Sol_75H71026Q00128.pdf
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- Solicitation number
- 75H71026Q00128
About this file
This is a Solicitation/Contract/Order for Commercial Items (Standard Form 1449) issued by the Gallup Indian Medical Center Acquisition Department for a 100% small business set-aside procurement.
The solicitation (75H71026Q00128) requires the contractor to provide one Carl Zeiss HFA3 Model 860 Visual Field Analyzer in accordance with Attachment A (Statement of Work) for delivery to Gallup Indian Medical Center, 1808 West Aztec Avenue, Gallup, New Mexico 87301. The offer due date is April 2, 2026 at 1:00 PM Mountain Daylight Time, with an anticipated award date of April 9, 2026. The solicitation contact is Adrian Segay at 505-339-9474 (no collect calls). The North American Industry Classification Standard (NAICS) code is 339115, with a size standard of 1,000 employees. This is a brand name solicitation designated as a rated order under the Defense Priorities and Allocations System (DPAS). All invoices must be submitted electronically through www.ipp.gov in compliance with electronic payment process requirements outlined in Federal Acquisition Regulation clause 352.232-71. The contract incorporates by reference FAR 52.212-1, 52.212-3, 52.212-4, and 52.212-5. Payment will be made to the Acquisition Department address, and delivery is FOB destination unless otherwise noted in the schedule.
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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
51CODE 16. ADMINISTERED BYCODE
X
X
X
339115
SIZE STANDARD:
100.00 % FOR:SET ASIDE:UNRESTRICTED OR51
REQUEST FOR
PROPOSAL
(RFP)
INVITATION
FOR BID (IFB)
10. THIS ACQUISITION ISCODE
REQUEST FOR
QUOTE (RFQ)
14. METHOD OF SOLICITATION
13b. RATING
NORTH AMERICAN INDUSTRY
CLASSIFICATION STANDARD
(NAICS):
SMALL BUSINESS
04/09/2026 1300 MD
04/02/2026
505-339-9474ADRIAN SEGAY
(No collect calls)
INFORMATION CALL:
FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME
4. ORDER NUMBER3. AWARD/ 6. SOLICITATION
75H71026Q00128
5. SOLICITATION NUMBER
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF
1 2 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30
TELEPHONE NO.
17a. CONTRACTOR/
15. DELIVER TO
Gallup NM 87301
1808 W. Aztec Avenue
Acquisition Department
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 FREE ON BOARD
(FOB) DESTINATION UNLESS
BLOCK IS MARKED
11.
SEE SCHEDULEX
12. DISCOUNT TERMS THIS CONTRACT IS A RATED
ORDER UNDER THE DEFENSE
PRIORITIES AND ALLOCATIONS
SYSTEM - DPAS (15 CFR 700)
13a.
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
(SDVOSB)
HUBZONE SMALL
BUSINESS
8(A)
Gallup Indian Medical Center WOMEN-OWNED SMALL
BUSINESS (WOSB)
ECONOMICALLY DISADVANTAGED
WOMEN-OWNED SMALL
BUSINESS (EDWOSB)
Gallup NM 87301
1808 West Aztec Avenue
Gallup Indian Medical Center
Gallup NM 87301
1808 W. Aztec Avenue
Acquisition Department
Gallup Indian Medical Center
24.
AMOUNT
23.
UNIT PRICE
22.
UNIT
21.
QUANTITY
20.
SCHEDULE OF SUPPLIES/SERVICES
19.
ITEM NO.
***100% Small Business Set-Aside***
***Brand Name***
This contract is subject to the electronic payment process by the Department of Treasury.
All invoices complying to the requirements at 52.212-4(g) must be submitted through www.ipp.gov. For additional information, refer to the incorporated clause at 352.232-71 Electronic Submission of Payment Requests (FEB
(Use Reverse and/or Attach Additional Sheets as Necessary)
HEREIN, IS ACCEPTED AS TO ITEMS:
X
XX
DATED
MISTY J. BILLY
. 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 (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3
AND 52.212-5 ARE ATTACHED. ADDENDA
26. TOTAL AWARD AMOUNT (For Government Use Only)
OFFER
STANDARD FORM 1449 (REV. 11/2021)
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: REFERENCE
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. 11/2021) BACK
24.
AMOUNT
23.
UNIT PRICE
22.
UNIT
21.
QUANTITY
20.
SCHEDULE OF SUPPLIES/SERVICES
19.
ITEM NO.
2022).
1 Contractor shall provide the Carl Zeiss - HFA3
Model 860, Visual Field Analyzer IAW Attachment A
- Statement of Work to the Gallup Indian Medical
Center in Gallup, New Mexico 87301.
32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE
32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE
2 2 of
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