SF-1449 - 75H70721Q00024.pdf

PDF 130 KB Posted Jun 2, 2021

Attached to: Medical Gases & Cylinder Rental Services
Solicitation number: 75H70721Q00024
Issued by: Department of Health and Human Services Indian Health Service

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File	Type	Posted
Past Performance Survey Form.docx	DOCX document	Jun 2, 2021
Medical Gas Refills - Cylinder Rental Services - Terms and Conditions.docx	DOCX document	Jun 2, 2021

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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

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225 Albuquerque Indian Health Service

IHSSANTAFEUNIT CODE 16. ADMINISTERED BYCODE

325120

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR203

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

06/16/2021 1530 MD

06/02/2021

505-256-6754PATRICIA TRUJILLO

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70721Q00024

5. SOLICITATION NUMBER

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

1 5 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

SANTA FE NM 87505

1700 CERRILLOS ROAD

IHSSANTAFEUNIT

15. DELIVER TO

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225

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 FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Albuquerque Indian Health Service

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

The Albuquerque Area Indian Health Service, Santa Fe Service Unit has a requirement for Medical Gases and Cylinder Rental Services.

This is a combined synopsis for commercial items or services prepared in accordance with format in FAR Subpart 12.6, as supplemented with additional information included in this notice.

The solicitation number is 75H70721Q00024 and is issued as a Request for Quote (RFQ), unless

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

JUDITH A. MARIANO

. 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 FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

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:

REF.

DUNS NO.:

VENDOR NAME:

ADRESS:

ZIP CODE:

TELEPHONE NO.:

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. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

otherwise indicated herein. The solicitation document and incorporated provision and clauses are those in effect through Federal Acquisition

Circular 2021-04.

The associated North American Industrial

Classification System (NAICS) code for this procurement is 325120 with a business size standard 1000.

This requirement is a Set-Aside for Small

Business Indian Firms and only quotes from qualified offerors will be considered.

Offers will be solicited from Small Business

Indian Firm concerns. If we do not receive enough competition and/or reasonably priced offers from the Small Business Indian Firm set-aside, we will then evaluate quotes and consider for award to other Small Business concerns. Any acquisition resulting from this cascading set-aside will be from such a concern as follows: First Tier: Small

Business; Second Tier: Service Disabled

Veteran-Owned Business; Third Tier: HUBZONE and

Fourth: All Other Large Business Concerns.

ONLY ONE AWARD WILL RESULT FROM THIS SOLICITATION.

FOB Destination shall be for the following

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

5 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 5

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70721Q00024

Albuquerque Area Indian Health Service facility:

SANTA FE SERVICE UNIT

Attn: Housekeeping Department

1700 Cerrillos Road

Santa Fe, New Mexico 87505

**SEE ATTACHED PRICE SCHEDULE AND SCOPE OF WORK

FOR ADDITIONAL DETAILS**

This solicitation will result in a Single Award with One (1) Base Year from date of award and

Four (4) 12-month option periods based on

Satisfactory Performance ratings.

State Taxes for labor/service costs (The Indian

Health Service is exempt from New Mexico State

Taxes for materials and supplies.)

Quote must be free on board (FOB) Destination

CONUS (Continental U.S.), which means that the seller must deliver the goes on its conveyance at the destination specified by the buyer, and the seller is responsible for the cost of shipping and risk of loss prior to actual delivery at the specified destination.

This solicitation requires registration with the

System of Award Management (SAM) prior to award, pursuant to applicable regulations and guidelines. Registration information can be found at www.sam.gov

All responsible offerors that respond to this solicitation must submit their quotes by June 16, 2021, by COB 3:30 p.m., (MDT). The quote shall be sent by U.S. Postal Service or by Email to:

patricia.trujillo@ihs.gov. Failure to comply with the below terms and conditions may result in offer being determined as non-responsive.

Question Submission: Interest Offerors must submit any questions concerning this solicitation at the earliest time possible to enable to respond. Technical questions must be submitted by

Email to: geradline.nieto@ihs.gov five (5) days prior to closing of the solicitation.

Continued ...

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