SPE2D1-17-D-0022-010.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. DUNS: DUNS+4:

PHONE: FAX:

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

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

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

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

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED 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) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

580-B80019

SPE2D1-17-D-0022

05-01-2019

36A79719F0036 36A79719Q0002

LATONYA L WHITESIDE 708-786-4985

36A797

Department of Veterans Affairs

National Acquisition Center

Building 37

1st Avenue, One Block North of Cermak

Hines, IL 60141

X

Y

334517

N/A

VAMC HOUSTON, TX

RECEIVING WHSE BLD

CHIEF, A&MMS B8001

2002 HOLCOMBE BLVD

HOUSTON TX 77030-

36A797

Department of Veterans Affairs

National Acquisition Center

Building 37

Hines, IL 60141

CANON MEDICAL SYSTEMS USA, INC.

2441 MICHELLE DR

TUSTIN CA 92780

Willa Valbuena-wvalbuena@us.medical.cano

Government@us.medical.canon

714-669-5509 TIN: 680178440 362352106

36A797

Department of Veterans Affairs

National Acquisition Center

Building 37

Hines IL 60141

See CONTINUATION Page

PURCHASE ORDER #580-B80019

FSC CLASS 6525 UPGRADE

VAMC REQUESTED DELIVERY DATE: 07-01-2019

CUSTOMER SURCHARGE: $3,933.00

CUSTOMER TOTAL: $284,839.00

Delivery Order 36A79719F0036 serves as confirmation that

Purchase Order #580-B80019 has been awarded in the amount of $284,839.00 this includes the $3,933.00 surcharge.

Upon submission of a signed and dated receiving report to the NAC, stations are advised to de-obligate $35,394.00 from this purchase order. No further obligations under this purchase order shall be made at the NAC. The equipment requirement has been fulfilled.

(See continued pages for Delivery Order Summary)

$280,906.00 Vendor Total

See CONTINUATION Page

X X

118585-1 05-21-2018

LaTonya L. Whiteside

CONTRACT OFFICER

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED 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 36. PAYMENT 37. CHECK NUMBER

FOR

PARTIAL FINAL

COMPLETE PARTIAL FINAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. 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. 2/2012) BACK

Delivery Order/Receiving Report Instructions

1. This delivery order also serves as the receiving report.

2. The signed and dated receiving report serves as documentation of authorization for payment of goods or services.

3. When the Equipment is delivered to the receiving service completion of Blocks 32a-32g acknowledging the official receipt of the item(s) is required.

4. Provide a copy of the order and the first page of all modifications to the NAC Contracting Officer within seven (7) business days of receipt of equipment.

5. De-obligate the remaining funds on the Purchase Order once the receiving report is submitted to the NAC.

6. If confirmation is not received within seven (7) business days of receipt of equipment, contractor's commercial proof of delivery will be accepted in lieu of customer's receiving report. The 80% interim payment will be authorized.

NOTE: Signing the Receiving Report does not constitute acceptance. Final acceptance of the equipment and installation will be based upon an inspection and test.

The vendor will notify the NAC when the equipment is ready for inspection. The final 20% payment will then be authorized following an acceptable inspection. For patient safety, we highly recommend that the system be tested by your local Medical Physicist and that Applications Training on the system be completed prior to first clinical use.

Please note that the local Physicist testing is not the SDC

Acceptance Inspection to which this notification is referring.

IF ANY STATEMENT OR TERM INCORPORATED INTO THIS DELIVERY

ORDER IS INCONSISTENT WITH ANY PROVISION OF THE UNDERLYING

CONTRACT, INCLUDING ITS ATTACHMENTS, THEN THE PROVISION OF

THE CONTRACT WILL TAKE PRECEDENCE AND GOVERN THIS ORDER.

JED