SF-18_IHS1338712.doc

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

1-2

1. REQUEST NO.

RFQ-18-8712

2. DATE ISSUED

1/2/18

3. REQUISITION/PURCHASE REQUEST NO.

IHS1338712

4. CERT.FOR NAT. DEF.

UNDER BDSA REG.2

AND/OR DMS REG. 1

RATING

5A. ISSUED BY

Great Plains Area Indian Health Service, 115 4th Avenue SE

Federal Building, Room 309, Aberdeen, South Dakota 57401

6. DELIVER BY (Date)

30 ARO

FOB DESTINATION FORMCHECKBOX

(See Schedule)

NAME

April Metcalfe Purchasing Agent April.metcalfe@ihs.gov

AREA CODE

NUMBER

477-8416

a. NAME OF CONSIGNEE Quentin N. Burdick I.H.S.

TO:

b. STREET ADDRESS

1300 Hospital Loop

a. NAME

b. COMPANY

c. CITY Belcourt

c. STREET ADDRESS

d. CITY

e. STATE

f. ZIP CODE

d. STATE

ND

e. ZIP CODE

58316

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK

5a ON OR BEFORE CLOSE OF

BUSINESS (Date1/12/18@ 11:00 a.m CST.

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 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)

MX-4070

S/N 65091493

MX-4111

S/N

45-62232 Maintenance Agreement for Sharp printer

Includes 72,000 copies for B&W. 12,000 for the color. Covers all parts, labor, mileage, drums and black toner. Does not include color toner, paper or staples. For one printer.

Maintenance Agreement for Sharp printer

Includes 72,000 copies for B&W. 12,000 for the color. Covers all parts, labor, mileage, drums and black toner. Does not include color toner, paper or staples. For one printer

This is a base plus four years, totaling five-year contract.

Mo.

Mo.

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 x 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)

CONTINUATION

PAGE 2 OF 2 PAGES

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

DUNS & BRADSTREET NUMBER:

(The Duns & Bradstreet number is required. Provided you do not have it, you may call 866-705-5711 and obtain one.) You will need a DUNS & BRADSTREET NUMBER to be awarded the purchase order and registered with the System for Award Management; you can register at www.sam.gov.

The quoter is hereby notified that they must be registered in the System for Award Management (SAM) before the Government will issue an award. (You may do this by going to www.sam.gov to register and you are required to update this registration every year prior to the expiration date.)

FEDERAL TAX ID NUMBER:

EMAIL ADDRESS:

NET TERMS: