government is not liable to the Contractor or under the terms of the contract, financially or otherwise – unless the unauthorized commitment successfully passes the ratification process.

The ratification process does not have any lead time, nor does the Government make any promise that an unauthorized commitment will be ratified and, therefore, the Contractor would be paid. The Contractor proceeds at its own risk if any of the terms of the contract are altered, changed, or modified without the written concurrence by a Contracting Officer.

(End of Clause)

SECTION D – DOCUMENTS, EXHIBITS, ATTACHMENTS, ETC.

Attachment A: Statement of Work (SOW)

Statement of Work 2026 – Kayenta Alternative Rural Hospital – Dental Lab Service

Background Kayenta Alternative Rural Hospital (KARH) serves a population of 20,000 people spread across a remote and sparsely populated area. Kayenta Alternative Rural Hospital (KARH) operates year-round, 24 hours a day in a crucial role that provides medical and dental health care services. The purpose of this contract is to provide Kayenta Alternative Rural Hospital with an ongoing account for off-site dental laboratory services (fixed, removable, and implant prosthodontics, and other adjunct services as provide) with contractor.

Scope Kayenta Alternative Rural Hospital requests services from a dental laboratory able to provide dental laboratory services such as; inlay/onlay crown & bridges, Titanium/Zirconia/Gold Abutment Implant, Complete Denture, Partial Denture, Night Guard, Soft/Hard Guard, Bleaching Tray, Ortho Retainer, Essix Retainer, Hawley Retainter, Custom Tray, Teeth Reset to KARH. Specific services are outlined briefly below. The contractor will work with KARH prosthodontist, dentist, Administrative Support Assistant, and Chief of Dental Services through completed lab slips as provided by dental laboratory services with remote support (telephone, email) to staff and doctors for any questions or concerns regarding lab cases. There will be a varying number of doctors (usually 3-6) submitting cases to dental laboratory all on the same account.

Objectives The contractor shall provide dental laboratory services and take reasonable and customary precautions to protect cases (models, impressions, implant components, etc.) and any equipment submitted with a case, belonging to KARH (articulators owned by KARH, etc.), in the usual manner that the contractor cares for cases and equipment.

Task The contractor shall provide fixed/crown & bridge (gold, PFM, all-ceramic including zirconia, and any other service available at dental laboratory removable prosthodontics (conventional and immediate complete and partial dentures, flexible partial dentures, interim partial dentures and any other service available at dental laboratory and implant prosthodontics (implant-supported fixed prostheses, implant-retained removable prostheses, single-unit and multi-unit fixed prostheses and any other services provided at dental laboratory as well as any adjunct lab services as available from the contractor (mouth guards, sleep apnea appliances, et. al.).

Delivery The contractor shall provide shipping labels, shipping containers, and lab slips/prescriptions upon request and as available to KARH in contractors usual manner. Delivery of cases will comply with dental laboratory’s usual time frames and methods/protocols for specific work as specified by the contractor. If any equipment belonging to the

Statement of Work 2026 – Kayenta Alternative Rural Hospital – Dental Lab Service contractor is damaged in shipping, all repairs and replacements shall be covered by the contractor or shipper according to the usual protocols at no cost to the Government.

Government-Furnished Property/Equipment No government property shall be provided to the contractor in their fulfilment of this contract.

Security Requirements As dental laboratory personnel will not work or perform any functions on-site at KARH, no physical security measures are required. Contactor will take reasonable precautions to comply with HIPAA regulations, in their usual and customary manner.

Place of Performance All services to be provided to KARH will be provided off-site, at the dental laboratory. facilities. Lab cases will be shipped from, and completed cases will be shipped to:

Kayenta Alternative Rural Hospital – Dental Department HWY 160 South Milepost 394.3

Kayenta, AZ 86003

Period of Performance The period of performance shall be issued as a Base plus two (2) option years duration of twelve (12) months from the date of award. (Base – 01/01/2026 – 12/31/2026, Option Year 1 – 01/01/2027 – 12/31/2027, and Option Year 2 – 01/01/2028 – 12/31/2028)

SECTION E – SOLICITATION PROVISIONS

52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES

52.212-2 EVALUATION – COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

NOV 2025

(DEVIATION)

(a)Evaluation factors. The Government will award a contract resulting from this solicitation to the responsible Offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

1. Task Specifications in accordance with the Statement of Work (Attachment A)

2. Delivery Schedule

3. Past Performance – history of working with the Navajo Area Indian Health Service (NAIHS)

(b) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).

