PR-NC-07-10176Page 1 of 33
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30
1. REQUISITION NUMBER
PR-NC-07-10176
PAGE 1 OF2. CONTRACT NO.3. AWARD/EFFECTIVE DATE4. ORDER NUMBER5. SOLICITATION NUMBER
PR-NC-07-10176
6.SOLICITATION ISSUE DATE
7. FOR SOLICITATIONINFORMATION CALL:
a. NAME
LACONDA S. CANNADY
b. TELEPHONE NUMBER
(No collect calls)
919-541-2631
8. OFFER DUE DATE/LOCAL TIME 9. ISSUED BYCODE 10. THIS ACQUISITION IS[ ] UNRESTRICTED[
X
] SET ASIDE:
Total
% FOR[] SMALL BUSINESS[] SMALL DISADV. BUSINESS[
]8
(A)NAICS:
541380
SIZE STANDARD:
$11M
11. DELIVERY FOR FOBDESTINATION UNLESSBLOCK IS MARKED[] SEE SCHEDULE12. DISCOUNT TERMS
Environmental Protection AgencyRTP Procurement Operations Division (D143-01)4930 Old Page RoadResearch Triangle Park, NC 27709
[ ] 13a. THIS CONTRACT IS A RATED ORDERUNDER DPAS (15 CFR 700)13b. RATING14. METHOD OF SOLICITATION[] RFQ[] IFB[
X
] RFP15. DELIVER TO CODE 16. ADMINISTERED BYCODE17a. CONTRACTOR/OFFERORCODEFACILITYCODE18a. PAYMENT WILL BE MADE BYCODE
,Environmental Protection AgencyResearch Triangle Park FinancialManagement Center (D143-02)Research Triangle Park, NC 27711
TELEPHONE NO.[ ] 17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK BELOWIS CHECKED[] SEE ADDENDUM19.ITEM NO.20.SCHEDULE OF SUPPLIES/SERVICES21.QUANTITY22.UNIT23.UNIT PRICE24. AMOUNT
1Validation testing for hydronic heater testmethod in accordance with SOW.
(Attach Additional sheets as Necessary)
1Each$0.00$0.00
25. ACCOUNTING AND APPROPRIATION DATA
N/A
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.[] 27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA[] ARE [] ARE NOT ATTACHED.[] ARE [] ARE NOT ATTACHED.28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN COPIES[] TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SETFORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TOTHE TERMS AND CONDITIONS SPECIFIED HEREIN.29. AWARD OF CONTRACT: REFERENCEOFFER[] DATED . YOUR OFFER ON SOLICITATION (BLOCK5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTHHEREIN, IS ACCEPTED AS TO ITEMS:30a. SIGNATURE OF OFFEROR/CONTRACTOR31a. UNITED STATES OF AMERICA
(SIGNATURE OF CONTRACTING OFFICER)
30b. NAME AND TITLE OF SIGNER
(TYPE OR PRINT)
30c. DATE SIGNED31b. NAME OF CONTRACTING OFFICER
(TYPE OR PRINT)
Natalia Fisher-Jackson
31c. DATE SIGNED32a. QUANTITY IN COLUMN 21 HAS BEENACCEPTED AND CONFORMS TO THE[ ] RECEIVED[ ] INSPECTED[ ] CONTRACT, EXCEPT AS NOTED33. SHIP NUMBER34. VOUCHER NUMBER35. AMOUNT VERIFIEDCORRECT FORPARTIALFINAL36. PAYMENT[ ] COMPLETE[ ] PARTIAL[ ] FINAL37. CHECK NUMBER32b. SIGNATURE OF AUTHORIZED GOVT. REPRESENTATIVE32c. DATE38. S/R ACCOUNT NUMBER39. S/R VOUCHER NUMBER40. PAID BY42a. RECEIVED BY
(Print)
41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER41c. DATE42b. RECEIVED AT
(Location)
42c. DATE REC'D
(YY/MM/DD)
42d. TOTAL CONTAINERSAUTHORIZED FOR LOCAL REPRODUCTIONSEE REVERSE FOR OMB CONTROL NUMBER AND PAPERWORK
STANDARD FORM 1449
(10-95)BURDEN STATEMENTPrescribed by GSA - FAR (48 CFR) 53.212
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