PO_75H71124P00214.pdf
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- Solicitation number
- 75H71124P00214
About this file
This document is an Order for Supplies or Services related to a federal contract opportunity. The key details are:
The contracting agency is the Department of Health and Human Services Indian Health Service, which awarded contract 75H71124P00214 to CRUTCHO CREEK FARMS LLC on 2024-04-16 for $19,350.00. The contractor shall furnish and install a sewer service line from the main to a home in El Reno, OK in accordance with the attached Statement of Work and drawing. The period of performance is 2024-04-16 to 2024-06-17. The oversight/monitor is Gary Lime, Construction Inspector, and the contract administrator is Noleen Powell, Contract Specialist. Invoices should be sent to the Oklahoma City Area Indian Health Service finance office.
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Text version
ORDER FOR SUPPLIES OR SERVICES
3. ORDER NO. 4. REQUISITION/REFERENCE NO.
PAGE OF PAGES
5. ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS
IMPORTANT: Mark all packages and papers with contract and/or order numbers. 1
1. DATE OF ORDER 2. CONTRACT NO. (If any) 6. SHIP TO:
a. NAME OF CONSIGNEE
c. CITY d. STATE e. ZIP CODE
7. TO:
a. NAME OF CONTRACTOR
f. SHIP VIA
8. TYPE OF ORDER
b. COMPANY NAME
c. STREET ADDRESS
d. CITY e. STATE f. ZIP CODE
9. ACCOUNTING AND APPROPRIATION DATA
a. PURCHASE b. DELIVERY
REFERENCE YOUR:
Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.
Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of this form and is issued subject to the terms and conditions of the above-numbered contract.
10. REQUISITIONING OFFICE
11. BUSINESS CLASSIFICATION (Check appropriate box(es))
a. SMALL b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED
13. PLACE OF
a. INSPECTION b. ACCEPTANCE
14. GOVERNMENT B/L NO. 15. DELIVER TO F.O.B. POINT
ON OR BEFORE (Date)
16. DISCOUNT TERMS
17. SCHEDULE (See reverse for Rejections)
04/16/2024
75H71124P00214 IHS1493079
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
RAY WILLIAMS
CRUTCHO CREEK FARMS LLC 1596239
CRUTCHO CREEK FARMS LLC 6625 N
6625 NE 10TH ST
OKLAHOMA CITY OK 73110
See Schedule
12. F.O.B. POINT
06/17/2024
OKLAHOMA CITY AREA OFFICE
701 MARKET DRIVE
OKLAHOMA CITY OK 73114
OKLAHOMA CITY OK 73114
RFQ:246-24-Q-010
ORACLE
ITEM NO.
(a)
SUPPLIES OR SERVICES
(b)
QUANTITY
ORDERED
(c)
UNIT
(d)
UNIT
PRICE
(e)
AMOUNT
(f)
QUANTITY
ACCEPTED
(g)
X
X
Destination Destination HHS NET 30P
f. SERVICE-DISABLED
VETERAN-OWNED
e. HUBZone
g. WOMEN-OWNED SMALL BUSINESS (WOSB)
ELIGIBLE UNDER THE WOSB PROGRAM
h. EDWOSB
UEI: DR5DXNMV8B33
Contractor shall furnish and install a Sewer Service Line from sewer main to home in El Reno, OK.
Continued ...
19. GROSS SHIPPING WEIGHT18. SHIPPING POINT 20. INVOICE NO.
21. MAIL INVOICE TO:
a. NAME
b. STREET ADDRESS
(or P.O. Box)
c. CITY d. STATE e. ZIP CODE
SEE BILLING
INSTRUCTIONS
ON REVERSE
17(h)
TOTAL
(Cont.
pages)
17(i)
GRAND
TOTAL
$19,350.00
22. UNITED STATES OF
AMERICA BY (Signature)
23. NAME (Typed)
TITLE: CONTRACTING/ORDERING OFFICER
EDSON W. YELLOWFISH
$19,350.00
OPTIONAL FORM 347 (Rev. 2/2012)
Prescribed by GSA/FAR 48 CFR 53.213(f)
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE
04/16/2024
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
Oklahoma City OK 73114
DATE OF ORDER
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION
CONTRACT NO.
AMOUNTUNIT
PRICE
UNITQUANTITY
ORDERED
SUPPLIES/SERVICESITEM NO.
IMPORTANT: Mark all packages and papers with contract and/or order numbers.
ORDER NO.
QUANTITY
ACCEPTED
04/16/2024 75H71124P00214
PAGE NO
(a) (b) (c) (d) (e) (f) (g)
Admin Office:
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
1 Contractor shall furnish and install a 19,350.00
Sewer Service Line from main to home in El
Reno in accordance with the Statement of
Work and drawing.
Additional Provisions and Conditions (10 pages; 3-12 are attached hereto)
Scope of Work includes: Statement of Work
(2 pages), drawing (1 page) attached)
Davis Bacon General Wage Decision
OK20240076 01/05/2024 is hereby incorporated, (attached)
FAR clause 52.213-4 attached.
FAR clause 52.204-7 applies.
Project Data:
133375.6.EMJK0000000-OKLAHOMA AREA
IHS.25235-ALL OTR SVCS.03/27/2024
Accounting Info:
2024.J5003IJ.25235 Appr. Yr.: 2024
CAN: J5003IJ Object Class: 25235
Funded: $19,350.00
Period of Performance: 04/16/2024 to
06/17/2024
Oversight/Monitor: Gary Lime, Construction
Inspector, Office: 580.331.3492.
Cell:580.583.2097.
Contract Administrator: Noleen Powell, Contract Specialist, Office: 405.951.3975.
OCAO Finance Contact: Erin Lonewolf, Office of Finance and Accounting, 405.951.3919.
Send original invoices to: Oklahoma City
Area Indian Health Service
Continued ...
Prescribed by GSA FAR (48 CFR) 53.213(f)
OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION
PREVIOUS EDITION NOT USABLE
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $19,350.00
DATE OF ORDER
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION
CONTRACT NO.
AMOUNTUNIT
PRICE
UNITQUANTITY
ORDERED
SUPPLIES/SERVICESITEM NO.
IMPORTANT: Mark all packages and papers with contract and/or order numbers.
ORDER NO.
QUANTITY
ACCEPTED
04/16/2024 75H71124P00214
PAGE NO
(a) (b) (c) (d) (e) (f) (g)
Attn: Finance 701 Market Drive Oklahoma
City, OK 73114 or email to: OKCAPInvoices@ihs.gov.
The total amount of award: $19,350.00. The obligation for this award is shown in box
17(i).
Prescribed by GSA FAR (48 CFR) 53.213(f)
OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION
PREVIOUS EDITION NOT USABLE
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $0.00
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