I

1

ORDER FOR SUPPLIES OR SERVICES

-7

"ZS

-. -.

1 ' :

I M P O R T A N T : M a r k a l l p a c k a g e s a n d p a p e r s with c o n t r a c t a n d l o r o r d e r n u m b e r s

r:

2 CONTRACT NO. (11 any)

1. DATE OF ORDER

i :>;s

SHIP TC

/

a. NAME OF CONSIGNEE

09/13/2003
3. ORDER NO.

4

03T48021001D

03T480210

REQUISITIONrREFERENCE NO.

DHHS/OPXS/OM?

5, ISSUING OFFICE (Address conespondence lo)

DHHS/PSC/AOS/D AM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

1
c. ClTY

WASHINGTON
f SHIP VIA

CAP.ME11 O.~l.lOS
-WATSOP!

7.T o :

I

a. NAME OF CONTRACTOR

QUALITY MANAGEMENT RESOURCES, INC.

8. TYPE OF ORDER

b. COMPANY NAME

1
C DELIVERY

c. STREET ADDRESS

1

REFERFNCE YOUR:

1333 GREEN COURT NW
2ND FLOOR

.

1

d. CITY

WASHINGTON

..

-.--.

Ireune. :nls dellvey criie: 1s
I:

Suo!ect li~nsrruc:~ons
covlalned
t h ~ ssjce only of tnis l o r n and IS

e STATE

Please furnish the follow8ngon Ihe t e r m
and conditions specified on both sides o:
this order and on Ihe atlachw sheets, i:

f. ZIP CODE

DC

03

~ssuedsuqec: to lne $ e m sano
condltlons of In? aoove-numoered
contra::

any, including dellvery as lnd~caled.

20005

I

9.ACCOUNTING AND APPROPRIATIONS DATA

I

10 REQUISITIONING OFFICE

DHHS/OPHS/OHAP

7530120
11. BUSINESS
CLASSIFICATION
--

(Check aopropnale boxF))

~)i_ a. SMALL

Destination

'

I

Desti~ation

X

1 14. GOVERNMENT B/UNO.

'-:

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13 PLACE OF

a. INSPECTION

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b. OTHER THAN SMALL

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12. F.O.B. POINT

I

c DISADVANTAGED

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Net 30

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I~estination

SUPPLIES OR SERVICES

(a)

(b)

QUANTITY
ORDERED UNIT
(c)

.

PRICE
i e ~

(d)

.

. .

.

.

-- ..,

1

17. SCHEDULE (See reverse ior Rerecl~onst

ITEM NO.

d WIOMEN-OWNED

I i 1 5 . D ~ O U N TERMS
T

15. DELIVER TO F O.B. POINT
, , , , RO , RO i O

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b. ACCEPTANCE

-

QUANTITY
ACCEPTED

=

(1)

(g)

'iJ+

Tz:.: ID Number.
DUNS Number:
CAM: 1990450 Obj. Class: 2522 FI: 2003
.

.-- ..

-..

-

If you have questions,- call Jo Lask:o at 301-443-3539.
1

..

.

..

..

--

... -

....

--.

Continued . . .

I

1

I

i
SEE BILLING
INSTRUCTIONS

ON REVERSE

~

2 0 . INVOICE NO

17(h).

I

TOTAL

b. STREET ADDRESS
(or P O . BOX)

(Conr.

I

I

21. MAIL l N v o l c E T o :

PARKLAWN BUILD ING, ROOM 16A-12
5600FISHERSLANE
.

:.

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19. GROSS SHIPPING WEIGHT

c. CITY

Id: STATE

ROcKvILLE

22. UNITED STATES OF AMERICA

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BY (S~gnalure)

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e ZIP CODE

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$50

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JO LASKO
TITLE: CONTRACTINGIORDERING

NSN 7540-01-152-8083
PREVIOUS EDITION NOT USABLE

XER
OPTIONAL FORM 347 i R s r

-51

C0:JTFACT l J 3 .

.-.:-.-.
....

!i$ any)

SUPPLEMENTAL'INVOICING INFORMATION
-

-

If desired, this order (or a copy thereof) may be used by the Contractor as the contractor's invoice. ~nsteadof a separate in\ )Ice, provided
the following statement. (signed and dated) is on (or attached to) the order: "Payment is requested in the amount of S
No
other invo~cewill be submitted." However, if the Contractor wishes to submit an ~nvoice,the following information must be PI )vlded;
contract number (if any), order number, item number(s), description of supplies or service. sizes, quantities, unit prices, and :xtended
totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs exceed SlO (except or parcel
post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an ordering activity d u ~ng the same
billing period, consolidated periodic billings are encouraged

inspected,

Quantity in the "Quantity Accepted" column on the face of this order has been:

.

'0a :cepted.

C] received

by me and conforms to th~scontract Items hsted below have been rejected for the reasons tndlcated
SHIPMENT
NUMBER

-

SIGNATURE OF AUTHORIZED U S GOVT REP

DATE RECEIVE?

FINAL

TOTAL CONTAINERS

RECEIVED AT

I

I

I TITLE
I

REPORT OF REJECTIONS
I
ITEM NO.

SUPPLIES OR SERVICES

QUANTITY

UNIT
I

REJECTED

1

REASOI

PTIONAL FORM 347 (Rev 6195) (BACK)

I

3:s'
%
..

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION..

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CONTRACTNO

ORDER NO

09/13/2003.

,.

ITEM NO.

SUPPLlESiSERVlCES

(A)

(0)

!

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- ^ .

,

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IMPORTANT: Mark all pacxaaes and papers wiin cnntran andlor oroer numbers
DATEOFORDER

=; , Gzs

-1

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@?T48@710013

..

O U A N T I V UNIT
ORDERED
IC~
(C!

UNIT
PRICE
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AI.OUI!T
(Fi

OLIANTI7

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1

Professional Service Contract f c r th5
O f f i c e o f HIV/AIDS P o l i c y , O f f i c e o f P u b l i c
Health and S c i e n c e , O f f i c e of t h e
- ..
S e c r e t a r y , DSHS

52,~ J S2 3.

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1 . P r o j e c t T i t l e : Radio Unica

2 . P e r i o d o f P e r f o r m a n c e : S e p t e m b e r 1 5 , 2'303 t h r o u ~ h1:lecernber 3 0 ,
-

3 . P u r p o s e o f . P-greement
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The p u r p o s e o f t h i s a g z e e m e n t i s t o s u p p o r t t h e a r r a n c e m e n t , s e t u p a n 3 manaaeRen: zf
I.
a n O f f i c e o f HI:!/AIDS P o l i c y (OHA?! b o o t h w i t h h e a . t h - - r e l a c e d m a t e r i a l s z c :;.is-,.?iz
P-.
h e a l t h f a i r s i n 12 c i t i e s .
The f a i r s a r e b e i n g s p , n s ? r e d by R a d i o U n i c a , a?ci w ~ l l
The v e n d o r w i l l )ray-ido s e r v i c e s a n d v o i c Ie t a l e r t
b e h e l d i n WalMart p a r k i n g l o t s .
- ,
f o r t h e d e v e l o p m e n t , p r o m o t i o n , a n d b r o a d c a s : o f P;P. h e a l t h m e s s a g e s t a r o e t l n g t n e
H i s p a n i c c o m m u n i t y . The PSAs w i l l f o c u s on t h e s i . ~c : - i t i c a l h e a l t . 1 a r e a s i ' d e n c i f i e d
b y H e a l t h y P e o p l e 2 0 1 0 : d i a b e t e s , c a r d i o v a s z u l a r l i s i a s e a n d s t r o c e , HIV/.;?IIDS,
i n f a n t m o r t a l i t y , immunization, asthma, and c a n c e r .

1.

.
a

4.

\\

Background

-A c c o r d i n g t o t h e 2000 C e n s u s , t h e H i s p a n i c p s p u l a t - o n h a s r i s e n 60 p e r c e n t s i n c e
1 9 9 0 , a n d i s cugg~ttl\l a_t_35 m i l l i o n . H i s p a n i c s a r ? now t h e nation:^ l a r o e s t
. .
minority group.
The p o p u l a t i o n e x p e r i e n c e s d i s e a s ? , : . l l n e s s a n d d e a t h a t
d i s p r o p o r t i o n a t e l y h i g h e r r a t e s t h a n non-Hispanics. :.n a n e f f o r t -:o e l i m i n a t e t h e s e
h e a l t h d i s p a r i t i e s , t h e Whit-e House a n d t h e 3 e p a r t l n e n ' : o f H e a l t h a n d - H u m a r S e r - v i c e s
(HHS) h a v e c a l l e d f o r F e d e r a l a g e n c i e s t o i n - r e a s e t h t r i r c a p a c i t y 10 r e a c h o u t t o
a n d s e r v e t h i s community.
Fundamental t o t h o s u c c ? s s of t h i s e f f o r t i s t h e a b i l i t y
t o c r a f t and d e l i v e r y h e a l t h messages t h a t a r e cu1;ur; l l y and l i n g l i s t i c a l l ~ y
a p p r o p r i a - t e ..
-

1

.

--

The HHS I n i t i a t i v e to-Eliminate R a c i a l ar.d E S h n i c iea:.th D i s p a r l t i ? z - h a s - S e T - t h ~0 1 . ~n
g o a l f o r elimination o f r a c i a l a n d e t h n i c d i s p a r i t - e s i n h e a l c h by t h e a
c o n j u n c t i o n w i t h t h i s i n i t i a t i v e , a r e p o r t r e l e a s e 3 1;isc y e a r p l a c e d t h e e l l m l n a t l o n
o f healrrh. disparities among t h e n a t i o r , chi-.: h e a - t h o b l e c t i v e s f o r t h e 21lst
centur::.
P u b l i c i n f o r m a t i o n a n d comrnunlty c u t r o a c ? i:: clne o f t h e c h r e e m a j o r a r e a s
f o r e m p h a s i s . OHAP p a r t i c i p a t i o n i n t h e WalM?rr/F.aiio U n l c a H i s p a n - c h e a l t h f a i r s i s
i n d l r e c t response t o t h l s goal.
,

IMFGRTAI~IT iIOTE: F.LL MEDIA SELECTIOL~I, ?F.OMOTIOf~l~I.
.]AT :3IkLC, COI'lPIU IICATIOPI 'PRODUCTS,
DISTRIBUTION PLAN, ETC., MUST BE SUBMITTSD T'J THE GO"ERNMEI,lT PROJ2CT OFFICE3 FOF
D9HS,
PUBLIC 4FFAIP.S OFFICE CLEP.R%bICE .:
Continued . . .

TOTAL CARRIED FORWARD TO I S T PAGE (ITEM 17(H))
NSN 7560.01-152-8082

Yi3-4910:

I
OPTKIWIL F W M l48 (fir, 6 3 5 1
PI.D I GS"
F A P ~ ~ ' ~ C F R I ~ I ~ I Y ~ :

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.. . .

ORDER FOR SUPPLIES OR SERVICES
SCHEDLILE - CONTINUATION ...

ii

;

CONTRACT NO.

09/13/2003
ITEM NO.

:. .

.. ..

QUANTITY VN!T
ORDERED
(Cj
iD!

SUPPLIESISERVICES

(A)

--

1/

IMPORTANT: Mark all pawages and papers w ~ t hcontran and/or oraer numoers
DATE OF ORDER

.-

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(B)

UNIT
PRICE

(El

AI~IO

"'1

QUSNTiT':

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11 d a c ~z n i r---.-----... - 2 - 4...-- A=:
.a s a r e s u l t of t h i s purchase order.
140 i r f c r ~ a t i o ; f r n i s h e i r s o r i e n s r s : 4 i ' r ; t-r
c o n t r a c t ; r i r i h e p e r f o r m a n c e nf i h ~ p
s u r i h a s e o r d z r 5-11 b e r s i e i s t
;,:kliz
by t h e c o n t r a c t o r r i t h o u i p r i o r appr;;aib
:he Gc.:er r e x i ? r o j e c i Cfiic?: 11'2;.
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A l l p r o d u c t s u n d e r t h i s p u r c h a s s c r d e r , i n c l ~ d i n c j,,:ri. t f ? . r e p o r r s In: :c=ucz:!:;z:c:.
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:xi

.

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5 . S t a C e m e n t o f Work

-

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See Attachmsnt Schedule tiealth F a i r s
-':

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TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 754&01.152-8082

50~-aa:o1

OPTIONAL FORM ld0 I R n 6351
P r . m # b d by G S 1
FAR448 CFRl5J 71)lri

,

. .'

--

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION.

,

I

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C.- D;zE

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the contractor will be paid as follows:

- Final report on the Health Tour

TOTAL CARRIED FORWARDTO 1ST PAGE (ITEM 17iH))
NSN 754001-152-8082

5~3.48101

OPTIONAL F W M 348 lc.v 6-35,
P t e w t b d Dv GSb
F r R l l d CFR15171Sr:

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION.

;

CONTRACT NO.

-.

ORDER NO

09/13/2003

.

ITEM NO.

..

i

i

IMPORTANT: Mar* all oackages and paDers w ~ t hm n t r a n andlor order numBers
DATE OF ORDER

3

_..

03T48021051D

,~

SUPPLIESISERVICES

(A I

QUlNTlTY UNIT
ORDERED
iC)
(Dl

(0)

UNIT
DRICE

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912
DESIGNATION O F PROJECT OFFICZ?.
M l g u e l Gorner, S e n i o r P o l i c y ~ n a l ~ s O
t ,f f i c e 3f HIV.'AIi;S P s L i z y , ?f f i z e :f "..-:;.-(---IH e a l t h S c i e n c e , OS/DHHS -T,OCATZD AT HHH E i l l l i i n g , 'eon 7 3 5 5 , 7 C i r
:?.i~as>ce~::e
A v e n u e , S .W., W a s h i n g t o n , D . C .
Z O i 0 1 I S HESEB'L' :ES::GNhTZD TEE P ? G J J Z P 3 7 : i:t?
TC
l l 9 N I T O D THE PERFOP.1'ANCE OF T H I S ORDER ON E Z H i L F 01 THi: GO'jiRNbiil<T.
7
i.23ii~ZT
OFFICE?, WILL PROVIDE NO SUPERVISOP,Y OR i N S T R 3 C T I O N . i L
'

938

PARTIAL PAYMENTS

Project Offlcer f o r approval-of payment.

COMMEP.CIAL I T E M S )

(JUNE 2 0 0 3 )

1 2 7 2 4 , 13.059, 1 3 0 6 7 ,

( I ) 52.232-1,

1 3 1 2 1 . AND 1 3 1 2 9 ) .

PAYMENTS (APF. 1 9 8 4 )

.

E:<TPL\S (APR 1 9 8 4 ) .
( I V ) 5 2 . 2 3 2 - 2 5 , PROMPT PAYMENT ( F E E 2 0 0 2 )
( V ) . 5 2 . 2 3 3 - 1 , D I S P U T Z S (DEC 1 9 9 8 ) .
Continued ...

(111) 5 2 . 2 3 2 - 1 1 ,

NSN 754CL01-152-8082

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OPTlON4L FDRM 34.E lrr.
Preul-0

6951

b y G5'

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DATE OF ORDER

!

CONTRACT NO.

.

ITEM NO.

SUPPLlESiSERVlCES

IA)

(B)

.

.

.

QUANTITY UNIT
ORDERED
(C!
(Dl

SIJaCO)]TMCTS c.s?, COI.!tjEi?CI.2..I ITE!.:;
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5 2 . 2 5 3 - 1 , COMPUTER GENEI)&?TED FO?.!!S
iJ A S 1 G C 1 .
(B! THE CONTPACTOP. SHALL COI.IPL'i

;?I! 5 2 . 2 4 4 - 6 ,

DACE

!

IMPORTANT: Mark all Damages and Daoers wrth Contract andlor order nurnoers

09/13/2003

I

I

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION. ,

UNIT
PRICE
(E!

2321 : .

z=s:=;.:

-

.
. .

ORDER NO.

C3T4@3210"31D
ALIOUN?
(F)

oLlA;:m-.

- --- -

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T,ZFEF,EI.ICE, UNLESS THE CIRCUEIST.?NCES DO NOT .%?PLY:
( 1 ) THE CLAUSES L I S T E D EELOW IMPLEI.ICi.iT P R O V I S I O N S
1,i.b'
0:. Z\:E.:3TI:.:Z
O?.C52.!
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( 1 ) 5 2 . 2 2 2 - 2 0 , WP.LSY-HEALEY
PUET,IC.COl.ITP.~.CTS ACT ( 1 3 C 1 3 ' 3 6 ) (4; U . . 3 .C. ZS-iS
( A P P L I E S TO SUPPLY COI~ITRRCTS O1.IE?. $ 1 0 , 0 0 0 I N THE U 1ITI:S. S T A T E S , PUIRTrJ ""^I
?? Tlf
U. S . V I R G I N I S L A N D S ! .
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EQUAL OPPORTUNITY FOR S P E C I A L DISA3LEI! V E T E R W S , VZTEF..=.i.IS O F 7:s:
8

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COIJTP-KTS

or

$ 2 5 , G O O OP NF.E!

.
.-

VIRGIN ISLANDS,

AND WAKE I S L A N D . i

CONTRACTS O F $ 2 5 , 0 0 0 OR MORE1 -.

THRESHOLD.)

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 7540-01-152.8082

313-AE-101

/I

OPTIONAL FORM YB I

R 695,
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.."w.t.e..,
GS"
FAR 8 4 8 C F R I 5 1 2 1 3 L 1

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ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

1

DATE OF ORDER

CONTRACT NO.

ORDER NO

ITEM NO.

... .

. 1.

,

,

OUANTITY UFllT
ORDEXED
(C)
ID)

(0)

i
AMOUAT
I

03T480210?1P ;I

.

SUPPLIESISERVICES

(A)

--

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IMPORTANT: Mark ail oacxages ana papers witn cnntran andlor order numbers

09/13/2013?

z

_,-

UNIT
PRICE

IF,

--

0~1:t:iiT'

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( E X C E P T FOP, THE T Y P E S Of SUBCOI~ITFACTS L I S T E D AT 1 7 . 5 0 ' ( 3 ) . )
( 2 ) L I S T E D BELOK AEZ ADDITI0NP.L CLAUSES THAT tl.2.Y A ? P L - ' :
( I) 5 2 . 2 0 5 - 6 ,
PROTECTIiiG THE. GOVERNMENT ' S I N T E R E S T i d t i :[,I SUBZOilT?b=.C'"Iii3 ?:IT:-:
C0NTRACTOP.S DEB&P.RED, SU-S?ENDED, OR PROFOSED FOP. D3E.a. i?lZPiT [JLILV 1 2 3 )
Llf3 TZ
CCP!TRACTS OVER $ 2 5 , 0 0 0 1 .
(11) 5 2 . 2 1 1 - 1 7 , DELIVERY O F EXCESS Q U A N T I T I Z S ( S E P T 1 1 ? 5 9 ) ( 3 P E ; L I Z S T C FI:,:E;-?212f
SUPPLIES) .
(111) 5 2 . 2 3 7 - 2 9 , F . O . B . O R I G I N ( J U N E 1 0 8 % ) ( ' I P P L I E ; TO S U P P L I E S I F DZLI:.'E?.:i
IS
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AT T H I S / T H E S E ADDRESS ( E S ) :
HTTP://WWW.ARNET.GOV

HAVE BEEN DISCOVERED:-'ANB
CHANGE I S DUE TO THE DEFECT I N THE I T E M .

TOTALCARRIED FORWARD TO 1ST PAGE (ITEM 17lH))
NSN 754C-01-152.8082

501-4810:

1

O P T O W L F ( R M 34B i R r , -51

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION

1
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CON7ENIEMCS.

ORDER.
PSC
FDA
CDC
NIH

CONTACTS ARE A S FOLLOWS:
(301) 443-3030
(30i'j e27-5090
(404) 639-744 1
PATTY E7dERETTE
M I C H E L L E SHORTER ( 3 0 1 ) 4 9 6 - 6 0 8 8
J E A N E T T E PANG
DAVID C A I N E

TOTAL CARRIED FORWARD TO ?ST PAGE (ITEM 17(H))
NSN 754C-01-152-8082

503-48-101

OPTIONAL FaRM 348 (R..

6911

P.cD, GSP
rARIdB CFRI53213C.

1
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17jH))
NSN 754CL01-152-8082

%3 r~ 151

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OPTlON4L FORM M l n r 655)
Prewmml by G 5 L
FARIU) CFR153214r.

I1 /

ORDER FOR SUPPLIES OR SERVICES
1 DATE OF ORDER

2 C O N l R A NO (If any)

I
I
I

a NAME OF CONSIGNEE

3 ORDER NO

4 REQUISITIONREFERENCE NO

01M00872801D

I

01M008728

n
b. STREET ADDRESS

ACQ.

PARKLAWN BLDG, ROOM 1 7 c - 0 s
5 6 0 0 F I S H E R S LANE
ATTN:
M . COWAN, 3 0 1 - 4 4 3 - 4 . 1 1 4

PARKLAWN B U I L D I N G , ROOM 5 - 9 5
5 6 0 0 F I S H E R S LANE
ROCKVILLE MD 2 0 8 5 7

1

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/I

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c. CITY

,20:57

MD

I.SHIP VIA

RAY QUALLS

!

a. NAME OF CONTRACTOR
S O C I A L & HEALTH

S E R V I C E S , LTD.

8. TYPE OF ORDER

,

--I

Ea. PURCHASE

b. COMPANY NAME

-

c. STREET ADDRESS

1 1 4 2 6 ROCKVILLE P I K E , S U I T E 1 0 .0

.

.

:

--

-

.-

-'b.

-.
. -- ...
.

d CrrY

6

ROCKVILLE

STATE

f ZIP CODE

20852

%.

-

b. OWER THAN SMALL

.

'I

-

C. DISADVA~AGED

1

1

I D e S t i ~ d b i 0 ..,;~

D e s t i n a t ion

I-'

14. GOVERNMENT BIVNO.

-

.

1 b. ACCEPTANCE

a. lNsPEcTIoN

Except
~ c ubill~w~nstnmaymson Ihe
, .this ddWry m e r IS
xl6jecl lo ~nslruciimscmlained on
tnisude m l y of lhis form and IS
issued subjm to the ~wmsano
mrid~t~orrs
d h e abovenumbered
contract.

d. WOMEN-OWED

I

.

Destination
13. PLACE OF

-.

1 10. REQUISITIONING OFFCE

11. BUSINESS CLASSIFICATION (Check appropriate boxies))

'.: .'@.

-

Please furn~shthe f d l m n g on the lerms
and cond~l~ons
speahed on both sldes of
tn~sorder and on the attached sheets. 11
any. ~ncludlngd e l l v q as ~nd~cdled

9. ACCOUNTING AND APPROPRIATIONS DATA

a SMALL

'

1

.

.

MD

DELNERY

!

REFERENCE YOUR:

-

12. F.O.B. POINT

eZlPCODE

0.STATE

1

ROCKVILLE

C

-,

h3 ; ,

9,'4;

HHS/SAMHSA/CMH S

5. ISSUING OFFICE (Address ocnespcmdence to)

7.TO:

1

1

6 SHIP TO

09/15/2001

DHHS/PSC/AOS/DAM/ADP

PAGE GF PkGES

11

IMPORTANT: Mark all packages and p a p e n whh contract andlor order numbers

I

15. DELIVER TO F.O.B. POINT
ON OR BEFORE (Dale)

16. DISCOUNT TERMS

02/04/2002

Net 30
I

-. .

.

.

,.

17. SCHEDULE (See mverse for Rejections)
ITEM NO.
(a)

QUANTITY
ORDERED UNrr
(d)
(c)

SUPPLIES OR SERVICES '
@)

T a x I D Number
DUNS N u m b e r :
CAN: C 9 6 C 0 5 J , O b j . C l a s s : Z b Z Z FY:
P e r i o d of P e r f o r m a n c e : 0 9 / 1 7 / 2 0 0 1
Del'ivery L o c a t i o n C o d e . P17C-05
HHS/SAMHSA/CMHS
c o n t i n u e d . ..

I
:-

:-

AMO*."

(0

;--'

QUANTITY
ACCEPTED

'

;j

(g)

!
2001

,,

t o 02/04/2302

I

. .:- ..

. .
19. GROSS SHIPPING WEIGHT

18 SHIPPING POINT

UNrr
PRICE
(el

1

I

...,I

.-

*...

20. INVOICE NO.

....

.-.

TOTAL

I

21. MAIL INVOICE TO

SEE BILUNG
INSTRUCTlONS
ON REVERSE

a. NAME

PSC/FMS
(301) 443-3020
PARKLAWN B U I L D I N G , ROOM 1 6 A z 1 2

b. STREET ADDRESS

5 6 0 0 F I S H E R S LANE
ROCKVILLE MD 2 0 8 5 7

(or P.O. Box)

'

1 TOTAL
d. STATE

c. CITY

23. NAME (TW)

22. UNITED STATES OF AMERICA
BY (Signature)

NSN 154001-152-8083
PREVIOUS EDITION NOT USABLE

e. ZIP CODE

?. -

. ) f f l G l f r ' &d?,.{~i~~

MARIE L . SUNDAY
TITLE: C0NTPACTINGX)RMRING OFFICER

':

O m D W FORM Y l IRm -51

R-AOOMARIM

WRl SlZlX.)

-- :.

..
CONTRACT NO. t if a n y
SUPPLEMENTAL INVOICING INFORMATION
If desired, this order (or a copy thereof) may be used by the Contractor as the Contractofs invoice, instead of a separate invoice! provided
the following statement. (signed and dated) is on (or attached to) the order. 'Payment is requested in the amount of S
. No
other invoice will be submitted.' However, the Contractor wishes to submit an invoice, the following information must be provided;
contract number (if any). order number, item number(s), description of supplies or service, sizes. quantities, unit prices, and ext&ded
totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs exceed S10 (except for parcel
post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an ordering activity during tbe same
billing period, consolidated periodic billings are encouraged.

I

RECEIVING REPORT
Quantity in the 'Quantity Accepted' column on the face of this order has been:
inspected.
by me and conforms to this contract. Items listed below have been rejected for the reasons indicated.

1

SHIPMENT
NUMBER

FINAL

TOTAL CONTAINERS

DATE RECEIVED

I

1

1 RECEIVED

GROSS WEIGHT

acceited.

rece~ved

1

SIGNATUREOF AUTHORIZED U.S. GOVT REP

DATE

1 TITLE

AT

I
I

REPORT OF REJECTIONS
ITEM NO.

UNIT

SUPPLIES OR SERWCES
-

.

.......

.

.

.--

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QUANTITY
REJECTED

REASON FOR,REJECnON
I

:. -

_ _ = _ . .

I

.~.

OPTIONAL FORM Y 7 (Rev 6195) (BACK)

--

..
. ~.
~

.ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION

PAGE

I

3

1

CONTRACT NO.

SUPPLlESfSERVlCES

QUANTITY UNm
ORDERED
(C)
(G)

(0)

UNIT
PRICE
(E)

1
4

AMOUNT

I

(F)

QUAKTIT,'
ACCEPTE3
(Gi

?

PARKLAWN BLDG, ROOM 17C-05
5600 FISHERS LANE
ATTN: M. COWAN, 301-443-4114
ROCRVILLE MD 20857
-

4

!

01M00872801D

(A)

1

/I

ORDER NO.

09/15/2001
ITEM NO.

PAGES

I

IMPORTANT: M a h all padcages and papers wim mntrad and/or order numbers.
DATE OF ORDER

OF

I

-

I1

For information or assistance call Narie L. Sunday
msunday@psc.gov

i

(:;01)443-7061 o r Emaii:

.

1

'1

I

Professional Service

-

.,

-

--

conditions.

FAR 32.102(D).

-

-i.-.id
.+.-

1.

INVOICE I N F O ~ T I O N

Number) or Social Security Number.

.NOTICE.. .
Continued . . .

TOTAL CARRIED FORWARD TO 1 ST PAGE (ITEM 17(H))
NSN 7YWl-152-3082

Y134&101

I
'

OFTIOWL FORM S4U IRI -51
P-b,(iY
FAP(MCFRlU113(rl

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 7Y001.1528082

~

1

~

1

~

1
-by
GSA
FAR I* F I R 1 5 3 1 I Y c l

Purchase Order: 01~00872801~

I1 6
Page 1 of

R

Attachment A

School Violence Prevention Comunication and Media
Materials - - Design and Development
-

BACKGROUND :

The Center for Mental Health Sewices (CMHS) provides nat
leadership for policies, programs and activities assigned to
improve mental health treatment and prevention services fkr
adults and children-with mental illnesses and their families, and
adults .and chi.ldren at-risk for psychiatric diagnoses. &day
CMHS is guiding a service system in transition, stimulating
capacity at the national, State, and local levels to improve and
enhance mental health treatment and support services and to
promote prevention and foster the mental health of all Americans.
CMHS works to develop, implement an evaluate state-of-the~art
approaches to meet the most challenging mental health service
issues for children, adolescents, and adults.
I

-.-%=

rJ'

.A

Acknowledging the mission of CMHS and the key role it plays in
fostering a public health approach to nationwide health-related
issues, the FY 2001 Department of Health and Human Servicks
appropriation---B.i:~lZ.,.-.:now
law, included $90.0 million for school-.
violence prevention activities to be undertaken by CMHS. ! The
- - -that
-Conference language accompanying the appropriation specif,ied
CMHS use the funds specifically to "improve mental"healt~1services for children with emotional and behavioral disorders who
are at risk of violent behavior." The House-Senate ~onfe!rence
report (1998) continued that "there are concerns about the recent
outbreaks of ..viol-encein our Nation's schools,and it is delieved
--that one important tool to address^-this problem 'is to imfi;rrov&
children's mental health services . . . . " Reducing the risk for
violence.either as a perpetrator, victim or witness is a~major
focus of the CMHS plan to utilize the school violence prevention
dollars.
1
.

