sf1449.doc
DOC document 64 KB Posted
- Solicitation number
- SMD70011Q0052
- Issued by
-
Department of State US Embassy Chisinau
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|---|---|---|
| Chisinau_Packing_Shipping_2010_Synopsis.doc | DOC document | |
| Packing_Shipping_services_2010.doc | DOC document |
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Text version
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30
1. REQUISITION NUMBER
PAGE 1 OF
2. CONTRACT NO.
3. AWARD/EFFECTIVE
DATE
4. ORDER NUMBER
5. SOLICITATION NUMBER
SMD70011Q0052
6. SOLICITATION ISSUE DATE
11/30/2010
7. FOR SOLICITATION
INFORMATION CALL
a. NAME
Ryan, Andrew F or Valeriu Cernea
b. TELEPHONE NUMBER(No collect calls)
+373-22-40-83-00
8. OFFER DUE DATE/ 12/15/2010
LOCAL TIME
5 PM
9. ISSUED BY
CODE
10. THIS ACQUISITION IS
Department of State US Embassy Chisinau
103A.Mateevici str., MD 2009
Chisinau, Moldova
Tel
Chisinau
FORMCHECKBOX
UNRESTRICTED
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SET ASIDE: % FOR
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SMALL BUSINESS FORMCHECKBOX
EMERGING SMALL BUSINESS
Tel:+373 22 40 83 00 Fax:+373 22 40 84 47
FORMCHECKBOX
HUBZONE SMALL BUSINESS SMALL BUSINESS
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SERVICE-DISABLED VETERAN OWNED FORMCHECKBOX
8(A)
NAICS:
SIZE STD:
| 11. DELIVERY FOR FOB |
| 12. DISCOUNT TERMS |
| FORMCHECKBOX |
13a. THIS CONTRACT IS A RATED ORDER
UNDER DPAS (15 CFR 700)
DESTINATION UNLESS BLOCK IS MARKED
FORMCHECKBOX
SEE SCHEDULE
13b. RATING
14. METHOD OF SOLICITATION
FORMCHECKBOX
RFQ FORMCHECKBOX
IFB FORMCHECKBOX
RFP
15. DELIVER TO:
Code
16. Administered by:
US Embassy Chisinau 103 A. Mateevici str., Chisinau, Moldova
17.a. CONTRACTOR/OFFEROR CODE FACILITY CODE
TELEPHONE NO:
18a. PAYMENT WILL BE MADE BY
US Embassy Chisinau
Attn: Budget & Finance Division
103A.Mateevici str., MD 2009
Chisinau, Moldova
FORMCHECKBOX
17b CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED
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SEE ADDENDUM
19.
ITEM NO.
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
Packing, shipping, storage and forwarding services – see attached continuation sheets.
(Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA
26. TOTAL AWARD AMOUNT (For Govt. Use Only)
FORMCHECKBOX
27a.SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA FORMCHECKBOX
ARE FORMCHECKBOX
ARE NOT ATTACHED.
FORMCHECKBOX
27b.CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA FORMCHECKBOX
ARE FORMCHECKBOX
ARE NOT ATTACHED.
FORMCHECKBOX
28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _____ COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED HEREIN.
FORMCHECKBOX
29. AWARD OF CONTRACT: REF. _________________ OFFER DATED _______________. YOUR OFFER ON SOLICITATION (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:
| 30a. SIGNATURE OF OFFEROR/CONTRACTOR |
| 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) |
30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT)
30c. DATE SIGNED
31b. NAME OF CONTRACTING OFFICER (Type or Print)
Ryan, Andrew F.
Contracting Officer 31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
STANDARD FORM 1449 (REV3/2005)
PREVIOUS EDITION IS NOT USABLE
Computer Generated
Prescribed by GSA - FAR (48 CFR) 53.212
19.
ITEM NO.
20.
SCHEDULE OF SUPPLIES/SERVICES
21.
QUANTITY
22.
UNIT
23.
UNIT PRICE
24.
AMOUNT
32a. QUANTITY IN COLUMN 21 HAS BEEN
FORMCHECKBOX
RECEIVED
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INSPECTED
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ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ____________________________
32b. SIGNATURE OF AUTHORIZED GOVERNMENT
REPRESENTATIVE
| 32c. DATE |
| 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT |
REPRESENTATIVE
| 32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE |
| 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE |
32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE
| 33. SHIP NUMBER |
| 34. VOUCHER NUMBER |
| 35. AMOUNT VERIFIED |
CORRECT FOR
| 36. PAYMENT |
| 37. CHECK NUMBER |
PARTIAL
FINAL
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COMPLETE
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PARTIAL
FORMCHECKBOX
FINAL
38. S/R ACCOUNT NO.
| 39. S/R VOUCHER NO. |
| 40. PAID BY |
| 41.a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT |
| 42a. RECEIVED BY (PRINT) |
41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER
41C. DATE
42b. RECEIVED AT (Location)
| 42c. DATE REC’D (YY/MM/DD) |
| 42d. TOTAL CONTAINERS |
STANDARD FORM 1449 (REV. 3/2005) BACK
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