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DEPARTMENT OF THE AIR FORCE81st CONTRACTING SQUADRON (AETC)

Combined Synopsis/Solicitation

Updated 20 Dec 19

Page of no later than

General Information

1. This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

3. This solicitation document and incorporated provisions and clauses are those in effect through:

Federal Acquisition Circular

Defense Federal Acquisition Regulation Public Notice

Air Force Federal Acquisition Circular

Requirement Information

Description:

Place of Delivery/Performance/Acceptance/FOB Point:

Line Item

Description

Quantity

Unit

Unit Price

Extended Price

Instructions to Offerors

FAR provision 52.212-1, Instructions to Offerors -- Commercial, applies to this acquisition. As prescribed in FAR 12.301(b)(1), the following addendum is provided for this solicitation and hereby amends any language therein: - Quoted amounts need to be net prices without tax - The Government reserves the right to award on an "All or None" basis - Provide Quote Expiration Date, Best Delivery Date, and any Discount Terms - Quotes, attachments, and all other correspondence as listed in this solicitation must be emailed to both points of contact (POCs)

Evaluation Criteria

FAR Provision 52.212-2, Evaluation -- Commercial Items, applies to this acquisition. As prescribed in FAR 12.301(c), the following addendum is provided for this solicitation and hereby amends any language therein:

Clauses and Provisions

FAR provision 52.212-3, Offeror Representations and Certifications -- Commercial Items with alternate I applies to this acquisition; the offeror verifies by submission of their offer that the representation and certifications posted at FAR 52.212-3 have been entered or updated electronically via the System for Award Management (SAM) Web site located at http://www.sam.gov/portal in the last 12 months, and are current, accurate, complete, and applicable to this solicitation. Alternatively, if the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (u) of this provision and include a completed copy with its offer. FAR clause 52.212-4, Contract Terms and Conditions -- Commercial Items applies to this acquisition. FAR clause 52.212-5, Contract Terms and Conditions Required To Implement Statutes or Executive Orders -- Commercial Items applies to this acquisition; the following checked clauses are hereby included by reference:

Instructions: click once if applicable, click twice if not-applicable, click reset to start over.

(Above SAT )

(Above 5.5M, POP greater than 120 days)

(Above $30k)

(Above $35k)

(Above $550k)

(Follow-on service contract above SAT

(Commodities above micro purchase)

(Above SAT to US vendors)

(Above $15k to US vendors)

(when 52.222-35 is included)

(Above SAT, POP greater than 120 days )

(If payment by GPC--uncheck 52.232-33)

The provisions and clauses listed below have been determined by the contracting officer to be necessary for this acquisition and consistent with customary commercial practices. The following provisions and clauses are hereby included by reference:

Only those that are applicable to ALL commercial solicitations at this location are shown below. Other provisions and clauses specific to unique situations such as Options, IDIQs, GFP, specific dollar thresholds, brand name or equal etc. will need to be added manually.

The following provisions and clauses are hereby included by full text:

Attachments

**Final step: Print to PDF to remove this text and all other instructions/buttons**

9.0.0.2.20120627.2.874785

“Notice to Offeror(s)/Supplier(s): Funds are not presently available for this effort. No award will be made under this solicitation until funds are available. The Government reserves the right to cancel this solicitation, either before or after the closing date. In the event the Government cancels this solicitation, the Government has no obligation to reimburse an offeror for any costs.”

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Program-Title: LED Sign

Solicitation-Number: FA3010-22-Q-C003

Use drop down to enter date: December 1, 2021

Use drop down to enter date: 2021-12-10

Insert time (i.e. 1500 CEST): 11:00 AM CST

CO Name / Email / Phone Number: Rachel Davis, Contracting Specialist

CO Name / Email / Phone Number: Phone: 228-377-1804 | Email: rachel.davis.15@us.af.mil

DropDownList1: Request For Quotation (RFQ).

Cell2: 06/10/2021

Cell2: 07/09/2021

Cell2: 05/21/2021

Cell2: LED Sign with installation/removal IAW attach 1/SOO

TextField10: 100% Small Business Set-Aside

TextField2: 339950

Cell1: 0001

Cell3: 1

Cell4: each

Button2:

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TextField9: 2 December 2021 @ 4:00 pm CST

TextField8: 31 December 2021

EXAMPLE:

(a) 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:

TECHNICAL CAPABILITY - An offeror’s quotation will be considered technically acceptable if it meets the specifications in the Performance Work Statement. Quotations that do not meet these requirements will be considered unacceptable and therefore under the evaluation process will not be considered for award.

PRICE - price will be evaluated on a comparative basis amongst all received quotations and the Government's estimate.