.

A significant amount is now known about the rlsk factors &hat are
reliable predictors of adolescent violence such as e8rly and
persistent antisocial behaviors, academic failure, allenation and
rebelliousness, family conflict, extreme economic deprivation and
availability of firearms. These risk factors have been I
correlated with the diagnosis of conduct disorder in children.
I

The recent Surgeon General's Report on Youth Violence views
violence from a developmental perspective. The developmental
perspective has enabled scientists to identify two general onset
trajectories of violence: one in which violent behaviors,emerge

..

~
. . . .

Purchase Order: 01M00872801D
Attachment A

before puberty, and one in which they appear after
early onset trajectory shows stronger links between childhood
factors and persistent, even lifelong involvement in vlolknce
behavior, (page viii, Executive Summary, Surgeon General 'is Report
on Youth Violence, 2001).
1
i

These important research findings need LO be dissemlnatedl to the
American public and CMHS has lahched a major communicati(ons
campaign to inform parents and other caregivers of childqen and.
1
youth about activit-ies they can take to decrease violence.
1

PURPOSE :

The goal of this project is to design a minimum of two p$oducts
n
to be made available to the public-at-large, based on cuyrent
and
relevant bullying and anti-bullying research in the field. The
products will be designed as complimentary products to odher
I
media-based work currently being conducted by CMHS on youth
violence prevenQiqn and anti-bullying strategies. These Iproducts
will have messag& about School and Youth Violence Prevention and
Anti-Bullying Strategies to be piloted locally and then <or use
nationally to advance the goals and objectives of the CMHS AntlI
Bullying Initiae-ive ,

l

STATEMENT OF WORK:

. .*

I

Specifically, the Contractor shall:

/

1. ~ e v i e wexisting information about public perceptions on

...
. .

b u l l y i n g a n d - i t s - r e l a t i o n s h i p to children's mental health and

school/youth violence.

.

- - - -

.

i

1

re

2. Utilize the above information to develop, write and provide a
graphic design for a minimum of two separate products parents and one for youth - on ways to communicate about1llnate
the
concept of bullying and strategies to reduce and/or elim!,'
:I
peer to peer bullying.
..-,.

.

I!I/

Using the information gathered above, as well as in-deptih
knowledge of communication strategies, the Contractor &all
Il
review the data and craft unique messages suitable for p;utting on
print materials. The Contractor shall pre-test these me\ssages
with the target audience (s), revise and provide CMHS witllh
1
relevant designs of effective messages and medium to mee,t
the
needs of the target audience(s). A certain amount of f1;iexibility
will be critical to the success of this work. It is beqieved
that research information may also suggest other elemenes

1"

.. .

Purchase Order: 01M00872801D
Attachment A

I

essential to building awareness and to motivating for behavior
change. The Contractor will build in the ability to respbnd to
these ideas within the context of the scope of work.
!/

1I

3.
Finalize the messages and develop the graphics for the final
product(s). The Contractor will not be required to print the
products under this acquisition.
I

I
I

1
4. Once messages are crafted and reviewed by CMHS for accuracy.
and input, the Cont-ractor shall develop the final camera-Leady -I
graphics needed to produce the final products.
-. I .-

I

7

7

5.
Develop a final report providing data and information'l on the
research, design and implementation phases of the overall
communication activities. This report will be provided t,o the
Project Officer (PO) in hard copy and electronically in 1
I
WordPerfect 6.0 or higher.

I

I,

General Requireypegts:
-'\%

11

1

I1
Independently, and not as an agent of the Government,
the
Contractor shall exert its best efforts and furnishlithe
i
necessary-pers.~~nel
to perform the work set forth below.

IY

All work under this project shall be monitored by the
Prolect Officer. All work will be submitted to thel~0-ir.
Wordperfect 6.0 or higher format.
I

1
II

All -reports,graphics and products developed and.pr&duced
under this project shall be the property of the ~overnment
which includes the Center for-Mental Health service6 -. (CMHSand the Substance Abuse and Mental Health Services
Administration (SAMHSA). SAMHSA and CMHS may utilize,
print, or disseminate such materials without further charge.

1

Specific Requirement:
Task 1:
-

I

I

The Contractor shall develop a detailed work @an
to
1
meet the goals of this contract and to carry out its
specific, delineated tasks. This plan must specify
available resources to be utilized and include1 a
detailed projected schedule of all activities ,;tobe
undertaken under this contract.

1

a.

At a minimum the work plan shall describe: a
proposed strategy for reviewing informati':on
I!
for
I

..

...

Purchase Order: 01M00872801D
Attachment A

the message development, appropriate
graphic design of final products.
b.

/
A work schedule showing specific tasks, including
the delivery of specific product (s), i.e. Lesearch
IF
information analysis, messages creation, flramework
for producing messages necessary to cornplebe the
project, personnel assigned to each task,
project completion dates of each task.

c.

1I
The Caaractor shall meet with the Pa-eitli_.z
in
person or telephonically to review the work plan.

d.

Within one week of meeting with the PO, the
Contractor shall revise the work plan to 1
incorporate comments from the PO.

--

I
1

i

Task 2:

I/ to
The Contractor shall review existing informati0,n
deter@ne
messages and perceptions with key audiences,
i.e. $@ents/caregivers
and youth are seen as dey
target audiences. This information will be compiled in
1
summary form for inclusion in the final product! report.
1
--. .
1
The Contractor shall review the information gat3hered in
'I
Task 2 and craft actual messages to be tested and
..
revised for final actual messages.
- -I
The Contractor shall collaborate with CMHS on final
I
-review of messages and materials development format.
Once approved the contractor will create the g:aI phic
design and lay-out, pre-test, make revisions and I
provide final graphics in reproducible form forI
production. The contractor will not be required to
reproduce these materials.
-I-4

Task 3:

1-

-

-

*

Task 4:

-I

I

Task 5:

The Contractor shall provide a final report to
on the activities undertaken in this contract.
..-..

DELIVERABLES:

ITEM

-

Task 1

DESCRIPTION
Develop Work Plan

NUMBER
OF COPIES
3

DUE DATE AFTER
CONTRACT AWARD
1
/I
2 weeks
I

Task 2

Complete Information
Gathering Phase

.-.

I

Purchase Order: 01M00872801D

Page 5 b f

Attachment A

Task 3

1~
i

Develop concepts/
.messages

10 weeks

.-

Task 4
Task 5

Develop graphics with
messages

16 weeks

Write final reports

20 weeks

..

I

PERIOD OF PERFORMANCE:

The anticipat~edp.e,riad..of performance is September 17.,....&Q . ..1.
.
through February 4, 2002, approximately a 20 week period.,

.

I

PROJECT OFFICER:

Louise Peloquin, Ph.D.
Center for Mental Health Services
Special Programs Development
5600 %is-hers Lane, Room 17C-05
~ockvi??fe,
Maryland 20857
Tel: (301)443-3898
FAX: (301)443-7912
Emaih .Lpeloqui@sarnhsa.gov
The Project Off ice will provide no supervisory or instruJtiona1
-assistance to contractor personnel. The Project of~icef's
1
function is primarily to provide the Contractor with working
data. The Project Officer is not empowered to make any
commitme.nt-s,
nor authorized to make any changes which affect
prices, terms, or delivery as specified in this order. Any such
proposed changes -shall be brought t o the immediate afttnfiOriof.-the Contracting Officer for action. The acceptance of ady
changes,by the Contractor without specific approval and written
consent of.the Contracting Officer will be at the contra$torls
own risk.
,-

. ..
.-

1

I

1
PAYMENT SCHEDULE:
-..a.

..

Five equal partial payments of $4,999.80 each are authorjzed
after completion and acceptance by the Project Officer of Tasks
I
1-5 for a total contract amount of $24,999.00.

The Contractor shall submit invoices, in an original and two (2)
copies to the PO. The Project Officer shall submit the lnvoice
and a signed receiving report to the Program Support Center,
I
I

-.
.-

...

..

Purchase Order: 01M00872801D
Attachment A

I

Financial Management Service, Division of Financial Operapions,
Parklawn Building, Room 16A-12, 5600 Fishers Lane, ~ockvible,
Maryland 20857, Phone: (301)443-3020 for payment.
i\
Invoices shall inclidk the following minimum information:I
a
a

a
a
a

Contractor's name and address
Purchase order number
Description of the services and price
Invoice period .
Cqntractor's:Inte~nalRevenue Service "Tax
Number" (TIN)
.

'I
I1

.-

dent if iiation
it

INSPECTION AND ACCEPTANCE:

..ThePO as a duly authorized agent of the ordering/contrac~ing
officer is responsible --forthe review and acceptance of ail1
I
.?I

FEDERAL A C Q U I S I ~ ~REGULATION
B
(FAR) 5 2 . 2 5 2 - 2 CLAUSES
INCORPORATED BY REFERENCE ( FEB 19 9 8 )

I

I

This contract.-j-aco.rp~ratesone or more clauses by reference, with
the same force and effect as if! they were given in full qext.
Upon request, the Contracting Officer will make their full text
- -available. ~ l s o ,the
.
full text: of a clause may be a>cessled
electronically at this address: htt~://www.arnet.aov/far
.

..

-...

52.21'3-4

52.243-1

-...

Terms and Conditions - Simplified
- 1
,.
. ..
Acquisitions - (Other Than Commercial Items) (MAY 200~1)
II
il
Changes-Fixed Price (AUG 1987), Altennate
(APR 1984)
..

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.

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,:.,,.?.

I

1 PAGE

I. CONTRACT ID CODE

AMENDMENT OF SOLlCrrATlONlMODlFlCATlON OF CONTRACT

Of PAGES

I

5 PROJECT NO (If applicable,
II

000001

X
1

l ~ e eBlock 16C

6 ISSUED BY

CODE

7 ADMINISTERED BY ((Idher than Item 6)

DHHS/PSC/AOS/DAM/ADP ACQ.
PARKLAWN BUILD ING, ROOM 5-95
5600 FISHERS L A N E
ROCKVILLE MD 20857

~ADP

II

DHHS/PSC/AOS/DAM/ADP
PARKLAWN BUILDING, RM 5-95
5600 FISHERS L A N E
ROCKVILLE MD 2 0857
I

(x) 9A AMENDMENT OF SOLICITATION NO

8 NAME AND ADDRESS OF CONTRACTOR (No sreer county. S f a and
~ ZIP Code)

SOCIAL & HEALTH SERVICES, LTD
Attn: RAY QUALLS
11426 ROCKVILLE PIKE, SUITE 100
ROCKVILLE MD 20852
..-

.- . .

.. .

-

i

CODE

-

-

.? 4

I./

.

:I

90 DATED (SEE ITEM 1 1 )

I

-.

100. DATED (SEE ITEM 1 1 )

I FACILITY COW-

.

~

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09/15/2001

it:I.
I

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-

(

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11.THlS ITEM ONLY APPUES TO AMENDMEWS OF SOUCITATIONS

II

-

2 The above nurrbered sd~alalron1s amended as set forth in Item 14

he hour and date ~
~ for receipt
e of Offers
d
G 1s eaended -1s not einended
Offem must adtnmedge rempt of th~samendment pnor to the hour and date speofied In the sdiolalron or as amended, by me ofh e fdlomng methods (a) By cziqX:etlng

I t w 8 and 15. and returning
copes of the amendmen!. (b) By a d t n d e d g n g recap1 of thls af'nendmenl cn each copy of the offer subrntted, or (c) By
separate letter or telegram v h ~ c hlndudes a reference to the s d ~ a l a l mand amendment numbers FAILURE OF YOUR ACKNOWLEDGEMEM TO BE RECEIVED AT
M E PLACE DESIGNATED FORTHE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If bJ
nrtue of mls amendment you deslre to change an offer already subrntted, wch change m y be made by telegram a lener, pfunded each telegram or letter makes
reference to the sollatatton and thls amendment, and IS recelved pnor to the openlnq hour and date specmed
12 ACCOUMING AND APPROPRIATION DATA (Ilrequrred)

I

13. THlS ITEM ONLY APPUES TO M~&J,I,oN
OF CONTRACTSIORDERS.
CHECK ONE

MODlFlES THE CONTRACTIORDER NO. AS DESCRIBED IN ITEM

h.
!Id

A THlS CHANGE ORDER IS ISSUED PURSUANT TO: (Speefyauthority) THE CHANGES SET FORTH IN ITEM 14 ARE W D E IN THE CONTRACT
ORDER NO. IN ITEM IOA.

I

/

8. THE ABOVE NUMBERED CONTFUCTiORDER IS MODIFIEDTO REFLECT THE ADMINISTFUTNE CHANGES (such as changes in paying ofcie.
appmpnaf~ondate e k ) SETFOWWlM ITEM ICPURSUANT TO THE AUTHORITY OF FAR 43103(b).

.

!I

I

4,
C. THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:
.

I
I

.

.

.

. .. .-

iI

D. OTHER (Specify type olmodifrcaflon and aulhorify)

'I

FAR 52.213-4(e) Terms and Conditions--S irnplified Acquisitions. . . . . .
copes to h e lssulng ofice
3 1s requ~redto rgn th~sd m m e n l and return
E. IMPORTANT:
Conmctor
1s not

X

R

14. DESCRIPTION OF AMENDMEM/MODIFICATlON (Organized by UCF sedion headings, ~ndudrngsoliafation/mnffad subject maner where leasrble.)

-

T a x I D Number:
D U N S Number.:

- -

..

T h e above referenced purchase order i s modified t o extend the period of performaice at no
.. .
additional cost.
T h e period of performance is changed from September 1 7 , 2001 through February 4 ,
September 17, 2001 through September 3 0 , 2002.

..

--

1

T h e anticipated due date for each t a s k shall be revised by mutual agreement b e t w ~ e nthe
Project Officer and the Contractor. T h e Payment Schedule remains consistent witfi
Continued . . '.

1

Except as provlded heren an terms and umd~t~ons
of the document referenced In ltem 9A M IOA, as heretofore changed, remlns unchanged and In full force and effeCl(
16A NAME AND TITLE OF CONTRACTING OFFICER (Type or pnnt)

15A NAME AND TITLE OF SIGNER (Type or pnnf)

1

I

MARIE L. SUNDAY
158 CONTRACTORIOFFEROR

15C DATE SIGNED

168 UNITED STATESOF AMERICA

'jAIGIEi;.
(Sgnahrre dpermn surnonzed

NSN 7540-01-1528070
Prenous edLm unusable

wnl

Ld'. ;.L_

(S~gnehned Conwamng O m e r )

16C DATE SIGNED
I

1

03~01~200,
1

STANDARD FORM'% (REV 1083)
Presmbed by GSA(/
FAR (48 CFR) 53.2$3

j
CONTINUATlON

REFERENCE NO OF DOCUMENT BEING CONTINUED

01M00872801D/O 00001

NAME OF OFFEROR OR CONTRACTOR

AGE
PI

OF

..

2 AMENDMENTMDIFICATION NO

/

1 CONTRACT ID CODE

AMENDMENT OF SOLlClTATlONlMODlFlCAllON OF CONTRACT
3 EFFECTIVE DATE

4 REOUIS1TK)NPURCHASEREQ NO

I

I

0002
6. ISSUED BY

CODE

7 ADMINISTERED BY (If orher fhan nem 6)

ADp

DHHS/PSC/AOS/DAM/ADP ACQ.
PARKLAWN BUILDING, ROOM 5-95
5600 FISHERS LANE
ROCKVILLE MD 20857

PAGE O F
I PAGES

I

l

l

-3

5 PROJECT NO (If applrcaue:
I
I

CODE

ADF
I

DHHS/ PSC/ASS/DAM/AD?
PARKLAWN BUILDING, RM 5-95
5600 FISHERS L A N E
ROCKVILLE MD 2 0857

li
I

!I
8. NAME AND ADDRESS OF CONTRACTOR (No.; meer am&.Iate m d Z 2 , P )

(x, 1 9 ~AMENDMENT
.
OF SOLICITATION NO
),

SOCIAL & HEALTH SERVICES, LTD.
Attn: RAY QUALLS
11426 ROCKVILLE PIKE, SUITE 100
ROCKVILLE MD 2 0852

90. DATED (SEE ITEM 11)

I
I

10A. MODIFICATIONOF CONTRACTIORDER NO.

01M00872801D
1i

CODE
-

108. DATED (SEE ITEM 11)
.-?..--

1 ,.,

L:;

t

FACILKY CODE

I

I

.

..

09/15/2001

..-,:

I

-.

.

.

,

I

I
I
11. THlS ITEM ONLY APPLIES TO AMENDMENTS OF SOLlClTAllONS

The h w r and date speofied for recapt d ORers
-1s extended - 1s not enended
Offers must acknowledge rempt of this amendment p n a lothe hour and date speafied In the sd~olabona as amended, by one d the f d l m n g methods (a) By ~ a n p l d t l n ~
Items 8 and 15. and relumlng
copes ol me amendment, (b) By acknowledging recept d mls amendment m each copy of the Dner subrntted. or (c) By

7The above numbered sollotason IS amended as set forth h Hem 14
-

separate letter a telegram wh~chlndudes a referenceto me s d ~ a l a t ~and
m amendment numbers FAILURE OF YOUR ACKNOWLEDGEMEM TO BE RECEIVED AT3
THE P U C E DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If by
n m e of l h ~ amendment
s
you d a r e lo change an Dner already subnuneLsuch change may be made by Wegam a letter, pmnded ea& telegram or lener makes
reference to the sotlulat~onand this amendment, and 1s reaelved Dnor to the openlnq nour and date speuPed
1
12 ACCOUMING AND APPROPRIATION DATA (If rqurred)

See Schedule

,,.

13. THlS ITEM ONLY APPLIES TO MO~I&ION

OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTIORDER NO. AS DESCRIBED IN ITEM 11
-

I

A. THlS CHANGE ORDER IS ISSUED PMRSUANT TO: (Spwwfyauthorify) THE CHANGES S E l FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NO. IN ITEM 10A.

I

B THE ABOVE NUMBERED COP11&46.V0l?DERS MODIFIED TO REFLECT THE ADMlNlSTRATNE CHANGES (such as changes m payng oflice.
appmpnabon dale. efc) SET FORTH IN ITEM 14. PURSUANT TO THE AUTHORITY OF FAR 43.103(b)

I!

.

I

X

I

C. THlS SUPPLEMENTALAGREEMENT IS ENTERED INTO PURSUANT TO AUTHORKY OF:

I

D. OTHER (Speufy type of rmMcalion and authority)

I

I FAR

E. IMPORTANT:

52.213-4(e) Terms and ~ o n d i t i b n s - - Simplified Acquisitions. . . . . .
D is required to sign this document and retum
coples to the lssulng office
Conlrada
is m t .

!
il

14. DESCRIPTIONOF AMENDMENT/MODIFICATION(Olganized by UCF sedron headings, induding sd;&alionr'mnfrad subject maner m e r e feasrble.)

T a x ID Number:
DUNS Number:
T h e above referenced purchase order is modified to extend the period of performance at no
I
additional cost.. .
Verbal authorization for the extension was provided Ray Qualls, Social
Ltd by Marie L . Sunday, Contracting/Ordering Officer.

&

Health Services,

li

T h e period of performance is changed from September 17, 2001 through September 3.4, 2002 t o
September 17, 2001 through September 30, 2003.
Continued

. ..

I

,.

Except as prmded herein, all t

w and cond~t~ons
d t h e document referenced in Hem 9A a 1 0 4 as heretdae changed, remins unchangedand in full faceand effect,

1%. NAME AND T I R E OF SIGNER (Type

cfprint)

156. CONTRACTORlOFFEROR

16A. NAME AND TITLE OF CONTPACTINGOFFICER (Type a o n n i )

1%. DATE SIGNED

.~

iRlGl@;

(jpnalvre ol p e r m eumonzed to upnJ
NSN 754041-1528070
P r e n w s edition unusable

1% DATE SIGNED

168. UNITED STATES OF AMERICA

&G?,:.J:.-:

~~unalure
ol ~oraaccino

-

A

?1/14/2002

STANDARD FORM 30 (REV. 1083)
Prescribed by GSA]
FAR (48 CFR) 53.243

-

11
CONnNUAT'ON SHEET

REFERENCE NO OF D O C U M E U BEING COFFTlNUED

01M00872801D/O 002

NAME OF OFFEROR OR CONTRACTOR

I

AGE

P2

OF

-

2. AMENDMENTlMODlFlCATlON NO

1 4. REQUISITIONPURCHASEREQ

3 EFFECTIVE DATE

CODE

NO

)5

I

:I

051 PAGES

I

i

9
L

PROJECT NO/(I1app"caWe)

1f

1

0003
6 ISSUED BY

1 PAGE

1. CONTRACT ID CODE

AMENDMENT OF SOLlCITATlONiMODlFlCATlON OF CONTRACT

7 ADMINISTERED BY (IIaher than Hem 6)

ADp

DHHS/PSC/AOS/DAM/ADP ACQ.
PARKLAWN BUILDING, ROOM 5-95
5600 FISHERS LANE
ROCKVILLE MD 20857

1

'ODE

~ADP

I

i

I

8. NAME AND ADDRESS OF CONTRACTOR (No.. sweer, counw. Sfae mdZIP Code)

(x)

.

SOCIAL & HEALTH SERVICES, LTD.
Attn: RAY QUALLS
11426 ROCKVILLE PIKE, SUITE 100
ROCKVILLE MD 20852

j

1

DHHS/PSC/AOS/DAM/ADP
PARKLAWN BUILDING, IUn. 5-95
5600 FISHERS L A N E
ROCKVILLE MD 2 0857

9A. AMENDMENT OF SOLICITATIONNO.

1 0 ~MODiFlCATlON
.
OF CONTRACTIORDER NO.

01M03872801D
-

CODE
-

~

i? 4
V I

-

I'

.

I FACILITY c~DE.

-

I

1

(100 DATED (SEE ITEM 7 7 )

__._

09/15/2001

I

-7:

I

..-

-

-

I

11. THlS ITEM ONLY APPUES TO AMENDMENTS OF SOUCITATIONS

3 T h e above numbered sollatabon 1s amended as set fcdh ln Item 14 The h w r and date speofied for recetpt of ORw
j l s extended
3 1 snot ehendea
Offers must acknowledge r e w p t of th~samendment p n a to the hour and date speaf~edIn the sdlatabon or asamended, by one of the tdluung methods (a) By mmplkng
Items 8 and 15 and retumlng
a p e s of the amendment: (b) By advlmledg~ngm p t d lhls anendmnt on each m p y of the offer submlled, a (cj By
separate lener a lelegram wh~ch~ndudesa reference lo h e soltatallon and amendment numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVEDAT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER Ifby
urlue of this amendment you derre to change an offer already submned. w c h change m y be made by telegram alener, prouded each telegram or lenermkes
reference to the soliatation and this amendment, and is rewfved pnor to me openinq hour and date specilied.
12. ACCOUKTING AND APPROPRIATION DATA (Ifrequired)

1

11
I

I

See Schedule

,

13. THlS ITEM ONLY APPUES TO MO~I&ION

OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTIORDER NO. AS DESCRIBED IN ITEM 14.

A THIS CHANGE ORDER IS ISSUED PURSUAKT TO: ( S p e w authonfy) m E CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

ORDER NO. IN ITEM 10A.

0. THE ABOVE NUMBERED C O ~ U O B D E MODIFIED
R ~
TO REFLECT THE ADMINISTRATNE CHANGES (su& as changes in payrng oflie.
app-c,?nalIcm date, ek.) SET FORTH IN ITEM 14. PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

I

. ..

.

C. THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

I

D. OTHER (Specify type olmodification and authority)

X

I

.

FAR 52.213-4(e)

E. IMPORTANT:

Conlraclor

Terms and conditions--~implifiedAcquisitions.. .
is not.

!2is requ~redto stgn this document and return

.

a p e s to (he issuing office.

14. DESCRIPTION OF AMENDMENTIMODIFICATION (Organized bv IICF seclion headings, Induding soliutalfm/amtrad subject matter M e r e IeasIble.)

T a x I D Number:
-..
DUNS Number:
T h e above referenced purchase order is modified t o extend the period of
additional cost .,
,

. .

.-. .

-

I
....

I

T h e period of performance is changed from September 17, 2001 through September 30, 2003 t o
September 17, 2001 through March 31, 2 0 0 4 .
T h e anticipated due date for each task shall be revised by mutual agreement-between the
Project Officer and the Contractor. T h e Payment Schedule remains consistent with
'.
completion and acceptance of the each task.
Continued . . .
Excepl as provlded heran, a i l l e m and condit~onsof the document r e f e r e n d In Item 9A or IOA as heretoforechanged, r e m i n s unchanged and In MI force and effect!
1 6 A NAME AND TITLE OF CONTRACTING OFFICER (Twe orpnnij

15k. NAME ANDTITLE OF SIGNER pwecwpnnt)

I

15C. DATE SIGNED

Previa~sedltton unusable

168. UNITED I

Presaibed by GSA~
FAR (48 CFR) 53.243

'I

SHE"^

cONTINuATlON

REFERENCE NO. OF DOCUMENT BEING CONTINUED

OF

AGE

01M0072000DD/0 0 0 3

I

NAME OF OFFEROR OR CONTRACTOR

SOCIAL & HEALTH SERVICES, LTD.

FAR';^^ CFRl 53

110

2. AMENDMEMIMODIFICATION NO.,

I PAGE

1. CONTRACT ID CODE

AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT

1

I

3 EFFECTIVE DATE

4. REOUISITK)N/PURCHASER M . NO.

OF PAGES

I

1

1

5 . PROJECT NO( (If apcJrcdbie:

1

0004
6. ISSUED BY

CODE

7. ADMINISTERED BY (If other than Hem 6 )

mp

DHHS/PSC/AOS/DAM/ADPACQ.
PARKLAWN BUILD ING , ROOM 5- 95
5600 FISHERS LANE
ROCKVILLE MD 2 0857

CODE

:I

Imp

I

DHHS/PSC/A@S/ DAY/ADF
PARKLAWN BUILDING, RM 5-95
5600 FISHERS LANE
ROCKVILLE MD 20857

I

I

8. NAME AND ADDRESS OF CONTRACTOR ( N o . sweet county. Sob andZlP Code)
. .

-

'I

9A. AMENDMENT OF SOLICITATION NO.

(XI

SOCIAL & ,HEALTH SERVICES, LTD.
11426 ROCKVILLE PIKE, SUITE 100
ROCKVILLE MD 2 0852
I
10A. MODIFICATIONOF CONTRACTIORDER NO.

01M00872801D
-

I

CODE

-I

.

-

, -

i1

-

:,-

FACIL~
CODE

09/15/2001

--

.

.

.- .

I

11. THlS ITEM ONLY APPUES TO AMENDMENTS OF SOUCITATIONS

3 The above numbered sd~olationis amended as set forlh'ln Item 14.

-

I

lOB.DAED(SEEITEMf1)

is enenaed

The h w r and date speafied for receipt of Offers

2 1 snot &ended
Offers must ackncmledge receipt of this amendment p n a to the hcur and date rpWrted in the sdidlation or as amended, by ooe d the f d l w n g methods: (a) By cand/elfng
Items 8 and 15. and relumlng
a p e s of h e amendmenl: @) By acknmledg~ngreceipl of lhls amendment on e a d copy of the offer subrntted: or ( c ) By

AS

separate letter a teiegram which indudes a reference 10me s d ~ d l a l i maniamendmenl numbws. FAILURE OF YOUR ACKNOMEDGEMENT TO BE RECEIVED
M E PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO M E HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If b i
rime 01 this amendmenl you desire to mange an Mer already submined, wch change may be made by wegram or letter, pronded earn teiegram or lener makes
reference to the solicitation and this amendment, and IS received pnor to me openinq hour and date specfied
,I
12. ACCOUNTING AND APPROPRIATION DATA (If repu'red)
1

I

See Schedule
13. THlS ITEM ONLY APPUES TO M&I$~TIoN
ONE

'

OF CONTRACTSIORDERS. IT MODIFIESTHE CONTRACTIORDERNO. AS DESCRIBED IN ITEM 14.

A M I S CHANGE ORDER IS ISSUED-PURSUANTTO: (SpwWfyauthority)THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NO. IN ITEM 10A.

1

B M E ABOVE NUMBERED C O b l l Z A X l O R D W S MODIFIED TO REFLECT THE ADMINISTRATWE CHANGES (such as changes In payng ofice.
appmpa11on dale. etc ) SET FORTH IN ITEM 14. PURSUANT TO THE AUTHORITY OF FAR 43 103b)

1

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANTTO ALITHORm OF:

I

D OTHER (Speafy type of mod~iicabonand authority)

I

I

.

X

I FAR 52.213-4(e)

E. IMPORTANT

Conlrada

Terms and conditions--~
implified Acquisitions. . .

