SF 1449 (11_2021).pdf

PDF 118 KB Posted May 30, 2025

Attached to: Prescription Eyeglasses for the Billings Area Indian Health Service (BAIHS) Locations.
Solicitation number: 75H709-BAIHS25Q-012
Issued by: Department of Health and Human Services Indian Health Service

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Written by GovTribe AI · May 30, 2025

This Standard Form 1449 (SF 1449) is a Request for Quote (RFQ) for Prescription Eyeglasses fabrication services for the Billings Area Indian Health Service (BAIHS) Federal Service Units. The solicitation (No. 75H70925Q00008) is a 100% small business set-aside with a base period from 07/01/2025 to 06/30/2026 and four additional one-year option periods extending through 06/30/2030. The contract will provide prescription eyeglasses to five specific service units: Blackfeet, Crow, Fort Belknap, Little Shell, and Northern Cheyenne, with distinct delivery locations for each unit in Montana.

The solicitation includes multiple line items for the base year and subsequent option years, each specifying the service unit, delivery location, and performance period. The RFQ was issued by the Billings Area Indian Health Service on 05/29/2025, with quotes due on 06/12/2025 at 1700 MT. The point of contact for the solicitation is Mitzi Horn, reachable at 406-247-7067. The North American Industry Classification System (NAICS) code is 339115, with a size standard of 1,000 employees, and the procurement is conducted under simplified acquisition procedures for commercial items.

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Other files

File	Type	Posted
Statement of Work 6.13.2025.pdf	PDF	Jun 13, 2025
Eyeglasses Fabrication Solicitation Questions and Answers.pdf	PDF	Jun 13, 2025
75H709-BAIHS25Q-012.pdf	PDF	Jun 4, 2025
Attachment_A_Revised_Eyeglass_Price_Schedule.xlsx	XLSX spreadsheet	May 30, 2025
Attachment_B.Area_Map.Billings_Area_IHS.pdf	PDF	May 30, 2025

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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

Billings MT 59101 P.O. Box 36600 2900 4th Avenue North Billings Area Indian Health Service

CODE 16. ADMINISTERED BYCODE

339115

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR224

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

06/12/2025 1700 MT

05/29/2025

4062477067MITZI HORN

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70925Q00008

5. SOLICITATION NUMBER

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

1 105 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Multiple Destinations

15. DELIVER TO

Billings MT 59101 P.O. Box 36600 2900 4th Avenue North

9. ISSUED BY

2. CONTRACT NO.

EFFECTIVE DATE

1,000

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 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)

Billings Area Indian Health Service

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.

TOTAL 100% SMALL BUSINESS SET ASIDE

This is a Request for Quote (RFQ) for Fabrication Services for Prescription Eyeglasses to be provided to the Billings Area Indian Health Serivce (BAIHS) Federal Service Units.

Period of Performance: 07/01/2025 to 06/30/2026

1 Prescription Eyeglasses for Blackfeet Service Unit Continued ...

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

DEEANDRA SALABYE

. 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

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.

Delivery Location Code: IHSBROWNING

IHSBROWNING

760 HOSPITAL CIRCLE

BROWNING MT 59417 US

2 Prescription Eyeglasses for Crow Service Unit

Delivery Location Code: IHSCROWAGENCY

IHSCROWAGENCY

One Hospital Way

10110 South 7650 East

CROW AGENCY MT 59022-0009 US

3 Prescription Eyeglasses for Fort Belknap Service

Unit

Delivery Location Code: IHSHARLEM

IHSHARLEM

669 AGENCY MAIN STREET

HARLEM MT 59526 US

4 Prescription Eyeglasses for Little Shell Service

Unit

Delivery Location Code: IHSLITTLESHELLHEALTH

IHSLITTLESHELLHEALTH

425 Smelter Ave. NE

Great Falls MT 59404 US

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

105 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 105

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70925Q00008

5 Prescription Eyeglasses for Northern Cheyenne

Service Unit

Delivery Location Code: IHSLAMEDEER

IHSLAMEDEER

420 NORTH CHEYENNE AVENUE

LAME DEER MT 59043 US

6 Option Year One

Prescription Eyeglasses for Blackfeet Service Unit

(Option Line Item)

Delivery Location Code: IHSBROWNING

IHSBROWNING

760 HOSPITAL CIRCLE

BROWNING MT 59417 US

Period of Performance: 07/01/2026 to 06/30/2027

7 Option Year One

Prescription Eyeglasses for Crow Service Unit

(Option Line Item)

Delivery Location Code: IHSCROWAGENCY

IHSCROWAGENCY

One Hospital Way

10110 South 7650 East

CROW AGENCY MT 59022-0009 US

Period of Performance: 07/01/2026 to 06/30/2027

8 Option Year One

Prescription Eyeglasses for Fort Belknap Service

Unit

(Option Line Item)

Delivery Location Code: IHSHARLEM

IHSHARLEM

669 AGENCY MAIN STREET

HARLEM MT 59526 US

Period of Performance: 07/01/2026 to 06/30/2027

9 Option Year One

Prescription Eyeglasses for Little Shell Service

Unit

(Option Line Item)

Delivery Location Code: IHSLITTLESHELLHEALTH

Continued ...

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