(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).:

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Example:

Attachment 1 - Performance Work Statement Attachment 2 - Quote Sheet: Attachment 1- Statement of Objectives Attachment 2 - Photos of LED Sign to be Replaced Attachment 3 - Implementation of Executive Order 14042, Compliance with Safer Federal Workforce Taskforce Guidance, DD Form 3150 Attachment 4 - DD Form 3150_Certification of Vaccination

PrintButton1:

CheckBox2: 1

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CUI (when filled in)

CUI (when filled in) Controlled by: OUSD(P&R) Controlled by: ASD(HA) CUI Category: HLTH: PRVCY; OPSEC LDC: DL(DoD Only) POC: osd.pentagon.ousd-p-r.mbx.forms@mail.mil

DD FORM 3150, OCT 2021

CONTRACTOR PERSONNEL AND VISITOR CERTIFICATION OF VACCINATION OMB No. 0704-0613 Expiration: 20220228

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PRIVACY ACT STATEMENT

Authority: DoD is authorized to collect the information on this form pursuant to Executive Order (E.O.) 14042, Ensuring Adequate COVID Safety Protocols for Federal Contractors; E.O. 13991, Protecting the Federal Workforce and Requiring Mask-Wearing; and E.O. 12196, Occupational Safety and Health Program for Federal Employees; as well as 10 U.S.C. 113, 10 U.S.C. 136, 10 U.S.C. 7013, 10 U.S.C. 8013, 10 U.S.C. 9013, 10 U.S.C. 2672, 5 U.S.C. chapter 79, and DoD Instruction 6200.03.

Principal Purpose: This information is being collected to implement Coronavirus Disease 2019 (COVID-19) workplace safety plans, including DoD's COVID-19 testing programs, and to ensure the safety and protection of the DoD workforce, workplace, and other DoD facilities and environments, consistent with the above-referenced authorities, the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force, and guidance from the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration.

Routine Use(s): While the information requested on this form is intended to be used primarily for internal purposes, in certain circumstances it may be necessary to disclose this information externally, for example to disclose information to: a person, organization, or governmental entity as necessary and relevant to notify them of, respond to, or guard against a public health emergency or other similar crisis, including to comply with laws governing the reporting of communicable disease or other laws concerning health and safety in the work environment; adjudicative or administrative bodies or officials when the records are relevant and necessary to an adjudicative or administrative proceeding; contractors, grantees, experts, consultants, students, and others as necessary to perform their duties for the Federal government; agencies, courts, and persons as necessary and relevant in the course of litigation, and as necessary and in accordance with requirements for law enforcement; or to a person authorized to act on your behalf. A complete list of routine uses may be found in the applicable System of Records Notice (SORN) associated with the collection of this information from contractor personnel and DoD visitors: DPR 39 DoD, DoD Personnel Accountability and Assessment System of Records, 85 Fed. Reg. 17047 (Mar. 26, 2020) (also available at https://dpcld.defense.gov/Portals/49/ Documents/Privacy/SORNs/OSDJS/DPR-39-DoD.pdf).

Consequences of Failure to Provide Information: Providing this information is voluntary. However, if you fail to provide this information, you will be treated as not fully vaccinated for purposes of implementing safety measures, including subject to COVID-19 screening testing and/or denied access to DoD facilities.

Failure to provide such information may also hinder DoD's ability to implement COVID-19 workplace safety plans, thereby increasing the health or safety risk to DoD-affiliated personnel and DoD facilities.

INSTRUCTIONS: This form should be completed by DoD contractor personnel and official visitors in accordance with current DoD Force Health Protection Guidance. DoD civilian employees should not complete this form.

1. NAME (Last, First, MI): 2. DoD ID NUMBER:

3. PLEASE CHECK THE BOX BELOW THAT COINCIDES WITH YOUR COVID-19 VACCINATION STATUS :

I am fully vaccinated.

Individuals are considered “fully vaccinated” two weeks after completing the second dose of a two-dose COVID-19 vaccine or two weeks after receiving a single dose of a one-dose vaccine. Accepted COVID-19 vaccines are those which have received a license or emergency use authorization from the U.S. Food and Drug Administration and those COVID-19 vaccines on the World Health Organization Emergency Use Listing.

“Fully vaccinated” also includes circumstances in which the individual was a participant in a U.S. site clinical trial and has received all recommended doses.

I am not yet fully vaccinated. I received only one dose of an accepted two-dose COVID-19 vaccine, or I received my final dose of an accepted COVID-19 vaccine less than two weeks ago.

I have not been vaccinated.

I decline to respond.

Individuals who choose not to complete the form will be assumed to be not fully vaccinated for purposes of application of the safety protocols. If you are not vaccinated due to medical or religious reasons, please check either “I have not been vaccinated” or “I decline to respond.” Note that if you have already received one dose of a vaccine, but are not yet fully vaccinated, or if you received your final dose less than two weeks ago, then you will be treated as not fully vaccinated until you are at least two weeks past your final dose and resubmit your vaccination information.