1s not

IS

requfred to rgn t h ~ sd m m e n l and relum

;II

-

1 - -' 1I

. . .

1

mpes to h e lssutng ofice

1

-

14 DESCRIPTION OF AMENDMEM~MODIFICATION(Oganrzed by UCF s d m n headings, mdudtng solrc!tatron/mntmd sutyed m n e r m e r e feas~ble)

Tax ID Number
.
. -.
..
--.
~. .,I
DUNS Number:
'~
The above referenced purchase order is modified to extend the period of performance at no
additional cost and to incorporate manadatory clause changes that were effective:December
31, 2003.

1- .+

I

.

'I

1. The perlod of performance is changed from September 17, 2001 through March
September 17, 2001 through July 30, 2004.
. - . I

-

-.I

2. The anticipated due date for each task still to be completed shall be revised by mutual
,I
agreement between the Project Officer and the'contractor. The Payment Schedule :remains
Continued . . .

_

Except as provided heren, all I-

and ca~d!lionsofthe document referenced In Item 9A or 1 0 4 as heretdae danged, remtns unchanged and In h l l forceand effedt
16A NAME AND TITLE OF CONTRACTING OFFICER ( T m orpnnti

15A NAME AND TITLE OF SlGhER (Type crpnnl)

'I

MARIE L. SUNDAY
150. CONTRACTORIOFFEROR

(Slpnatun dperpn eumonzed m wnl

NSN 7540-01-1528070
Pr&ws edition unusable

I 15C. DATE SIGNED

168. UNITED STATES OF AMERICA

3f11G1h1.
I

(Slpnafure d COn8acMo Cffi=erl

,"-L
Lm

I 1,;6C.DATE SIGNED
II

I /'9/03/2003

STANDARD FORM 30 (REV 1083)

!I

CONT'NUAT'ON SHEET

REFERENCE NO OF DOCUMENT BEING CONTlNUED

-

01M00872801D/O 0 0 4
-

--

:I

NAME OF OFFEROR OR CONTRACTOR

SOCIAL

&

/I

HEALTH SERVICES, LTD.

ITEM NO.

OUANTITY UNIT

SUPPLIESSERVICES

(C)

(B)

(A)

(0)

UN.PRICE

(E)

AMOUNT

(F)

c o n s i s t e n t w i t h c o m p l e t i o n a n d a c r e p t a n c e o f t h e e.ich t a : k .
3 . C l a u s e 9 2 9 , P a g e s 3 a n d 4 o f 4 , O p t i o n a l Form 3 4 6 o f t h c 0 r l g i n a 1 ' 0 r
modified t o :
- .

..

a.
D e l e t e "FAR C l a u s e 5 2 . 2 3 2 - 3 4
P a y m e n t b y E 1 e c t : : o n i c E'uncs T r a n s f e r .
I.
Central Contractor Registration
(!,lay 1 9 9 9 ) " a n d t i e f o 1 : o w i n q s e c t i o n w 15:: sc;r:s
w i t h " N o t i c e . . . . . . . t h r o u g h . . . . . . . N::H - - - - - M i c h e l l e S o d c e r
( 3 0 1 )496-6088."

.

Cent-ra-l_ C o n t r a c t o r 1 : e g i s t r a t i o ~ ( O c t o b e r
b.
Add FAR C l a u s e s 5 2 . 2 0 4 - 0 7
P a y m e n t b y E l ~ c t r o n i cF u n d s T
A l t e r n a t e I ( O c t o b e r 2 6 3 ) a n d 52.232-23
.
C e n t r a l Contractor Rggistfafion -(October 2003).
4.

.

I.-

. ,

A l l o t h e r t e r m s a n d c o n d i t i o n s o f t h e p u r c h a s e o r d e r relrain unchanaeci.

P e r i o d o f P e r f o r m a n c e : 09/17/2.001 t o 07/30/2004

. . . .

-

.....

....

.-

-

....................

. . . . . . .

NSN 754041-151-8087

~PTIONUFORM 33E 14-86)
~ b - r a d by GSA
FAR U 8 CFR153 110

I

I

ORDER FOR SUPPLIES OR SERVICES

I

IMPORTANT: Mark all packages a n d papers wkh c o n t r a c t andlor o r d e r numbers
1 DATE OF ORDER

2 CONTRACT NO (If any)

4 REQUISITDNIREFERENCE NO

01M00879601D

01M008796

1

I

HHS/SAMHSA/CMHS/SPDB

i

OMB No. 0993-01 i

I

5 ISSUING OFFICE (Address OrYreSpMdenoe lo)

b STREET ADDRESS

DHHS/pSC/AOS/DAM/ADP ACQ.
PARKLAWN BUILD I N G , ROOM 5 - 95
5 6 0 0 F I S H E R S LANE
ROCKVILLE MD 2 0 8 5 7

PARKLAWN BLDG, ROOM 1 7 C - 0 5
5 6 0 0 F I S H E R S LANE
ATTN:
M. COWAN, 3 0 1 - 4 4 3 - 4 1 1 4

I

1
c. CITY

ROCWILLE

!I

/

d.

STATE

1 MD

' e. ZIP CODE
7 n s ~ -

f. SHIP VIA

R A Y QUALLS

'.TO:

I

I

1

1

3 ORDER NO

PAGE OF PAGES

1

6 SHIP TO

a NAME OF CONSIGNEE

09/15/2001

1

a NAME OF CONTRACTOR

SOCIAL

HEALTH S E R V I C E S , L T D .

&

.

.

~

-

I

REFERENCE YOUR:

- --

1 1 4 2 6 ROCKVILLE PIKE, SUITE. 1 0 0

d. CrrY

MD

Please furnish the M l e n g on the l e m s
and m d ~ t i w
speafied on both sides of
this ader and m me attached Sh.33B. rf
any, including delivery as ~nd~cated.

I.ZIP CODE

I

HHS/SAMHSA/CMHS

11. BUSINESS CLASSIFICATION (Check appmpnatebox(es))

c. DISADVANTAGED

.

1

..

13. PLACE OF

I b. ACCEPTANCE

a. INSPECTION

IDestihattur

~estination

16. DIYWNTTERMS

ON OR BEFORE (Date)

.

01/16/2002
I

SUPPLIES OR SERVICES
(b)

:I
'I
(0 I

.

UNIT
PRICE
(e)

Tax I D Number
DUNS N u m b e r :
CAN: C 9 6 C 0 5 1 0 b j . C l a s s : 2 5 2 2 FY: 2 0 0 1
P e r i o d of P e r f o r m a n c e : 0 9 / 1 7 / 2 0 0 1 t o 0 1 / 1 6 / 2 3 0 2
D e l i v e r y L o c a t i o n Coder- P 1 7 C - 0 5
HHS/SAMHSA/CMHS/SPDB
Continued ;..

A M O F T : - - --

.--

1

\7 4

1

.

..

1

.

18. SHIPPING POINT

- .

'I

-'-

QUANTITY
ORDERED UNIT
(d)
(c)

I

I

..

~

.

1

..-.

1

I

17(h).
TOTAL
7-=--,

21. MAIL INVOICE TO.

PSC/FMS
(3011 443-3020
PARKLAWN B U I L D I N G , ROOM 1 6 A - 1 2
5 6 0 0 FISHERS LANE
ROCKVILLE MD 2 0 8 5 7

a. NAME
SEE BILLING
INS7RUCTIONS
O N REVERSE

b. STREET ADDRESS
(or P.O. Box)

,

..

I 2 4 , 911.00
...

1 GRAND
TOTAL
d. STA'rE

22. UNITED STATES OF AMERICA
BY (Sgnature)

NSN 754Wl-tU4fb33
PREVIOUS EDITION NOT USABLE

4

e. ZIP CODE

~

1 23. NAME ( T W )

.

flRIGINRi ~ G I E D

1

I

MARIEL.SUNDAY

T l n E CONTRACTlNWORDERlNG OFFICER

1J
,

:

QUANTITY
ACCEPTED

--

-*.>.

1

. .. .

(9)

M . INVOICE NO.

19. GROSS SHIPPING WEIGHT

-

Net 30

17. SCHEDULE (See reverse for Rejedions)
ITEM NO.
(a)

d. WOMEN-OWNED

-I '

15. DELIVER TO F.O.B. POINT

14. GOVERNMENT BD
I NO.

Destination

.-I

r,

b.OlHERTHANSMALL
.

...
--

'I

l o . REQUISITLONING OFFICE

7511362

.r'

.

20852

9. A C C O U ~ I N GAND APPROPRIATIONS DATA

a. SMALL

.

Except ta b~lllng~nstmc(Tmsm the
I ., ilns ael~very
order IS
x
t
o insmdicas mtainec on
l h d side m l y d this Iand is
id?ed wbjecl lo the terms and
a+d~t~omof the abow-numbered
ogtraa.

.

:.

e. STATE

ROCKVILLE

12. F.O.B. POINT

I 11 b DELIVERY .

a PURCHASE

c. STREET ADDRESS

G

1

8 TYPE OF ORDER

b COMPANY NAME

O P T O W L FORM LU7 I& -5)
R-~OS**ARI~~FRIUII~.I

..
. ..

CONTRACT NO.

(if a n y )

p2,G:

2 37 ;

I

SUPPLEMENTAL INVOICING INFORMATION

'I provided
If desired, this order (or a copy thereof) may be used by the Contractor as the Contractots invoice, instead of a separate invoice,
the following statement. (signed and dated) is on (or attached to) the order: 'Payment is requested in the amount of $
. No
other invoice will be submitted.' However, a the Contractor wishes to submit an invoice. the following information must be provi'ded;
I
contract number (if any), order number. item number(s), description of supplies or service, sues, quantities, unit prices, and extended
totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs
post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an
billing period, consolidated periodic billings are encouraged.

1

i

RECEIVING REPORT
Quantity in the 'Quantity Accepted' column on the face of thi; order has been:
inspected.
by me and conforms to this contract. Items listed below have been rejected for the reasons indicated.
SHIPMENT
NUMBER

PART'AL

I

FINAL

I

TOTAL CONTAINERS

DATE RECENED

1

( GROSS WEIGHT

I

RECENEDAT

SUPPLIES OR SERVICES
-

.

UNIT
.

:

received
.

SIGNATURE OF AUTHORIZED U.S. GOVT REP.

1
!I

REPORT OF REJECTIONS
ITEM NO.

acckpted.

..*

QUANm

REJECTED

I

REASON FOR REJECTION
I

O P ~ O N A LFORM 347 (Rev. U95) (BACK)

-

AGEor

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

IMPORTANT: Mark all paekages and papers with mntrad andlor order numbers
CONTRACT NO.

DATE OF ORDER

ORDER NO.

09/15/2001

01M00879601D
SUPPLIEYSERVKES

ITEM NO.
(A)

QUANTI'TY UNIT

ORDERED
(C)
(D1

(B)

UNIT
PRICE
(E)

(F)

PARKLAWN BLDG, ROOM 17C-05
5600 FISHERS LANE
ATTN: M. COWAN, 301-443-4114
ROCKVILLE MD 20857
.

PAGES

1 ;

I

#I

OUANTIlY

ACCECTES

(Gi

..

For information or assistance call Marie L. Sunday. (:!01)443-7081 o r Email:
msunday@psc.gov
PROFESSIONAL SERVICE
-

..
.

..

.

.

--

See Attachment A, 7 Pages, for the Statem
conditions.
Disregard information in Block 21 of Opti
A, "Payment and Invoicing ~rovikions"for

922
PARTIAL PAYMENTS
Recurring service -,Pactial payment autho
\>,
FAR 32.102 (D).
.

929

..

.

INVOICE INFORMATION/CLAUSES INCORP
. ,..A. . . -. ... ,

== <.

.-<.

1. INVOICE INFORMATION
In addition to the information required by
must contain the foliowing: f ax
Number) or Social Security Number.
2. CLAUSES INCORPORATED BY REFERENCE (FAR
This contra& incorporates one or more
effect as if they were--givenin full text.
will make their full text available. Also,
accessed electronically at this
FEDERAL ACQUISITION REGULATION
FAR 52.232-34 PAYMENT BY ELECTRONIC FUNDS
REGISTRATION (MAY 1999)
NOTICE. . .
IN ACCORDANCE WITH THE REQUIREMENTS OF THE
THE.DEPARTMENT OF HEALTH AND HU
Continued . . .

TOTAL CARRIED FORWARD TO IST PAGE (ITEM 17(H))
NSN 754M)l-152-80BZ

-

5034&IOt

I

( W T W

FORM a48 I-P

-51
DI

(is1

I A R ( V c l R ) U IlYci

1

1
ORDER FOR SUPPLIES OR SERVICES

)

PAGE O F P4GES

Purchase Order: 0 lM00879601D
Attachment A

Page 1 o

PACKAGING OF YOUTH VIOLENCE PREXENTION AND ANTI-BUL: YING
EDUCATION MATERIAL

BACKGROUND :

The Center for Mental Health Services (CMHS) provides nE .ional
leadership for policies, programs and activities assign€ 1 to ..
improve mental health treatment and prevention services :or
adults and children with mental illnesses and their fami .ies, arid
adults and children -at risk for psychiatric diagnoses. ,~day
CMHS is guiding a service system in transition, stimulat - ng
capacity at the national, State, and local levels to i m ~rove and
enhance mental health treatment and support services anc
promote prevention and foster the mental health of all I
CMHS works to develop, implement an evaluate state-of-tl
approaches to meet the most challenging mental health sc
issues for children,
adolescents, and adults.
,r" c
.-

Q

- at

Acknowledging the mission of CMHS and the key role it p: iys in
fostering a public health approach to nationwide health. related
issues, the FY 2001
-. . Department of Health and Human Serv: :es
appropriation bill, now law, included $90.0 million for ;chool
The
violence prevention activities to be undertaken by CMHS
Conference language accompanying the appropriation -spec: F - i ed-that
CMHS use the funds specifically to "improve mental heal1 I
services for children with emotional and behavioral disc cders who
are at rjsk of violent behavior." The House-Senate Con: 2rence
report (1998) continued that "there are concerns about-1le recent
outbreaks of viol-ence in our Nation's schools and it is 2elieved
that one important tool to address this problem is to ii ?rove
children's mental health services. . . . " Reducing the ri c for
ma jor
violence either as a perpetrator, victim or witness is
focus of the CMHS plan to utilize the school violence p evention
dollars.
-rr-

-*.

+

A significant amount is now known about the risk factor
reliable predictors of adolescent violence such as earl
persistent antisocial behaviors, academic failure, alie
rebelliousness, family conflict, extreme economic depri
availability of firearms. These risk factors have been
correlated with the diagnosis of conduct disorder in ch

that are
and
ation and
ation and
ldren.

The recent Surgeon General's Report on Youth Violence v ews
violence from a developmental perspective. The develop ental
perspective has enabled scientists to identify two gene a1 onset

Purchase Order: 01M00879601D
Attachment A

trajectories of violence: one in which violent behaviors emerge
before puberty, and one in which they appear after pubeky . The
early onset trajectory shows stronger links between chilbhood
factors and persistent, even lifelong involvement in vioaence
behavior, (page viii, Executive Summary, Surgeon Generay1s Report
on Youth Violence, 2001).
In order to compliment the message development around
violence prevention and anti-bullying messages, CMHS neebs to .
engage with commu~ications'and marketing experts for helb wlth
developing a persuasive marketing package to "sellrf
messages. It has long been evldent that print
pamphlets, are o£ limited interest and
on ways to enhance and motivate "real"
PURPOSE :

The goal of this project is to expand the reach, awareness and
utilization of-r'cy~~'
messages and behavior change activities by
creating ancillary communication products and dissemination
avenues which will support and enhance the reasons to egage
more healthy behaviors.

nI

.

STATEMENT OF WORK:

The Contractor shall review all current literature,
products and supporting promotional items which
'uniform" and "branding" look for the youth
and anti~bullyinginitiative. Upon review of all the pdoposed
elements of -a promotional package -of violence prevention.and
anti-bullying tools, the Contractor shall recommend and test
various products with key target audiences (latency aged youth
and parents/care givers) . Utilizing that research, the
Contractor shall design a consistent look to the communication
products for the Initiative as well as design a minimum of 4
products (including ancillary products) that can be utilized to
promote violence prevention and anti -bullying act iy=tie.$. The
Contractor shall also research distribution venues such as 800
numbers and fulfillment procedures for getting these maherials
out to the target audiences (parents and school-age yout'h).
'~

Specifically, the Contractor shall:
Review all materials, produced to dare, on youth violence
prevention and anti -bullying strategies, within the condext of
relevant the Substance Abuse and Mental Health Services
1.

~

..

-. ..

Purchase Order: 01M00879601D
Attachment A

(I

Page 3 087

Administration (SAMHSA), CMHS and other nationally and
internationally designated programs. Many of these materials
will be provided by the Project Officer (PO) and CMHS.
1~

!I
Design and develop a \\consistent"look for the materlials
and
suggest ancillary materials which could be used to enhanlice and
promote these messages.
2.

3.
Use the information gathered above, as well as in-deb~h
knowledge of communication arid marketing strategies, to bevelop =
an innovative.look and design for the Initiative a d pr&~est
these with the target audiences. In collaboration and
consultation with CMHS, the Contractor shall make revisions and
conduct final graphic development for production of the approved
products. A certain amount of flexibility will be criti,calto
the success of this work.

--

Finalize the proposed graphics and design elements for each
Some production elements will be included
final product €&pent.
in this procurement.

4.

-

.

'

5

Research and present to CMHS a variety of mechanism that can
be used for -diiQffibationand fulfillment to disseminate theseproducts to the public in a timely manner.
5.

Once the products are crafted and reviewed by CMHS for accuracy
and input, the contractor will develop the graphics and design
elements needed to produce the final products.
-

General Requirements:

II - -

=

Independently, and not as an agent of the ~overnrnent,the
Contractor shall exert its best efforts and furnisi the
necessary personnel to perform the work set forth delow.
All work under this project shall be monitored by the
Project Officer. All work will be submitted to the PO In
Wordperfect 6.0 or hlgher format.
All reports, graphics and products developed and produced
hnder this project shall be the property of the ~ofernment
which includes the CMHS and SAMHSA. SAMHSA and CMHS may
utilize, print, or disseminate such materials without
further charge.

--

.-

-- ..

Purchase Order: 01MOO879601D
Attachment A

Page 4 o 7

Specific Requirements:
Task 1:

The Contractor shall develop a detailed work F .an to
meet the goals of this contract and to carry c it its
specific, delineated tasks. This plan must SF 2cify
available resources to be utilized and include a
detailed projected saedule of all activities :o be
undertaken under this contract.
a.
,

-

At.a minimumi:the work plan shall describe a
-proposed strategy for reviewing inf--at+ xi for
product development and potential graphic design
elements for the "branding" piece.

b.

A work schedule showing specific tasks, F ~tential
review and completion dates.

c.

The Contractor shall meet with the PO eit ler in
pqgson or telephonically to review the wc rk plan.

d.

Within one week of meeting with the PO, t
contractor shall revise the work plan to
----%nco.~orate comments from the PO.
.. .-

Task 2:

.

Task 3:

4-

-

.-

The Contractor shall review existing research, messages
and current youth violence prevention and anti -bullying
materials to begin strategic planning for "brc iding" of
--.our
products into a consistent, recognizable-fxmat for
the puhlic. This information will be compiled LT! summary form for inclusion in the final produc : report.
The Contractor shall present this preliminary report to
CMHS for review and approval.

-

The Contractor shall review the information g; thered in
Task 2 and suggest designs for key elements ar
products,.
"..-..
.

Task 4:

The Contractor shall collaborate with CMHS on final
review of suggested graphics and product desic n and
development. Once approved the contractor wi: 1 create
the graphic design and lay-out, pre-test, rev: se and
complete for production. Some production elemc nts will
be included with this task.

1

Purchase Order: 0 1MOO87960 1D
Attachment A

Page 5 of17
1

,
I

il
The Contractor shall research various distribunion
methods including 800 numbers and fulfillment
mechanisms for getting these products out to the target
audiences, - The contractor will pyesent the prodosed
distribution mechanisms for review and approvaj by
CMHS .

Task 5 :

1

I

Task 6:

The Contractor shall provide a final report tothe CMHS
Project Officer on the activities undertaken in this
contract.; - _%.. _
.
.
- - s
:
:
. -.

/

.

.

..

*

L-.

-.

.

-.

'

.

.

DELIVERABLES:

ITEM

DESCRIPTION

Task 1

Develop Work Plan

Task 2

Information Gathering

Task 3

Craft sages/
Graphics/~roduct
s

NUMBER
OF COPIES

DUE DATE AFTER
CONTRACT AWARD

3

2 weeks

.>-'- ,

Task 4
12 wdeks
I.

Develop Final
Product (s)

Task 5
Task 6

"

Write and Submit
Final Report

I

PERIOD OF PERFORMANCE:

The period of performance is September 17, 2001 through January
16, 2002.
PROJECT OFFICER:

....

Louise Peloquin, Ph.D.
Center for Mental Health Services, DPDSPP, SPDB
5600 Fishers Lane, Room 17C-05
Rockvilie, Maryland 20857
Tel: (301)443-3898
FAX: (301)443-7912
Email: Lpeloauin@samhsa.qov

Purchase Order: 01M00879601D
Attachment A

The Project Off ice will provide no supervisory or instrudtion-1
assistance to Contractor personnel. The Project 0ffi.certIs
function is primarily to provide the Contractor with wor$ing
data. The Project Officer is not empowered to make any
commitments, nor authorized to make any changes which affiect
prices, terms, or delivery as specified in this order. Any such
proposed changes shall be brought to the immediate attendion of
the Contracting Officer for action. The acceptance of aJy
changes by the Contractor without spacific approval and dritten
-consent of the Confracting Officer will be at the ~ontrac~tor's
.. .own risk.
7:

I

:I

-.

.

PAYMENT SCHEDULE:

Six equal partial payments of $4,166.50 each are authoriz'edafter
completion and acceptance by the Project Officer of Tasks 1-6 for
a total contract amount of $24,999.00.
I

PAYMENT AND I N V q a N G PROVISIONS:

The Contractor shall submit invoices, in an original and two (2)
copies to the PO. The Project Officer shall submit the invoice
and a signed P e e i v I R g report to the Program Support ~ent&r,
Financial Management Service, Division of Financial oper+ions,
Parklawn Building, Room 16A-12, 5600 Fishers Lane, -&ckvl'll-le;=
Maryland 20857, Phone: (301)443-3020 for payment.
Invoices shall include the following minimum information:
Contractor's --nameand address Purchase order number
Description of the services and price
Invoice perlod
Contractor's Internal Revenue Service "Tax Identlfication
Number" (TIN)

I----

I

I

INSPECTION AND ACCEPTANCE:

The PO as a duly authorized agent of the ordering/contracbing
officer is responsible for the review and acceptance of all
deliverables.

!

ji

Purchase Order: 0 1MOO879601D
Attachment A

Page 7 0 4 7

I
FEDERAL ACQUISITION REGULATION (FAR) 52.252-2 CLAUSES
INCORPORATED BY REFERENCE .(FEB 1998)

'I
This contract incorporates one .or more clauses by reference,
with
the same force and effect as if they were given in full iext.
Upon request, the Contracting Officer will make their full te'xt
available. Also, the full text-of a clause may be accesbed
electronically at this address: htto://www.arnet.ao~/fa-r
-

-

---.
. .

52.213-4-

- ..

,I

.-

TeYms -andConditions - SimplifiedAcquisitions
'I
(Other Than Commercial 1tems) (MAY 2001)

7;
'

.

Changes-Fixed Price (AUG 1987), ~lteknate
(APR 1984)

:

(I
PAGE 0%P A G E S

1 CONTRACT ID CODE

AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT

I,

i

2 AMENWENT/MODIFICATION NO

3 EFFECTIVE DATE

4 REOUlSlTlOWURCHASE R E 0 NO

5 PROJECT NO! (11 apdrwbie

;I
I

l ~ e eBlock 16C

000001
6. ISSUEDBY

CODE

,

ADP

7 ADMINISTERED BY (Ifother than nem 6)

DHHS/PSC/AOS/DAM/ADP ACQ.
PARKLAWN BUILDING, ROOM 5-95
5600 FISHERS LANE
ROCKVILLE MD 20857

CODE

lADF

DHHS/PSC/AOS/DAM/ADP
PARKLAWN BUILDING, RM 5-95
5600 FISHERS L A N E
ROCKVILLE MD 2 08 57

8 NAME AND ADDRESS OF CONTRACTOR l N a . s@eel.county. SLale mdZlP Code)

(x)

SOCIAL & HEALTH SERVICES, LTD.
Attn: RAY QUALLS
11426 ROCKVILLE PIKE, SUITE 100
ROCKVILLE MD 2 0852

9A. AMENDMENT OF SOLICITATION NO.

9B DATED (SEE ITEM 11)

1OA MODIFICATIONOF CONTRACTIORDER NO

01M00879601D

CODE

+

1-,

-

FACILITY

CDor

-.--.

09/15/2001

I

11. THlS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

3 The above numbered sd~olat~on
IS amended as set fwlh In Item 14

I

-

7'
I

-

The h w r and date speafied for rece~ptof ORerS
-11sBnended -IS not ehended
Offers must ackwwdedge rempt of lhls amendment pnor to the h w r and date speofied In Me sollotason or as amended by m e of Ihe f d l w n g methods (a) By CanplLllng
Item 8 and 15, and returning
copes of the amendment. (b) By a c k M e d p n g receipt ofthls amendment m each mpy of (he offer submtled or (c} By

separate letter a lelegram h c h Indudesa reference lo the sol~otat~m
and amendment n u m b FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT
M E PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO M E HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If by
nrtue of this amendmenl yau desre lo change an offer already subrmtted. such change m y be made by telegram a letter, pmnded each telegram or letter m k e s
referenca to the M l ~ d a t ~ oand
n thls amendment, and IS reoelved pnor to the openlnq hour and date speCmed
12. ACCOUNTING AND APPROPRIATION DATA (If requrred)

See Schedule
13. THlS ITEM ONLY APPLIES TO M&&TION

-1

A FiCp;GI;s\EE

OF CONTRACTWRDERS. IT MODIRES THE CONTRACTIORDER NO. ASDESCRIBED IN ITEM 1i.
I

ISSUEDORSUANT TO: (SWfyavlhoriiyJ

.. B. M E ABOVE NUMBERED CO

M E CHANGES SET FORTH IN ITEM 14 ARE M4DE IN THE CONTRACT

.

PURSUANT

CTIQRDER 1 MODIFIED TO REFLECT M E ADMINISTRATNE CHANGES (such as charges In payng ofc
i e.
appropriatim dale, e1c.J S E T P O IN
~ ITEM
TO M E A U M O R l l Y OF FAR 43.1031b).

. .

--- ..
-

I

I
C. THlS SUPPLEMENTALAGREEMENT IS ENTERED INTO PURSUANT TO ALrmORrPl OF:

1~
.

-. ..-

.

I FAR

E. IMPORTANT:

Terms and conditions--S irnplified ~ c ~ u i s i t i b n s .. .

52.213-4(e)

CMlraaa

is not.

1s required to sgn this document and return

14. DESCRIPTION OF AMENDMENTWODIFICATION(Organized by

T a x I D Number:
DUNS Number:

..- -

I

D. O M E R (Specify type of modificafion and authority)

X

-

. . . .

m p e s lo the n w n g ofice

UCF section headrrgs, including soli~taborr/mnl~ad
sobjecf maner *ere feasrble.)

'1
~l

.. -. .

.-

--..

~

T h e above referenced purchase order is modified t o extend the period of
additional cost.

at n o

T h e period o f performance is changed from September 1 7 , 2001 through January 16, 2002 to
September 17, 2001 through September 3 0 , 2002.
The anticipated due date for each task shall be revised by mutual agreement betwden the
I
Project Officer and the Contractor. The Payment Schedule remains consistent wit?
'1
Continued . . . .
Except as pronded heran, allierms and u n d ~ t l m sof the document referenced In ltem 9A or 1 0 4 as heretoforechanged, remlns unchanged and ln full force and etfecll
16A NAME AND TITLE OF CONTPACTING OFFICER (Type orpnnl)

15A NAME AND TITLE OF SIGNER (Type or pnnt)

MARIE L. SUNDAY
1~

150 CONTRACTORIOFFEROR

1 15C DATE SIGNED

1 16C DATE SIGNED

168 UNITED STATES OF AMERICA
.

(.S&-nanahrred person nuionzed lo sgn)

NSN 754001-1528070
Prenws ed~timunusable

03/01/2002

I.S&-nafure d CmIracMp Omerl

STANDARD FORM 30 (REV 1043)
Presmbed by GSA~
FAR (48 CFR) 53.243

'I

il
CONT'NUATlON
SHE*

REFERENCE NO OF DOCUMENT BEING CONTlNUEO

01M00879601D/O 00001

NAME OF OFFEROR OR CONlR4CTOR

SOCIAL & HEALTH SERVICES. LTD .

I

Oi 2

1

n

Scanmar

wG

S ~

FAR 148 CFRI 5 3 / 1 0

REFERENCE NO. OF DOCUMENT BEING CONTINUED

01MOO879601D/O002
NAME OF OFFEROR OR CONTRACTOR

SOCIAL

& HEALTH

SERVICES, LTD.

