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
Bid Protests Not Available