SF-1449.pdf

31c. DATE SIGNED (mm-dd-yyyy)

05/05/2017

7. FOR SOLICITATION

INFORMATION CALL:

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND

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.

15. DELIVERY TO

AMERICAN EMBASSY KAMPALA

PLOT 63/67 SPRING ROAD BUGOLOBI

P.O BOX 7007,

KAMPALA

16. ADMINISTERED BY

AMERICAN EMBASSY KAMPALA

PLOT 63/67 SPRING ROAD BUGOLOBI

P.O BOX 7007,

KAMPALA

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

1. REQUISITION NUMBER

PR6001656

PAGE 1 OF

2. CONTRACT NO. 3. AWARD/EFFECTIVE

DATE (mm-dd-yyyy)

4. ORDER NUMBER 5. SOLICITATION NUMBER

SUG50017R0012

6. SOLICITATION ISSUE

DATE (mm-dd-yyyy)

05-03-2017

a. NAME

Doug DeMaggio

b. TELEPHONE NUMBER (No collect calls)

+256 414 306001

8. OFFER DUE DATE/

LOCAL TIME

06-05-2017

9. ISSUED BY

AMERICAN EMBASSY KAMPALA

PLOT 63/67 SPRING ROAD BUGOLOBI POBOX 7007, ATTN:

GSO

KAMPALA

UGANDA

11. DELIVERY FOR FOB

DESTINATION UNLESS

BLOCK IS MARKED

12. DISCOUNT TERMS

CODE

SEE SCHEDULE

THIS CONTRACT IS A

RATED ORDER

UNDER DPAS (15 CFR

700)

13b. RATING

14. METHOD OF SOLICITATION

10. THIS ACQUISITION IS

X UNRESTRICTED OR SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL

BUSINESSNAICS:

SIZE STANDARD:

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 3/2005)

Prescribed by GSA - FAR (48 CFR) 53.212

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (Type or print) 31b. NAME OF CONTRACTING OFFICER (Type or Print)

Doug DeMaggio

30c. DATE SIGNED (mm-dd-yyyy)

X

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

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

29. AWARD OF CONTRACT: REF. OFFER

DATED . YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

HEREIN, AS ACCEPTED AS TO ITEMS:

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

1 Cell phone services

See attached

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

17a. CONTRACTOR/

OFFEROR

FACILITY

CODE

CODE 18a. PAYMENT WILL BE MADE BY

AMERICAN EMBASSY KAMPALA - ATTN: FMC

(KampalaInvoices@state.gov)

PLOT 1557 GGABA ROAD NSAMBYA

P.O.BOX 7007,

KAMPALA

UGANDA

CODE

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

CODE CODE

TELEPHONE NO.

X ARE

X ARE

8(A)

RFQ IFB X RFP

SEE ADDENDUM

13a.

SERVICE-DISABLED VETERAN-

OWNED SMALL BUSINESS

X EMERGING SMALL

BUSINESS

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

(mm-dd-yyyy)

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

32a. QUANTITY IN COLUMN 21 HAS BEEN

36. PAYMENT

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

STANDARD FORM 1449 (REV. 3/2005) BACK

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (mm-dd-yyyy) 42d. TOTAL CONTAINERS

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

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

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

37. CHECK NUMBER

PARTIAL FINAL

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE (mm-dd-yyyy)

32d. PRINT NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE (mm-dd-yyyy)

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

FINAL COMPLETE PARTIAL