1

AGE

I 2

OF

2

1 CONTPACTIDCOM

AMENDMENT OF SOLlClTATlONlMODlFlCAnON OF CONTRACT

PAGE OF PAGES

1

1
2 AMENDMENTIMODIFICATION NO

3 EFFECTIVE DATE

4 REQUISITK)NPURCHASE REQ NO

I
1

0003
6. ISSUED BY

CODE

7. ADMINISTERED BY ( f a r than Hem 6)

ADp

DHHS/PSC/AOS/DAM/ADP ACQ.
PARKLAWN BUILDING, ROOM 5-95
5600 FISHERS LANE
ROCKVILLE MD 2 0857

ADP

DHHS/PSC/AOS/DAM/ADP
PARKLAWN BUILDING, RM 5 - 95
5600 FISHERS LANE
ROCKVILLE MD 2 0857

8. NAME AND ADDRESS OF CONTRACTOR (No.. streef. county. Sf*

mdZfP Code)

3M3 No. G r j : ) . , :

i

9A. AMENDMENT OF SOLlClTATlON NO

I

SOCIAL & HEALTH SERVICES, LTD.
Attn: RAY QUALLS
11426 ROCKVILLE PIKE, SUITE 100
ROCKVILLE MD 20852

2

15 PROJECT NO/ (/fanp~,,carne:

i!

90. DATED (SEE ITEM 11)

..
10A. MODIFICATIONOF CONTRACT/ORDER NO

01M00879601D

-

I??J

CODE

FAClLlNC

r.. I

-

bK

i

- 100 DATED (SEE ITEM 11)

-- -

09/15/2001

-.I

I 1 THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOUCITATIONS

D m e above numbered sollotabon1s amended as set falh h Item 14. The hour and date spedfiedfor r-pt
of Offers
SISexlendea. -is not ;?tended
Offers must acknowledge receipt of this amendmenl pnw to the hour and date speafied In the solidlationwas amended, by one d lhe follmMng methods: (a) By
I t e m 8 and 15, and returning
copies of lhe amendment: (b) By advlowledging recelpt of Ihls amwimenl m each copy of the offer wbmned: or (c) By
separate lener w telegarnwhich indudes a referenceto lhe sdititatim andamendmnt numbers. FAILURE OF YOUR ACKNOWLEDGEMENTTO BE RECEIVED
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If
S
w i m n t yw desire to change an offer already submilled. such change may be made by Uegrarn w lener. puvided each Wegrarn or lener makes
virtue of I ~aIm
reference lo the solidtation and thls amendment, and is rece~vedprior to me opening hour and date specified
12. ACCOUNTING AND APPROPRIATION DATA (If required)
11. THlS ITEM ONLY APPLIES TO M&IW@TION

. ..

OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTIORDERNO. AS DESCRIBED IN ITEM 114.

,I

A. THlS CHANGE ORDER IS ISSUEDPJJRSUANT TO: (Speufy authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTFWCT
ORDER NO. IN ITEM 10A.

1

0. THE ABOVE NUMBERED C
appropriation dale, elt.) SE#b%

.

C.TQ .DER IS MODIFIED TO REFLECT THE ADMINISTRATNE CHANGES (such as charges in payng ome.
IN ?m.r~;
PURSUANT TO THE AUTHORIN OF FAR43.103(b).

I

1

1

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANTTO AUTHORW OF:

-.

I

-7 --

P

I

D OTHER (Speufy type of modrficatfon and authonly)

X

I

Terms and Conditions--S implified Acquisitions. . .

FAR 52.213-4 (e )

E. IMWRTAHT:

a

Contrador

IS

not

3 IS requlredto rgn th~sdocument and return

. . .

1

.

1

mpes to lhe lssulng ofice

14 DESCRIPTION OF AMENDMENTlMODlFlCATlON (Oqanrzed by UCF sedron headrrgs. ~lcludrrgsol~ulatronlmnlradsutyed maner *ere

feasfble )

--

1

_

T a x I D Number:
-- DUNS Number : .
\fl 1 '
T h e above referenced purchase order is modified to extend the period of perforrnaRce at no
additional cost.,
,,

The period of performance is changed from September 17, 2001 through September
September 17, 2001 through March 3 1 , 2004.
T h e anticipated due date for each task shall be revised by mutual agreement. betd&en the
11
Project Officer and the Contractor. The Payment Schedule remains consistent witlh
completion and acceptance of each task.
Continued . . .

/I
I

Except as ponded heren, all terms and u n d ~ t ~ m
ofsthe document referenced In Itern 9A or 10A, as heretoforechanged. rerralns unchanged and In full face and eff&t
16A NAME AND TITLE OF CONTRACTING OFFICER (Tpe or pnyt)

1

1% NAME ANDTITLE OF SIGNER (Type orpnnt)

I

150. CONTRACTORIOFFEROR
-

ISlpnaluredperson euihonledfosign)
NSN 7540-01-1528070
Prenous editim unusable

1%. DATE SIGNED

160. UNITED STATES OF AMERICA

(Sw~alon
d~ o n b a c l i w ~ > e r l

STANDARD FORM 30 (REV. 1083)
Presmbed by G S t
FAR (48 CFR) 53243

-

REFERENCE NO. OF DOCUMEKT BEING CONnNUED

ORDER FOR SUPPLIES OR SERVICES
IMPORTAM: Mark all packages and papers with contnct andlor order numbers
a. M

09/16/2004
3 ORbERNO

HHSP233200400125U

04T999915

5 ISSUING OFFICE ( A h -

cons-

b. STREETADDRESS
HHH B U I L D I N G ,

to)

5600

FISHERS

ROOM

-

DHHS / O P H S / O H A P

DHHS/PSC/SAS/DAM
PARKLAWN B U I L D I N G ,

1

I

E OF CONSIGNEE

I

4. REaULSTrlOWREFERENCENO

PAGE, OF PAGES

I/

1

8. SHIP TO.

2. COMPACT NO. (fldny)
2630100174
ICS-194

1. M T E OF ORDER

1

200

5-101

136E

ROOY

INDEPSNDENCE

AVE.,

SW

..

LANE

R O C K V I L L E MD 2 0 8 5 7

c cm
WASHINGTON

P a u l Lvnch

7.m

-.

a NAME OF CONTRACTOR
MACRO I N T E R N A T I O N A L ,

INC.

-

Pike

1

8 lYP!2OFORDER

b COMPANY NAME
c. S T R m ADORESS
1 1 4 2 0 Rockvill-e

I. SHIP V L ~

~-

~

--

.- - -

d. ClPl

I k 'b

?URCWE

-

RFTOP194

1. ZIP CODE

MD

. .

-:

revnp, t i s ddmv ordef k

20852
10. REQUISITK)NING OFFICE

11. BUSINESS CLASSIFICATION (Chsdr sppmpriote tor(es)j

'?%.%

m.SMALL

'

Pksse hmish me ldwi-gon h e lsrms
and amdlons rpecifted m b d h sides or
his arder and cm ltm alached sheets. i f
any. indudhg d e l i as indicated.

8. ACCOUNllMG AND APPROPRUTWWIS DATA

r

DELMRY

REFERENCE YOUR

w. STATE.

Rockville

Ia,T

2,

FI L DISDVANTAGED

b. OTHER THAN SMALL

(I.W O M E N W E D

-

Destination

12. F.O.B. POINT

1 6 . D I S C O F TERMS

15. D E L M R TO F.O.B. W I N 1
ON OR BEFORE Ds(d
.
.

14. GOVERNMEHT MAO.

a. INSPECTION

b. ACCEPTANCE
D e ~ f n 3 t i a ..Ln

Destination

N e t 30

ITEM NO.

SL'PPLIES OR SERVICES

OUANTITY
ORDERED

[a)

(b)

k)

W T

W)

..

'I

-9

.?

-'-

1

10

= --

WANTlTY
ACCEPTED

(e)

I

and R e c r u i t n e n t P.rogl'am

-* .

:

1992598 O b j . C l a s s : 2512 F Y : 2004
Period o f P e r f e r ~ a n c s - - 0 9 / 2 1 / 2 0 0 4 t o 09/20/2305

CAN:

Continued

...
I

I

I 18 SHIPPING POINT

I

I

I
20 INVO1CE NO.

18. GROSS SHIPPINGWElGHl

I

I

21 MAIL INVOICE TO

a NAME
SEE BIUING
NSTRUC~ONS
mREVEf?sE

PSC/FMS
b STREET ADDRESS
(aP 0 BOX)

(3011

5600

FISHERS

.

443-3020

PARKLAWN B U I L D I N G ,

2,029,
. a

ROOM 1 6 A - 1 2

LANE
GRAND
TOTAL

c. CIIY
ROCKVILLE

22 UNITE0 STATES OF AUERICA
BY Cmalors)

STATE

MD

2,029,587.00

e ZIP CODE

p857

4W

E (Typed)

PATRICK

A.

JOY

4

1

T m E CONTRACTING'ORDERING OFFICER
USN 7WOl-lPb063
FUMOUS

-ON

~ Q T VSAB~.E

----...

,I
UNrf
PRICE
IS I

i. 3

Commissioned Corps Cornminication

I

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17. SCHEDULE p e e nmKIe t a R o j u c f h s )

Tax I D Number:
D U N S Number:

- -

I

13. PLACE OF

1

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-ACY*YI,~CFR~OI~X.)

Department.

--....-

-'d.-Uu..

TOTAL CARRIED FORWARD TO i
~m+a-im

s PAGE
~ (~EM
IT(~))
O m n um

u YI w . * m )
c-crGU

V Y I I48

cm, 63>IXCl

-

I M P O R t A m Ma*

PA&

OF PAGES

I

3 1

I1

04 packages and papen M h cmnad and101 adn rurnben.

DATE OF ORDER
CONTRACT NO
09/16/2004 26301D0174 ICS-194
ITEM NO.
SUPPLlESlSERViCES

W)

A

!

ORDER FOR SUPPLIES OR SERVlCES
SCHEDULE CONTINUATION

7

1I

ORDER NO

HHSP23320040012>U
QUANTITY UNK
ORDERED

It)

(8)

(D)

UNIT
PRICE
(E!

I

O (F) U

QUAh'TiTY

ACCEPTED

(Gj

I

This task order ernphasipes the development of a cel.trt.l image or i'ientity that
il
connects with the public about how the Comissionei Corps serves t > e public hea1:k
'I
is t:.at this image form tne basis
needs of the American people. Equally impor:zn:
'I
of 2 new recruitment program for new officers from th: natlonal po~>lof health
,
professions students, residents, graduates, post-gradrates and pratticingprofessionals.
1

~...*

TOTAL CARRIED FORWARD TO !ST PAGE (ITEM 17(H])
-101

.

.

'I

1

W W A L FORM 34a v
u
. &=I

II

ORDER,FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUAIION

-

.-

.

.

1
1

SAGE OF
4

1

PAGES

7

--

!
!

1

i
!

,

I

i
!

I

..--..

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
HW 7-1-1-

)OYCle~

..

'1
.

O n m M L IORY Y l h -I
r*ynD.aL"GY

IYI W C I P I D l I X c I

I
ORDER FOR SUPPLIES OR SERVlCES
SCHEDULE CONTINU.ATION

PAGE OF PAGES

-

i

09/16/2004
ITEM YO.

26301D0174

I

7

I

IMPORTANT: Ma* aR pacAages and p a p m wlth con(nct andlor d w numbers.
CONTRACT NO.
DATE OF ORDER

1

mDER NO.

HHSP233200400125,U

ICS-194
SUPPLIESERVICES

QUANTIW UNll

(B)

ORDERED
(C)
ID)

i t s e s s e n t i a l a c t i v i t i e s i n o t h e r departments anc ige
DHS, EPA), d e v e l o p b r a n d s , t h e m e s , m e s s a g e s , ( s t o r y b i n
c o m m u n i c a t i o n s which s u ' c c i n c t l y d e i c r i b e the( work bf
what i t i s a c c o m p l i s h i n g , - t h e c a r e e r o p p o r t u J i t i e s b i t
a s s i g n m e n t s i t s u p p o r t s , t h e p r i n c i p a l com? e n t s f
T h e s e b r a n d s , t h e m e s ,I rnessabes
p r o f e s s i o n a l rewards.
must b e b u n d l e d s o t h a t t h e y a r e a t t r a c t i v e b n d e f l e c
i n f o r m a t i o n a n d r e c r u i t m e n t t o o l s a n d s u b m i t b e d to1 t h
d r a f t f o r m f o r comment and i n f i n a l form f o d a c c e p k a n
b.Develop g r a p h i c s
m a t e r i a l developed
c.Develpp p h o t o a n d
s t o r y l i n e s and o t h e r m a t e r i a l
by t h e t a s k o r d e r o f f ~ i c e r .
d.Based o n t h e m a t e r i a l p r o d u c e d i n i t e m 3 a , b , a n c
a d v e r t i s e m e n t s , r a d i o s p o t s a n d t e l e v i s i o n a v e r t i em

I

UNIT
PRICE

(E)

AMOUNT

1

1

PUANTIn
ACCEPTED

(G!

(F)

~ c i e s (DOJ, UPDA, DOC.
!s a n d o t h e r ' c r i t t e n
. h e PHS Commi ; s i o n e d C o r p s ,
o f f e r s , t h e Zypes o f
. t s t r a n s f o r r n d t i o r . , a n d i!ts
s t o r y l i n e s dnd o c h e r macer
ive both a s 'eneral
! task order
:fficer both i n

1

1 1

t

4. Media S t r a t e g y

i n g t h e gene a 1 p u b l i c about
l i t m e n t o f h e l t h profes!ion
1s.
u eos u tf loer t sr et ah i ti n agr et h e g e - e r a 1
n
,

a b o u t t h e PH

Commissioned

Corps.
c . I d e n t i f y and

5 . Media Campaign
n g t h e materdals develoded

I

ign.
-

--

6 . - M e e t i n g s w i t h t h e TOO

II

a . W i t h i n 2 weeks o f t h e a w a r d o f t h i s c o n t r a
proposed. p l a n of work u n d e r t h i s c o n t r a c t , i
b W i t h i n o n e month from t h e a w a r d o f t h i s c o
w i t h t h e TOO t o d i s c u s s p r o g r e s s , a c t i v i t i e s
contract.
c A t t h e c o n c l u s i o n of t h e c o n t r a c t , meet w i
under t h e c o n t r a c t and recommendations f o r
Commissioned Corps C o m m i n i c a t i o n a n d
Continued . . .

.'

me
cludi
tract
and p
t,

t 1 i t h t h e TOO d o d i s c u s s a
g .he t i m i n g f o b d e l i v e r a b l e s .
a n ( e a c h month h e r e a f t e r ,
od ~ c t sr e q u i r e d a s p a r t o f

1

I

1

h t h e TO( t o r e v i e w p d o d u c t s g e n + r a t e / i
ture c t

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

1

IMPORTAHT: Mark a l packaqn ad papm wnh canncl m&or order m m b m
DATE OF ORDER
CONTRACT NO

09/16/2004

26301C0174

ORDER HO

1C5-194
QUANTTf UNIT

SUPPLlEYSERVlCES

ITEM W.

ORDERED

IC;

101

(A)

(D)

UNIT
PRICE

IE)

R e c r u i t m e n t Program

wNTi

CIUAVTTTV
ACCEPEC

(0

:

IG!

1
i
8

The C o n t r a c t o r S h a l l i n v o i c e o n a m o n t h l y basis

1
I

. ...

DESIGNATION OF PROJECT OFFICERS
D r . R o b e r t Knouss a n d D r . R o b e r r Williams LOCATED .AT
443-4000 r e s p e c t i v e l y ARE HEREBY

:202)205-1842 and (301):

I

RNET.GOV/FAR

Continued

.. .

TOTAL CARRIED FORWARD TO.1ST PffiE (ITEM 17(H))
WSN 7 W t - 1 5 2 6 0 8 1

,

Sm4c101

I

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Y( C-

-,l*rllY

wa~

*
.
(U
I
cm, U I , * C l

1

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTlNUATlON

PLE
OF

PAGES

71

7

IMPORTANT: Mart el packaqes and papers vllh cmtract andor order numben

DATE OF ORDER
09/16/2004

26301D0174

ITEM NO

-

2

ICS-194
SUPPUESISERVICES

ti

(A1

1

ORDER NO
HHSP233200400:25C

CONTRACT NO

QUANTIW
ORDERED

IC)

(El

1

UNIT

UNIT

AM3UN-T'

(E)

Q)

:ee

NIt

OUANTllY
ACCEDED
(Gt

MICE

101

,
b

-

'

I

I

T o t a l amount of award: $ 2 , 0 2 9 , 5 8 7 . 0 0 .

.

T h e o b l i g a t i m :'or t h i s awart:

1s

show4 i n b c x
I

17 ( i )

1

-

.
I

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--

4-

-.-

.

I

i

II
I

---- .
--

f

--

-

_ _

1

-.

- -

-

=-

I
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NSN 7YM)l-l52dW2

TOTAL CARRIED FORWARD TO 1ST P A M (ITEM 17(HI)
mw1

I
OmOULHlRYWIn-M)
r-*a
**a W C m m I l y t ,

09/15/04

mD

1 6 : 28-

--

PAX-

@I002
\

&

RFTOP# 194
TITLE: Commissioned Corps Communication add
Recruitment Program
PART I1 - CONTRACTOR'S REPLY: CONTRACT #263-01-D-0174
TO # ICS-194

Contractor: Macro International Inc.
Points of Contact: Paul Lynch, Contracts Administrator
Phone- 240-747-4769
Fax- 301-984-3972
Address: 11420 Rockville Pike, Rockville, rvlD 20852
*

.-

Pricing Method: TFM - -MH Admir =-Total Cost:
IT i
Grand Total: 82,U29,586
ESTIMATED NUMBER OF HOURS: 9,360
PROPOSED COMPLETION DATE: 1 year from signing

FOR THE C O ~ E T O R :
Signature

--<

-. -

.

September 15.2004
Date

1

SOURCE SE&EFION:
.-

-- .

WE HAVE REMEWED ALL SUBMITTED PROPOSALS HAVE DETERMMED THIS FIRM
SUBMITTED THE BEST OVERALL PROPOSAL AND THE PRICE/COST IS REASONABLE_.

1 -

c

--

Billing Reference # N N IF233 2 0 0 ~ ~ 5~V/ 2
Appropriations Data: 7ry01
Y O ccr&
: 4-/??
3 ~7 S/

I'vu
I

RECOMMENDED:

71s

FAX Y

APPROVED:
FAX#

I

i

%I ~'/3-276/

Signature - ~ o h i r a c tOfficer
i~~

/i ~ a t 6

-

NIH APPROVAL el,)
~35CONTRACTOR SHALL NOT EXCEED THE ESTLMATEDLABOR HOURS OR E ~ T E TASK
D ORDER
AMOUNT WITHOUT THE WRITTEN APPROVAL OF THE CONTRACTING OFFICER & PICS
COORDINATOR

APPROVED:
Signature-Leny Mannmg, NIH-PICS Coordinator

Date

-

AMENDMENT OF soucrrAnONllrloWFlcAnoN OF CONTRACT
2 m m J C m C * T Y I l WO

13 B E C l W E M E

0001

09/24/2004

0. ISSUED BT

D A ~

14 ~

R

E

O

.

U

D

7. AD*(INISTEREDBY (I/ W h a r abm 8)

DHHS/PSC/SAS/DAH
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

I

1

1. 00HTAICT1DCOOE

DHHS/PSC/SAS/DAM
PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE
RKKVILLE MD 20857

1
PA&€ OFPUKS

-

1

5 PROJECT

I

IDAHII

Ill

1
(Ilapdrcsbls)

I

'1

I

MACRO INTERNATIONAL, INC
Attn: Paul Lynch
11420 Rockville Pike
Rockville MD 20852

1- 1

I

I

I

I'I1

1 M MOOlFlCITlONOF COHTRACTIOROERNO.

26301D0174

CODF

'I

9A AMENDMENT OF SOCICITATION NO.

L - U ~ ~ D O E S C ( U I T U C T O R ~ M . C - . ~ W L I P C ~ ~ )

ICS-194

1

AH5P233200100125U

52

,.

,

la DATED l?X€

.

ITEM

fa

..

09/16/2004

11
9

. - ..

.

I

~mustadm~srsaptdhts~menanentprlcrb~h.hourdd.(oopd~hh~u~rmnded.bl~~~~llam~msthodm:(~)~DDmdW~g
!4mmIrrJ15,adnhm~
c o p b . d h ~ @ ) ~ y ~ r e c s b ( d h t s ~ o n u c h ~ d t h s ~ ~ u d ) ~
a p r s b U b u t . b p n m r v h l c h h 6 d . . a ~ t o h m a k i l a U m m d ~ n s n b aFNLUEOFYOURACKNOWLDWJEMENTT~BEAECENDDA~
.
THEPUCE DESlGM4TED FOR THE R E M P T OF OFFERS PRtCR TO THE HOUR
DATE SPECIFIED MAY RESULT IN RWECllONOF YOUR OFFER H by
v t h a o t m b u n a r ~ m l p u ~ ~ c h ~ m o ( h t . h . d l r ~ . a r h ~ m r ) . ~ m a d a b y ~ a k ( t w , p r a 3 J d . s d r ~ r m a ~ m a L a

I

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See Schedule
15. THBITOI APWES O W L Y-~WNSOF
~
M

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~ ITYaMREB TM W ~W l U C T ~ I ( Q
AIT
~ DE-ED

IN l l d .l 4 .

'II

ATHIS C W G E ORDER LS ISSUED P V R S U M TO: ( s m s c a h o r d y ) THE CWNGES SET FORM IN ITW 14 *RE MADE IN THE CONTRACT
dRDER NO. IN ITEM 10A.

I

0 THE ABQVE NUMBERED WNTRACTIDW)ER IS MODIFIED TO REFLECT THE *DUINISTRATM CHANGES (sod?n UWlpU b, P4"0 &,
wkvwmbon dsh,.Ic)SET FORRTllsrn $4.w
w TO ME UrmORlfY OF FAR U.1cqb).

.

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P U R S W T O WEAUTHORilY OF.

..
D. OTHER (Sp-

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-7 -- --

&pa dm&Xxlkn md u#m?yj

-

I;

Tax ID Number:
---.
!4. . . . -.
[. . - DUNS Number:
5
The above referenced order is herby modified to add Tracy Self, Director, Secretarial
Initiates (202) 401-2305 as co-project officer.

-

.

All other terms and conditions of the original order remain unchanged by reason of this
modification.

..

-.a

..

-

11

.-.

.. .

(I

1

I
Sep 0 6 05 1 0 : 4 4 a

P- 2

I

I

'I
1. COMRACT ID CODE

AMENDMENT OF SOLlCl'rATlONlMODlFlCATlON OF CONTRACT
2. WENOMENTMODIFICAllON NO.

13. EFFECT~VEDATE

0002

(09/05/2005

I1
I

MACRO INTERNATIONAL, INC.
Attn: Paul Lynch
11520 Rockville Pike
R o c k v i l l e MD 20852

I

zzF

1 4

-

,-..., ,
I

1

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9A AhlENOMENT OF SOLICITATION NO

1- -1

E6. M E 0 {SEE lTEM 11)

--

1 IDA MODlFlCATlOHOF CONTRACTIORDER NO.

F ~ I U N CODE

;1

\I

~nnu'l

DHHS/PSC/SAS/DAM
PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE
ROCKVILLE M D 20857

6. NAME AND ADDRESS OF CONTRACTOR (M.. .err( m t y . -fa

!

3

16. PROJECT NO. (IIapcric&el

105~5259~2
( 7. MMlNlSlERED BY (11 other man U r n UJ

DHHS/PSC/SAS/DAH
PARKLA'HN BUILDING, ROOM 5-101
5600 FISHZRS LANE
ROCKVILLE MD 20857

PAGES

I1II

4. REOUIS~~ONIPURC%E REO.NO.

IDLY

8. LSSUEO BY

I

OF

PAGE

_-

I

I

09/16/2004

11. THIS ITEM ONLY APPUES TO AMENDMENTS OF SOLICITATIONS

,

I

I

I

---

I

1
$999.986.001

nferenmla h o sanalallon and h i s msndmml, and ir rmlvsd orbr to ftw o o ~ n h pb u r and dale weCjfibd
12 ACCOUNTING AND APPROPRIATIONM T A
kW *
Net Increase:
S O L St-harltll P

--..---A-

I I T H I S rrEH APPUES ONLY TO UODIFICAllONS OF COKTRAWSIORDERS, ITMODIFIES THE COMlRACIIORDER ND. AS DESCRIBED IN ITEM 14.

A THIS CHANGE ~
E IS ISSUED
R
PURSUANT TO: (SpedEy OUUWIIY)
W E R NO IN ITEM 1PA
_.- .. .--

___

THE CHANGESs

I

n FORTH IN ITEM 14 AREMADE INTHE CONTRACT

1

8. THE ABOVE NUMBERED COKTRACTK)RDER tS MODIFIED TO REFLECT 'ME ADMlMSTRATlM CHANGES fanhsr chlnger br p p l g ~ .
ammmolrrul delo, o1c.J SET FDRTH IN I l E M 14. PURSUWJTTOTHE AUTnDRrlY OF FAR 43.103(3).

-

FAR 43.103(a)

I 0. OTHER (Spodfy type Y
Cn~dmctm

L MPORTMT:

d

.'

~

1':; b

3. m mquiiud lo d01 hlr dalnaonl and nlwn

14. DESCRIPTION OF AA~ENDMENTIWODIFICATION
( O q u d z e d by UCF ndim headinpr, incb&g t

1
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n

omm.

~ rvbjvci
b mUWwhOm
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Isa9bIs.J - - -

--

DUNS Number:

I. --

(I

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Tax I D Number:

---

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h *dhon(y)

no^

-

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C THIS SUPPLEMEMAL AGREEMENTIS ENTERED 1KfO PURSUANTTO THE AUWDRITY OF.

X

I

- .-

. --

--

I

(1

... - .- - -

. .

I

THE ABOVE REFERENCED ORDER IS HEREBY MODIFIED TO EXPAND THE STATEMENT OF WORK AND :EXTEND
THE PERIOC OF PERFORMANCE THROUGH SEPTEMBER 30, 2006.
I

CHANGES FOR LINE ITEM WUMBER: 1
Total Amount changed
from $2,009,492.00 t o $2,999,577.00
End Date changed from 20-SEP-05 to 20-SEP-06
I

CHAYGES FOR
Contlaued

LINE

...

ITEM NUMBER:

2

-

EXQOPL
as ~ m v h h
da c ~ na1
. tanm and c m d ~ l o n rot ~ h docurrat
o
rokmncod ~nion M or 10h

1 s . NAME NUJ TITLE OF SIGNER (Typo crpn'nl]

T ~ o lc ~ E R / v / N , EKEC. c / P

+~ l ) b m
h

sr M I O I ~ dlulp.d.
~
16A W E AND f m E OF M N T

m d .~lsd. 1

NG OFFlC R (Type orpllnl)

'I

,
'

PATRICK A. JOY

I

16C. DATE SIGNED

158. COHTRACTORIOFF OR

a . o ~ < L

-

7Yw1-1516010

Working Copy

-.

09/07/2005
I

STWJDIRD FORM 30 (REV 10d.3)
-PI
by GSA
FAR (48 CFR) 53143

I

I

1

Sep 0 6 0 5 1 0 : 4 S a

CONTlNUATlON SHEET

I

REFEREEICE NO. OF OOCUUENT BEWG COKnNUED

I

26301D0174

NAME OF OFFEROR OR CONTRACTOR

W.CRO INTERNATIONAL, INC

ICS-l94/HHSP233200400125U/0002

.
-

-

ITEM NO.

SWPUEYSEFMCES

(A)

(8)

-

OWANTIT

1C)

T o t a l Amount c h a n g e d ;
from 520,095.00 t o $ 2 9 , 9 9 6 - 0 0
- The S t a t e m e n t of work i s r e v i s e d t o i n c l u d e t h e f o . l o w i n
performance:

1 1.

