W56HZV15D0049W56HZV19F0235.pdf

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

Offeror To Complete Block 12, 17, 23, 24, & 30

1. Requisition Number Page 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 Code 10. This Acquisition is Unrestricted OR Set Aside: % For:

Small Business Women-Owned Small Business (WOSB) Eligible Under the Women-Owned Small Business Program

Hubzone Small Business EDWOSB

Service-Disabled Veteran-Owned Small Business NAICS:

Email: 8(A) Size Standard:

11. Delivery For FOB Destination Unless Block Is Marked

12. Discount Terms 13a. This Contract Is A Rated Order Under DPAS (15 CFR 700) 13b. Rating

See Schedule 14. Method Of Solicitation RFQ IFB RFP

15. Deliver To Code 16. Administered By Code

Telephone No.

17a. Contractor/Offeror Code Facility 18a. Payment Will Be Made By 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 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)

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 Deliver All Items Set Forth Or Otherwise Identified Above And On Any Additional Sheets Subject To The Terms And Conditions Specified.

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) 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

SEE SCHEDULE

W56HZV-15-D-0049 2019FEB15 W56HZV19F0235

LORI E. FINCHEM (586)282-2767

LORI.E.FINCHEM.CIV@MAIL.MIL

W56HZV

U.S. ARMY CONTRACTING COMMAND

WARREN, MICHIGAN 48397-5000

333413

X DOA3

SEE SCHEDULE

S5111A

DCMA HAMPTON

2128 PERSHING AVENUE

FORT EUSTIS, VA 23604

757-315-4301

0ATN2 0W9D1

STACLEAN DIFFUSER COMPANY, LLC

2205 EXECUTIVE DR

SALISBURY, NC 28147-9008

HQ0338

DFAS-COLUMBUS CENTER

SOUTH ENTITLEMENT OPERATIONS

P O BOX 182317

COLUMBUS OH 43218-2317

SEE SCHEDULE

SEE CONTRACT ADMINISTRATION DATA $307,263.20

X X

X 2

/SIGNED/

JAMES R. JONES III

JAMES.R.JONES3.CIV@MAIL.MIL (586)282-7425 2019FEB15

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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 36. Payment 37. Check Number Correct For Partial Final Complete Partial Final

38. S/R Account No. 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

CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SUPPLEMENTAL INFORMATION

Buyer Name: LORI E. FINCHEM

Buyer Office Symbol/Telephone Number: CCTA-ALS-E/(586)282-2767

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

Type of Business: Other Small Business Performing in U.S.

Surveillance Criticality Designator: C

Weapon System: Collective Protection Equipment

*** End of Narrative A0000 ***

Contract Number: W56HZV-15-D-0049

Delivery Order: W56HZV-19-F-0235

Contract Item: Navy Shipboard Collective Protection Systems (CPS)

Pre-filter, CPS 1-Deep (NSN 4240-01-610-3401)

Pre-filter, CPS 2-Deep (NSN 4240-01-610-3397)

Pre-filter, CPS 3-Deep (NSN 4240-01-610-3345)

Pre-filter, CPS 5-Deep (NSN 4240-01-610-3447)

Previous Contract Amount: $628,601.86

Amount of this Action...: $307,263.20

Total Contract Amount...: $935,865.06

1. Delivery Order W56HZV-19-F-0235 is awarded under the terms and conditions of Contract W56HZV-15-D-0049 pursuant to Federal

Acquisition Regulation (FAR) clause 52.216-22 -- Indefinite Quantity and Defense Federal Acquisition Regulation Supplement (DFARS) clause 252.216-7006 -- Ordering.

2. The ordering period for this delivery order is 1,096 days through 1,460 days from date of contract award (Ordering Year Four).

3. Award is made for the following:

Item: Pre-filter, CPS 1-Deep

NSN: 4240-01-610-3401

Part Number: 8477562-1

Unit of Issue: Each

CLIN: 0014AA

Quantity: 26 Each

Unit Price: $ 51.20

Total Price: $ 1,331.20

Item: Pre-filter, CPS 2-Deep

NSN: 4240-01-610-3397

Part Number: 8477562-2

Unit of Issue: Each

CLIN: 0024AA

Quantity: 71 Each

Unit Price: $ 51.70

Total Price: $ 3,670.70

Item: Pre-filter, CPS 3-Deep

NSN: 4240-01-610-3345

Part Number: 8477562-3

Unit of Issue: Each

CLIN: 0034AA

Quantity: 5,535 Each

Unit Price: $ 52.74

Total Price: $291,915.90

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W56HZV-15-D-0049/W56HZV19F0235

