QUOTE FORM (No Clauses).docx

** THIS IS NOT AN ORDER **

PLEASE PROVIDE DELIVERED PRICES (FOB DESTINATION)

REFERENCE: SPMYM4-26-Q-3565

SET ASIDE: SMALL BUSINESS

NAICS: 326220

QUOTE DUE: 07/16/2026; 13:00 PM HST

CONTACT

DLA MARITIME – PEARL HARBOR

CONTRACT SPECIALIST: Vanessa Garcia Desk Phone: 808-473-8000 x3241 Email Quotes to: vanessa.a.garcia18.civ@us.navy.mil

VENDOR INFORMATION

Vendor Name:

CAGE Code:

Phone:

Email:

Quoted Valid for ___ Days

*** PLEASE FILL OUT THIS FORM COMPLETELY***

** In accordance with FAR 52.204-7(b)(1), an Offeror is required to be registered in SAM when submitting an offer or quotation, and must be listed as active, to prevent unduly delaying award. Information, instructions, forms, etc. for the System for Award Management (SAM) are available at https://www.sam.gov/portal/public/SAM/ **

Attention: Provisions below MUST be filled in to be considered for award.

SHIPPING INFORMATION

PLACE OF MFG/COUNTRY OF ORIGIN: _____________

ESTIMATED DELIVERY TO PEARL HARBOR__________ Calendar Days ARO

FOB TERMS: DESTINATION

SHIP TO:

DoDAAC: N32253 Country Code: USA

PEARL HARBOR NAVAL SHIPYARD IMF

667 SAFEGUARD STREET, BLDG 167-1 RECV 808-

473-8000X4961

PEARL HARBOR, HI 96860-5033

UNITED STATES

Government Representative, DLA Distribution Email: distrcustomerservice@dla.mil

IMPORTANT NOTE: The below Required Delivery Date (RDD) shall be met or exceeded in order to ensure your offer is considered responsive. If no offers are received which meet or exceed the Government’s RDD, award may proceed to the LPTA offeror, and may be made based on soonest delivery.

GOVERNMENT RDD: EARLIEST DATE

PAYMENT INFORMATION

PAYMENT TERMS______%______DAYS DISCOUNT TERMS __________________

Preferred Method payment: Wide Area Workflow (WAWF) Payment terms are always Net 30 AFTER the material has passed inspection and has been accepted.

REQUEST AND RECEIVING REPORTS is applicable to this solicitation. Please note that the WAWF (Wide Area Work Flow) will be used as the method of payment for supplies and/or services procured under this solicitation.

Information regarding WAWF is available on the internet at https://wawf.eb.mil.

YOUR COMPANY INFORMATION

YOUR BUSINESS SIZE: ___ Large (LG), ___ Small (SB), ___ Small-Disadvantaged Business (SDB), ___ Veteran-Owned Small Business (VOSB), ___ Women-Owned Small Business (WOSB), ___ Economically Disadvantaged Women-Owned Small Business (EDWOSB), ___ Service Disabled Veteran Owned Small Business (SDOVSB), ___ (HUBZONE), ___ (8a).

QUOTING AS MANUFACTURER? Yes ___ No ___

Name of Quoted Manufacturer ___________________

QUOTING AS: ___ AUTHORIZED DISTRIBUTOR or ___ THIRD PARTY DEALER

IS YOUR COMPANY’S PRICING INDEPENDENT FROM THE MANUFACTURER? Yes ___ No ___

SAM CAGE CODE: ________________

Representations must be filled in below, and provided with the submission of the quote.

Offers received without completed representaions may not be considered for award.

PRINTED NAME_______________________________SIGNATURE_____________________________

DATE______________

MATERIAL INFORMATION

Shipping to be included in the Unit Price

Unit Price$________, Total Price$_______

CLIN 0001: DESCRIPTION

HOSE, NITRILE 4" I.D. X 50' LONG, (CONTINUED BELOW), CERTIFICATE OF CONFORMANCE REQUIRED UV & ABRASION RESISTANT NITRILE TUBE & NITRILE COVER. NON-SLIP GRIP EXTERIOR SURFACE FOR SAFETY AND HANDLING. HELICAL WIRE REINFORCED, W/HEAVY DUTY CAMLOCK FITTINGS & FOUR (4) STAINLESS STEEL LOCKING ARMS, COPPER ALLOY UNS NO. 92200, 4" M/CL X 4" F/CL, FULLY ASSEMBLED, RATING: FULL VACUUM TO 250 PSI.

PACKAGING REQUIREMENTS: PACKING TO PREVENT ANY DAMAGE INCLUDING KINKING, GOUGES, CUTS, OR ABRASIONS OF HOSE COVERS; OR DAMAGE/DEFORMATION OF END FITTINGS. PACKAGING SHALL NOT VIOLATE THE MINIMUM BEND

RADIUS OF HOSE ASSEMBLY (16 INCHES OR LESS)

ADDT’L MATERIAL INFORMATION

Is there a minimum order quantity? SPECIFY: __________ Are there any quantity breaks? RANGE AND PRICING: _______________

Does the item offered contain hazardous materials? No ___ Yes ___ (MSDS Required)

EVALUATION CRITERIA

☒ If checked, the Government anticipates making a single award (all or none), If this box is not checked, requirement will be evaluated for split award.

Source selection criteria:

1. TECHNICALLY ACCEPTABLE

1. PRICE

1. DELIVERY

Quotations submitted by each vendor will be evaluated in accordance with the specifications provided in the solicitation, and determined to be either acceptable or unacceptable. Technical submissions that do not meet the minimum requirements will be rated as "Unacceptable" and will no longer be considered for further competition or award. The Government intends to make an award without discussions.

☒ If checked, SPRS evaluation procedures apply to determine vendor responsibility.

Other than Certified Cost and Pricing Data may be requested to support fair and reasonable price determination.

INSPECTION

Inspection Location: ☒ Final Inspection at Destination Inspection Terms: QA1 ☐ , QA2 ☐ , QA3 ☐ , QA4 ☐ Inspection Time: QA-4 material has a 7-day inspection time and QA-2 and QA-3 have a 30-day inspection time.

BUY AMERICAN

DFARS Buy American Act - Balance of Payments applies if >$15,000.00.

DFARS Buy American Act - Free Trade Agreements may apply if > $25,000.00.