Sf 18 - RFQ 20-171 Fort Yates Keratometers.pdf

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS IS a SMALL BUSINESS SET ASIDE

PAGE OF PAGES

1. REQUEST NO.

RFQ-20-171

2. DATE ISSUED

09/04/2020

3. REQUISITION/PURCHASE REQUEST NO.

IHS1400023

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)

5b. FOR INFORMATION CALL (NO COLLECT CALLS) 7. DELIVERY OTHER

FOB DESTINATION (See Schedule)

NAME

Susan K. Davis, Contract Specialist

Susan.Davis2@ihs.gov

TELEPHONE NUMBER 9. DESTINATION

AREA CODE

NUMBER

226-7572

a. NAME OF CONSIGNEE

Fort Yates IHS Hospital

TO:

b. STREET ADDRESS

10 North River Road

a. NAME

c. CITY

Fort Yates

c. STREET ADDRESS

d. CITY

e. STATE

f. ZIP CODE

d. STATE

ND

e. ZIP CODE

58538

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK

5a ON OR BEFORE CLOSE OF

BUSINESS (Date)

September 11, 2020 @1pm 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)

QUANTIT

Y

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

THIS IS A SMALL BUSINESS SET-ASIDE FOR

BRAND NAME OR APPROVED EQUAL

GENERAL DESCRIPTION: Firm Fixed-Price Order for Right On Retinomax K Plus 5 Auto-Refractor

Keratometer for the Standing Rock, Fort Yates IHS

Hospital in Fort Yates, North Dakota;

Please see attached Specifications;

Shipping

Period of Performance is to be 60 Days ARO;

BASIS FOR AWARD: Lowest Price Technically

Acceptable;

1.

EA

LS

Total

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 15. SIGNATURE OF PERSON AUTHORIZED TO

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

d. CITY e. STATE f. ZIP CODE

c. TITLE (type or print) NUMBER

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)

SF 18 CONTINUATION FORM PAGE 2 OF 2 PAGES

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QTY

(c)

UNIT

(d)

UNIT

PRICE

(e)

AMOUNT

(f)

The quoted “unit price” must be an all-inclusive cost.

All “inclusive unit price” is defined to include travel, lodging, per diem, fringe benefits, federal, state and local taxes plus all other costs pertinent to the performance of this contract;

INSTRUCTIONS: To be considered an acceptable quote, the SF18 MUST be completed and signed, returned and/or provided by the date and time stated above in Box 10;.

ATTACHMENTS:

(a) Specifications

(b) Clauses incorporated by reference

(c) Clauses incorporated in full text.

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.

If applicable, DUNS +4:

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.

You are required to update this registration every year prior to the expiration date.)

FEDERAL TAX ID NUMBER:

EMAIL ADDRESS:

NET TERMS:

http://www.sam.gov/ http://www.sam.gov/