Signed-PO_75H71122P00676.pdf

ORDER FOR SUPPLIES OR SERVICES

3. ORDER NO. 4. REQUISITION/REFERENCE NO.

PAGE OF PAGES

5. ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS

IMPORTANT: Mark all packages and papers with contract and/or order numbers. 1

1. DATE OF ORDER 2. CONTRACT NO. (If any) 6. SHIP TO:

a. NAME OF CONSIGNEE

c. CITY d. STATE e. ZIP CODE

7. TO:

a. NAME OF CONTRACTOR

f. SHIP VIA

8. TYPE OF ORDER

b. COMPANY NAME

c. STREET ADDRESS

d. CITY e. STATE f. ZIP CODE

9. ACCOUNTING AND APPROPRIATION DATA

a. PURCHASE b. DELIVERY

REFERENCE YOUR:

Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.

Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of this form and is issued subject to the terms and conditions of the above-numbered contract.

10. REQUISITIONING OFFICE

11. BUSINESS CLASSIFICATION (Check appropriate box(es))

a. SMALL b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED

13. PLACE OF

a. INSPECTION b. ACCEPTANCE

14. GOVERNMENT B/L NO. 15. DELIVER TO F.O.B. POINT

ON OR BEFORE (Date)

16. DISCOUNT TERMS

17. SCHEDULE (See reverse for Rejections)

07/15/2022

75H71122P00676 IHS1456520

Oklahoma City Area IHS

701 Market Drive

Oklahoma City OK 73114

MANDY FLAMING

WESTERN SEALCOATING & STRIPING LLC 1611105

WESTERN SEALCOATING & STRIPING LLC

10379 N 2198 RD

CLINTON OK 73601

2022.J50ZL21.25407

12. F.O.B. POINT

10/15/2022

CLINTON INDIAN HEALTH CENTER

10321 N 2274 RD

CLINTON OK 73601

CLINTON OK 73601

ORACLE

ITEM NO.

(a)

SUPPLIES OR SERVICES

(b)

QUANTITY

ORDERED

(c)

UNIT

(d)

UNIT

PRICE

(e)

AMOUNT

(f)

QUANTITY

ACCEPTED

(g)

XX

X

Destination Destination HHS NET 30P

f. SERVICE-DISABLED

VETERAN-OWNED

e. HUBZone

g. WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOSB PROGRAM

h. EDWOSB

UEI: Y27GL73DLMF9

Contractor shall repair, asphaltic pavements on the oval perimeter road and related parking lots in accordance with the Statement of Work and Drawing at the Clinton Indian Health Center.

Continued ...

19. GROSS SHIPPING WEIGHT18. SHIPPING POINT 20. INVOICE NO.

21. MAIL INVOICE TO:

a. NAME

b. STREET ADDRESS

(or P.O. Box)

c. CITY d. STATE e. ZIP CODE

SEE BILLING

INSTRUCTIONS

ON REVERSE

17(h)

TOTAL

(Cont.

pages)

17(i)

GRAND

TOTAL

$49,640.55

22. UNITED STATES OF

AMERICA BY (Signature)

23. NAME (Typed)

TITLE: CONTRACTING/ORDERING OFFICER

KATRINA EATON

$49,640.55

OPTIONAL FORM 347 (Rev. 2/2012)

Prescribed by GSA/FAR 48 CFR 53.213(f)

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION NOT USABLE

07/15/2022

Oklahoma City Area IHS

701 Market Drive

Oklahoma City OK 73114

Oklahoma City OK 73114

DATE OF ORDER

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

IMPORTANT: Mark all packages and papers with contract and/or order numbers.

ORDER NO.

QUANTITY

ACCEPTED

07/15/2022 75H71122P00676

PAGE NO

(a) (b) (c) (d) (e) (f) (g)

Admin Office:

Oklahoma City Area IHS

701 Market Drive

Oklahoma City OK 73114

Appr. Yr.: 2022 CAN: J50ZL21 Object Class:

25407

Period of Performance: 07/15/2022 to

10/15/2022

1 Contractor shall repair, asphaltic 49640.55 DO 1.00 49,640.55 pavements on the oval perimeter road and related parking lots in accordance with the Statement of Work and Drawing at the

Clinton Indian Health Center.

Additional Provisions and Conditions (nine pages; 4-12 are attached hereto)

Scope of Work including Drawings (attached)

Statement of Work (23 pages), Drawing (3 pages)

Davis Bacon General Wage Decision

OK20220018 Dated 02/25/2022 is hereby incorporated, 7 pages (attached)

FAR Clause 52.213-4 attached FAR Clause

52.204-7 applies

Indian Health Center POC: Eric Stoneroad, Facility Manager

Cell: 580-678-9961

Office: 580-331-3449

E-mail: eric.stoneroad@ihs.gov

Contract Specialist (C): Jeffrey Earnest, (IHS/OKC) 405-951-3740

Send original invoice to:

Oklahoma City Area Indian Health Service

Attention: Finance

701 Market Drive

Oklahoma City, OK 73114

Or Fax to: 405-951-3873

Continued ...

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION

PREVIOUS EDITION NOT USABLE

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $49,640.55

DATE OF ORDER

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

IMPORTANT: Mark all packages and papers with contract and/or order numbers.

ORDER NO.

QUANTITY

ACCEPTED

07/15/2022 75H71122P00676

PAGE NO

(a) (b) (c) (d) (e) (f) (g)

Invoice inquiries may be made to Denise

Karr at 405-951-3919 denise.karr@ihs.gov

The total amount of award: $49,640.55. The obligation for this award is shown in box

17(i).

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION

PREVIOUS EDITION NOT USABLE

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $0.00