SF-18 Form Request for Quote.doc
DOC document 92 KB Posted
- Attached to
- XTREME-6 Syringe Pump
- Solicitation number
- NIHLM2012358
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Request for Quotation Form
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| File | Type | Posted |
|---|---|---|
| Contract Terms and Conditions | — | |
| SF-18 Form Request for Quote.doc | DOC document |
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REQUEST FOR QUOTATIONS
(THIS IS NOT AN ORDER)
| THIS RFQ ( IS ( IS NOT A SMALL BUSINESS SET ASIDE |
| PAGE |
OF
PAGES
1. REQUEST NO.
NIH-NLM-2012358
2. DATE ISSUED
3. REQUISITION/PURCHASE REQUEST NO.
| 4. CERT. FOR NAT. DEF. UNDER BDSA REG. 2 AND/OR DMS REG. 1 |
| > |
| RATING |
5A. ISSUED BY
NATIONAL LIBRARY OF MEDICINE
ACQUISITION MANAGEMENT BRANCH, STATION SUPPORT SECTION
6707 DEMOCRACY BOULEVARD, ROOM 770B
BETHESDA, MD 20817-7973
6. DELIVER BY (Date)
7. DELIVERY
_____ FOB DESTINATION _______ OTHER (See Schedule)
9. DESTINATION
a. NAME OF CONSIGNEE
5b. FOR INFORMATION CALL: (Name and telephone no.) (No collect calls)
NAME
Lisa Josephowitz
| TELEPHONE NUMBER |
| b. STREET ADDRESS |
AREA CODE
NUMBER
594-7725
8. TO:
a. NAME
b. COMPANY
c. STREET ADDRESSG
c. CITY
City
State
f. ZIP CODE
d. STATE
e. ZIP CODE
10. PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS (Date)
IMPORTANT:
This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.
11. SCHEDULE (Include applicable Federal, State and local taxes)
ITEM NO.
(a)
SUPPLIES/SERVICES
(b)
QUANTITY
(c)
UNIT
(d)
UNIT PRICE
(e)
AMOUNT
(f)
XTREME-60 Syringe Pump w/Integrated Controller (as referenced in Solicitation # NIHLM2012358)
| 12. DISCOUNT FOR PROMPT PAYMENT |
| > |
| 10 CALENDAR DAYS % |
| 20 CALENDAR DAYS % |
| 30 CALENDAR DAYS % |
| d. CALENDAR DAYS |
| NUMBER |
| PERCENTAGE |
NOTE:
Additional provisions and representations _____ are _____ are not attached.
| 13. NAME AND ADDRESS OF QUOTER |
| 14. SIGNATURE OF PERSON AUTHORIZED TO SIGN QUOTATION |
15. DATE OF QUOTATION
a. NAME OF QUOTER
b. STREET ADDRESS
16. SIGNER
a. NAME (Type or print)
b. TELEPHONE
c. COUNTY
AREA CODE
d. CITY
e. STATE
f. ZIP CODE
c. TITLE (Type or print)
NUMBER
AUTHORIZED FOR LOCAL REPRODUCTION
STANDARD FORM 18 (REV 6-95)
Previous edition not usable
Prescribed by GSA - FAR (48 CFR) 53.215-1(a)
| CONTINUATION SHEET |
| REF. NO. OF DOC. BEING CONT’D |
PAGE
OF
NAME OF OFFEROR OR CONTRACTOR
SUPPLIES/SERVICES
(B)
QUANTITY
(C)
UNIT
(D)
UNIT PRICE
(E)
AMOUNT
(F)
ALL VENDORS MUST ADDRESS THE ITEMS BELOW WHEN SUBMITTING THEIR REQUEST FOR QUOTE
All terms and conditions and the attached Representations and Certifications must be completed and included in the RFQ proposal for evaluation of your Quote. The exemption from application of service contract act attached should also be included.
Sponsored by GSA
FAR (48 CFR) 53.110A
| CONTINUATION SHEET |
| REF. NO. OF DOC. BEING CONT’D |
PAGE
OF
NAME OF OFFEROR OR CONTRACTOR
ITEM NO.
(A)
SUPPLIES/SERVICES
(B)
QUANTITY
UNIT
(D)
UNIT PRICE
(E)
AMOUNT
NSN 754-01-152-8067
OPTIONAL FORM 336 (4-86)
| CONTINUATION SHEET |
| REF. NO. OF DOC. BEING CONT’D |
PAGE
OF
NAME OF OFFEROR OR CONTRACTOR
ITEM NO.
(A)
SUPPLIES/SERVICES
(B)
QUANTITY
UNIT
(D)
UNIT PRICE
(E)
AMOUNT
| CONTINUATION SHEET |
| REF. NO. OF DOC. BEING CONT’D |
PAGE
OF
NAME OF OFFEROR OR CONTRACTOR
ITEM NO.
(A)
SUPPLIES/SERVICES
(B)
QUANTITY
UNIT
(D)
UNIT PRICE
(E)
AMOUNT
| CONTINUATION SHEET |
| REF. NO. OF DOC. BEING CONT’D |
PAGE
OF
NAME OF OFFEROR OR CONTRACTOR
ITEM NO.
(A)
SUPPLIES/SERVICES
(B)
QUANTITY
UNIT
(D)
UNIT PRICE
(E)
AMOUNT
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