(c) Notice of award. A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of provision)

The following Federal Acquisition Regulations provisions incorporated by reference also apply:

☐ 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO

INFLUENCE CERTAIN FEDERAL TRANSACTIONS

SEP 2024

52.203-18

PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE

CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS OR

STATEMENTS-REPRESENTATION

JAN 2017

☒ 52.204-7

SYSTEM FOR AWARD MANAGEMENT – REGISTRATION

NOV 2025

(DEVIATION)

☐ 52.204-7 Alt I

SYSTEM FOR AWARD MANAGEMENT—REGISTRATION, WITH

ALTERNATE I

NOV 2025

(DEVIATION)

52.207-6 SOLICITATION OF OFFERS FROM SMALL BUSINESS CONCERNS AND

SMALL BUSINESS TEAMING ARRANGEMENTS OR JOINT VENTURES

(MULTIPLE-AWARD CONTRACTS)

AUG 2024

☐ 52.209-12 CERTIFICATION REGARDING TAX MATTERS OCT 2025

☐ 52.216-31 TIME-AND-MATERIALS/LABOR-HOUR PROPOSAL REQUIREMENTS –

COMMERCIAL ACQUISITION

NOV 2021

☐ 52.219-4 NOTICE OF PRICE EVALUATION PREFERENCE FOR HUBZONE SMALL

BUSINESS CONCERNS

NOV 2025

(DEVIATION)

☐ 52.219-31 NOTICE OF SMALL BUSINESS RESERVE MAR 2020

☐ 52.222-18 CERTIFICATION REGARDING KNOWLEDGE OF CHILD LABOR FOR

LISTED END PRODUCTS

FEB 2021

52.222-48 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS FOR MAINTENANCE, CALIBRATION, OR REPAIR OF

CERTAIN EQUIPMENT–CERTIFICATION

MAY 2014

☐ 52.222-52 EXEMPTION FROM APPLICATION OF THE SERVICE CONTRACT LABOR

STANDARDS FOR CERTAIN SERVICES-CERTIFICATION

MAY 2014

☐ 52.222-56 CERTIFICATION REGARDING TRAFFICKING IN PERSONS COMPLIANCE

PLAN

OCT 2020

☐ 52.223-1

BIOBASED PRODUCT CERTIFICATION

MAY 2024

☐ 52.223-4

RECOVERED MATERIAL CERTIFICATION

MAY 2008

☐ 52.229-11 TAX ON CERTAIN FOREIGN PROCUREMENTS—NOTICE AND

REPRESENTATION

AUG 2025

(DEVIATION)

☐ 52.237-1

SITE VISIT

APR 1984

☒ 52.240-90 SECURITY PROHIBITIONS AND EXCLUSIONS REPRESENTATIONS AND

CERTIFICATIONS

52.209-2 PROHIBITION ON CONTRACTING WITH

INVERTED DOMESTIC CORPORATIONS –

REPRESENTATION

(a) Definitions. As used in this clause—

Inverted domestic corporation means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c).

Subsidiary means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

(b) Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation, or a subsidiary of an inverted domestic corporation, unless the exception at 9.108-3(b) applies or the requirement is waived in accordance with the procedures at 9.108-5.

(c) Representation. The Offeror represents that-

(1) It □ is, □ is not an inverted domestic corporation; and

(2) It □ is, □ is not a subsidiary of an inverted domestic corporation.

(End of provision)

52.209-11 REPRESENTATION BY CORPORATIONS

REGARDING DELINQUENT TAX LIABILITY OR A

FELONY CONVICTION UNDER ANY FEDERAL

LAW

(a) The Government will not enter into a contract with any corporation that—

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that–

(1) It is □ is not □ a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is □ is not □ a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

(End of provision)

52.252-1 SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE

FEB 1998

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es):

Revolutionary FAR Overhaul - FAR Overhaul - FAR Part Deviation Guidance | Acquisition.GOV

Federal Acquisition Regulation - https://www.acquisition.gov/browse/index/far

Department of Health and Human Services Acquisition Regulation – https://www.acquisition.gov/hhsar

(End of Provision)

52.252-5 AUTHORIZED DEVIATIONS IN PROVISIONS NOV 2020

(a)The use in this solicitation of any Federal Acquisition Regulation (48 CFR Chapter 1) provision with an authorized deviation is indicated by the addition of "(DEVIATION)" after the date of the clause.

(b)The use in this solicitation of any Department of Health and Human Services (48 CFR Chapter 3) provision with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation.

(End of Provision)

The following Department of Health and Human Services Acquisition Regulation provisions also apply:

☐ 352.219-70 MENTOR-PROTÉGÉ PROGRAM DEC 2015

☐ 352.223-71 INSTRUCTIONS TO OFFERORS – SUSTAINABLE ACQUISITION DEC 2015

☐ 352.225-5 NOTICE OF INDIAN ECONOMIC ENTERPRISE SET ASIDE MAR 2022

☐ 352.226-4 NOTICE OF INDIAN SMALL BUSINESS ECONOMIC ENTERPRISE SET

ASIDE

MAR 2022

☐ 352.226-7 INDIAN ECONOMIC ENTERPRISE REPRESENTATION MAR 2022

☐ 352.239-73 ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY

NOTICE

DEC 2015