I certify that the information provided in this form is accurate and true to the best of my knowledge.

I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (18 U.S.C. 1001). Checking “I decline to respond” does not constitute a false statement.

4. DATE (YYYYMMDD) 5. SIGNATURE (Full Name) mailto:osd.pentagon.ousd-p-r.mbx.forms@mail.mil?subject=CUI%20Question%20regarding%20DD%20Form%203150

DRAFT

SAMPLE

DD FORM 3150, OCT 2021

Page of

CUI (when filled in)

Document Controlled Unclassified Information when filled in

CUI (when filled in)

Document Controlled Unclassified Information when filled in

Controlled by: OUSD(P&R)

Controlled by: ASD(HA)

CUI Category: HLTH: PRVCY; OPSEC

LDC: DL(DoD Only)

POC: osd.pentagon.ousd-p-r.mbx.forms@mail.mil

CUI designation indicator

DD FORM ####, YYYYMMDD DRAFT

NEEDS DD67

PREVIOUS EDITION IS OBSOLETE.

Page of

CUI (when filled in)

Document Controlled Unclassified Information when filled in

CUI (when filled in)

Document Controlled Unclassified Information when filled in

CONTRACTOR PERSONNEL AND VISITOR CERTIFICATION OF VACCINATION

OMB No. 0704-0613 Expiration: 20220228

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PRIVACY ACT STATEMENT

Authority: DoD is authorized to collect the information on this form pursuant to Executive Order (E.O.) 14042, Ensuring Adequate COVID Safety Protocols for Federal Contractors; E.O. 13991, Protecting the Federal Workforce and Requiring Mask-Wearing; and E.O. 12196, Occupational Safety and Health Program for Federal Employees; as well as 10 U.S.C. 113, 10 U.S.C. 136, 10 U.S.C. 7013, 10 U.S.C. 8013, 10 U.S.C. 9013, 10 U.S.C. 2672, 5 U.S.C. chapter 79, and DoD Instruction 6200.03.

Principal Purpose: This information is being collected to implement Coronavirus Disease 2019 (COVID-19) workplace safety plans, including DoD's COVID-19 testing programs, and to ensure the safety and protection of the DoD workforce, workplace, and other DoD facilities and environments, consistent with the above-referenced authorities, the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force, and guidance from the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration.

Routine Use(s): While the information requested on this form is intended to be used primarily for internal purposes, in certain circumstances it may be necessary to disclose this information externally, for example to disclose information to: a person, organization, or governmental entity as necessary and relevant to notify them of, respond to, or guard against a public health emergency or other similar crisis, including to comply with laws governing the reporting of communicable disease or other laws concerning health and safety in the work environment; adjudicative or administrative bodies or officials when the records are relevant and necessary to an adjudicative or administrative proceeding; contractors, grantees, experts, consultants, students, and others as necessary to perform their duties for the Federal government; agencies, courts, and persons as necessary and relevant in the course of litigation, and as necessary and in accordance with requirements for law enforcement; or to a person authorized to act on your behalf. A complete list of routine uses may be found in the applicable System of Records Notice (SORN) associated with the collection of this information from contractor personnel and DoD visitors: DPR 39 DoD, DoD Personnel Accountability and Assessment System of Records, 85 Fed. Reg. 17047 (Mar. 26, 2020) (also available at https://dpcld.defense.gov/Portals/49/Documents/Privacy/SORNs/OSDJS/DPR-39-DoD.pdf).

Consequences of Failure to Provide Information: Providing this information is voluntary. However, if you fail to provide this information, you will be treated as not fully vaccinated for purposes of implementing safety measures, including subject to COVID-19 screening testing and/or denied access to DoD facilities. Failure to provide such information may also hinder DoD's ability to implement COVID-19 workplace safety plans, thereby increasing the health or safety risk to DoD-affiliated personnel and DoD facilities.

INSTRUCTIONS: This form should be completed by DoD contractor personnel and official visitors in accordance with current DoD Force Health Protection Guidance. DoD civilian employees should not complete this form.

3. PLEASE CHECK THE BOX BELOW THAT COINCIDES WITH YOUR COVID-19 VACCINATION STATUS :

I am fully vaccinated.

Individuals are considered “fully vaccinated” two weeks after completing the second dose of a two-dose COVID-19 vaccine or two weeks after receiving a single dose of a one-dose vaccine. Accepted COVID-19 vaccines are those which have received a license or emergency use authorization from the U.S. Food and Drug Administration and those COVID-19 vaccines on the World Health Organization Emergency Use Listing. “Fully vaccinated” also includes circumstances in which the individual was a participant in a U.S. site clinical trial and has received all recommended doses.