Update a n d c o n t i n u e a s m o d i f i e d Task 3, 4, a n d 5 and
Develop a n d t e s t a d d i t i o n a l m e s s a g e s a n d m a t e r .als a
2 .
i n f o r m a t i o n and r e c r u i t m e n t c a m p a i g n a p p r o v e d b y t ie TOO
m a t e r i a l s s h a l l i n c l u d e a - t a minimum:-T r a v e l i n g r y ? c r u i t , & & n tq-z h i b i t s ;
~ b v e rpoinC p r e s e n t a t i o n s ;
c. R e c r u i t m e n t and p u b l i c i n f o r m a t i o n v i d e o s ;
M a t e r i a l s a n d me'ssages s u i t a b l e f o r u e b s i t e p r ! s e n t a
Kedia b r i e f i n g m a t e r i a l .
3 . E x e c u t e a new p r o g r a m .
..
a. T o c o l l e c t o f t i c e r p r o f i l e s s u i t a b l e f o r u s e i I h i g h
c o n t r i b u t i o n s and a c h i e v e m e n t s ;
I b . U s i n g t h e s e p r o f i l e s , t o d e v e l o p stories s u i t a ) l e . f a
o u t l e t s ; and,
c . To d i s t r i b u t e t e~ a n d e n c o u r a g e t h e i r p u b l i c a : i o n .
4 . Develop a n d c o n d o m a f t e r TOOs a p p r o v a l a new rromot
.. ..
include :
a . A program t o i m p r o v e r e c o g n i t i o n o f t h e C o r p s ~mong
p o t e n t i a l r e c r u.;-i.t--sa,;.. ...
b. Media o a t l e t s p e c i f i c promotional, news and fe l t u r e
p u b l i c a t i o n s u i t a b l e m a t e z i a l f o r e n h a n c i n g p u b l i c aware
r e c r u i t s ; and,
c. M a t e r i a l s u i t a b l e f o r s p e a k e r s a n d p r o m o t e r s o i t h e
p u b l i c e d u c a t i o n and i n f o r m a t i o n . e f f o r t s .
5 . C o n t i n u e m e e t i n g s w i t h t h e TOOS a n d t h e PHs Re i o u r c e
b a s i s . Ac+the f i r s t meeting d u r i n g t h e extended p :riod
r e v i s e d b o r k p l a n f o r the p e r i o d t h r o u g h S e p t e m b e r 3 0 , 2
a p p r o v e d by t h e T0Os.---

I:

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FOB: D e s t i n a t i o n
D i s c o u n t Terms:
. .
Net 30
P e r i o d of Performance: 09/21/2004 t o 09/30/2006

Change I t e m 1 t o r e a d a s f o l l o w s ( a m o u n t shown i s t le o b 1

Commissioned C o r p s C o n m i n i c a t i o n a n d R e c r u i t m e n t
Program
Accounting I n f o :
7540140 CAN: 1992598 O b j . C l a s s : 2512 FY: 2004
Funded: 5 0 . 0 0
Accounting Info:
7550140 CAN: 1992598 Obj. C l a s s : 2512 FY: 2005
C o n r i n s e d ...

a17

P.3

Working Copy

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Scp 0 6 0 5 10: 4 5 a

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AMENDMENT OF SOUCTTAflONIM001FICA~ONOF CONTRACT

PAGE OF PAQES

I
2 AMENDMENTNODIFII%TION

IS.EFFECTIVE M E

NO.

1 4 . REOUISITIONIPURCHABE REP. NO.

15. P R M C T N3. (n;r&hbb)

DHHS/PSC/SAS/DAN

DHKS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISSERS LANE
ROCKVILLE MD 20857

P E N . BLDG., ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

,

- ..
I

8. W E AND ADDRESS OF COMRACTOR Pa.m.
m*,

MACRO INTERNATIONAL, INC
A r m : Paul Lynch
11420 Rgckville P i k e
R o c k v i l l e MD 20852

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80. MTED

IFACIUTY CODE
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THE PLMX O E S I U L U ~ ~FOR
D THE R6CEIPT OF OFFERS PRIOR TO ThE HOUR WD MTE SPECIFIED MAY RESULT IN R M C l 7 D N OF YOUR OFFER ll by
vVPle d fils amendmnlyoudealm to d w j o mn
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Increase:

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pppmp'latbn Un,r y 9 E l FORTH IN ITEM H.PUR8UAHl TO THE AUlWORm OF P N ? 43.Imlbl.

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FAR 52.212-4 Contracc Term and C o n d i r i o n s
C o m m e r c i a l Item

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Tax ID Number:

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DUNS Number:
:[
- - The above referenced c o n t r a c t is m o d i f l r d t o expand the l e v e l of effort and extend t h e
p e r i o d of performance.
The Secretary h a s decided t o s t r e n g t h e n t h e Corps' h e a l t h p r o f e s s i o n r e c r u i t m e n t e f f o r t s ,
particularly for p h y s i c i a n s and n u r s e s . The Corp will begin s t a f f i n g s 210 person h e a l t h
and medical response (HAMR) team w i t h active d u t y personnel.. Therefore the l e v d l o f
e f f o r t f o x t h e c o n t r a c t needs t o b e increased particularly in I t e m 4 of ~ G * S O W . . & Oh e l p
with t h i s eff~rt.
Continued

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NAME AH! TITLE OF SIGNER
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R€FERENCE NO. OF DoCVMEFCr BEING CDKnMJED

COmNUAT'ON
U

2630100174

E OF OFFEROR OR CVUTRACTOR

ICS-394/8HSP23320040O125U/O003

Message

Joy, Patrick (PSC)
From:

Joy, Patrick

Sent:

Monday, September 20,2004 3:34 PM

To:

'Paul Lynch'

Subject: RE: HHSP233200400125U, RFTOP 194
-

-

I have received a copy of a fax letter Larry sent to you. I assume you will receive it also.

Patrick A. Jo?, CACRl
Contracting Officer . ..Program Support Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857

*L

- 1I

.

-.

(301) 443-9265
F a (301) 443-2761
I n an eflort to evaluate customer satisfactiolz, the staflof the PSC would appreciate your takirzg a feu,
nloments to complete ourCy~tonrerComment Card by clicking on the lirlk belon-. you? til~leand eflort
in providirlg this valuable feedback pertairling to the products or services vou received is great!\.
appreciated.

-----Original Message----From: Paul Lynch [mailto:plynch@shs.net]
Sent: Monday, September 20,2004 3:09 PM
To: Joy, Patrick
Subject: RE: HHSP233200400125U, RFTOP 194
-.

...

..

Thank you, Patrick! We are.very excited about the opportunity to work on this project. This is
start off the week!

-1.

>

very nice-way to

Does this require Larry Manning's approval as well before we begin work?
Thanks again,
Paul

.-.

I

From: Joy, Patrick [mailto:PJoy@psc.gov]
Sent: Monday, September 20, 2004 2:38 PM
To: Knouss, ~ o b e r t ;Williams, Robert C; 'Paul Lynch'
Subject: HHSP233200400125U, RFTOP 194

Attached is the fully executed order for Commissioned Corp Communication and Recruitment #rogram.

Message

<<HHSP233200400125U.pdf>>

Patrick A. JOY,CACRl
Contracting Officer
Progleam Support Center, S.4S
5600 Fishel*sLane, Rm 5-101
Rockville, RID 20857
(301) 443-9265
Fax (301) 443-2761

-

Irz ail effort to evaluate cztstorrler satisfaction, the staff of the PSC would appr-eciate yo
morrzerzts to coniplete o w Customer-Coiiziize~ztCard by clickiizg or1 tlze link below. Yw
irl providi~zgtlzis valziable feedback pertairzing to tlze products or senices y o i ~receivea
appreciated.

Jov. Patrick (PSC)
From:
Sent:
To:
Subject:

Joy, Patrick
Monday, September 27,2004 8.1 1 PM
'Paul Lynch'; Self, Tracy (0s); Knouss, Robert
HHSP233200400125U Modification 1

Attachments:

HHSP233200400125U MOD 1.pdf

Attached is Modification 1 to the above~eferencedorder. Please ensure that it is made a part of th ~fficialfile.

HHSP2332004001
!5U MOD 1 .pdf (8..
-

-

Patrick A. Joy, CACM
Contracting Officer
Program Support Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265
Fax (301) 443-2761 "<=:

7-

-..

-2

ln an effort to evalllate custonter-satisfaction, the staff of the PSC wolild appreciate vour taking a \v rnor?lerrtsto ..
conlplete our Clistomer Comment Card by clicking on tlte link belo~v. Yolo. tinte and effort in prc 'ding tl~isvalliable
feedback pertaining to the pmdactror~servicesyou received is greatljl appreciated.

.

-

I

Joy, Patrick (PSC)

!I
:~
I

From:
Sent:
To:
Subject:

Joy, Patrick A. (PSC)
Friday, June 17,2005 11:13 AM
'Paul Lynch'
PlCS Order ICS-194 HHSP233200400125U

~

Paul,

'

'I

I hope you can help me. ~ccordingto our finance office we have only paid you $139,606.07 so far. Are you that behind on
billing or have we messed up. We need to get a handle on the amount lest due to future work and p/oposed modifications.
Also, please ensure that Dr. Knouss's name and phone nupber is on all the invoices so they will be
finance office.

Patrick A. Joy, CACM
Contracting Officer
Frog~-amSupport Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265
the staff of the PSC wo~cldoppreciare your tnking n feb, nlonzenu to
complete our Customer Corninerlt Card by clicki~lgon the link below. Yolir time and effort in provj:di17~this r)ulrrtlble
.feedbuck perruining to the products or senices you received is greatly appreciated.
bl an effort to evaluate cusron7er s&ifnction.

2 i . - .

....- .-. ... '-

.

-

Message

Joy, Patrick (PSC)
From:

Joy, Patrick A. (PSC)

Sent:

Friday, June 17, 2005 2:32 PM

To :

'Paul Lynch'

Subject: RE: PlCS Order ICS'194 HHSP233200400125U
Please fax any outstanding invoices to me on 301 -443-2761

Patrick .4. Joy, CACRl
- .
Contracting officer
Program Support Center, S:S
5600 Fishers Lane, Rm 5-101
Rockville, RID 20857
(301) 443-9265
F a (301) 443-2761
In an efSort to evaluate customer satisfaction, the staflof tlze PSC woztld appreciate ?JOLtctkirzg a felts
ntomelzts to complete our.@gtonter Comme~ttCard by clickirlg on the l i d below. You tirue and e f i r t
in providing this valuable fxdback pertainirlg to the prodzlcts or services vou received s greatly
appreciated.
.

-----Original Message----From: Paul Lynch [mailto:plynch@shs.net]
Sent: Friday, June 17, 2005 11:37 AM
To: Joy, Patrick A. (PSC)
Subject: RE: PIC5 Order ICS-194 HHSP233200400125U

--

Hi Patrick,

.-

..

...

..

.

Our records indicate that you have paid us for Invoices #3, #5, and #7 (total = $139,606.07).
. .

We just mailed Invoice #9 which will take us through May 31, 2005. Once you receive this invc ce, we will have
billed you $417,442.07 (of which $277,836 will be outstand~ng).
Beginning with Invoice # l o , we will add Dr. Knouss's name and phone number to the invoice.
.-.
I hope that this helps. Please let me know if you would like us to resubmit any invo~ces.

Thank you, -Paul Lynch
Business Operations & Contracts Specialist

From: Joy, Patrick A. (PSC) [mailto: PJoy@psc.gov]
Sent: Friday, June 17, 2005 11:13 AM

Page 2 of 2

Message

To: 'Paul Lynch'
Subject: PICS Order ICS-194 HHSP233200400125U
Paul,
I hope you can help me. According to our finance office we have only paid you $139,606.07 sc
behind on billing or have we messed up. We need to get a handle on the amount lest due to f~
proposed modifications.

Are you that
re work and

11.

.- .-

Also, please ensure that Dr. Knouss's name and phone number is on all the invoices so they h be sent to him by
our finance office.

Patrick A. Joy, CACRl
Corltracting Officer
Program Support Center, S44&
5600 Fishers Lane, Rm 5-101
Rockville, RlD 20857
(301) 443-9265
F a (301) 443-2761

-.
--.

a

In an efSort to evaluate clrstol7zer satisfaction, the stafS of the PSC would appreciate yo raking n feIt1
moments to conzplere our Custorrzer Comment Card by clicking on the link belo~t-.Yo1 tirne and efSort
in providing this valuable,fe&back pertaining to the products or services you recriveu greatly
wappreciated.

c c H t t ~ ~ : / / ~ t ~ w ~ . p ~ ~ . g o ~ ~ / ~ ~ r v e y / C z ~I .htm>>
stoerl/cstoer
>.--.A

-. -

/

Page 1 of 1

Joy, Patrick (PSC)
From:

Paul Lynch [paul.f.lynch@orcmacro.com]

Sent:

Friday, July 08, 2005 2 5 7 PM

To :

Joy, Patrick A. (PSC)

Cc:

'JIII Herzog'; 'Ray Qualls'

Subject:

RE: HHSP233200400125U

Attachments: Commissioned Corps Modification Budget CL.xls
Patrick,

~

ORC Macro is pleased to submit the attached budget in response to your June 24 e-mail. We look forward to
continuing our work with the Commissioned Corps through September 30, 2006.
- - . ..- -:: .
.
-. .,
.
. .
--;

+.

I

If you experience any problems ,w~ththe file or if you have any questions, please feel free to contact me.

I

Thank you,
Paul Lynch
Business Operations & Contracts Specialist
ORC Macro
240-747-4769

- --

From: Joy, Patrick A. (PSC) [mailto:PJoy@psc.gov]
Sent: Friday, June 24, 2005 8:39 AM
-,-*a
-. .
To: 'Paul Lynch'
Subject: HHSP233200400125U
#

Paul,
Please provide a budget for the attached.
<<proposed modification.pdf>>
..
thanks

Patrick A. Joy,
CACRI
.
Contracting Officer
Program Support Center, SAS
5600 Fishers Lane, Rnl 5-101
Rockville, RID 20857
(301) 443-9265
Fax (301) 443-2761

.

.
. -

..

'

.

.. -

.

In an r f ~ o r t t oevaluate customer surisfuctior~,the stujj'of the PSC bvould uppreciulr
urornents to co~rlpleteour Custorner Cornrnerrr Card by clicki~rg011 the link below.
in providirlg this valuable feedback pertairlirtg to the products or services you rcceivedis greatly
uppreci~rted.

-

.- ....

ORC Macro, SHS Division
Extension of PlCS Contract #26301D0174. ICS-194
July 8. 2005
Period of Performance: September 20,2005 - September 30. 2006

!

-

1

i!

Message

Page 1 of 2

Joy, Patrick (PSC)
From:

Joy, Patrick A. (PSC)

Sent:

Monday, September 05,2005 12:04 PM

To :

'Paul Lynch'

Cc:

'Jill Herzog'; 'Flay Qualls'

Subject:

RE: HHSP233200400125U

-

Attachments: HHSP233200400125U Mod 2.pdf
Attached is proposed modification number 2 to Order HHSP233200400125U. Please review, rint, sign and fax
back to my attention.
..
: .

.

.

--

..
.
-.

Patrick A. Joy, CACM
Contracting Officer
Program Support Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265
Fax (301) 443-2761 -

,--;
-

In an effort to evaluate
. custonzer
. .. . satisfactiorz, the staflof the PSC would appreciate yo r taking a few
nzoments to conzplete our Customer Comment Card by clicking on the link below. Yo1 r tiltle and effort
in providirzg this valuable feedback pertaining to the products or services you receive6 is greatly
. --*
appreciated.
,

-

-----Original Message----From: Paul Lynch [mailto:paui.f.lynch@orcmacro.com]
Sent: Friday, July 08, 2005 2:57 PM
To: Joy, Patrick A. (PSC)
Cc: 'Jill Herzog'; 'Ray Qualls'
Subject: RE: HHSP233200400125U

-

Patrick.
ORC Macro is pleased to submit the attached budget in response to your June 24 e-maii. We ook forward to
continuing our work with the Commissioned Corps through September 30, 2006.
If you experience any problems with the file or if you have any questions, please feel free to cc ltact me.
Thank you,
Paul Lynch
Business Operations & Contracts Specialist
ORC Macro
240-747-4769

_.

I
-

Message

From: Joy, Patrick A. (PSC) [mailto:PJoy@psc.gov]
Sent: Friday, June 24, 2005 8:39 AM
To: 'Paul Lynch'
Subject: HHSP233200400125U

Paul,
.- ..

Please provide a budget for the attached.
<<proposed modification.pdf>>
thanks

Patrick A. Joy, CACRl
Contracting Officer
Program Support Center, S&
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265
F'm (301) 443-2761

-.-

- -.

In an effort to evaluatr customer satisfaction, the staff of the PSC would appreciate your taking a Jew
nlonlents to co~npleteour cwtonter Cornrnent Card by clicking on the link belo*,. ~ o u jtinle
- and effort
in providirrg this valuable$%dback pertaining to the products or services you received $ greatlx
appreciated.
I

<< H t t ~ : / / ~ u v ~ ' w . ~ p s ~ . g o ~ , w ~ p ~ e v / ~ - ~ ~1.~htm
t ~ m>e>r ~ / ~ s t o n e r

I

--

I

Joy, Patrick (PSC)
From:

Sent:
To:
Subject:

Joy, Patrick A. (PSC)
Wednesday, September 21,2005 10:07 AM
'paul.f.lynch @orcmacro.com'
Re: HHSP233200400125U

Thought I already sent.it will-resend on thurs Patrick Joy,
Contracting Officer
..........................
Sent from my BlackBerry Wireless Handheld
-

(

ACM

.

- - - - -Original Message----From: Paul Lynch <paul.f.lynch@orcmacro.com>
To: Joy, Patrick A-. (PSC)-cPJoy@psc .gov>
Sent: Wed Sep 21 09:48:13 2005
Subject: RE: HHSP233200400125U

-

. .. :

2;-

..

Hi Patrick,
Do you know when we can expect to receive a signed, fully exc cuted copy of
Modification #2?

-

\=
Thank you,
Paul Lynch
Fax # - - 301-984-3972
d'

e

From: Paul Lynch [maslto:paul.f.lynch@orcmacro.com]
Sent: Tuesday, September 06, 2005 11:41 AM
To: 'Joy, Patrick A . (PSC)'
Cc: 'Jill Herzog'; 'Ray Qualls'
Subject: RE: HHSP233200400125U

-.-

.

-

.

*.

.--

Hi Patrick,
I faxed a signed copy to your attention.
receive it.

Please let me know if you do not

Thank you,
Paul Lynch

From: Joy, Patrick A . (PSC) [mailto:PJoy@psc.govl
Sent: Monday, September 05, 2005 12:04 PM
To: 'Paul Lynch'
Cc: 'Jill Herzog'; 'Ray Qualls'
Subject: RE: HHSP233200400125U

Attached is proposed modification number 2 to Order ~ ~ ~ ~ 2 3 3 2 0 0 4 0 0 1 2 5 ~ .
Please review, print, sign and fax back to my attention.

1
I
I

Patrick A. Joy, CACM
Contracting Officer
Program Support Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265
Fax (301) 443-2761
In an effort to evaluate customer satisfaction, the staff of the PSC would
appreciate your taking a few moments to complete our customer CommentwCard
by clicking on the link bklbw. Your time and effort in .f;rov&ing this
valuable feedback pertaining to the products or services you keceived is
greatly appreciated.
'

- - - - -Original Message-----

From: Paul Lynch [mailto:paul.f.lynch@orcmacro.corn]
Sent: Friday, July 0$,\2005
2:57 PM
To: Joy, Patrick A. (PSC)
Cc: 'Jill Herzog'; 'Ray Qualls'
Subject: RE: HHSP233200400125U
...--.* - .. . ,
.. .-

Patrick,

1:I

.'-

---.-

ORC Macro is pleased to submit the attached budget in responsib to your June
24 e-mail. We look forward to continuing our work
Corps through*~eptember30, 2006.
--

If you experience any problems with the file or if
please feel free to contact me.
Thank you,
Paul Lynch
Business Operations
ORC Macro
240-747-4769

&

Contracts Specialist

From: Joy, Patrick A. (PSC) [mailto:PJoy@psc.gov]
Sent: Friday, June 24, 2005 8:39 AM
To: 'Paul Lynch'
Subject: HHSP233200400125U

,

.

..

-.

-*.-.

-.

questions,

- --

Paul,
Please provide a budget for the attached.
<<proposed modification.pdf>>
thanks
Patrick A. Joy, CACM
Contracting Officer
.
Program Support Center, SAS
5600 Fishers Lane, Rrn 5-101
Rockville, MD 20857
(301) 443-9265
Fax (301) 443-2761
In an effort to evaluate customer satisfaction, the staff of he PSC would
appreciate your taking a few moments to complete our Customer comment Card
by clicking on the link-below. your time and effort in provi ing thi's
eceived is
valuable feedback pertain'iKg t6 the products or servi~es=--~ou'
greatly appreciated.

.--

- --

Joy, Patrick (PSC)
From:

Ray B. Qualls [rqualls@shs.net]

Sent:

Monday, June 26,2006 3:37 PM

To:

Joy, Patrick (PSC)

Cc:

Knouss, Robert (HHSJOPHS);Jill Herzog; Paul Lynch

Subject:

1
RE: Labor Categories: ICS-194 Commissioned Corps Communication and Recruitment
Program

Attachments: Rate Justification - Jun 2 0 0 6 . ~ 1 ~

i~
I

.

Patrick,
Thank you for your guidance on this issue.
-

-

.

. .

--

-

I have added my responses below:

=+

-

,

I~
1~

7;-

--.

.
.--

iIl

From: Joy, Patrick (PSC) [mailto:Patrick.J~y@psc.hhs.gov]
Sent: Tuesday, June 20, 2006 3:53 PM
TO: Ray B. Qualls
Cc: Knouss, Robert (HHSIOPHS); Jill Herzog
Subject: RE: Labor Categories: ICS-194 Commissioned Corps Communication and

!

. x.?:

C

Ray,

i

.

c

-

thanks for the explana.tion.
.<*-.-..+. - -.

..,

..

. .. .

== :.

..

--. ..

I have some issueslconfusion on my part.

/I

1) we only have one project director you can not bill under that category for more then one
individual.

I

I

.I _ _

Adding labor categories will allow us to use the project director and media director categories for only one
individual.
-..
.
..
..-.

2) The same goes for media director.
See above.

I

3) if you want to modify the order to include the other labor categories, that is fine. Please
.-.
submit supporting documentation for the rates proposed and we can modify.
Supporting documentation is attached. Please revie,w and provide approval if they are acceptable.

1I
;I
1

4) Include a statement that these changes will not increase the total amount of the order.
Statement is included with the supporting documentation.

5) resubmit the invoice re-allocating all the hours to the correct indivuals (i.e. mddia specialist I
& II) with the correct new proposed rates.
Re-allocated invoices will follow once the rates are approved.

'I

.. .

Thanks!
Ray Qualls
Contracts Manager
240-747-4765

Patrick A. JOY, CACRl .
Procurement Analyst
P~*ogram
Support Center, SAS
5600 Fishe1.s Lane, Rm 5C-18
Rockville, RID 20857
(301) 443-9265
F a (301) 594-0736
'

.

-

-

-

---. .

aking a.few
'nlc and effort
~reatly

In an effort to evaluate czlstolrler satisfaction, tlze stafSof the PSC ~louldapprec7ate ya
monzents to complete our Customer Corrtntent Card by clickilzg 011 the link below. Yozl
ilz providing this \~alziablefeedback pertaining to the products or senlices you I-ecelved
appreciated.

-

From: Ray B. Qualls [mailto!rqual\s@shs.net]
Sent: Tuesday, June 20,2006 2:58 PM
.
To: Joy, Patrick (PSC)
Cc: Knouss, Robert (HHSIOPHS); Jill Herzog
Subject: FW: Labor Categories: ICS-194 Commissioned Corps Communication and Recruitme
---".,.%<,

-%.

-

Patrick,
-

~twe forward it

The attached document was prepared upon request of Robert Knouss for ICS-194. He asked
..
to you for your review.
--.

Please let us know if you have any questions.
Ray Qualls
Contracts Manager
240-747-4765
From: Ray B. Qualls
.-...
Sent: Wednesday, June 14, 2006 1 1 : O l AM
To: Rknauss@osophs.dhhs.gov
Cc: Jill Herzog; Tina Sweep; Paul Lynch
Subject: Labor Categories: ICS-194 Commissioned Corps Communication and Recruitment PI

ram

Mr. Knouss,
We recently discussed some issues regarding labor categories for this project. You requestecj 4 detailed
description of the work completed under labor categories with more than full time hours for thc? rq,arch and April
rmed.
periods. You also requested updated labor categories that better fit the functions being perf01
1~

I

--

.=

-..

Page 3 of 3

Please find our justification and proposed categories attached. Please let me know if you have
categories are acceptable we will apply them to the May costs.
Thank you for your guidance on these issues.
Ray Qualls
Contracts Manager
240-747-4765

1

~l

Joy, Patrick (PSC)
From:
Sent:
To:
Subject:

Joy, Patrick (PSC)
Wednesday, September 13,2006 2.1 6 PM
Paul F. Lynch
HHSP233200400125U ICS-194

Please provide a budget for the following:-.

..

-

The Secretary has decided to strengthen the Corps' health profession recruitment forts, particularly
for physicians and nurses. The Corp will begin staffing a 210 person health and m lical response
(HAMR) team with active duty personnel.. Therefore the level of effort for the cont zt needs to be
increased particularly in Item 4 of the SOW to help with this effort.
You proposal should not exceed $500,000.00:~
..

?--

Patrick A. Joy, CACM
.
P~*ocul*ement
Analyst
Program Suppol0tCenter, SAS
5600 Fishers Lane, Rm 5C-18
Rockville, MD 20857
.<..'\>>
(301) 443-9265
F~IX(301) 594-0736
.-a-

In an effort to evaluate cust~p?,e~sayisf~~tion,
the staff of the PSC would appreciate your t a k i ~ ~a gj rnonle~ltsto
complete our Customer Comment Card by clicking on the link below. Your time and effort in pro. ling this valutlble
feedback pertaining to the products or services you received is greatly appreciated.
I

..

..

.:-

--

--.

.

/

HHSP233200400 125U ICS- 194

~agelofl

Joy, Patrick (PSC)
From:

Paul.F.Lynch @orcmacro.com

Sent:

Thursday, September 14, 2006 4.1 1 PM

To :

Joy, Patrick (PSC)

Subject:

RE: ~ ~ ~ ~ 2 3 ' 3 2 0 0 4 0 0
ICS-194
125~

I

Attachments: HHSP233200400.125U ICS-194 Modification Budget CL.xls

!

'

II

Good afternoon, Patrick - We are pleased that the Commissioned Corps has dec~dedto continue our contract
We have attached a budget estimate for the work as requested below.

-.

Please let me know if you have any questions.
-

..

Thank you,
. .. . . . . . . . , Paul Lynch
Business Operations & Contracts Specialist
..
ORC Macro
240-747-4769

.

. - .---.

.

.......

I

7 z . : -

.

--

I

:I

. -

-

I

From: Joy, Patrick (PSC) [mailto:Patrick.Joy@psc.hhs.gov]
Sent: Wednesday, September 13, 2006 2:16 PM
To: Paul F. Lynch
Subject: HHSP23320040012'QICS-194

Please provide a budget
for
:--+-+,.
.....the following:
.

.--

The Secretary has decided to strengthen the Corps' health profession recruitmeht efforts,
particularly for physicians and nurses. The Corp will begin staffing a 210-person,health and
medical response 1HAMR)-team with active duty personnel.. Therefore the level of effort for
the contract needs to be increased particularly in Item 4 of the SOW to help with this effort.

--

.

.

.

You proposal should not exceed
-..
$500,000.00.
..

Patrick A. Joy, CACM
Procurement Analyst
Program Support Center, SAS
5600 Fishers Lane, Rm 5C-18
Rockville, MD 20857
(301) 443-9265
F a (301) 594-0736

.

....

.

.--.

In an e80or.t to evaluate clistoriler sarifiction, the stuf of the PSC \could appreciate you
monienrs to complete our Customer Comntent Card by clickirtg oil the link below. Yourtime and efort
in providing this vulriable feedback pertaining to the products or services you received i? greutly
appreciated.

.-..

ORC Macro. SHS Division
Extension of PlCS Contract #26301~0174,ICS-196
July 8.2005
Penod of Performance: September 20,2005 - September 30,2006

From:
Sent:
To:
Cc:
Subject:

Joy, Patrick (PSC)
Friday, September 22,2006 11:36 AM
Knouss, Robert (HHS/OPHS); 'Paul.F.Lynch@orcmacro.com'
PSC PSC-Finance
HHSP233200400125U

Attachments:

HHSP233200400125tl Modifcation 3.pdf

Attached is a fully executed copy of Modification 3

.
HHSP233200400 1
25U Modifcation ...

:

-

. -

-.

-

--

Patrick A. Joy, CACM
Procurement Analyst =
Program Support Center, SAS
5600 Fishers Lane, Rm 5C-18
Rockville, MD 20857
(301) 443-9265
Fax (301) 594-0736

- --

7~
I

-

.' -x'

In an effort to evaluate customer-satisfactio~z,the staff of the PSC would appreciate yolir t a k i ~ ~ag elz*rllonlents to
complere our Customer Comment
-.-.-&.Card
.. by clickilzg on the link belou: Your time and effort ill prc riding this ,!allcable
feedback pertaining to the products or services yo11 received is greatly clypreciated.

Joy, Patrick (PSC)
From:

Paul F. Lynch [plynch@shs.net]

Sent:

Friday, September 22, 2006 2:00 PM

To:

Joy, Patrick (PSC)

Subject: RE: ~ ~ ~ ~ 2 3 3 2 0 0 4 0 0 1 2 5 ~

Thank you, Patrick!

From: Joy, Patrick (PSC) [mailto:Patrick.Joy@psc.hh~gov]
Sent: Friday, September 22, 2006 11:36 AM
To: Knouss, Robert (HHSJOPHS);- Paul
F. Lynch
.
Cc: PSC PSC-Finance
. .
Subject: HHSP233200400125U. ' "

Attached is a fully executed copy of Modification 3
<<HHSP233200400125U Modifcation 3.pdf>>

Patrick A. Joy, CACM
Procurement Analyst
Program Support Cqnt.er, SAS
5600 Fishers Lane, R A ' ~ c - 1 8
Rockville, MD 20857'
(301) 443-9265 ... -,,. -. .. FXK(301) 594-0736
In an effort to evaluate customer satisfaction, the staff of the PSC would appreciate y~ ' ~ a k i l ga few
molnellts to complete our Customer Comment Card by clicking on the link below. Yo, time and effort
in providing this valuable feedback pertaining to the products or services you receivec s greatly
appreciated.
.

