SF1449 _ 75H71322Q00039.pdf

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

Portland OR 97209 1414 N.W. Northrup, Suite 800 Portland Area Indian Health Service

IHS-NEW-PORTLAND

IHSFORTHALL CODE 16. ADMINISTERED BYCODE

X

X

334516

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR301

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

06/10/2022 1700 ET

06/06/2022

DANIEL OTIS

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H71322Q00039

5. SOLICITATION NUMBER

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

1 10 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

FORT HALL ID 82303

33 North Mission Road FortHall

15. DELIVER TO

Portland OR 97209 1414 N.W. Northrup, Suite 800 Portland Area Indian Health Service

9. ISSUED BY

7.

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)

IHS-NEW-PORTLAND

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.

Delivery: 30 Days After Notice to Proceed Period of Performance: 06/15/2022 to 06/14/2023

FOR ADMINISTRATIVE QUESTIONS REGARDING THIS

DELIVERY ORDER,

PLEASE CONTACT DANIEL OTIS, CONTRACT SPECIALIST,

BY EMAIL AT Daniel.Otis@IHS.GOV

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

KAREN A. SAHMAUNT

. 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

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.

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.

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.

1 Ortho VITROS 5600 Integrated System

Ortho VITROS 5600 Integrated System Service

Ortho Chemistry Reagents Class I - VI

Ortho Immunoassay Reagent

1001 Ortho VITROS 5600 Integrated System

Ortho VITROS 5600 Integrated System Service

Ortho Chemistry Reagents Class I - VI

Ortho Immunoassay Reagent

(Option Line Item)

06/15/2024

Period of Performance: 06/15/2023 to 06/14/2024

1002 Ortho VITROS 5600 Integrated System

Ortho VITROS 5600 Integrated System Service

Ortho Chemistry Reagents Class I - VI

Ortho Immunoassay Reagent

(Option Line Item)

06/15/2025

Period of Performance: 06/15/2024 to 06/14/2025

1003 Ortho VITROS 5600 Integrated System

Ortho VITROS 5600 Integrated System Service

Ortho Chemistry Reagents Class I - VI

Ortho Immunoassay Reagent

(Option Line Item)

06/15/2026

Period of Performance: 06/15/2025 to 06/14/2026

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

10 2 of

A - Solicitation/Contract Form C - Description/Specifications

Deliverables F - Deliveries or Performance I - Contract Clauses J - List of Documents, Exhibits and Other Attachments K - Representations, Certifications, and Other Statements of Bidders L - Instructions,Conditions, and Notices to Bidders

A - Solicitation/Contract Form

C - Description/Specifications

Deliverables

EQUIPMENT

Oty. Product

Code Item Rental

Type Term

1 6802413 VITROS 5600 Integrated System CPT 60

SERVICE

Oty. Product

Code Item Rental

Type Term

1 6802800 5600 SYSTEM SERVICE AGREEMENT Silver 60

Chemistry Reagent List

Package Product Code

Billing Product Code

Product Grouping

Package Description

Item Description

Volume

Total Cost

CLASS I

8196057 1504380 Class 1 ALBUMIN/5 PACK/250 SLDS Albumin 3,500 1053180 1290162 Class 1 ALKP/5 PACK/300 SLDS Alkaline

Phosphatase 3,000

6844288 6844290 Class 1 ALTV/5PACK/300 CLS ALTV 3,600 8433815 8747693 Class 1 AST/5 PACK/300 SLDS AST 2,400 8102204 1504307 Class 1 BUN/5 PACK/300 SLDS BUN 4,200 1450261 1504448 Class 1 CALCIUM/5 PACK/300 SLDS Calcium 4,200 6844471 6844472 Class 1 CHLORIDE/CL-/5 PACK/250

SLDS

Chloride incl.

Urine

4,000

6802584 6802680 Class 1 CREATININE/IDMS

STD/5PK/300SLD

Creatinine 4,800

8262396 8464703 Class 1 ENZYMATIC CO2/5

PACK/300 SLDS

Enzymatic CO2 2,400

1707801 1504281 Class 1 GLUCOSE/5 PACK/300 SLDS Glucose 4,800 8157596 1504240 Class 1 POTASSIUM/K+/5 PACK/250

SLDS

Potassium 3,500

8379034 1504265 Class 1 SODIUM/NA+/5 PACK/250

SLDS

Sodium 4,000

8159931 1539691 Class 1 TOT BILIRUBIN/5 PACK/300

SLDS

Total Bilirubin 3,600

8392292 1504349 Class 1 TOTAL PROTEIN/5

PACK/250 SLDS

Total Protein 3,500

CLASS II

8383051 1504489 Class 2 BUBC/5 PACK/300 SLDS BUBC 1,800