I am not yet fully vaccinated. I received only one dose of an accepted two-dose COVID-19 vaccine, or I received my final dose of an accepted COVID-19 vaccine less than two weeks ago.

I have not been vaccinated.

I decline to respond.

Individuals who choose not to complete the form will be assumed to be not fully vaccinated for purposes of application of the safety protocols. If you are not vaccinated due to medical or religious reasons, please check either “I have not been vaccinated” or “I decline to respond.” Note that if you have already received one dose of a vaccine, but are not yet fully vaccinated, or if you received your final dose less than two weeks ago, then you will be treated as not fully vaccinated until you are at least two weeks past your final dose and resubmit your vaccination information.

I certify that the information provided in this form is accurate and true to the best of my knowledge.

I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (18 U.S.C. 1001). Checking “I decline to respond” does not constitute a false statement.

9.0.0.2.20120627.2.874785

DD Form 3150, "Certification of Vaccination"

Forms Management Office

OUSD(P&R)

Click this button to save this form.:

Click this button to print this form.:

Click this Reset button to erase data from all fields.:

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Enter today's date in YYYYMMDD format.:

1 of 4. Select for "I am fully vaccinated." : 0

2 of 4. Select for "I am not yet fully vaccinated.": 0

3 of 4. Select for "I have not been vaccinated.": 0

4 of 4. Select for "I decline to respond..": 0

Select for "I attest that the information provided in this form is accurate and true to the best of my knowledge.": 0

Sign here.:

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 81ST TRAINING WING (AETC)

MEMORANDUM FOR KEESLER AFB CONTRACTOR EMPLOYEES

FROM: 81st Contracting Squadron

310 M Street, Bldg. 4605 Rm 102 Keesler AFB MS 39534

SUBJECT: Implementation of Executive Order 14042, Compliance with Safer Federal Workforce Taskforce Guidance, DD Form 3150

1. In Accordance With Executive Order 14042, starting 10 Dec 21, all contract employees that work within a facility on Keesler AFB shall be required to present a DD Form 3150, Contractor Personnel and Visitor Certification of Vaccination. Contractors that are not fully vaccinated or fail to produce a DD Form 3150, are required to show proof of a negative COVID-19 test result to enter a DoD facility. The COVID-19 test results must be from a test dating no later than 72 hours prior to seeking entrance to the DoD Facility. Contractors can utilize the 81 TRW screening process as available.

2. Contractor employers shall ensure compliance with the Safer Federal Workforce Taskforce. Guidance can be found at: https://www.saferfederalworkforce.gov/contractors/. In accordance with this guidance, the Contract employer or supervisor shall validate the employee vaccination status as recorded on their DD Form 3150. Acceptable forms of validation are as follows: a copy of the record of immunization from a health care provider or pharmacy, a copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published on September 3, 2020), a copy of medical records documenting the vaccination, a copy of immunization records from a public health or State immunization information system, or a copy of any other official documentation verifying vaccination with information on the vaccine name, date(s) of administration, and the name of health care professional or clinic site administering vaccine.

DEITRE L. BROWNE

Contracting Officer

Attachment:

1. DD Form 3150 https://www.saferfederalworkforce.gov/contractors/

2021-11-29T08:49:24-0600

BROWNE.DEITRE.LYNN.1174194110

LED Sign 1

LED Sign 2

LED Sign 3

Statement of Objectives Keesler Medical Center Replacement LED Sign

15 November 2021

1. Overall Objective. The Keesler Medical Center requires the procurement of an LED Display to inform the local population of MDG announcements including hours of operation and the MDG vision statement.

2. Contract Objectives. The objective of this requirement is to identify an experienced signage company who can provide a replacement LED sign as described below.

2.1. LED sign must be at least 4ft. x 7ft. (L x W) but no bigger than 5ft. x 8ft. LED sign must have a minimum of p5 pixel pitch with at least a 30 ft. viewing distance. LED sign must meet electrical standard specifications (208v single phase with a 30 amp breaker). LED sign must support Ethernet cable(s) (Cat 5e or Cat 6) connectivity to a computer that can manage signage content over hospital standalone network. LED sign must contain software application to manage software content that supports Windows based operating systems. LED sign must have 5 year warranty on parts, on site services, and any defects.

2.2. Contractor must remove old sign and properly dispose of it. Contractor must install new sign in designated location. Contractor must ensure LED sign is fully functionally prior to leaving site Contractor must ensure they have the appropriate lift equipment, tools and personnel to mount sign. Contractor must be able to obtain a military base pass to access DOD installation.

3. Contract Requirements. The contractor shall provide a proposal that states the resources and capabilities for the requirement as stated above. The contractor shall remove the current sign and install a new one on the existing structure.