STACLEAN DIFFUSER COMPANY, LLC

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

Item: Pre-filter, CPS 5-Deep

NSN: 4240-01-610-3447

Part Number: 8477562-5

Unit of Issue: Each

CLIN: 0044AA

Quantity: 173 Each

Unit Price: $ 59.80

Total Price: $ 10,345.40

TOTAL DELIVERY ORDER VALUE = $307,263.20

4. The delivery schedule is provided in Section B.

5. Accelerated delivery is acceptable at no additional cost to the Government.

6. The total price for this delivery order is $307,263.20. Pursuant to the issuance of this delivery order, the Government will have ordered the following total quantities:

CLIN 001x Pre-filter, CPS 1-Deep 70 Each

CLIN 002x Pre-filter, CPS 2-Deep 327 Each

CLIN 003x Pre-filter, CPS 3-Deep 17,014 Each

CLIN 004x Pre-filter, CPS 5-Deep 696 Each

The remaining available contract quantity balances are as follows:

CLIN 001x Pre-filter, CPS 1-Deep 155 Each

CLIN 002x Pre-filter, CPS 2-Deep 48 Each

CLIN 003x Pre-filter, CPS 3-Deep 27,986 Each

CLIN 004x Pre-filter, CPS 5-Deep 1,554 Each

7. All other terms and conditions of this contract remain unchanged and in full effect.

*** END OF NARRATIVE A0001 ***

3 12

PIIN/SIIN

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

SUPPLIES OR SERVICES AND PRICES/COSTS

0014 PRE-FILTER, CPS 1-DEEP

NSN: 4240-01-610-3401

Mfr CAGE: 53711

Mfr Part Number: 8477562-1

0014AA FOURTH ORDERING YEAR 26 EA $ 51.20000 $ 1,331.20 ________________________ ______________ __________________

COMMODITY NAME: PRE-FILTER, CPS 1-DEEP

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: EH9S0216EH PRON AMD: 02 ACRN: AA

AMS CD: SM2B1100000

PSC: 4240

Description/Specs./Work Statement _________________________________

TOP DRAWING NR: NO TDP

StaClean Diffuser Company LLC P/N 8477562-1 is source-controlled.

(End of narrative C001)

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS SECTION D

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Certificate of Conformance required at Acceptance.

(End of narrative E001)

Deliveries or Performance _________________________

DOC SUPPL

REL CD MILSTRIP ADDR SIG CD MARK FOR TP CD ______ ________ ______ ______ ________ _____

001 W56HZV8366V701 W562RM J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 26 01-SEP-2019

FOB POINT: Destination

SHIP TO:

(W562RM) SU W0MC ARMY GENERAL SUPPLY

CENTRAL RECIEVING

10TH STREET AND K AVENUE

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

TEXARKANA,TX,75507-5000

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-15-D-0049/W56HZV19F0235

5 12

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0024 PRE-FILTER, CPS 2-DEEP

NSN: 4240-01-610-3397

Mfr CAGE: 53711

Mfr Part Number: 8477562-2

0024AA FOURTH ORDERING YEAR 71 EA $ 51.70000 $ 3,670.70 ________________________ ______________ __________________

COMMODITY NAME: PRE-FILTER, CPS 2-DEEP

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: EH9S0217EH PRON AMD: 02 ACRN: AA

AMS CD: SM2B1100000

PSC: 4240

Description/Specs./Work Statement _________________________________

TOP DRAWING NR: NO TDP

StaClean Diffuser Company LLC P/N 8477562-2 is source-controlled.

(End of narrative C001)

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS SECTION D

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Certificate of Conformance required at Acceptance.

(End of narrative E001)

Deliveries or Performance _________________________

DOC SUPPL

REL CD MILSTRIP ADDR SIG CD MARK FOR TP CD ______ ________ ______ ______ ________ _____

001 W56HZV8366V702 W562RM J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 71 01-SEP-2019

FOB POINT: Destination

SHIP TO:

(W562RM) SU W0MC ARMY GENERAL SUPPLY

CENTRAL RECIEVING

10TH STREET AND K AVENUE

TEXARKANA,TX,75507-5000

6 12

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-15-D-0049/W56HZV19F0235

7 12

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0034 PRE-FILTER, CPS 3-DEEP

NSN: 4240-01-610-3345

Mfr CAGE: 53711

Mfr Part Number: 8477562-3

0034AA FOURTH ORDERING YEAR 5535 EA $ 52.74000 $ 291,915.90 ________________________ ______________ __________________

COMMODITY NAME: PRE-FILTER, CPS 3-DEEP

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: EH9S0219EH PRON AMD: 02 ACRN: AA

AMS CD: SM2B1100000

PSC: 4240

StaClean Diffuser Company LLC P/N 8477562-3 is source-controlled.