*.

->

--

I

ORDER FOR SUPPLIES OR SERVICES

- . ,

r

IMPORTANT: Mark all packages and papers w l t h contract andlor order numbers
1 DATE OF ORDER

10/28/2003

I

-.

- , ,

1

- .-- _

2 CONTRACT NO (11 any1

3 ORDER NO

Indicated

b. STREET ADDRESS

1

c CITY

d STATE

I

- I SHIP

TOM SWEENEY

a NAME OF CONTRACTOR

O

..

1
/ _I

.

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a PURCHASE

REFERENCE YOUR:

~:-

d. CITY

I.ZIP CODE

e. STATE

BETHESDA

MD

Exdebt for billi?ginstrucbonson the
revine, th~sdellvery ordw 5s
sublect to ~nstmcbonsmnta~nedon
th~ss~deonty of this form and IS
subect lo the nrms and
conlddnns of the above-numbered

lu8
mitt

10. REOUlSlTlONlNG OFFICE

DHHS/AHRQ

Indicated On Call
11. BUSINESS CLASSIFICATION (Check appropriate
a. SMALL

t&

ee3$1

b;

E

b. OTHER THAN SMALL

Destination

C.

DlsAovANTAcEo

-

b, ACCEmrJC:p...

16 DISCOUNT TERMS

15. DELIVER TO F.O.B. POINT
ON OR BEFORE (Date)

14. GOVERNMENT BIUNO.

13. PLACE OF

SCHEDULE
(See reverse lor Rejed,onsJ

SUPPLIES OR SERVICES
(b)

.

OUANTITY
ORDERED

UNIT

(c)

(d)

8

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ACC; PTED

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(9)
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18. SHIPPING POINT

I
20. INVOICE NO.

19. GROSS SHIPPING WEIGHT

I

17(h).
TOTAL

;I

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21 MAIL INVOICETO

Indicated On Call

I

I

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I

I

$50,000.00

SEE BILLING
INSTRUCTIONS b STREET ADDRESS
ON REVERSE
(or P O . Box)

-

NTE

17(i).

GRAND
TOTAL
c. CITY

e. ZIP CODE

d. STATE

$So,oo0) oo

I
22. UNITED STATES OF AMERICA

1

.

PREVIOUS EDITION NOT USABLE

23. NAME (TvoedJ

'1

JO LASKO

BY (Slgnarure)

NSN 754C-01-752-8083

/

/

==,

_

_

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UNIT
PRICE
lei

Period of Performance: 10/01/2003 to
09/30/2004

a NAME

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17.

(a)

.

Indicated On Call .

Indicated On Call

." h

Destination

ITEM NO

-

. .
.
.--

.

20814

9. ACCOUNTING AND APPROPRIATIONS DATA

Destination

1

Please furnish the following on the terms
and conditions speafied on both s~desof
mis order and on the anached sheets. fi
any. including delivery as indicated.

=

b DELIVERY

'I -

-:

7910 WOODMONT AVE, SUITE 1400

a. INSPECTION

I

8 TYPE OF ORDER

b COMPANY NAME

12. F.O.B. POINT

e ZIP CODE

VIA

NORTH AMERICAN NETWORK, INC.

E

1

on Call

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

c STREET ADDRESS

PAGES

I

04R000037

5. ISSUING OFFICE (Address correspondence to)

7 TO

07

a NAME OF CONSIGNEE

4 REOUlSlTlONlREFERENCE NO

I

PAGE

1

6 SHIP TO

HHSP23320042008RB

j

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-

TITLE CONTRACTlNGlORDERlNG OFFICER

1

OPTIONAL FORM 347

d1-Dal4

T

IR.r

6351

GSMAR (48 CFR, 53 PIX.)

Public Affairs BPA - North American

I

JUSTIFICATION

1

Successful marketing of AHRQ to professionals and consumers is critical to the mission, image,
and visibility of AHRQ. Part of AHRQ's marketing effort involves producing audio hews
releases (ANRs) and public ssrvice announcements (PSAs) written specifically for rahio. These
are self-contained radio stories which include a sound bite fiom AHRQ's director or dther expert.
They are sent only to radio stations, networks or talk shows whose listeners are our takget
audience. To produce these properly we have a need for professional audio taping of the ANRs
and PSAs and subsequent dishbution to the a&ropriate radio avenues. AHRQ has no facility for
this kind of production. NORTH AMERICAN NETWORK is a professional, indenebdently ..
owned and operated radio bioadcasting ageiicy located in Bethesda, Maryland. specisllzing
-exclusively in radio news serviices, they have been providing quality news arid p u b d f f a i r s
programming to radio stations and networks since 1984. In addition to ANRs and ~ d A s ,
of
NORTH AMERICAN NETWORK can arrange radio tours, and produce monthly
consumer information. They upload the spots to their Web site fiom which radio stations can
download broadcast quality versions.
I

SCOPE OF WORK

.. <-..

,+,

NORTH AMERICAN NETWORK will record the sound bites fiom experts provided by AHRQ.
These may be recorded in person or over the phone as availability of the expert permits.
NORTH AMERICANXETWRK will work with public affairs staff to produce a s k p t for the
---- .
radio spot (usually 60 seconds in length) that incorporates the sound bite. Then N O ~ T H
AMERICAN NETWORK will have a professional voice record the text of th_e scripI>
will add the sound bite, editing when needed to remove extraneous sounds or tighten
length. The finished piece and the written script will be uploaded to www.radiospacd.corn.
From language provided by AHRQ public affairs, NORTH AMERICAN NETWORK then will
produce and distribute an advisory to radio stations alerting them to the finished pieck, and
provide audiotapes to stations that require them. NORTH AMERICAN ~ ~ ~ ~ ~ R K h i l l f o l l o w
up with all stationslnetworks that accepted the tape or download to see how the spots were used.
They will provide a written report to AHRQ of the total usage (including gross audience
impressions) within 6 weeks of first distribution of the radio spot. No single call o r d b is to
exceed $2,500.00. Pickup and delivery will be made dunng normal office hours bedeen 9 a.m.
and 5 p.m. Turnaround times will be determined at the time of call order.

~

-

,

ORDER FOR SUPPLIES OR SERVICES

,I

,

,

.

,---

I

,

PAGE OF PAGES

,

1. DATE OF ORDER

1:

I

6 SHlP TO:

2. CONTRACT NO. (If
any)

HHSP23320042008RB

10/29/2003

I

1

IMPORTANT: Mark all packages and papers w ~ t hcontract and/or order numbers

I

a. NAME OF CONSIGNEE

I

3. ORDER NO.

4. REQUlSlTlONlREFERENCE NO.

DHHS/ AHRQ

00
5. ISSUING OFFICE (Address correspondence lo)

b. STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

REDLANTJ TECHNOLOGY CENTER
1ST FLOOR
: .
540 GAITHER ROAD
..

.

II

.

r CITY

d. STATE

ROCKVILLE
TOM SWEENEY

7. TO:

MD

f. SHIP VLA

a. NAME OF CONTRACTOR

B. TYPE OF

b. COMPANY NAME
-

. -

'a

--

.

...~--

-,,,

1.

.

mntained on

this side cmiy of this lam and is
,sued subpc( to the I m n s and
wnd~bms01 the above-numbered

terms
Pkase furnish the following on
and f o o d i l h s specified on both sides c4
d. CITY

e. STATE

MD

. -.

; reverse. this delivery ader D
subjea lo ins-ns

BETHESDA

-~-:

b. DELIVERY

~

REFERENCE YOUR:

7910 WOODMONTAVE, SUITEl40D

ORDER,^

a. PURCHASE

. - -.

.

c. STREET ADDRESS

20850

j

i

NORTH AMERICAN NETWORK, INC.

this order and on the atlad& thee&, il
any, induding delivery as indicated.

1. ZIP CODE

-

e. ZIP CODE

conlrad

;

20814

9. ACCOUNTING AND APPROPRIATIONS DATA

10. REQUISITIONING OFFICE

DHHS/AHRQ
11. BUSINESS CLASSIFICATION (Check appmpn;de $x(es))

E

\fC

a. SMALL

1 14. GOVERNMENT WUNO

Destination

12. F.O.B. POINT

c. DISADVANTAGED

b. OTHER THAN SMALL

13. PLACE OF

a. INSPECTION

b.ACcEmLmL

Destination

.

\
.

1

17. SCHEDULE (See reverse for Rejedrons)

(b)

QUANTITY
ORDERED

UNIT
PRICE
ie)

- - -- -

, .-#

Tax ID Number
DUNS Numbsr :
CAN: 0000000 Obj. Class: 0000 FY: 2004
Period of

AMTUNT

QUANTITY
ACCEPTED

cn

(9)

-.
~

.

. ..

. .;

-1

.<

- - -

. .--

If you have questions, call Jo Lasko at 30
Continued . . .
.

I

.,

18. SHIPPING POINT

I
19. GROSS SHIPPING WEIGHT

I

1

I

I

17(h).

2 0 INVOICE NO.

TOTAL

21. MAIL INVOICE TO:
V

a. NAME

SEE BILLING
INSTRUCTIONS b. STREET ADDRESS
ON REVERSE (or P.O. Box)

---+

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

$0.07

17(i).

GRAND
TOTAL

I
c. CITY

Id. STATE

ROCKVILLE

MD

e. ZIP CODE

20857
JO LASKO

BY (Signature)
&(kd.chdpaITLE:

PREVIOUS EDITION NOT USABLE

1

23. NAME (Typed)

22. UNITED STATES OF AMERICA

NSN 7540-01-1526083

-

'I

1
(a)

.

Net 30
- .

Destination

SUPPLIES OR SERVICES

16. DISCOUNT TERMS

09/30/2004

-,

ITEM NO.

'

!

15. DELIVER TO F.O.B. POINT
ON OR BEFORE (Dale)

-

d. WOMEN-OWNED

1

CoNTRAcTINmoRDERING o;fIcEI

FILE

I

OVW3NAL FORM Y 7 1R.r
R
-

6S5l

q W * R ( M CJRlS3.211.1

.....

1
!

ORDER FOR SLIPPLIES OR SERVICES

;I

IMPORTANT: Mark all packages and papers rrifh wnbact and/or wder numbers
DATE OF ORDER

CONTRACT NO.

10/29/2003

MSP23320042008RB

ITEM NO.

i~

00

SUPPLlESlSERVlCES

(A)

1

ORDER NO

QUANTITY
ORDERED
(C)

(6)

UNIT
(Dl

UNIT
PRICE
(E)

AMO"NT

IMPORTANT NOTE:

..

(GI

'~

YOUR BPA NUMBER HAS C W G E 3 FROM 20333R TO M ~ ~ 2 : , 3 2 0 0 4 2 0 0 ~ 8 ~ ~ .

.

This BPA Is for audio production services.
Call Limitation:

/Fl'~

I

Renew Blanket Purchase Agreement (BPA)
for the period October 1, 2003 through
September 30, 2004.
- .-

QUANTITY

ACCEPTED

See Statemznt of Work below.

$2500.00

..

Authorized Callers: ~ a r e nCarp
.
- . .
.
-

-

--

981

BLANKET..PURCHASE AGREEMENT

Government or accepted by the Vendor.
invoices for payment.

Continued

...

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 7540.01.152-8082

50yblot

OPTlONAL FORM l44 ( R r b95l
-trrGU

FILE

FAR

faCFR) 5311YCl

I
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

PAGE OF PAGES

'

-

1

IMPORTANT: Mark all packages and papers mth o m b a a andlw order numbers:
DATE OF ORDER

CONTRACT NO.

ORDER NO.

10/29/2003

HHSP23320042008RB

00

Government A u t h o r i z e d . C a l l e r .
6 . A l l s h i p m e n t s under t h i s A g r e e m e n t s h
a copy o f t h e o r d e r s l i p s h o w i n g . t h e £ 0 1 1
A.
Name o f S u p p l i e r
B.
BPA n u m b e r
C.
D a t e o f purchase
D.
Callordernumber
An i t e m i z e d l i s t of s u p p l i e s o r
E.
F.
Q u a n t i t y , u n i t p r i c e & extension
G.
D a t e of d e l i v e r y
7.
S e r v i c e s / s u p p I , i e ~ n o t covered by B l o c
under t h i s BPA.
1h%%ubtfu1
c a s e s , the C
C o n t r a c t i n g O f f i c e r prior t o p e r f o r m i n g a

. . .-.
..

FAILURE ON THE PART O F THE CONTRACTOR
I N C A N C E L L A T I O ~ ~TFIIS''BPA.
'~~

8.

A S PRESCRIBED I N 3 2 . 1 1 1 0 ( A ) ( 1 ) , I N S E R T TH
PAYMENT BY ELECTRONIC FUNDS TRANSFER - CE
( A ) METHOD O F PAYMENT. (1) ALL PAYMENTS B

--,

O F T H I S CLAUSE- A S USED I N T H I S CLAUSE, T
AND MAY ALSO INCLUDE THE PAYMENT INFORMAT
( 2 ) I N THE EVENT THE GOVERNMENT I S UNABLE
THE CONTRACTOR AGREES TO E I T H E R ( I ) ACCE'PT PAYMENT BY CHECK OR SOME OTHER
(11) REQUEST THE GOVERNMENT TO EXTEND THE
GOVERNMENT CAN MAKE PAYMENT BY E F T (BUT S
CONTRACTOR U S I N G THE E F T INFORMATION CO
REGISTRATION (CCR ) DATABASE. I N THE EV
DATABASE.
Continued

...

,

.

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 75dC41-152-8082

y 1 ~ 1 0 1

FILE

'I

OPTDUAL FORY

Y(I

I&. b95)

R I o m4 G U
FAR i 4 I C F ~ l 5 3 2 1 3 ( r l

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11

Il

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

PAGE OF PAGES

11

IMPORTANT. Mark all packaqes and p a p with mnbad andlor ordw numben
DATE OF ORDER

CONTRACT NO

10/29/2003

HHSP2332004200BRB

ITEM NO
(A)

ORDER NO

00

SUPPLlESlSERVlCES

OUANTlrY

(8)

ORDERED
(c)

UNIT

UNIT
PRICE

(0)

I
1

QUANTIn
ACCEPTED
(GI

(E)

EITHER THE AUTOMATED CLEARING HOUSE (ACH) NETWORK, SUBJECT TO T

(D) SUSPENSION OF PAYMENT- IF THE CONTRACTOR'S EFT INF3RMATION
THIS CONTRACT UNTIL CORRECT EFT INFORMATION IS ENTERED INTO THE

OF INTEREST PENALTIES APPLY.
(E) LIABILITY FOR UNCOMPLETED OR ERRONEOUS

(I) MAKING A CORRECT, PAYMENT;

GOVERNMENT IS D E E W Z O HAVE MADE PAYMENT
RECOVERY OF ANY ER~OMOUSLY DIRECTED F

APPLY.

-..

FEDERAL RESERVE SYSTEM.

-

CONTRACT AS PROVIDED FOR IN THE ASSIGNMENT
CONTRACTOR SHALL REQULRE AS A CONDITION OF

SHALL APPLY TO THE ASSIGNEE AS IF IT WERE T

CONTRACTOR'S FINANCIAL AGENT.cP>
Continued . . .
I

I

TOTAL CARRIED FORWARD TO IST PAGE (ITEM 17(H))
NSN 754WJ1-152-8082

50W&101

FILE

I

;I

I(

OPTWNAL FORU 2 4 I R r . €A51

m

m

t

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F l l 14OffRjUZIXCI

4

1

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

I

-

DATE OF ORDER

CONTRACT NO.

ORDER NO

10/29/2003

HHSP23320042008RB

00

SUPPLIES~SERVICES

QUANTITY
ORDERED
(c)

(0)

(A)

1

PAGE OF PAGES
I

1 5

1

11

'1

IMPORTANT: Mark all padrages and papers with m a a d andlw order numbers.

ITEM NO

'I

UNIT
(D)

UNIT
PRICE
(E)

:I
AM~UNT

'1

(5)

OUANTIP
ACCEPTED
(G)

(I) PAYMENT INFORMATION. THE PAYMENT OR DIS3URSING OFFICE SHAL
CONTRACTOR AVAILABLE PAYMENT INFORMATION THAT IS SUITA3LE FOR
THE DATE OF RELEASE OF THE EFT INSTRUCTION r 0 THE FEDERAL RESE
GOVERNMENT MAY REQUEST THE CONTRACTOR TO DESIGN AT^ A AESIRED FO
FOR DELIVERY OF PAYMENT INFORMATION FROM A LIST OF FORWTS AND
OFFICE IS CAPABLE OF EXECUTING. HOWEVER, TH3 GOVERNMENT DOES N
PARTICULAR FORMAT OR METHOD OF DELIVERY IS PVAILABLE A'r ANY PART1
OFFICE AND RETAINS THE LATITUDE TO USE
CONVENIENT TO THE GOVERNMENT. IF THE GOVE
ACCORDANCE WITH PARAGRAPH (A) OF THIS
INFORMATION TO THE REMITTANCE ADDRESS
( END OF CLAUSE)- . .-

(A) DEFINITIONS. AS USED IN THIS CLAUSE--

GOVERNMENT.
DUN AND BRADST
DATA UNIVERSAL NUMBERING SYSTEM +4 (DUN

ASSIGNED AT THE-DBCRETTON OF THE BUS1

REGISTERED IN THE

CCR DATABASE

MEANS T ~ T -

RECORD "ACTIVE".
PROSPECTIVE AWARDEE SHALL BE REGIST
PERFORMANCE, AND THROUGH FINAL PAYM
SOLICITATION.
PAGE OF ITS OFFER, THE ANNOTATION

-

BRADSTREET DIRECTLY TO OBTAIN ONE
(1) AN OFFEROR MAY OBTAIN A DUNS NUMBER-Continued . . .

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 741Ml-152-8082

50~4-101

d
OPTtOtUL FORM 348 1 C r (1951
R
-

FILE

EM

bl GSb

(M cFR1U213Irl

(

ORDER FOR SUPPLIES OR SERVICES

PAGE OF PAGES

'1

IMPORTANT: Mark all packages and papen with mntracl andlor order numbers.
DATE OF ORDER

CONTRACT NO

ORDER NO

10/29/2003

HHSP23320042008RB

00

ITEM NO
ORDERED
(C)

(8)

(I) IF LOCATED WITHIN THE UNITED STATES, BY CALL&

'1

PRICE
(El

cF1
DU~
AND BRADS:*REET AT '1

(D)

.

ACCEPTED
(GI

BRADSTREET OFFICE.
(I) COMPANY LEGAL BUSINESS.
RECOGNIZED.
(IV) COMPANY MAILING ADDRESS, CITY, STATE
(V) COMPANY TELEPHONE NUMBER.
(VI) DATE THE COMPANY WAS STARTED.
(VII) NUMBER OF EMPLOYEES AT YOUR LOCATION.
(VIII) CHIEF EXECUTIVE OFFICER/KEY MANAGER.
(IX) LINE OF BUSINESS (INDUSTRY).
ENTITY) .
(D) IF THE OFFEROR DOES NOT BECOME REGIS

WHEK

CONSIDERATION
~ G I S T E R I N G. OFFE
APPLYING FOR REGISTRATION IMMEDIATEL

DATABASE AFTER THE INITIAL REGIST

OF THIS CONTRACT AND IS NOT A SUB
DOCUMENT.

TRANSFERRED THE ASSETS USED IN PERFORMING
NECESSARY REQUIREMENTS REGARDING NOVATION

IN THE CCR

Continued

I
NSN 7540-91-1526082

DATABASE; (B) COMPLY

.

I
1
1
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
5034&101

I

1
OPTIONAL FORM 348 I R n Wl
P m s M b#GSA

FILE

-

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

1
I

PAGE OF PAGES

I

-

7

1 1 1

IMPORTANT: Mark all packages and papen mth oDntrad a d w order numben
DATE OF ORDER

C O K I W C T NO

ORDER NO

10/29/2003

HHSP23320042008RB

00

ITEM NO.

SUPPLIES/SERVICES

(8)

(A)

OTHER THAN THE CONTRACTOR INDICATE
INCORRECT INFORMATION WITHIN T H E M
OF THE ELECTRONIC FUNDS TRANSFER (
(2) THE CONTRACTOR SHALL NOT CHANGE THE
PAYMENTS, AS APPROPRIATE, IN THE C
OF ASSIGNMENT OF CLAIMS (SEE FAR S
SHALL BE SEPARATELY REGISTERED IN
CONTRACTOR'S CCR RECORD THAT INDI
AN ULTIMATE RECIPIENT OTHER THAN
INCORRECT INFORMATION WITHIN THE M
OF THE EFT CLAUSE OF THIS CONTRACT. (H) OFFERORS AND CONT-RACTORGMAY OBTAIN IN
CONFIRMATION REQUIREMENTS VIA THE
1-888-227-2423,OR 269-961-5757.
(END OF CLAUSE)

1

QUANTITY

UNIT

,

1

'

I
<I
-

'RICE
IE)

-

(Gi

948
52.213-4 TERMS AND CON~~ITIONS
- SIMP
COMMERCIAL ITEMS). (AUG 20031

'IVE ORDER:
I

13) (E.O.!S 1272

I

12724, 13059, 13067, 13121, 13129).

(I) 52.232-1, PAYMENTS (APR 1984).
(111) 52.232-11, EXTRAS (APR 1984).
(IV) 52.232-25, PROMPT PAYMENT (FEB 2002) .
(V) 52.233-1, DISPUTES (JUL 2002).

ICORPORATEDBY

1

'IVE ORDER:
)IES (SEPT 2002)
I/
:RO-PURCIYjlSE

I

THRESHOLD.)

9

I . . 35j45)
lERTO RICO, OR T

U.S . VIRGIN ISLANDS) .
Continued . . .

J

I

I

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17rH))

-- - - --

NSN 75rC-01 -1574nR7
.

50-101

I

I
I1

'1

OPTIONAL FORM
R
-

FILE

1-

695)

4G U

FAR 1.8 WRL U 1 1 X C I

-.

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

,

I1

PAGE OF PAGES

VIRGIN ISLANDS, AND WAKE ISLAND.)

. .
..--

--

?

EXCEED $25 , 000 y:'""..

-

-""

-z

__i

.

-,

SUPPLIES) .
F.O.B. ORIGIN).
F .O.B ,DESTINATION) .
Continued . . .

TOTAL CARRIED FORWARD TO ?STPAGE (ITEM 17(H))
NSN 75dW1-152-8082

SOYklOl

FILE

:I

OFTONAL FORM l48 I&. -1
P7ncnD.b4 GSA
F I R V I I CSR1U3lXc)

1
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

PAGE OF PAGES

-

IMPORTANT: M a n all packages and papers 4th ambad

! ?

DATE OF ORDER

CONTRACT NO.

ORDER NO.

10/29/2003

HHSP2332004200BRB

00

ITEM NO.
(A)

1 1 1

~1

and/or order numbers.

SUPRIESISERVICES

QUANTITY

(8)

ORDERED
(C)

UNIT

UNIT

(D)

PRICE
(E)

1
1

AMO%NT

1

QUANTl7
ACCEPTEC
(Gl

(C) FAR 52.252-2, CLAUSES INCORPORATED BY REFERENCE (F3B 1998). Tk.IS C O N T ~ C T
INCORPORATES ONE OR MORE CLAUSES BY REFERENIE, WITH THZ SAME FORC:: rn EF~ECI.AS IF
THEY WERE GIVEN IN FULL TEXT. UPON REQUEST, THE CCNTRAZTING OFFIC~RWILL MAKE THEIR
FULL TEXT AVAILABLE. ALSO, THE FULL TEXT OF A CLAUSE M4Y BE ACCESSED ELEC~RONICALLY
..
AT THIS/THESE ADDRESS (ES):
[INSERT ONE OR MORE INTERNET ADDRESSES]
(D) INSPECTION/ACCEPTANCE. THE CONTRACTOR S : W L TENDER FOR ACCEPTJLNCE
THE RIGHT TO INSPECT OR TEST ANY
ACCEPTANCE. THE GOVERNMENT MAY REQUIRE REP
-.

PRICE, THE GOVERNMENT .MUST-EXERCISE ITS P
(1) WITHIN A REASONABLE PERIOD OF TIME AF
HAVE BEEN DISCOVERED; AND
12 ) BEFORE ANY
CHANGE O C ~ S
CHANGE IS DUE TO THE DEFECT IN THE ITEM.

.
-.

SUBSTANTIAL

.

"

.

WRITTEN NOTICE-TYUIWB COtdTRACTING OFFIC

.

-

--...

TO TERMINATE THIS CONTRACT, OR ANY PART
EVENT OF SUCH TERMINATION, *THE CO~TPACT
AND SHALL IMMEDIATELY CAUSE ANY AND ALL OF
CEASE WORK. SUBJECT TO THE TERMS
OF THI
..-. .

PRIOR TO THE NOTICE OF TERMINATION, PLU
....

FOR THIS PURPOSE. THIS PARAGRAPH DOES
THE CONTRACTOR'S RECORDS. THE CONTRAC

HEREOF, FOR CAUSE IN THE EVENT OF
CONTRACTOR FAILS TO COMPLY WITH AN
PROVIDE THE GOVERNMENT, UPON REQUE
LIABLE TO THE CONTRACTOR FOR ANY
Continued . . .

!

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 754041-152-8082

90116101

FILE

1'~I
OPTIONAL FORM

Ma I-.

*-

* osr
6%)

F I R (43 CFRI 53113(cI

1
I

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION

PAGE OF PAGES

I 3.0

DATE OF ORDER

CONTRACT NO.

ORDER NO.

10/29/2003

HHSP23320042008RB

00

ITEM NO

1

11

i

IMPORTANT: Mark all packages and papers mm m a a c t andlor order numberr.

/

SUPPLlESlSERVlCES

(8)

QUANTITY
ORDERED
(C)

1

TERMINATION FOR CONVENIENCE.

HEREUNDER ARE MERCHANTABLE AND FIT FOR USE
THIS CONTRACT.
(END OF CLAUSE)
NOTICE. . .
IN ACCORDANCE WITH THE REQUIREMENTS OF
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
TRANSFER (EFT). YOUR .FAILURE TO PROVIDE FU
APPROPRIATE
DIRECTED TO THE
ORDER. CONTACTS ARE, AS FOLLOWS:
(301) 443-3020
PSC
JEANETTEPANG
(301) 827-5090
FDA
DAVID CAINE
CDC
PATTYEVERETTE
(404) 639-7441
NIH
MICHELLE SHORTER (301) 496-6088

1

UNIT

(D)

1

1

UNrr

1

PRICE
IE)

1

1

I1

AMOUNT

;I

(9

1

OULVJTITY

ACCEPTED

(GI

1

I

MENT ACT OF 199

CONCERN IN^

STI ~ N S
EPT+L
BE
SHOWN IN BLOCK 21 01 THIS

4

1 jER

IN ADDITION TO THE.-INFORMATION REQUIRED BY 2.232-25 ( ROMPT PAYM NT), YO&
INVOI 1
~EMpLoyER sfI D E N T I F ~ I o N
MUST CONTAIN THE FOLLOWING: TAX IDENTIFICAT ON
NLR.1BER) OR SOCIAL-'5ECURITY NUMBER.

THIS CONTRACT INCORPORATES THE FOLLOWING C
AND EFFECT AS IF THEY WERE GIVEN IN FULL

FEDERAL ACQUISITION

REGULATION

(48 CFR CHAP
[ER THAN

FAR 52.213-4 TERMS AND CONDITIONS - - SIMPL
COMMERCIAL ITEMS) (JUNE 2003 )
FAR 52.243-1 CHANGES - FIXED PRICE
(AUG 1987)
NOTICE. . .
IN ACCORDANCE WITH THE REQUIREMENTS OF THE
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES

'ION IMPRO
'AYMENT BY :LECTRONI FUNDS
,ETE INFOR LTION TO THE
)NS CONCER N G EFT S ~ L BE
L

continued . . .

I
NSN 75dC-01 -152.8082

I
I
I
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
Y)~~%IOI

FILE

I

I

~1

1

I
OPT-

FORM YII (Rr 6351
R-bd
4 GSA
FAR I48CFRI U 2 1 3 1 F I

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATlON OF CONTRACT
2. AMENDMENTlMODlFlCATlON NO.

1 4. REQUlSlTIONlPURCHASE REQ.NO.

3. EFFECTIVE DATE

0001
6 ISSUED BY

2

I

GAB )I
I

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

I

Ii

4

9A. AMENDMENT OF SOLICITATION NO.

mmy, stare end ZIP w e )
-

1'

15. PROJECT NO! (~appl~cable)

7. ADMINISTERED BY (If dher man Item 6)

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

8. NAME AND ADDRESS OF CONTRACTOR ( N o .

I

1

04R000213

07/22/2004
GAB

CODE

PAGE 0%PAGES

1

.

