PO_75H71125P00204-signed-.pdf

PDF 214 KB Posted Jul 24, 2025

Attached to: Lagoon Rehabilitation Mayetta, KS
Solicitation number: 75H71125P00204
Issued by: Department of Health and Human Services Indian Health Service

About this file

Written by GovTribe AI · Jul 24, 2025

This is a Standard Form 1449 (Solicitation/Contract/Order for Commercial Items) for a lagoon rehabilitation project awarded by the Indian Health Service Oklahoma City Area Office. The contract was awarded to Ohlsen Right of Way and Maintenance, Inc. for $10,000.00, with a performance period from 07/22/2025 to 09/26/2025. The contract involves rehabilitating a lagoon as specified in the attached Statement of Work and drawings, located in Mayetta, Kansas.

Key contract details include a delivery date of 09/26/2025, payment terms of NET 30, and the contract is classified under NAICS code 237110 with a size standard of $39.50. The contract specialist is Jeffrey Earnest, and the oversight monitor is Jim Shane. Invoices should be submitted electronically to okcapinvoices@ihs.gov or mailed to the Oklahoma City Area Indian Health Service Finance Department, with copies sent to the contract specialist and oversight monitor.

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IHSOKLAHOMACITY

OKLAHOMA CITY OK 73114

701 MARKET DRIVE

IHSOKLAHOMACITY

785-3366112

1499028

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

IHSOKLAHOMACITY CODE 16. ADMINISTERED BYCODE

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

405-951-3740Jeffery Earnest

75H71125P00204

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION 5. SOLICITATION NUMBER

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

1 13 IHS1514082OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

SENECA KS 66538

892 US HIGHWAY 36

OHLSEN RIGHT OF WAY & MAINTENANCE,

Attn: BRETT OHLSEN

OHLSEN RIGHT OF WAY AND MAINTENANCE INC 1499028

17a. CONTRACTOR/

OKLAHOMA CITY OK 73114

701 MARKET DRIVE

OKLAHOMA CITY AREA OFFICE

15. DELIVER TO

Oklahoma City OK 73114 701 Market Drive

9. ISSUED BY

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: NC6QLTJS6151

LAGOON REHABILITATION

Delivery: 09/26/2025 Period of Performance: 07/22/2025 to 09/26/2025

1 Contractor shall rehabilitate the lagoon as shown 10000 J3 1.00 10,000.00 on the drawings and described in The Statement of Continued ...

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

$10,000.00

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

EDSON W. YELLOWFISH 07/24/2025

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

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.

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.

Work.

Project Data:

129901.3.HGFK0000000-OKLAHOMA AREA IHS.25235-ALL

OTR SVCS.05/20/2025

Accounting Info:

2025.J5002IR.25235 Appr. Yr.: 2025 CAN: J5002IR

Object Class: 25235

Funded: $10,000.00

Additional Provisions and Conditions (10 pages;

4-13 are attached hereto)

Scope of Work includes: Statement of Work (4 pages), drawing (1 page) (attached).

Davis Bacon General Wage Decision KS20250152

Dated 04/10/2025 is hereby incorporated, (attached)

FAR Clause 52.213-4 attached FAR Clause 52.204-7 applies

Oversite Monitor: Jim Shane, Engineering

Technician

Office Phone: 785-364-2309

Cell: 580-678-6535

E-mail: donald.shane@ihs.gov

Contract Specialist (C): Jeffrey Earnest, Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

13 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 13

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

OHLSEN RIGHT OF WAY AND MAINTENANCE INC 1499028

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

75H71125P00204

(IHS/OKC) 405-951-3740

E-mail jeffrey.earnest@ihs.gov

Complete invoices and supporting documentation shall be sent either electronically via e-mail or by regular postal mail to the paying office (Bill

To) below:

Bill To:

E-mail Invoice to: okcapinvoices@ihs.gov

Or mail invoices to:

Oklahoma City Area Indian Health Service

Attention Finance Department

701 Market Drive

Oklahoma City, OK 73114

Accounts Payable POC is Alicia Kinney

Phone 405-951-3924

E-mail alicia.kenney@ihs.gov

Please Note: Email a copy of the invoice to the

Contract Specialist and Oversite Monitor so that they can verify work is complete and make sure it is received in the system.

The total amount of award: $10,000.00. The obligation for this award is shown in box 26.

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