PO_75H71124P00380.pdf
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- Solicitation number
- 75H71124P00380
About this file
This document is an Order for Supplies or Services for Contract 75H71124P00380, awarded by the Department of Health and Human Services Indian Health Service to LYDAY CONSTRUCTION LLC for $9,625.00. The order requires the contractor to furnish and install a water service line for L VANBRUNT in Wagoner, OK in accordance with the provided Statement of Work and drawing. The period of performance is from 08/07/2024 to 10/07/2024. The award was made on 08/09/2024 under RFQ 246-24-Q-0189. The contract is set aside for small businesses. Oversight and administration will be provided by the Oklahoma City Area IHS 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)
08/07/2024
75H71124P00380 IHS1496386
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
SHAWN D LYDAY
SHAWN LYDAY 1627606
LYDAY CONSTRUCTION LLC 3209 BE
3209 BENNETT ROAD
HOWE TX 75459
See Schedule
12. F.O.B. POINT
10/07/2024
OKLAHOMA CITY AREA OFFICE
701 MARKET DRIVE
OKLAHOMA CITY OK 73114
OKLAHOMA CITY OK 73114
RFQ 246-24-Q-0189
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: HFMWKRHX16D3
CONTRACTOR SHALL FURNISH AND INSTALL A
WATER SERVICE LINE FOR L VANBRUNT IN
WAGONER, OK (WAGONER, CO.) IN ACCORDANCE
WITH THE STATEMENT OF WORK AND DRAWING
PROVIDED.
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
$9,625.00
22. UNITED STATES OF
AMERICA BY (Signature)
23. NAME (Typed)
TITLE: CONTRACTING/ORDERING OFFICER
EDSON W. YELLOWFISH
$9,625.00
OPTIONAL FORM 347 (Rev. 2/2012)
Prescribed by GSA/FAR 48 CFR 53.213(f)
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE
08/09/2024
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
08/07/2024 75H71124P00380
PAGE NO
(a) (b) (c) (d) (e) (f) (g)
ADDITIONAL PROVISIONS AND CONDITIOINS (10
PAGES; 3-13 ARE ATTACHED HERETO)
SCOPE OF WORK INCLUDES; STATEMENT OF WORK
(3 PAGES), DRAWING (1 PAGE ATTACHED).
DAVIS BACON GENERAL WAGE DECISION
OK20240030 04.05.2024 IS HEREBY
INCORPORATED, (ATTACHED).
FAR CLAUSE 52.203-4 ATTACHED.
FAR CLAUSE 52.204-7 APPLIES.
Admin Office:
Oklahoma City Area IHS
701 Market Drive
Oklahoma City OK 73114
Period of Performance: 08/07/2024 to
10/07/2024
1 CONTRACTOR SHALL FURNISH AND INSTALL A 9625 J3 1.00 9,625.00
WATER SERVICE LINE FOR L VANBRUNT IN
WAGONER, OK IN ACCORDANCE WITH THE
STATEMENT OF WORK AND DRAWING PROVIDED.
Project Data:
134465.3.HGFK0000000-OKLAHOMA AREA
IHS.25235-ALL OTR SVCS.05/24/2024
Accounting Info:
2024.J5002IH.25235 Appr. Yr.: 2024
CAN: J5002IH Object Class: 25235
Funded: $9,625.00
OVERSIGHT/MONITOR: ANDREW BANTA,
SUPERVISORY CIVIL ENGINEER,
OFFICE: 918.586.8410., CELL: 918.752.9191.
ANDREW.BANTA@IHS.GOV.
CONTRACT ADMINISTRATOR: NOLEEN POWELL,
CONTRACT SPECIALIST, OFFICE: 405.951.3975.
NOLEEN.POWELL@IHS.GOV.
OCAO FINANCE CONTACT: ERIN LONEWOLF, OFFICE
OF FINANCE AND ACCOUNTING, 405.951.3919.
SEND ORIGINAL INVOICES TO OKLAHOMA AREA
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)) $9,625.00
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
08/07/2024 75H71124P00380
PAGE NO
(a) (b) (c) (d) (e) (f) (g)
INDIAN HEALTH SERVICE
ATTN: FINANCE
701 MARKET DRIVE, OKLAHOMA CITY, OK 73114.
The total amount of award: $9,625.00. 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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