(End of narrative C001)

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Certificate of Conformance required at Acceptance.

(End of narrative E001)

Deliveries or Performance _________________________

DOC SUPPL

REL CD MILSTRIP ADDR SIG CD MARK FOR TP CD ______ ________ ______ ______ ________ _____

001 W56HZV8366V700 W562RM J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 285 01-SEP-2019

002 750 01-OCT-2019

003 750 01-NOV-2019

004 750 01-DEC-2019

005 750 01-JAN-2020

006 750 01-FEB-2020

007 750 01-MAR-2020

008 750 01-APR-2020

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Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

FOB POINT: Destination

SHIP TO:

(W562RM) SU W0MC ARMY GENERAL SUPPLY

CENTRAL RECIEVING

10TH STREET AND K AVENUE

TEXARKANA,TX,75507-5000

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-15-D-0049/W56HZV19F0235

9 12

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0044 PRE-FILTER, CPS 5-DEEP

NSN: 4240-01-610-3447

Mfr CAGE: 53711

Mfr Part Number: 8477562-5

0044AA FOURTH ORDERING YEAR 173 EA $ 59.80000 $ 10,345.40 ________________________ ______________ __________________

COMMODITY NAME: PRE-FILTER, CPS 5-DEEP

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: EH9S0218EH PRON AMD: 02 ACRN: AA

AMS CD: SM2B1100000

PSC: 4240

Description/Specs./Work Statement _________________________________

TOP DRAWING NR: NO TDP

StaClean Diffuser Company LLC P/N 8477562-5 is source-controlled.

(End of narrative C001)

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS SECTION D

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Certificate of Conformance required at Acceptance.

(End of narrative E001)

Deliveries or Performance _________________________

DOC SUPPL

REL CD MILSTRIP ADDR SIG CD MARK FOR TP CD ______ ________ ______ ______ ________ _____

001 W56HZV8366V703 W562RM J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 173 01-SEP-2019

FOB POINT: Destination

SHIP TO:

(W562RM) SU W0MC ARMY GENERAL SUPPLY

CENTRAL RECIEVING

10TH STREET AND K AVENUE

TEXARKANA,TX,75507-5000

10 12

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-15-D-0049/W56HZV19F0235

11 12

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

CONTRACT ADMINISTRATION DATA

PRON/ PRON/

AMS CD/ AMS CD/

LINE MIPR/ OBLG JO NO/ OBLIGATEDLINE MIPR/ OBLG JO NO/ OBLIGATED

ITEM GFEBS ATA STAT ACCT ASSIGN ACRN AMOUNTITEM GFEBS ATA STAT ACCT ASSIGN ACRN AMOUNT_____ _________ _____ ___________ ____ _______________ _________ _____ ___________ ____ __________

0014AA EH9S0216EH 2 AA $ 1,331.20

SM2B1100000

0024AA EH9S0217EH 2 AA $ 3,670.70

SM2B1100000

0034AA EH9S0219EH 2 AA $ 291,915.90

SM2B1100000

0044AA EH9S0218EH 2 AA $ 10,345.40

SM2B1100000

TOTAL $ 307,263.20

OBLIGATED OBLIGATED

ACRN ACCOUNTING CLASSIFICATION AMOUNTACRN ACCOUNTING CLASSIFICATION AMOUNT____ _________________________ ______________ _________________________ __________

AA 97 X4930AC9D 6D 26FB S20113 W56HZV $ 307,263.20 __________________

TOTAL $ 307,263.20

LINELINE

ITEM ACRN EDI/SFIS ACCOUNTING CLASSIFICATIONITEM ACRN EDI/SFIS ACCOUNTING CLASSIFICATION_____ ____ _______________________________________ ____ __________________________________

0014AA AA 97 0X0X4930AC9D S20113 6D0000SM2B110000026FB S20113 W56HZV

0024AA AA 97 0X0X4930AC9D S20113 6D0000SM2B110000026FB S20113 W56HZV

0034AA AA 97 0X0X4930AC9D S20113 6D0000SM2B110000026FB S20113 W56HZV

0044AA AA 97 0X0X4930AC9D S20113 6D0000SM2B110000026FB S20113 W56HZV

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