Solicitation - FA860122Q0054.pdf

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 6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY

13b. RATING

14. METHOD OF SOLICITATION

CODE

15. DELIVER TO 16. ADMINISTERED BY CODE

18a. PAYMENT WILL BE MADE BY CODE17a. CONTRACTOR/

OFFEROR

CODE

FACILITY

CODE

CODE

TELEPHONE NO.

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

RFQ IFB RFP

SEE ADDENDUM

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

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

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

30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

31b. NAME OF CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

10. THIS ACQUISITION IS UNRESTRICTED OR

NAICS:

SIZE STANDARD:

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

SET ASIDE: % FOR:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

ARE ARE NOT ATTACHED

ARE ARE NOT ATTACHED

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

8 (A)

EDWOSB

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SMALL BUSINESS

Created On: 16 Mar 2022, 08:08 AM Eastern Standard Time

Solicitation/Contract Form

LifePak 15 v4 equipment

Proposal Identifier: FA860122Q0054 Date: 16 Mar 2022

Supplies or Services & Prices or Costs

Additional Information/Notes

Description/Specifications/Statement of Work

Requirements Equipment needed:

- 99577-001957 - Lifepak 15 V4 : Qty of 3 each o Essential for obtaining basic and more advanced vital signs to deliver safe and quality care to all patients requesting emergency services.

- 21330-001176 - LP Lithium-Ion Battery 5.7 Amp Hrs. : Qty of 9 each o Essential for the Lifepak 15s to function.

- 11160-000011 - NIBP Cuff-Reusable, Infant : Qty of 3 each o Essential in obtaining patient blood pressure

- 11160-000013 - NIBP Cuff-Reusable, Child : Qty of 3 each o Essential in obtaining patient blood pressure

- 11160-000017 - NIBP Cuff-Reusable, Large Adult : Qty of 3 each o Essential in obtaining patient blood pressure

- 11160-000019 - NIBP Cuff-Reusable, Adult : Qty of 3 each o Essential in obtaining patient blood pressure

- 11171-000046 - M-LNCS DCI, Adult Reusable Sensor : Qty of 3 boxes o Essential in obtaining patient pulse oximetry

- 11171-000049 - M-LNCS DCI, Adult Reusable Sensor : Qty of 3 boxes o Essential in obtaining patient pulse oximetry

- 11220-000028 - Carry Case Top Pouch : Qty of 3 each o Used to carry extra critical medical items/equipment used in patient care

- 11220-000039 - Carry Case Back Pouch : Qty of 3 each o Used to carry extra critical medical items/equipment used in patient care

- 11577-000002 - Lifepak 15 Basic Carry Case : Qty of 3 each o Used to carry extra basic and critical medical items/equipment used in patient care

- 11996-000474 - 4G Modem: Verizon Cellular non-Kore : Qty of 3 each o Used to connect with Lifepak 15 for transmittal of critical patient info and vital signs to hospital. This information is used in the hospital to better prepare for the incoming patient and to provide quicker emergency interventions.

Packaging and Marking

Inspection and Acceptance

Deliveries or Performance

Overall Contract Delivery Period

Contractor Destination

Contract Administration Data

Special Contract Requirements

Contract Clauses

List of Attachments

Number Attachment Name

Attachment Description Reference Identifier

Date Line Item

SOW LifePak 15 V4 07Feb2022

Statement of Work SOW 16 Mar

Representations, Certification, & Other Statements

Instructions, Conditions, & Notices to Offerors or Quoters

Evaluation Factors for Award

1940 ALLBROOK DR RM 109

BLDG 1 CP 937 257 6803

WRIGHT PATTERSON AFB, OH 45433-5344

UNITED STATES

Adoniss Gibson, Email: adoniss.gibson@us.af.mil Telephone: 9375224643