NORTH AMERICAN NETWORK, INC.
Attn: TOM SWEENEY
7910 WOODMONT AVE, SUITE 1400
BETHESDA MD 20814

,I

:I

90. DATED (SEE ITEM 11)

10A MODIFICATIONOF CONTRACTIORDER NO.

HHSP23320042008RB
-

CODE

I? J1

-

',I

I

--

I

-

1

/lOB. DATED (SEE ITEM 13)

I
I
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

;I
is exten6ed.

O T h e abwe numbered solicitation is amended as set forth h Item 14. The hour and date spes~ed
(or receipt of 0Hef-s

is not eiitended.

OHers must acknowledge receipt of lhis amendment priu lo the hour and date specified in the s o l i n or as amended, by one ofthe (olbwing m e w s : (a) By mmpdting
I t e m 8 and 15, and rehuning
W e s of the amendment (b) By aclrnowledgingreceipt of Lhii amendment on ekh copy ol the offer summed; or (c) By
separale kner or telegram which indudes a reference to the solcitation andamendment number. FAILURE OF YOUR ACKNOWLEDGEMENTTO BE RECEIVEDAT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. llby:
v+'lue of this amendment y w desire to change an offer already submitted, such change may be made by telegram or letter, pmvided each telegmn or letter makes
!
reference to the solicitation and this amendment, and is received prior to me openinq hour and date specified.
1
12. ACCOUNTING AND APPROPRlATlON DATA (Hrequired.)

'I

See Schedule
13. THlS ITEM APPLIES ONLY TO MO$;<~ONS

OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTlORDER NO. AS DESCRIBED IN ITEM 14.

:I

. .

A. THlS CHANGE ORDER IS ISSUED PURSUANT TO: (Specifyaulhority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NO. IN ITEM 10A.

cX

X

FAR 52.243-1

1

CHANGES

(DECREASE FUNDS)

0. THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in payinO office.
apprcpnabon date, efc) SET F O R W C f f E M 74. PURSUANT TO THE AUTHORITY OF FAR 43 103(b).

1

C. THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO THE AUTHORITY OF:

I

D. OTHER (Specrfy type of modifrcatim and authority)

''II

I

E. IMPORTANT:

Contractor

is not.

14. DESCRIPTION OF AMENDMENTMODIFICATION

Tax ID Number:
DUNS Number:
Modification to BPA HHSP23320042008RB
Prior Order Total . . . . . . . . . . . $ 50,000
Decrease Order ~ o t a l
. . . . . . . . . 6,290
New Order Total . . . . . . . . . . . . . . 43,710
Funds not needed in FY04.
7541700
CAN #4-K7225YM O/C: 25.22
Not T o Exceed Amount changed to: $43,710.00
Contracting Officer changed from J O LASKO
to
Period of Performance: 10/01/2003 t o 09/30/2004
Continued . . .

-

1

1'

1

..-..
JULIA

C

Z

1

SAVOY

Except as pmvided heren, all terms and conditions of the document referencedin ltem 9A or 10A. as heretoforechanged, remains unchanged and in full f-

15A. NAME AND TITLE OF SIGNER (Type orprint)

;I

copies to the issu~ngoffice.

is required to sign this document and retum

(Organizedby UCF seclion headings, including sol~itationlmntract
subject maffer where feasible.)

and effed

:'I1

YCTlNG OFFICER (Type

16A. NAME AND TITLE OF CONT

I

150. CONTRACTOWOFFEROR

16C'. DATE SIGNED

07/22/2004
(Signature olpenw avmoped la sign)

NSN 754001-152-8070
Previous edition unusable

1

STANDARD FORM 30 (REV. 1 M 3 )
Presmbedby GSA
FAR (48 CFR) 53.243

'1

OM6 No. 0990-0115
/

ORDER FOR SUPPLIES OR SERVICES

I

a NAME OF CONSIGNEE

01/12/2004
4 REOUISITIONIREFERENCE NO

3. ORDER NO

DHHS / A H R Q

001

1
I

5 ISSUING OFFICE (Address conespondence lo)

b. STREET ADDRESS

DHHS/PSC/SAS/DAM

REDLAND T E C H N O L O G Y C E N T E R
1ST F L O O R
5 4 0 GAITHER ROAD

BUILDING,

PARKLAWN

ROOM

5-101

5 6 0 0 FISHERS LANE
ROCKVILLE

MD 2 0 8 5 7
ROCKVILLE

MD

a NAME OF CONTRACTOR

NORTH A M E R I C A N N E T W O R K ,

INC.

8 TYPE OF ORDER

b COMPANY NAME

O a PURCHASE

. ,-

c STREET ADDRESS

7 9 1 0 W O O D M O N T AVE,

SUITE

e STATE

*

BETHESDA

MD

1-

DELIVERY

T x c e p t lor bdl~nglnsmcbons on the
reverse th~sdellvery order IS
dubject to InslruCbons contained on
tLls wde only oi trvs form and e
ksued subled to me 1-s
and
ofthe above-numbered

Please fumlsh the follomng on Ihe terms
and cnndlbons speafied on both s~desof
l h ~ order
s
and on the anached sheets I(
any lnclud~ngdellvery as lndlcaled

f ZIP CODE

1
_i

- -.

REFERENCE YOUR

1400

d CITY

2 0 8 1 0

'II

1. SHIP VIA

TOM SWEENEY

e. ZIPCODE

d. STATE

c. ClTY

7.TO:

-

1

I

1

6 SHIP TO

2 CONTRACT NO (IlanyJ
HHSP23320042008RB

1 DATE OF ORDER

PAGE OF PAGES

/

IMPORTANT: M a r k all p a c k a g e s a n d p a p e r s w i t h c o n t r a c t a n d l o r o r d e r n u m b e r s

-=-

+hens
cmtracL

20814

9 ACCOUNTING AND APPROPRIATIONS DATA

10 REOUlSlTlONlNG OFFICE

DHHS/AHRQ

7541700
11 BUSINESS CLASSIFICATION (Check apprupnagQ$fes))

0

a SMALL

-

Destlnatlon

12 F O B POINT

13 PLACE OF

--.
#.x.

a INSPECTION

b ACCEPTANCE

Destination

b OTHER THAN SMALL

c DISADVANTAGED

j

15 DELIVER TO F o B POINT
ON OR BEFORE (Date)

14 GOVERNMENT W ~ N O

- .-

d WOMENQWNED
16 DISCOUNT TERMS

Net 3 0

11/30/2003

Destination
17 SCHEDULE (See reverse lor Rejechons)

1

SUPPLIES OR SERVICES

ITEM NO

OUANTITY
ORDERED

1

OUANTlrY
ACCEPTED

UIdIT
PRICE

(9)

Tax I D Number:
D U N S Number:
C A N : K 7 2 2 5 Y M Ob]. C l a s s : 2 5 2 2 F Y :
Period of Performanc6i 10/01/2003
1

4

CALLS

COMPLETED FOR

C o n t i n u e d

2004

t o 09/30

2004

THE M O N T H O F

...

18 SHIPPING POINT

19 GROSS SHIPPING WEIGHT

17(h)
TOTAL
(Con1

20 INVOICE NO

pages)

21 MAIL INVOICE TO

4

i

a NAME

sg,soo.oo
PSC/FMS

SEE BILLING
INSTRUCTIONS b STREET ADDRESS
ON REVERSE (or P 0 Box)

PARKLAWN

(301)

443-3020

BUILDING,

ROOM

16A-12

5 6 0 0 F I S H E R S LANE

17(1)
GRAND
TOTAL

11

c. CITY

I

-

ROCKVILLE

22. UNITED STATES OF AMERICA

I

MD

$9.80~0.00

e. ZIP CODE

d STATE

1

20857

I

1

1

23 NAME (Typed)

.

BY (S~gnature)

JULIA C .

SAVOY

TITLE: CONTRACTINGIORDERING OFF,ICER
NSN 754041-152-8083
PREVIOUS EDITION NOT USABLE

//

1

:

.
OPTIONAL FORM 1 4 1 I R r

R-bdqGSMW7I.d

6.35)

CTR) 53 21x.l

-=..

-

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

i

-

PAGE OF PAGES

;I

IMPORTANT: Mar* all packages and papers wth contract and/or order numbers
DATE OF ORDER

CONTRACT NO.

ORDER NO

01/12/2004

HHSP23320042008RB

001

ITEM NO.
(A)

SUPPLlESlSERVlCES

OUANTITY

(0)

ORDERED
(C)

UNIT

1

UNIT

1

AMOUNi

PRICE
(D)

(E)

OUANilN
ACCEPTED
IG)

(F)

NOVEMBER 2003

Total

amount

o f award:

$9,80-0.00. The

o b l i g a t i o n

1

for tlis award i ~
shown
. i n box

17 ( i ).

!
-

,

-

.

.

. .

..

.

-

.

..

*-

=-'.

-

. -:-.

.

i

-

.

..

!
.~..

.

~

-

.. .-

a_..~_

-...

_

I

il

..

.

7 -

.....
.- -.

.- -

.

.-

i

I

...-..

.

9

;

I

i

!
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 154&01.152.8082

wm-loi

A
OPTIONAL FORM Y B I R r ma)

Rmmm q G S r
F A R I I I C F R ) !AllYrl

I

c No. 0990-0175
11
ORDER FOR SUPPLIES OR SERVICES
IMPORTANT: Mark a l l p a c k a g e s a n d p a p e r s w l t h c o n t r a c t a n d l o r o r d e r n u m b e r s

HHSP23320042008RB

01/14/2004
3. ORDER NO.

j

1

:

PAGE OF JAG::

1

-

I

I

(

6 SHIP TO

2 CONTRACT NO (If any)

1 DATE OF ORDER

1

a NAh4E OF CONSIGNEE

4. REQUISITIONIREFERENCE NO

002
5, ISSUING OFFICE (Address correspondence to)

b. STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

REDLAND TECHNOLOGY CENTER
1ST FLOOR
540 GAITHER ROAD
-

-

.-

;I
.

.

-

c. ClTY

ROCKVILLE
f SHIPVIA

TOM SWEENEY

7 TO

Y

a NAME OF CONTRACTOR

NORTH AMERICAN NETWORK, INC.
b COMPANY NAME

c. STREET ADDRESS

B TYPE OF ORDER I
-

.

..

-

7 91 0 WOODMONT -AVE, SUITE 14 00

.

-

I

( /Zb

m a PURCHASE

..

<-

xcept for b'illnng ~nstrucbonson Ihe

(

I

1

d. CITY

-

DELIVERY

REFERENCE YOUR:

e. STATE

I.ZIP CODE

BETHESDA

1

;--?

/eveme. thrr delwery order 1s
subject lo !nsvucsons contained on

11

Please lurnish the Idlowing on the terms
and mndibons s p e f l ~ e don both sides of
this order and o n the attached sheets, 8
any, mcluding delivery as indicated.

[his side only ofthis form and 1s
ssued subiect to the t e n s and
, * i f me above-oumbefed
'ontract.
I

;I

( 10. REQUISITIONING OFFICE

9. ACCOUNTING AND APPROPRIATIONS DATA

,

I

11. BUSINESS CLASSIFICATION (Check appmpri*

wes))

'D

a. SMALL

Destination

12. F O B . POINT

b. OTHER THAN SMALL

C.

DISADVANTAGED

-

IS. DELIVER TO F.O.B. POINT
ON OR BEFORE (Date)

14. GOVERNMENT BIUNO

13 P U C E OF

( b ACCWTRWE-

a. INSPECTION

Destination

d WOMEN-OWNED

1

-'+

16. DI~COUNTTERMS

.

~estination
17 SCHEDULE (See reverse for Re~ect~onsl

ITEM NO.

(a)

SUPPLIES OR SERVICES

QUANTITY
ORDERED

(b)

Ic)

UNIT

PRICE

-

1

-

.

1

OUANTIN
ACCEPTED

AMOUNT

b4

Tax ID Number:
DUNS Number:
CAN: K7225YM Obj . Class: 2522 FY: 2004
Period of Perfurmance: 10/01/2003 to 09/30/2004
2 CALLS COMPLETED FOR THE MONTH OF
Continued . . .
.. ..

1

18 SHIPPING POINT

21. MAIL INVOICE TO:

1

22. UNITED STATES OF AMERICA

MD

1

1

e. ZIP CODE

$4.00'0.00

20857

,I

23. NAME (Typed)

BY (Signature)

.

17(i).
GRAND
TOTAL

d. STATE

ROCKVILLE

lpaw,

b
~

c. ClTY

17(h)
TOTAL
(Con!.

$4,00:0.00
'1

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 'FISHERS LANE
'

b. STREET ADDRESS
(or P.0 BOX)

I
.--.

a. NAME
SEE BILLING
lNSTRUCTlONS
ON REVERSE

1

I
20 INVOICE NO

19 GROSS SHIPPING WEIGHT

J U L I A C . SAVOY

:I

1

1

TITLE. CONTRACTINGIORDERING OFFICER
NSN 154041-152-8083
PREVIOUS EDITION NOT USABLE

77

Y

'

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OPTDNAL FORM 361

(R.V

695)

-

ORDER FOR SUPPLIES OR SERVICES

PAGE OF PAGES

I

IMPORTANT: Mark all packages and papers with mntract andlor order numbers.
DATE OF ORDER

CONTRACT NO.

01/14/2004

HHSP23320042008RB

ITEM NO

ORDER NO.

002

SUPPLIES~SERVICES

QUANTITY

(8)

ORDERED
(C)

(A)

UNIT

UNIT

(0)

PRICE
(E)

OUAIU'T~F

AMO+

#I
(F) 1

ACCEPTED
IGi

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Total

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NSN 790-01.1524082

YJw-101

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OPTIONAL FORM 348 ( ~ ( -51
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R m t d bl GSA
FAR (48 CFR) YPIYcI

INSTRUCTIONS FOR USE:

This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acquisi\ion Management, ASC, Room 5-77, Parklawn Bldg., no later than c.o.b., the 5th day of each month.
(degative reports are required.)
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BLANKET PURCHASE AGREEME~T
I
RECORD-OWALL~ontractor~N~rth~~merican~~etwork,~lnc.

M0nth:,~ecernber-20031

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1

-

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Pages
1

Date of
Call

Call
Number

Ordered

Dollar
Amount

General Description
of Items

By

BPA.# 2008RB
: CAN #4-K7225YM

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Initial Amount or Balance Carried ~owa-rd.. . . . . . . . . . . . . . . . . . . . . . . . . . . . -.. . . . . . . . . . .
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,

procured by Authorized Callers.
Signature of Authorized Program Official: [

/

ORDER FOR SUPPLIES OR SERVICES

1 1 ;

IMPORTANT: Mark all packages and papers w i t h contract andlor order numbers

03/17/2004

!I

6. SHIP T O

2. CONTRACT NO. (Ilany)

1. DATE OF ORDER

PAGE D i PAGES

HHSP23320042008RB

-

I

/

a. NAME OF CONSIGNEE

14.REOUISITIONIREFERENCE NO.

3. ORDER NO

003

I

5. ISSUING OFFICE (Address correspondence to)

b. STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

REDLAND TECHNOLOGY CENTER
1ST FLOOR
540 GAITHER ROAD
-

,

C.

ClTY

ROCKVILLE
1. SHIP VIA

TOM SWEENEY

7. '0:

a. NAME OF CONTRACTOR

NORTH AMERICAN NETWORK, INC.
b. COMPANY NAME

-

.

.

c. STREET ADDRESS

.

--

d. CITY

,I

8.TYPE OF ORDER

( & b. DELIVERY

m a . PURCHASE

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MD

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=Lbjecl to insvucoons mnlatned on
ttils side on4 of l h ~ sl o r n and is
idsued subject to the lenns and
dbnditbons ol the above-numbered
+tract.

Please furnish the following on (he terms
and conditions specified on both sldes of
this order and on the anached sheets, il
any, including delivery as indicated.

1

20814

9. ACCOUNTING AND APPROPRIATIONS DATA

1

10. REQUISITIONING OFFICE

DHHS/AHRQ

7541700

;I

11. BUSINESS CLASSIFICATION (Check appmpriad bo@s))

'D

Destination

12. F.O.B. POINT

b. OTHER THAN SMALL

C.

--

14. GOVERNMENT BIUNO.

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"l~estination
1 b ACEFIX?$CE -

Destination

DISADVANTAGED

d. WOMEN-OWNED
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13 PLACE OF

a INSPECTION

..

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e. STATE

a. SMALL

=

REFERENCE YOUR:

7910 WOODMONT AVE, SUITE 1400

BETHESDA

1

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IS. DELIVER TO F.O.B. POINT
ON OR BEFORE (Dale)

.

Net 3.0

02/29/2004

.=

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17 SCHEDULE (See reverse lor Rejecbons)

SUPPLIES OR SERVICES

ITEM NO
(a)

ORDERED

(b)

1

QUANTIM
ACCEPTED

-1

Tax ID Number:
'5'DUNS Number:
CAN: K7225YM Obj. Class: 2522 FY: ~ u u 4

-.

1

-.

1 CALL COMPLETED FOR THE MONTH OF FEB 2004
(continued . .
18. SHIPPING POINT

1

19. GROSS SHIPPING WEIGHT

I

120.INVOICE NO.

I
21. MAIL INVOICE TO:

.

.

a. NAME
SEE BILLING
INSTRUCTIONS
ON REVERSE

b. STREET ADDRESS
(or P.0. Box)

22. UNITED STATES OF AMERICA
BY (Signature)

-

..

$000

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

d. STATE

.

e ZIP CODE

1

'

(Conr
pages)

4
I

17(i).
GRAND
TOTAL

S1.71d.00

23. NAME (Typed)

JULIA C. SAVOY

1

4

TITLE: CONTRACTINGIORDERING OFFICER
NSN 754&0l-152-8083
PREVIOUS EDITION NOT USABLE

OPTDYAL FORM 347 18- -51
R~-~GS~*LI((UICFRIS~~~Y~)

I
ORDER FOR SUPPLIES OR SERVICES
SCHEDLILE CONTlNUATlON

PAGE OF PAGES

-

/I

IMPORTANT: Mark all packages and papers mlh wnbad andlor order numbers
DATE OF ORDER

CONTRACT NO

ORDER NO

03/17/2004

HHSP23320042008RB

003

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 754041-152-8082

Ww&10(

1

1

I

1

OPTCJNAL FORM Y l InR
4 GSA
F I R I ~ C F R ) 5321%~)

INSTRUCTIONS FOR USE: This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acquisition Management, ASC, Room 5-77, Parklawn Bldg., no later than c.o.b., the 5th day of each month.
(Negative reports are required.) .

BLANKET PURCHASE AGREEMENT
RECORD OF CALL
Contractor North American Network, Inc.

Month: February 2004

I

1

1

Pages
I

BPA # HHSP23320042008RB
CAN #4-K7225YM

I

I

Date of
Call

Call
Number

Ordered

BY

I

General Descripti*
of ltems

1i

Dollar
Amount

Balance
Remaining

, ,

(Do NOT use)
For Program Use

I

L

\

Initial Amount or Balance Carried Forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

:

36,200.00

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I hereby kertlfy that the above suppliesl~ervicesare authorized purchase wder the above referenced BPA and were

procured by Authorized Callers.
S~gnatureof Aulhorlzed Program Offic~al

I

1

ORDER FOR SUPPLIES OR SERVICES
2. CONTRACT NO. (#any)

6. SHIP TO:(I

HHSP23320042008RB

05/13/2004
3. ORDER NO.

PAGES

/I

IMPORTANT: Mark all packages a n d p a p e n with c o n t r a c t andlor o r d e r n u m b e r s
1. DATE OF ORDER

oi

PAGE

a. NAME OF CONSIGNEE

4. REQUISITIONIREFERENCE NO.

DHHS/AHRQ

004

/b

5 ISSUING OFFICE (Address conespondenm lo)

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

I

STREET ADDRESS

REDLAND TECHNOLOGY CENTER
1ST FLOOR
540 CAITHER ROAD

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I

c. UTY

d STATE

ROCKVILLE

e ZIP CODE

20850

1. SHIP VIA

TOM SWEENEY

7,'O:

MD

. .

.

a. NAME OF CONTRACTOR

NORTH AMERICAN NETWORK, INC.

I

8 T<PE OF ORDER I

b COMPANY NAME

I ffi

O a PURCHASE

. ,

.

. .
..
7910 WOODMONT AVE, SUITE 1400

c. STREET ADDRESS

d. CITY

. ...

=
-.-.

.-

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:Ims srde oniy 01 mu formand is
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P k 5 e furnish the follming on the terms
and o D n d i r soecjhed on both sides of
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any, incluling d e l i as i n d i t e d .

1. ZIP CODE

:kmkct

20814

9. ACCOUNTING AND APPROPRIATIONSDATA

10. REQUISITIONINGOFFICE

DHHS/AHRQ

7541700
11. BUSINESS CLASSIFICATION (Check appmpfi&

--

Destination
b,

Destination

ACem.A~cE
-

1I

15. DELIVER TO F.0.8. POINT
ON OR BEFORE (Dale)

14. GOVERNMENT BIUNO.

13. PLACE OF
a. INSPECTION

b

c. DISADVANTAGED

b. OTHER THAN SMALL

a. SMALL
12. F.O.B. POINT

. =zI

Except fo/bl'ing m s t r u c M n s on the
irevene. this dellvery order is
I,sublect lo insmrtions contained a

e. STATE

BETHESDA

b DELIVERY

I

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----

REFERENCE YOUR:

04/30/2004
.-j4

Destination

ITEM NO

SUPPLIES OR SERVICES

UNlT

ORDERED
(c)

-.

(4
-

1 ?6.DISCOUNT TERMS
.

Net .30..

.

'I

17. SCHEDULE (See reverse tor Rejedions)

QiANTlM

d. WOMENQWNED

QUANTITY
ACCEPTED

UNlT
PRICE
(e)

(9)
.--.

DUNS Number-:
CAN: K7225YM Obj.

..

Class:

2522 FY': 2004

4CALLS COMPLETED FOR THE MONTH APR -04

I

I
19. GROSS SHIPPING WEIGHT

18, SHIPPING POINT

I

I
20. INVOICE NO.

I

I

17(h).
TOTAL
(Con!.
pages)

21. MAIL INVOICE TO.
.

a. NAME

SEE BlUlNG
INSlRUCTIONS
ON REVERSE

b. SIREET ADDRESS
(or P.O. Box)

. -

$0.00,

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

I
17(i).
GRAND
TOTAL

'I

c. CITY

ROCKVILLE

d. STATE

- .

22. UNITED STATES OF AMERICA

\

MD

$7,800.OO

e. ZIP CODE

I

20857
23. NAME (Typed)

JULIA

BY (Signature)

C.

SAVOY

~

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TITLE: CONTRACTINGIORDERING OF~ICER
NSN 754001-152-8083
PREVIOUS EDITION NOT USABLE

$

O n W L FORM Y7 1 % ~hm
Ra-

4 G S M I R 1- CFR113 21X.1

..

.- -

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ORDER FOR SUPPLIES OR SERVlCES
SCHEDULE CONTINUATION

-

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 754W1-1524082

%+..6101

1

PAGE OF PAGES

2

1

2

'1
O P T I O W FORM Y I&.

-)*m

b951

FAR 148 C I R I U I 1 X c l

lNSTRUCTlONS FOR USE:

This form is to be maintained on a monthly basis, with a copy'to be submitted to the Division of Acquisition Management, ASC, Room 5-77, Parklawn Bldg., no later than c.o.b., the 5th day of each month.
(Negative reports are required.)

'

BLANKET PURCHASE AGREEMENT
Contractor North American Network, Inc.
RECORD OF CALL
I

Month: April 2004

I

- -b

-

-

1

1

-

-

I
-

~abes

BPA # HHSP23320042008RB
: CAN #4-K7225YM

11,

Date of
Call

Call
Number

Dollar
Amount

General Description
of Items

Ordered
By

I

lnitial Amount or ~alancecarried ~oiward.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .
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(Do NOT use)
For Program Use

Balance
Remalning

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Monitoring Spanlsh Safe Medications

I
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1 I hereby certify that the above supplieslservicesare authorized purchase under the above referenced=~ and were
-

procured by Authorized Callers.

-

Signature of Authorized Program Offlclal:

-

I

ORDEI.

J R SUPPLIES OR SERVICES

I

HHSP23320042008RB

09/06/2004

a. NAME OF CONSIGNEE

3. ORDER NO.

4.REQUISITION/REFERENCE NO.

DHHS/AHRQ

005

i

I

5. ISSUING OFFICE (Address conespondence lo)

b. STREET ADDRESS

DHHs/Psc/sAs/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

REDLAND TECmOLOGY CENTER
1ST FLOOR,
540 GAITHER ROAD

-

..

,

c. CITY

..

d. STATE

ROCKVILLE
TOM SWEENEY

7.TO:

7

2 CONTRACT NO (Iany)
f

1. DATE OF ORDER

MD

e.

DP CODE

20850

1. SHIP VIA

a. NAME OF CONTRACTOR

NORTH AMERICAN NETWORK, INC.

. .

..

.

.

.

8. TYPE OF ORDER

c. STREET ADDRESS

.-

7910 WOODMONT AVE, SUITE 1400

.-.

.

d. CITY

.

Excepl f a biding insrruct&s on the
- -&:thk
delivery order IS
subjkt to inslructions cnnlained on
this s/de only of this lam and a
IS+
subled to the terms and
conditions of the above-numbered

C

e. STATE

BETHESDA

MD

f. ZIP CODE

Please furnish the following o n n t terms
and c m d I o n s spe*~ed on both sides 0t
this order and on the aanached sheets, it
any, including delivery as indimled.

.20814

9. ACCOUNTING AND APPROPRIATIONS DATA

I
10. REQUISITIONING OFFICE

I

DHHS/ ~ R Q

7541700

..

REFERENCE YOUR:

. -

,..

.

...

.

1

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B 4.DELIVERY

C a. PURCHASE

b. COMPANY NAME

~p

-

-

11.BUSINESS CLASSIFICATION (Check appropnale box(es))

.-,'. .U
...- b. OTHER THAN SMALL

a. SMALL

- wl:

Destination

12.F.O.B. POINT

. ..

13. PLACE OF

14.GOVERNMENT BRINO.

16. DISCOUNT TERMS

IS.DELIVER TO F.O.B. POINT
ON OR BEFORE (Dale)

.

Net 30

05/31/2004

I b. ACCEPTANCE

a. INSPECTION

d. WOMEN-OWNED

-

Destination

SUPPLIES ORSERVICES . .

ITEM NO.

..

.

1

17. SCHEDULE (See reverse tor Rejedions)

(a)

b4

Tax ID Numbel
DUNS Number:
CAN: K7225YM Ob]. Class:

td)

(CI

!b)

L>La r l :

(el

(0

!-JI

QUANTITY
ACCEPTED

(a

LUU;

-

2 CALLS COMPLETED-.FOR T H E MONTH OF MAY 2004

!

-

.

Continued . . .

I
18.SHIPPING POINT

1

I
17fh).
TOTAL

20. INVOICE NO.

19. GROSS SHIPPING WEIGHT

21.MAIL INVOICE TO.

so:00 7

a. NAME

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

SEE BILLING
INSTRUCTIONS
ON R N E R S E

b. STREET ADDRESS
(or P.O. BOX)

d. STATE

c. CITY

ROCKVILLE
22. UNITED STATES OF AMERICA

MD
.

fl

/1

e. ZIP CODE

I

17(i).
GRAND
TOTAL

1
I

$4,400.00

20857

1 23. NAME frmedi
. .. .
JULIA C. SAVOY

BY (Signature)

1
I

4

1

TITLE: CONTRACTlNGlORDERlNG OFFICER

/ O P ~ O W LFORM 347

NSN ~ Y W I - ~ S Z ~ O B ~

PREVIOUS EDITIONNOT USABLE

/'

msj

-

I

it SUPPLlES OR SERVICES
SCHEDULE CONTINUATION

ORDEfi

PAGE OF PAGES

-

1

IMPORTANT: Mark all packages and papers with mntrad andlor order numbers
DATE OF ORDER

CONTRACT NO

ORDER NO

I

INSTRUCTIONS FOR USE: This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acquisition Management, ASC, Room 5-77, Parklawn ~ l d ~no. ,later than c.o.b., the 5th day of each month.
(Negative reports are required.)

BLANKET PURCHASE AGREEMENT
RECORD OF CALL
Contractor North American Network, Inc.

Month: May 2004

1

Date of
Call

1

1

Call
Number

Ordered
BY

Pages

BPA # HHSP23320042008RB
CAN #4-K7225Y M

i
4
1%

I
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General ~ e s c r i ~ t i o i
!
of Items ,
. (8

Dollar ,
Amount

Balance
<Fernaining

I

t

(Do NOT use)
For Program Use

8

Initial Amount or Balance Carried Forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . . . 1 : 26,690.00)

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5/20

12

KC
KC

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Production/Distribution English Childre
Production/Distribution Spanish Childr

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1

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I hereby certify that the above supplieslservices are authorizeb purchase u d ~ e the
procured by Authorized Callers.
Signature of Authorized Program Official.

-

,

I

\i(1

3 R SUPPLIES OR SERVICES

ORE.

