Sf 18 - RFQ 20-172 Siss Opt Equip .doc

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

1. REQUEST NO.

RFQ-20-172

2. DATE ISSUED

09/08/2020

3. REQUISITION/PURCHASE REQUEST NO.

IHS1399084

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)

FORMCHECKBOX

FOB DESTINATION FORMCHECKBOX

(See Schedule)

NAME

Susan K. Davis, Contract Specialist Susan.Davis2@ihs.gov

AREA CODE

NUMBER

226-7572

a. NAME OF CONSIGNEE WWKMHCC/Sisseton IHS

TO:

b. STREET ADDRESS

100 Lake Traverse Drive

a. NAME

c. CITY Sisseton

c. STREET ADDRESS

d. CITY

e. STATE

f. ZIP CODE

d. STATE

SD

e. ZIP CODE

57262

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK

5a ON OR BEFORE CLOSE OF

BUSINESS (Date)

September 16, 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)

QTY

(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 Zeiss OS Cirrus HD-OCT (Model 6000) with Angio Plex OCT Angiography, Version 9.5. Includes GCGPA, Smart HD Scans, FastTrac, Adv RPE, GCA, Ant Seg Basic; To be included in package is Anterior Segment Premier Module for the Woodrow Wilson Keeble Memorial Health Center, Sisseton IHS, in Sisseton, SD;

Please see attached Specifications; Quote to include:

Installation: $____________________

Training: $____________________ Shipping: $ ____________________

1.

EA

Total

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 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)

SF 18 CONTINUATION FORM

PAGE 2 OF 2 PAGES

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QTY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

Period of Performance is to be 60 Days ARO;

BASIS FOR AWARD: Lowest Price Technically Acceptable;

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: