SF18.Pharmacist_FPSU.pdf

PDF 1006 KB Posted Apr 6, 2016

Attached to: PHARMACY SERVICES Federal contract opportunity
Solicitation number: RFQ-10-16-035-REL
Issued by: Department of Health and Human Services Indian Health Service

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Standard Form (SF)-18 Request for Quotation

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RFQ-10-16-035-REL.Pharmacy_Services.docx	DOCX document	Apr 6, 2016

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REQUEST FOR QUOTATION

(THIS IS NOT AN ORDER)

THIS RFQ IS IS NOT A SMALL BUSINESS SET-ASIDE

15. DATE OF QUOTATION

16. SIGNER

a. NAME (Type or print)

c. TITLE (Type or print)

b. TELEPHONE

AREA CODE

NUMBER

STANDARD FORM 18 (REV. 6-95)

Prescribed by GSA-FAR (48 CFR) 53.215-1(a)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable

8. TO:

b. COMPANYa. NAME

c. STREET ADDRESS

d. CITY e. STATE f. ZIP CODE

9. DESTINATION

a. NAME OF CONSIGNEE

b. STREET ADDRESS

c. CITY

d. STATE e. ZIP CODE

7. DELIVERY

FOB DESTINATION

OTHER

(See Schedule)

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS (Date)

IMPORTANT: This is a request for information and quotations furnished are not offers. 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 service. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotation 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)

12. DISCOUNT FOR PROMPT PAYMENT

a. 10 CALENDAR DAYS (%) b. 20 CALENDAR DAYS (%) c. 30 CALENDAR DAYS (%) d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

b. STREET ADDRESS

c. COUNTY

d. CITY e. STATE f. ZIP CODE

14. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

PAGE OF PAGES

1. REQUEST NO. 2. DATE ISSUED 3. REQUISITION/PURCHASE REQUEST NO. 4. CERT. FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG. 1

RATING

5a. ISSUED BY 6. DELIVER BY (Date)

5b. FOR INFORMATION CALL (NO COLLECT CALLS)

NAME TELEPHONE NUMBER

AREA CODE NUMBER

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REQUEST FOR QUOTATION

(THIS IS NOT AN ORDER)

THIS RFQ

IS NOT A SMALL BUSINESS SET-ASIDE

15. DATE OF QUOTATION

16. SIGNER

a. NAME (Type or print)

c. TITLE (Type or print)

b. TELEPHONE

AREA CODE

NUMBER

STANDARD FORM 18 (REV. 6-95) Prescribed by GSA-FAR (48 CFR) 53.215-1(a) AUTHORIZED FOR LOCAL REPRODUCTION Previous edition not usable

8. TO:

b. COMPANY

a. NAME

c. STREET ADDRESS

d. CITY

e. STATE

f. ZIP CODE

9. DESTINATION

a. NAME OF CONSIGNEE

b. STREET ADDRESS

c. CITY

d. STATE

e. ZIP CODE

7. DELIVERY

FOB DESTINATION

OTHER

(See Schedule)

10. PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS (Date) IMPORTANT: This is a request for information and quotations furnished are not offers. 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 service. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotation 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)

12. DISCOUNT FOR PROMPT PAYMENT

a. 10 CALENDAR DAYS (%)

b. 20 CALENDAR DAYS (%)

c. 30 CALENDAR DAYS (%)

d. CALENDAR DAYS

NUMBER

PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

b. STREET ADDRESS

c. COUNTY

d. CITY

e. STATE

f. ZIP CODE

14. SIGNATURE OF PERSON AUTHORIZED TO SIGN QUOTATION

PAGE

PAGES

1. REQUEST NO.

2. DATE ISSUED

3. REQUISITION/PURCHASE REQUEST NO.

4. CERT. FOR NAT. DEF. UNDER BDSA REG. 2 AND/OR DMS REG. 1

RATING

5a. ISSUED BY

6. DELIVER BY (Date) 5b. FOR INFORMATION CALL (NO COLLECT CALLS)

NAME

TELEPHONE NUMBER

AREA CODE

NUMBER

THIS RFQ IS A SMALL BUSINESS SET-ASIDE.: 1

7. DELIVERY. FOB DESTINATION: 1

NOTE: Additional provisions and representations are attached.: 1

NOTE: Additional provisions and representations are not attached.: 0

7. DELIVERY. OTHER (See Schedule): 0

THIS RFQ IS NOT A SMALL BUSINESS SET-ASIDE.: 0

PAGE OF: 1

4. CERT. FOR NAT. DEF. UNDER BDSA REG. 2 AND/OR DMS REG. 1. RATING:

3. REQUISITION/PURCHASE REQUEST NUMBER:

1. REQUEST NUMBER: RFQ-10-16-035-REL

5a. ISSUED BY: PHS Indian Health Service, 2900 4th Ave N, Billings, MT 59101

5b. FOR INFORMATION CALL (NO COLLECT CALLS). NAME: Rita Langager, Contract Specialist

