SF1449_cell_phone_RFQ_2014.rtf

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

1. REQUISITION NUMBER

2. CONTRACT NO.

3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER

5. SOLICITATION NUMBER

SUP300-14-Q-0002

6. SOLICITATION ISSUE DATE

06/03/2014

7. FOR SOLICITATION

INFORMATION CALL

a. NAME James Henry , Contracting Officer

b. TELEPHONE NUMBER(No collect calls) 380-44-521-5696;

380-44-521-5250

8. OFFER DUE DATE/ LOCAL TIME

07/15/2014 @ 5:00 pm

9. ISSUED BY CODE

10. THIS ACQUISITION IS

11. DELIVERY FOR FOB

12. DISCOUNT TERMS

US Embassy Kiev 4 Igorya Sikorskoho St., Kyiv 04112, Ukraine

UNRESTRICTED

SET ASIDE: % FOR

SMALL BUSINESS

DESTINATION UNLESS BLOCK IS MARKED

SEE SCHEDULE

HUBZONE SMALL BUSINESS

13a. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 700)

8(A) 13b. RATING

NAICS:

SIZE STD:

14. METHOD OF SOLICITATION

16. ADMINISTERED BY CODE

US Embassy Kiev 4 Igorya Sikorskoho St., Kyiv 04112, Ukraine

James Henry, Contracting Officer, US Embassy Kiev, Ukraine

18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO.

Electronic Bank Transfer 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.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

1.

Cellular Phone Communication Services (As per attached RFQ and Scope of Work)

(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 __1___ 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.

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) James Henry

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (REV 4/2002)

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

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 FOR

36. PAYMENT

37. CHECK NUMBER

PARTIAL

FINAL

COMPLETE PARTIAL 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. 4/2002) BACK