PO_75H71124P00358.pdf

IHSOKLAHOMACITY

OKLAHOMA CITY OK 73114

701 MARKET DRIVE

IHSOKLAHOMACITY

918-5983568

1043976

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

Oklahoma City OK 73114 701 Market Drive Oklahoma City Area IHS

IHSLAWTON CODE 16. ADMINISTERED BYCODE

X

237110

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR303

REQUEST FOR

PROPOSAL

(RFP)

INVITATION

FOR BID (IFB)

10. THIS ACQUISITION ISCODE

REQUEST FOR

QUOTE (RFQ)

14. METHOD OF SOLICITATION

13b. RATING

NORTH AMERICAN INDUSTRY

CLASSIFICATION STANDARD

(NAICS):

SMALL BUSINESS

07/15/2024

405-951-3975NOLEEN POWELL

75H71124P00358

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

246-24-Q-0173

5. SOLICITATION NUMBER

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

1 3 IHS1498184OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

HULBERT OK 74441

9011 N 547 RD

JERRY'S EXCAVATION INC. 9011 N

Attn: JERRY

JERRYS EXCAVATION 1043976

17a. CONTRACTOR/

LAWTON OK 73501

1515 LAWRIE TATUM ROAD

IHSLAWTON

15. DELIVER TO

Oklahoma City OK 73114 701 Market Drive

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$39.50

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

ISSUE DATE

DELIVERY FOR FREE ON BOARD

(FOB) DESTINATION UNLESS

BLOCK IS MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

HHS NET 30P

THIS CONTRACT IS A RATED

ORDER UNDER THE DEFENSE

PRIORITIES AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

HUBZONE SMALL

BUSINESS

8(A)

Oklahoma City Area IHS

WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

UEI: ZNSNNEJW8711

CONTRACTOR SHALL FURNISH DRAIN FIELD CHAMBER

SUPPLIES FOR LAWTON INDIAN HEALTH OEHE IN

ACCORDANCE WITH ATTACHED STATEMENT OF WORK.

Delivery: 08/26/2024

1 07/26/2024-08/26/2024 CONTRACTOR SHALL FURNISH 9886.81 LS 1.00 9,886.81

DRAIN FIELD CHAMBER SUPPLIES FOR LAWTON INDIAN

HEALTH OEHE.

Continued ...

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

$15,585.60

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

EDSON W. YELLOWFISH 07/29/2024

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

246-24-Q-0173

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 (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Government Use Only)

OFFER

STANDARD FORM 1449 (REV. 11/2021)

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

See schedule

29. AWARD OF CONTRACT: REFERENCE

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. 11/2021) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Project Data:

131017.5.EMJK0000000-OKLAHOMA AREA

IHS.26067-Other Supplies - Direct.06/26/2024

Accounting Info:

2024.J5003ZH.26067 Appr. Yr.: 2024 CAN: J5003ZH

Object Class: 26067

Funded: $9,886.81

Period of Performance: 07/26/2024 to 08/26/2024

2 07/26/24-08/26/24 CONTRACTOR SHALL FURNISH DRAIN 5698.79 LS 1.00 5,698.79

FIELD CHAMBER SUPPLIES FOR LAWTON INDIAN HEALTH

OEHE.

Project Data:

131017.3.HGFK0000000-OKLAHOMA AREA

IHS.26067-Other Supplies - Direct.06/26/2024

Accounting Info:

2024.J5002IH.26067 Appr. Yr.: 2024 CAN: J5002IH

Object Class: 26067

Funded: $5,698.79

OVERSIGHT/MONITORING: DYLAN LANTIS, PROJECT

ENGINEER-DSFC, 405.354.5653.

CONTRACT ADMINISTRATOR: NOLEEN POWELL, CONTRACT

SPECIALIST, OFFICE: 405.951.3975.

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

3 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 3

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

JERRYS EXCAVATION 1043976

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

75H71124P00358

OCAO FINANCE CONTACT: ERIN LONEWOLF, OFFICE OF

FINANCE AND ACCOUNTING, 405.951.3919.

SEND ORIGINAL INVOICES TO: OKLAHOMA CITY AREA

INDIAN HEALTH SERVICE

ATTN: FINANCE

701 MARKET DRIVE, OKLAHOMA CITY, OK 73114 OR

EMAIL: OKCAPInvoices@ihs.gov.

The total amount of award: $15,585.60. The obligation for this award is shown in box 26.

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

Sponsored by GSA

FAR (48 CFR) 53.110