8. TO. a. NAME:

13. NAME AND ADDRESS OF QUOTER. f. ZIP CODE:

16. SIGNER. a. NAME (Type or print):

16. SIGNER. b. TELEPHONE. AREA CODE:

16. SIGNER. b. TELEPHONE. NUMBER:

16. SIGNER. c. TITLE (Type or print):

13. NAME AND ADDRESS OF QUOTER. e. STATE:

13. NAME AND ADDRESS OF QUOTER. d. CITY:

13. NAME AND ADDRESS OF QUOTER. b. STREET ADDRESS:

13. NAME AND ADDRESS OF QUOTER. c. COUNTRY:

13. NAME AND ADDRESS OF QUOTER. a. NAME OF QUOTER:

8. TO. c. STREET ADDRESS:

8. TO. d. CITY:

11. SCHEDULE (Include applicable Federal, State and local taxes). ITEM NUMBER. COLUMN A. Line 18 of 18:

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: This is a Request for Quotation (RFQ) for a

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: Pharmacist at the Fort Peck Service Unit,

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: Poplar, Montana. The services shall be provided in

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: accordance with the attached Statement of Work

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: and purchase order terms and conditions.

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: The procurement is conducted pursuant to the

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: the authority of Federal Acquisition Regulation

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: (FAR) Part 13, Simplified Acquisition Procedures;

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: and FAR 37.104, Personal Services Contracts

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: (Public Law 103-332, Department of the Interior

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: and Related Agencies Appropriation Act, Title II,

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: September 30, 1994, 108 Stat. 2530 as

11. SCHEDULE (Include applicable Federal, State and local taxes). SUPPLIES/SERVICES. COLUMN B.: implemented by 25 U.S.C. 1638c).

11. SCHEDULE (Include applicable Federal, State and local taxes). QUANTITY. COLUMN C.:

11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT. COLUMN D.:

8. TO. e. STATE:

8. TO. f. ZIP CODE:

5b. FOR INFORMATION CALL (NO COLLECT CALLS). TELEPHONE NUMBER. AREA CODE: 406

8. TO. b. COMPANY:

5b. FOR INFORMATION CALL (NO COLLECT CALLS). TELEPHONE NUMBER. NUMBER: 247-7293

9. DESTINATION. a. NAME OF CONSIGNEE: Fort Peck Service Unit

9. DESTINATION. b. STREET ADDRESS: 107 H Street East

9. DESTINATION. c. CITY: Poplar

9. DESTINATION. e. ZIP CODE: 59255

9. DESTINATION. d. STATE: MT

PAGES: 10

2. DATE ISSUED. Enter 2 digit month, 2 digit day and 4 digit year.: 2016-04-06

10. PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS (Date). Enter 2 digit month, 2 digit day and 4 digit year.: 4/22 @ 12 pm

15. DATE OF QUOTATION. Enter 2 digit month, 2 digit day and 4 digit year.:

6. DELIVER BY (Date). Enter 2 digit month, 2 digit day and 4 digit year.: See Item 2

11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:

11. SCHEDULE (Include applicable Federal, State and local taxes). AMOUNT. COLUMN F.:

11. SCHEDULE (Include applicable Federal, State and local taxes). UNIT PRICE. COLUMN E.:

12. DISCOUNT FOR PROMPT PAYMENT. a. 10 CALENDAR DAYS (%):

12. DISCOUNT FOR PROMPT PAYMENT. b. 20 CALENDAR DAYS (%):

12. DISCOUNT FOR PROMPT PAYMENT. c. 30 CALENDAR DAYS (%):

12. DISCOUNT FOR PROMPT PAYMENT. d. CALENDAR DAYS. NUMBER:

12. DISCOUNT FOR PROMPT PAYMENT. d. CALENDAR DAYS. PERCENTAGE:

14. SIGNATURE OF PERSON AUTHORIZED TO SIGN QUOTATION. Digital Signature:

14. SIGNATURE OF PERSON AUTHORIZED TO SIGN QUOTATION. This is a protected field:

File details come from the government source that posted it. Updated Nov 14, 2017.