This is a Veteran-Owned Small Business Set-aside 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 40 None 676-18-2-1339-0002 36C25218Q0804 03-29-2018 Pauline Ludwig 414-844-4868 0069D Great Lakes Acquisition Center (GLAC) Department of Veterans Affairs 115 S 84th St, Suite 100 Milwaukee WI 53214-1476 x 0 N 339112 1000 employees N/A 0069D Department of Veterans Affairs Tomah VAMC 500 E Vaterans St Tomah WI 54660 36C252 Great Lakes Acquisition Center (GLAC) Department of Veterans Affairs 115 S 84th St, Suite 100 Milwaukee WI 53214-1476 Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 Processing Tables Purchase order 676-A8 Please reference all correspondence and invoices with the above number The Contracting officer is the only person authorized to modify or make changes to this contract. 676-3680160-1339-828100-2660-676-A8 SPM0CP2A1 x x Pauline Ludwig Contracting Officer SECTION B - CONTINUATION OF SF 1449 BLOCKS CONTRACT ADMINISTRATION DATA (Continuation from Standard Form 1449, block 18A.) 1. Contract Administration: All contract administration matters will be handled by the following individuals: A. CONTRACTOR: B. GOVERNMENT: Pauline Ludwig, Contract Specialist Great Lakes Acquisition Center 115 S 84th St. Milwaukee, WI 53214 (414) 844-4868 2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: [X] 52.232-33, Payment by Electronic Funds Transfer System for Award Management (Jul 2013) 3. INVOICES: Invoices shall be submitted in arrears in accordance with: a. 852.232-72 Electronic Submission of Payment Requests (Nov 2012) b. Upon Acceptance of Items FACSIMILE, E-Mail, and Scanned Documents are Not Acceptable forms of Submission for Payment Requests. For assistance setting up e-Invoice, the below information is provided: *OB10 e-Invoice Setup Information: 1-877-489-6135 *OB10 e-Invoice email: [email protected] *FSC e-invoice contact information: 1-877-353-9791 *FSC e-invoice email: [email protected] BASIS OF AWARD: The Government will make the award to the most fair and reasonably priced offer. SCHEDULE OF SUPPLIES/SERVICES AND PRICES/COSTS (SF 1449, Continuation of Blocks 19 24) Contractor shall provide the following processing tables and accessories for the Tomah VAMC, Tomah, WI. Offeror shall provide the following Brand Name only product: Item No. Description QTY UNIT UNIT PRICE TOTAL PRICE 1 Skytron ERGOSTAT-30X72-E Ergostat powered height adjustable surgical instrument processing workstation, including 30 x 72 white work surface overhead fluorescent light, 2 shelves and power strip. Overall size: 73.5 W x 33 D x 81 H 4 ea 2 Skytron AB30230CL Akro bin, Clear (5pack) 4 Ea 3 Skytron BR36NW Bin rail, 36 4 Ea 4 Skytron CPUHBK Vertical CPU holder 4 Ea 5 Skytron EPS36NW Electrical plug strip 36 , 15 amp 4 Ea 6 Skytron EWBHBK Ergostat waste basket & holder 4 Ea 7 Skytron FREC72BB Ergostat footrest 72 4 Ea 8 Skytron FSKBB Flat screen keyboard mount 4 Ea 9 Skytron FSS1DMBK Flat screen arm, surface mount 4 Ea 10 Skytron KTAMBK Keyboard & mouse tray, surface mount 4 Ea 11 Skytron LES72NW Lower shelf, Ergostat, 18 x 72 4 Ea 12 Skytron MFS1536NW Multi-function shelf, 15 x 36 4 Ea 13 Skytron SPS36BT Spool holder, 36 4 Ea 14 Assembly of Skytron Ergostat prep/Pack tables 4 Job TOTAL B.1 DELIVERY SCHEDULE ITEM NUMBER QUANTITY DELIVERY DATE 1-14 SHIP TO: Tomah VAMC 500 E Veterans St Tomah, WI 54660 USA All 30 days ARO

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