RFQ-09-141.doc

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ FORMCHECKBOX

IS FORMCHECKBOX

IS NOT A SMALL BUSINESS SET-ASIDE

PAGE OF PAGES

1. REQUEST NO.

RFQ-09-141

2. DATE ISSUED

08/13/2009

3. REQUISITION/PURCHASE REQUEST NO.

IHS1070021

4. CERT.FOR NAT. DEF.

UNDER BDSA REG.2

AND/OR DMS REG. 1

RATING

5A. ISSUED BY

Aberdeen Area Indian Health Service, Room 309 Federal Building

115 4th Avenue Southeast, Aberdeen, South Dakota 57401

6. DELIVER BY (Date)

FORMCHECKBOX

FOB DESTINATION FORMCHECKBOX

(See Schedule)

NAME

Nichole Archambeau, Contract Specialist

AREA CODE

NUMBER

226-7567

a. NAME OF CONSIGNEE

Ft. Totten Health Care Facility

TO:

b. STREET ADDRESS 3883 74th Ave NE

a. NAME

b. COMPANY

c. CITY

Ft. Totten

c. STREET ADDRESS

d. CITY

e. STATE

f. ZIP CODE

d. STATE

ND

e. ZIP CODE

58335

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK

5a ON OR BEFORE CLOSE OF

BUSINESS (Date) August 24, 2009 IMPORTANT: This is a request for information, and quotations furnished are not offiers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State and local taxes)

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

1.

2.

3.

4.

5.

Firm Fixed-Price purchase order for the purchase of dental materials for siding, windows and doors at the Ft. Totten PHS, IHS Health Care Facility, Ft. Totten, ND.

See attached Bid Schedule.

DUN & Bradstreet Number:

(The Dun & Bradstreet number is required. Provided you do not have one, you may call 866-705-5711 and obtain a number.)

Federal Tax ID Number:

Delivery Period:

Email Address:

Complete attached bid schedule

12. DISCOUNT FOR PROMPT

PAYMENT

a. 10 CALENDAR DAYS

b. 20 CALENDAR DAYS

c. 30 CALENDAR DAYS

d. CALENDAR DAYS

NOTE: Additional provisions and representations FORMCHECKBOX are FORMCHECKBOX are not attached.

SIGN QUOTATION

15. DATE OF

QUOTATION

a. NAME OF QUOTER

b. STREET ADDRESS

c. COUNTY

16. SIGNER

a. NAME (Type of print)

b. TELEPHONE

AREA CODE

AUTHORIZED FOR LOCAL REPRODUCTION

FormFlow/Delrina Inc.

STANDARD FORM 18 (REV 6-95)

Previous edition not usable

Prescribed by GSA-FAR (48 CFR) 53-215-1(a)