'

IMPORTANT: M a r k all packages a n d papers w ~ t h
c o n t r a c t a n d l o r o r d e r numbers
2 CONTRACT NO (11any)

1 DATE OF ORDER

6 SHIP TO

HHSP23320042008RB

PAGE OF PAGES

1

a NAME OF CONSIGNEE

09/06/2004

I

I

4 REQUISITIONIREFERENCENO

3 ORDER NO

DHHS/AHRQ

006
5 ISSUING OFFICE (Address conespondenat lo)

b STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

REDLAND TECHNOLOGY CENTER
1ST FLOOR
540 GAITHER ROAD
c CITY

d STATE

llm

ROCKVILLE
a. NAME OF CONTRACTOR

NORTH AMERICAN NETWORK, INC.

B. TYPE OF

b. COMPANY NAME

ORDER

7910 WOODMONT AVE, SUITE 1400 . ,

-

-

/ .

.

.-

.

;

~

.

e. STATE

d. C I M

BETHESDA

REFEREKCE YOUR:
--.-..

--

.

1. ZIP CODE

9. ACCOUNJING AND APPROPRIATIONS DATA

-?

1
31

DHHS/AHRQ

l l . BUSINESS CLASSIFICATION (Check appmpriate box(es))

a. SMALL

-- b. OTHER THAN SMALL

#

X.".

Destination

12. F.O.B. POINT

----

. .
.

this slide oniy of mis form and is
iss+ subject to me terms and
conditions 01 me aboue-numbered

Please furnish lhe following on the terms
and wnddms speM~edon both sides of
order and on the anached sheets, il
any, including delivery as indlcaled.
10. REQUlSrllONlNG OFFICE

7541700

E x l fw bii\ing instrucb%nsm the
hs dellvery order is

&:

subikt to inslructions contained on

20814

MD

d. DELIVERY -.

(

a. PURCHASE

c. STREET ADDRESS

e ZIP CODE

20850

II

I. SHIP VIA

TOM SWEENEY

7. TO:

I

c. DISADVANTAGED

'6. DISCOUNT TERMS

1s. DELIVER TO F.O.B. POINT

14. GOVERNMENT BRMO.

d. WOMEN-OWNED

ON OR BEFORE (Date)
13. PLACE OF

--

b. ACCEPTANCE

a. INSPECTION

-

Destination

Destination

.

,

. ..

,

ITEM NO.

SUPPLIES OR-SERVICES

(a)

(b)

;,

(d)

IC)

.

.. . .

UNIT
PRICE

..

.-cAMOUNT,

F

. ==

( f)

le)

-

(9)

b -,

.

.

--

2 CALLS COMPLETED FOR THE MONTH OF J U L Y 2004

1

Continued . . .

.

4,4%@._qO_.. ~ - .

..

I

.

19. GROSS SHIPPING WEIGHT

18. SHIPPING POINT

20 INVOICE NO.

I

I
$0.00

a. NAME
SEE BILLING
ON REVERSE

b. STREET ADDRESS
(01P.O.

Box)

.. - .

PSC/FMS ' (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

I

l

s
.. I
171;).

d.

c. CITY

ROCKVILLE

A

17(h).

TOTAL

21 MAIL INVOlCE TO:

INSTRUCTIONS

S
MD

~

I

ke. ZIP~CODE
~
20857

GRAND
TOTAL

4

$4'4000'p

23. NAME (Typed)

22. UNITED STATES OF AMERICA

JULIA C . SAVOY

BY (S~gnature)

TITLE. CONTRACTINGIORDERINGOFFICER
NSN 754041-152-8083
PREVIOUS EOlTlON NOT USABLE

-- .
--

QUANTITY
ACCEPTED

Tax ID Number:
DUNS Number:
CAN: K7225YM C u j . u a s s : 2522 FY: 2004
-

.

1

17. SCHEDULE (See reverse for Rejecl~ms)

QUANTITY
ORDERED UNIT

-

Net 30

07/31/2004

r

OPTIONAL FORM 347 f R n 0 5 1

R

I

e 17

G S M m l e CFRIJI 2lX.l

..

-. ..

I

ORDER
A SUPPLIES OR SERVICES
SCHEDULE CoNTlNuATloN

PAGE OF PAGES

-

2

DATE OF ORDER

CONTRACT NO

006

I

SUPPLIESISERVICES

(A)

i

--

I

ORDER NO

09/06/2004 HHSP23320042008RB
ITEM NO

I
I

IMPORTANT: Mark all packages and papers mth conbad and/or order numbers

QUANTITY UNIT
ORDERED
(C)
( 0

(8)

T o t a l amount of award: $4,400.00. The ob1lga:lon
17 (i).

UNrT
PRICE
(E)

A M(F)
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NSN 754M)l-152-8082

SO-101

OPTIONAL FORM U d l b 6951
Rn4 GS*
FLRI48CFRI 5 3 2 I X c I

lNSTRUCTlONS FOR USE:

This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acquisition Management, ASC, Room 5-77, Parklawn Bldg, no later than c.o.b., the 5th day of each month.
(Negative reports are required.)

BLANKET PURCHASE AGREEMENT
RECORD OF CALL
Contractor North American Network, Inc.

Month: July 2004

I

1

Pages

BPA # HHSP23320042008RB
CAN #4-K7225YM

,

,

Date of
Call

Call
Number

General ~e~criptiod
of Items '

Ordered

BY

Dollar
Amount

*t

5

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Balance
.Remaining

(Do NOT use)
For Program Use

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Initial Amount or Balance Carried Forward. . . . . . . . . . . . . . . .,.. . . . . . . . . . . . . . . . ,. . . . . . . . . : 22,290.001
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Monitoring English Children's Vision

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Monitoring Spanish Children's Vision

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I hereby certify that the above supplieslservices are authorized purchase uMer the above referenced BPA and were
procured by Authorized Callers.
Signature of Authorized Program Offic~al (

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7

ORDt. .-OR SUPPLIES OR SERVICES

.-

IMPORTANT: M a r k all packages a n d papers w i t h c o n t r a c t a n d l o r o r d e r numbers
1 DATE OF ORDER

2 CONTRACT NO (If any)

6 SHIP TO

HHSP23320042008RB

09/06/2004

a NAME OF CONSIGNEE

I

3. ORDER NO

4. REOUlSlTlONREFERENCE NO.

007
5 ISSUING OFFICE (Address conespondenw loJ

b. STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

REDLAND TECHNOLOGY CENTER
1ST FLOOR
I 540 GAITHER ROAD

-

d. STATE

ROCKVILLE
I. SHIP A
VI

TOM SWEENEY

7.TO:

Lxz-

c. ClTY

-

a. NAME OF CONTRACTOR

-

NORTH AMERICAN NETWORK, INC.

-

e. ZIP CODE

-

8 TYPE OF ORDER

b COMPANY NAME

k

m a PURCHASE

c
7910 WOODMONT AVE, SUITE 1400.:
REFERENCE YOUR

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a bdl~ngl n s ~ b o n on
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se m a delwery order IS
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Ide only of thls fwm and IS
d s u b 6 1 to the terms and
lbons of the above-numbwed
act

Pleaselumish the following on the terms
and m d i b o n s w e d on both sides of
the order and on
allached sheets, if
any, including delivery as i n d i t e d .

1. ZIP CODE

e. STATE

BETHESDA

.-. -.

MD . 20814

9. ACCOUNTING AND APPROPRIATIONS DATA

--

,

10. REOUlSrrlONlNG OFFICE

DHHS/AHRQ

7541700
11. BUSINESS CLASSIFICATION (Check appropriate box(esJJ

a. SMALL

Destination

12. F.0.B. POINT

1

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16. DISCOUNT TERMS

15. DELIVER T o F 0.0. POINT
ON OR BEFORE (Dale)

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Destination

14. GOVERNMENT w u N o .

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13. PLACE OF
a. INSPECTION

d. WOMEN-OWNED

- c. DISADVANTAGED

b. OTHER THAN SMALL

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17. SCHEDULE (See reverse tor RejedionsJ

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IOUANTITY~

(a)

Ib)

Tax ID Number:
DUNS Number :
CAN: K7225YM Ob].
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ORDERED~
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(c)
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SUPPLIES OR SERVICES

ITEM NO.

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OUANTlTY
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2004

2 CALLS COMPLETED FOR THE MONTH OF
SEPTEMBER 2004 Continued . . .

-

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la. SHIPPING POINT

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20. INVOICE NO.

19. GROSS SHIPPING WEIGHT

I

TOTAL
(Conf
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21. MAlL INVOKE TO:
a. NAME
SEE BILLING
INSTRUCTIONS
ON REVERSE

$0.00
PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

b. STREET ADDRESS

(or P.O. BOX)

22. UNITED STATES OF AMERICA

-

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/ 1

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e. ZIP CODE

1

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23. NAME (Typed)

JULIA C. SAVOY

BY (S~gnarure)

TITLE: CONTRACTlNGlORDERlNG OF1

R
OPTIONAL F O W 347 IRr Wl

NSN 754C-01-152-8083
PREVIOUS EDITION NOT USABLE

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$4,40

20857

MD

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GRAND
TOTAL

d. STATE

c. CITY

ROCKVILLE

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.< SUPPLIES OR SERVICES

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 7540-01-152-8082

YI?-U101

1

PAGE OF PAGES

11
OPTIONAL FORM 2 4 law. -51
R
Q GSL
FAR (48 CFRI 511131c1

INSTRUCTIONS FOR USE: This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acquisition Management, ASC, Rooms-77, Parklawn Bldg., no later than c.o.b., the 5th day of each month.
(Negative reports are required.)

BLANKET PURCHASE AGREEMENT
RECORD OF CALL
Contractor North American Network, Inc.

Month: September 2004

Date of
Call

1

1

Call
Number

Ordered

Pages

BPA # HHSP23320042008RB
CAN #4-K7225YM

,

I

BY

General ~escri~tidh
of Items !

:+

Dollar
Amount

. 4,

Balance
Remaining

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Initial Amount or Balance Carried Forward. . . . . . . . . . . . . . .:. . . . . . . . . . . . . . . . . . . . . . . . . . ,
9115

16

KC

,

(Do NOT use)
For Program Use

11,600.00

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9115

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ProductionIDistribution Spanish
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Amendment to Decrease

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I hereby certify that the above ~ ~ ~ ~ l i e s l s e r vare
i c eauthorized
s
purchase h d e r the above referenced BPA and were
procured by Authorized Callers.
,

Signature of Authorized Program Oflic~al:

4

1 I
d

1 THIS
CONTRACT IS A RATED ORDER
UNDER DPAS (15 CFR 350)

AWARD 1 CONTRACT
2

CONTRACT (Proc lnsf ldenl ) NO

3

EFFECTIVE DATE

Program Support Center, HHS
Division of Acquisition Mana ement,SAS
Parklawn Buildmg, Rmm 5-18]
5600 Fishers Lane
Rochrille, MD 20857
.
-

1

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7. NAME AND ADDRESS OF CONTRACTOR (No.. street, city, county, State a n d ZIP Code)

American Urban Radio Networks
432 Park Avenue, South, 14th Floor
New York, NY 10016
DUNS:
,

--

CODE

...

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Title:

1 1 1 4 f

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9

~ ~ H E R ~ e e b e l o w )

DISCOUNT FOR P R O ~ P T
PAYh1ENT

A

10. SUBMIT INVOICES

1 ITEM
-

--

See Sect~onG 2
CODE

12 PAYMENT
w ~ L LBE MADE BY

Financ~alManagement Service
Parklawn Buildmg, Room 16A-12
5600 Fishers Lane
Rockville. MD 20857

!~
1

14. ACCOUNTING AND APPROPRIATION DATA

7540120
4-1990123 252V $200,000.00

@ 41 U.S.C. 253(c) ( 01 )

ort tali-ty

FOB ORIGIN

FACILITY C O D E

13. AUTHORITY FOR USING OTHER THAN FULL AND OPEN
COMPETITION:
)

I1

1

8. DELIVERY

Net 30

~.

CODE
11 SHIP TOIMARK FOR

cdDE1

6 ADMINISTERED BY (If other than Item 5)

CODE

10 U.S.C. 2304(c) (

o;Pms

04T276356

ISSUED BY

EIN:

P
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4 REQUISITION 1 PURCHASE, REQUEST PROJECT NO

HHSP23320032201TC
5

RATING

ad id campai$ll

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and Health ~ i s ~ a j i t i e s

Period of kerformance: June 11, 2004 to J$e

10, 2 0 0 4

- i - 4.-. -

Contract

e: Firm ~ixe-&~rice
I

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(x)SEC.

I

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DESCRIPTION

-

PAGE(S)

PART I THE SCHEDULE

XI

A

x/

B

X

I

C

DESCRIPTION ISPECS.,/ WORK STATEMENT

x

D

PACKAGING AND MARKING

X

E

INSPECTION AND ACCEPTANCE

x
x

I

l

1

SOLICITATION ICONTRACT FORM

1 SUPPLIES OR SE,RVICES 8 PRICES ICOSTS

2

1

I
I(x3l SEC. 1
DESCRIPTION
1
PART II - CONTRACT CLAUSES
/ X I I CONTRACT CLAUSES I

1

.

-

1

J

I

LIST OF ATTACHMENTS

I ---

- '-

-

DELIVERIES OR PERFORMANCE
CONTRACT ADMINISTRATION DATA

L

INSTRS.. CONDS.. 8 NOTICES TO OFFERORS

H

SPECIAL CONTRACT REQUIREMENTS

M

EVALUATION FACTORS FOR AWARD:\

CONTRACTOR'S NEGOTIATED AGREEMENT (Contrador is requrred

18.

-..

AWARD (Conlnctor i s not required to sip;
... . .

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&s document.) Your

L m

~
~
~
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$
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*rbe
~
by
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~ or~_nges
~ are
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in fullamve,is h e r e y acceved as to the items listed a&,ve and on any conenua~ion
sheers. This award consurnwales the conlract which consis'k of Ihe fdlowmg documents:
(a) the Govemmenl's soliotat~onand your offer, and (b) ttils awardkontract. NO furlher
document necessary.

Janet
19C DATE SIGNED 20s

H. Miller
19C DATE SIGNED

UNITED STATES OF AMERICA

I BY

-

I

20A. NAME OF CONTRACTING OFFICER

NAME AND TITLE OF SIGNER p y p e orpnnt)

NSN 7540 - 01 152 8069
PREVIOUS EDITION UNUSABLE

....

-

F

(S~gnafureof p e w authorized to sfgn)

.....

REPRESENTATIVES AND I~-JSTRUCTIONS
I
REPRESENTATIVES, CERTIFICATIONS AND
OTHER STATEMENTS OF OFFERORS;

G

BY

PAGE(S)

PART III LIST OF DOCUMENTS. EXHIBITS~ANDOTHER A T ~ A C H
PART IV

to sign this documenl and relum
copies to issuing ofice.)
Contract.
agrees to h r i s h and deliver all items w p d o m all the senices set lo* or
othervnse identified above and on any continuallon sheers for the consideratlon.slated
herein. The nghls and obligations ol the ParlleS to this Contract shall be subject to and
govemed by the follcwing documents: (a) this awardlconlracf, (b) the solicitation, rf any.
and (c) such povis~ons,represenlalions,certrficaltons,and spedficat~ons.as are attached
or ~ncorvoratedbv reference heretn, lAIfachments are listed herein.)

19A

I

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CONTRACTING OFFICER W L L COMPLETE ITEM 17 OR 18 AS APPLICABLE
17.

_

l

ISG. TOTAL AMOUNT OF CO~TRACT--~~./$
=
16. T A B L E OF CONTENTS

(Sfgnature of Conlractrng Officer)

'1
STANDARD FORM 26 (REV
PlesmWd GSA
FAR I48 CFR153

4.

BS.

2I4lar

CnBtrd b ? . P s M~ d r An. B8mch(1011141-2454

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PART I
THE SCHEDULE
SECTION B
B.l

-

SUPPLIES OR SERVICES AND PRICES/COSTS

In consideration of performance of the work descri
Section.C, ~escription/Specifications/WorkStateme
Contractor shall be reimbursed as follows:
Firm Fixed Price: $200,00Q.00

!d in
. , the

I
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HHSP23320042201TC
I1
P a g e 2 of 1 5

~l
PART I
THE SCHEDULE

C.l

PROJECT T I T L E
Il
Infant Mortality and ~ e a l t hDisparities Radio Campdign

C.2

PURPOSE OF THE CONTRACT

The overall goal of the-project is to provide a media base
to support the technical assistance efforts of...th:e&iilot . .
The contractor '&all". assist OMH in the development o f the
media campaign effort based upon their expertise in
reaching the African American population.
-

In light of these overarching goals, the specific
objectives of this program are to:

~

~

I

Develop,a, structure for a national media
those id?~widuals in the pilot locations
reduction i n infant deaths amongst the African ~i,brican
populat :on.
-L.-

-iL

-

-

,#

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state-based p'artners

Support HRSA and its community- and
in reaching those at risk through a mass media efkort. It
is well documented that the more people heai inf4inatfon
through as many communications channels as possiblle, the
W
greater the likelihood for change. African Americans
use
.radio as one of their primary modes of communicatkon.

I

provide am-frameworkfor information to be delivered To a'n
entire African American family through one media Houtlet
H ages of
and various formats for music and to reach various
those who might have a role in infant care.
Create a relationship with the existing talent wibh an
interest and appeal for issues related-to infant brtality
and other disparities initiatives. The cont;actbr shall
have the ability to connect with the kind of celebrities
that have credibility and standing regarding such issues
within the African American community.
I

I
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Enhance participation of families in playing a rble from
the beginning of one's pregnancy through
ensure that infants are properly cared foT and

!~

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:

PART I
THE SCHEDULE

expectant mother receives proper prenatal care. ~ h e s ePSA
awareness messages serve to reinforce work at theI
community level through HRSA.
1~
Create the capacity to develop an expertise in developing
messages around this initiative and the ~epartmeAt
s
entire health dispariti-es initiative.

The primary focus of this first phase of the national
campaign will..focus on laying a strategic found-qion up&
which additional outreach by communities can re1
build support to bring about a change in behavior to thus
reduce the rate of infant mortality amongst ~frldan
Americans.
The messages will enhance the effords of the
pilot states in developing their initiatives.

--

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C.3

OVERVIEW

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The Department of Health and Human Services (HHS) has a
long history in the fight to eliminate racial and eihnic
disparities in health. While gains have been made,
signific2"ri't-"dfSparities in some health outcomes for racial
and ethnic minorities remain. To address this challenge,
the Secretary charged the Deputy Secretary with mar$hal-*ng
the Department's resources and talents to achieve
reductions in disparities.

I

- < .

1-

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~ t - t h request
e
of the Deputy Secretary, a plan of-aition to
address-rac-fa1 and ethnic disparities in health-was.. .> - I
the
recently finalized. The plan establishes the Closiyg
Health Gap Initiative and calls for new and expande@.
activities to address disparities using a targeted And
'I
coordinated Departmental approach. As a first measyre,
the
Closing the Health Gap Initiative will focus on raclal and
'I
ethnic infant mortality, cancer screening and managgment,
cardiovascular disease and stroke, diabetes, H.~V/AI$S,and
child and adult immunization disparities. Other hehth
issue areas requiring Departmental action will be
-i'ncorporatedin the future.
1

.~

Under the Closing the Health Gap Initiative, HHS acbions
targeting the elimination of racial and ethnic healFh
disparities must address one or more of the
objectives:

-.
--.

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..- .

PART I
THE SCHEDULE

Strengthening the science
Connecting people with services
Helping pe0~1e take charge of their health
Establishing partnerships that matter
To ensure momentum in meeting these objectives, th Closing
the Health Gap Initiative also calls for developme t of .'
focused initiaEives around each of the six dispari y health
areas. -This program, Closing the Health Gap -?miti Live 'on
Infant Mortality, was developed in response to thi
directive. For more than 20 years, research has s own that
some racial and ethnic minorities experience great r rates
of infant mortality. In 2001, in the U.S., infant of
black mothers had a mortality rate of 13.3, more t an four
times the rate for infants of Chinese mothers who
experienced the lowest rate of 3.2. The mortality rate for
infants o f ~ i l i ~ i nmothers
o
was 5.5 and 5.7 for in ants of
non-Hispanic white mothers. Both of these rates w re lower
than the rates for infants of Hawaiian (7.3) and A erican
Indian --mothers
(9.7). At the same time, some raci 1 and
-**- - - ethnic minorities continued to experience the high st rates
of infant mortality from low birth weight (LBW) an SIDS.
- i-gliest
Infants of-black and Puerto Rican mothers had'the
infant mortality rates from low birth weight. The r rates
were approximately four and two times, respective1 , that
of infants born to white mothers. With respect to SIDS,
infants of black mothers had a rate that was 2.5 t mes that
-of white mothers.

-

This project supports the implementation of the Af
American-focused Risk Reduction component of the H
Closing the Health Gap Initiative on Infant Mortal
through the communication and media outreach compo
The goal is to accelerate the rate of change among
American populations and reduce the significant di
in infant mortality for African Americans through
national campaign centered around education and aw
messages. The primary areas of infant mortality di
for the African American population are related to
birth weight (LBW)/preterm birth (PTB) and Sudden
Death Syndrome (SIDS). This media effort will supp
current pilot projects to be funded through HRSA i

ican
S
tY
ent .
African
parity
reness
parities
low
nfant
rt the
a pilot

-

.
.
-.
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--__

-..-

PART I
THE SCHEDULE

to four States selected on the basis of having significant
11
African American births and high infant mortality rates
due
to LBW/PTB and s ~ D S ; - t h states
e
identified are South
Carolina, Michigan, Mississippi, and Illinois. ~ h dmedia
component is key to the overall program initiative which
will serve to reinforce the work of the local
partners.
11

.

Each state will ocus attention on imp1
0 two communities to: ( 1 ) build
projects in-.-one
.
.=:..'
existing act ivi es that contribute to infant m~ri?$~i
reduction; and (2) employ evidence-based interventdons that
could cont;ibute to reductions in LBW/PTB and infaAt
mortality that arq associated with LBW/PTB or SIDS. In
support of these states, the Contractor must have d strong
base for outreach in these areas specific to ~frican
Americans
-

.

.

.

..

.

. .

::
.

04

1~

f =

The office%£ Minority Health (OMH) is a collaborative
partner i n this project with HRSA and has the
responsibility for providing media support to the riational
campaigzlr--The media buy and production of publlc service
announcements (PSAs) are part of the national
..
support the overall initiative.
11

-_-

-

C. 4

STATEMENT OF WORK

1

I

This national campaign is unique in that it not only_ provides awareness messages but calls for a change in
behaviors. Given this need, the community needs to
perceive this as more than merely playing-a radio Jpot.
11

I

-- ..
4

1

Working with the Project Officer and other individyals
(possibly other Contractors associated with varioud aspects
of the campaign) assigned to the program, the ~ont!~ctor
I
shall provide all necessary personnel, materials, services
and otherwise do all thihgs necessary to perform the tasks
Jisted below:
4.1

1

Strategically recommend an,d secure
'I
individuals for talent to reach this audien~e;

Provide Talent.

II

PART I
THE SCHEDULE

Assist OMH in writing a PSA and
be able to articulate culturally appropriate
messages to African Americans in a way that' allows
for receptive receipt of information;

4.2

Writing Assistance.

4.3

Production.

I

Produce a professional , quali!y,
educational piece;

.

4.4

PSA CDS.

8'

Provide copies via CD ( 2 0 ) of eadh PSA,

4.5

The-Cbntractor shall allocate ai4time on-a
-network'bf stations for a five - week-perk to
include the pilot states through various m?sic
genres. (see Attachment 1 for schedule of
broadcasts) ;

4.6

The Contractor shall blay a
role in assisting OMH in impacting the lives of
African Americans. The Contractor must ha+e
cdpsiderable reach into the community throkgh its
network of stations to effectively reach i dividuals
P
at all levels and all ages with the focus on African
Americans
and infarit ncrtality.
- -

Airtime.

I

Community Outreach.

'

-+-.&-

-

-

-.-

PART I
THE SCHEDULE
SECTION D
D.l

- PACKAGING AND MARKING

PAYMENT OF POSTAGE AND FEES

All postage and fees related to submitting informatlion
including forms, reports, etc . , to the Contracting 10:ficer
or the Project Officer shall be paid by the Contractor.
MARKING

-

.

. --

--

e

.-

7;-

All infdrmation -submitted to the Contracting Officer or
Project Off-icer shall clearly indicate the contract number
and deliverable for which the information is being 1
submitted.

PART I
THE SCHEDULE
SECTION E
E.l

- INSPECTION

INSPECTION

-

-

AND ACCEPTANCE

.

.

Inspection and acceptance of all services called : )r by the
contract shall be made by the Project Officer in
conjunction with the PSC--ContractingOfficer.
E.2

52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 19
)
- 3.

..

.

This contract incorporates one or more clauses by
reference, with the same force and effect as if tl ty were
given in full text. Upon request, the Contracting )fficer
will make their full text available. Also, the fu: text of
a clause may be -accessed electronically at this/tl !se
address (es):

FAR C M W 3 E -NO?
52.246-4

TITLE AND DATE
Inspection of Services - Fixed

PART I
THE SCHEDULE
SECTION F

-

DELIVERIES OR PERFORMANCE

The period of performance for this contract shall e
June 11, 2004 through June 10, 2005, unless the pe iod is
extended by modification to this contract.
DELIVERY SCHEDULE

.

.

The ~ontractor'shallwork with the Project ofrice?
other sourFes to develop Public Service Announceme
other media as for the "Closing the Gap" media can
The Contractor shall produce and deliver the apprc
announcements as indicated in Attachment 1 - Deli1
Tablc. In addition the Contractor shall prepare ar
distribute 20 compact disks (CDs) of each approvec

a-rid
ts and
aign.
riate
rable
.

PSA .

?,

,J

*One (1) hardcopy of each PSA shall be submitted t the'
Contracting Officer, Division of Acquisition Manas ment ,
AOS, General -AcquisitionsBranch, Parklawn Buildir , Room
5-101, 5600 Fishers Lane, Rockville, MD 20857.
.--

F.3

- -

...-

5 2 . 2 5 2 - 2 CLAUSES INCORPORATED BY REFERENCE (FEB 15 8
.--..

his contract incorporates one or more clauses by
reference, with the same force and effect as if tk y7 .yere.=..
given in full text. Upon request, the Contracting fficer
will make their full text available. Also, the ful text of
a clause may be accessed electronically at this/tf se
address (es):
.

h t t p : //www. a r n e t . g o v / f a r /
. -d

FAR CLAUSE NO.
52.242-15

TITLE AND DATE
stop-work Order.

(AUG 1989)

....

PART I

THE SCHEDULE
SECTION G

-

CONTRACT ADMINISTRATION

The Contractor shall forward electronic funds tranAfer
in£ormation in writing to HHS Program Support center,
Division of Financial Operations, Parklawn ~uildind,Room
16-05, 5600 Fishers Lane, Rockville, Maryland
accordance with Section I, Clause 52.232-34.
-

G.2

INVOICE~SU=MISSI~N

.

20857t
Jr

In

----.

-

In addition to the information required by Section I ,
Clause 52.232-25 the following information is also required
for submission of a proper invoice.
Signature of an authorized official certifyingI the
invoicg to be correct and proper for payment;

a)

-

%,

'I

b)

Peri~dof performance for which costs are claimed:' and

c)

Tax--4denLif
ication number (employer's identification
number) or social security number.

I

I
,?

d)

.
e)

. =_

The voucheis shall show the Contract ~&-&er,
game, and
telephone number of the Government Project Of5icer on
the face page of the voucher.

~

The Contractor shall submit vouchers monthly.+_One
-.I
original voucher complete with all required backup
documentation shall be forwarded to the contracting
Officer and addressed as follows:

Department of Health and Human Services
Division of Acquisition Management,
Parklawn Building, Room 5-101
5600 Fishers Lane
Rockville, ~ a r ~ l a n d20857

~

Three copies of the voucher with copies of ali
required backup documentation shall be submitied
directly to the Finance office for payment. All calls
concerning payment shall be directed to the
helpline on (301) 443-6766.

PART I
THE SCHEDULE

Payment Office:
-

-

Department of Health and Human Services,
PSC/FMS/DFO Commercial Payments Section
Parklawn Building, Room 16A-2
5500 Fishers Lane
20857
Rockville, Maryland
--

.

G. 3

.

-

Project- o f f i c e r - -

----

The project Officer responsible for the technical
requirements covered by this contract, as contempl
Section [G.41 , "Technical Monitoringt'hereof, will
designated by separate correspondence.
-

\.?.

Performance of the work under this contract shall I e
subject to the technical monitoring of the Project Officer.
The te~m--!!Tec'knical Monitoring" is defined to incl ~ d e ,without limitation, the following:

,.

. .-

--- .

= =

a) Technical directions to the Contractor which rec irect the
contract effort, shift work emphasis between wo: k areas
or tasks, require pursuit of certain lines of ii w i r y
fill in details or otherwise serve to accomplisl
contractual scope of work,
.1

b) Providing information to the Contractor for ass.stance in
the interpretation of drawings, specifications
technical portions of the work description.
(

C) Review and, where specified by the Contract, apl roval of
technical reports, drawings, specifications-bandtGchnica1
information to be delivered by the Contractor tc the
Government under the contract.
Technical direction must be within the general scc )e of
work stated in the contract. The Project Officer ioes not
have the authority to and may not issue any techni :a1
direction which (i) constitutes an assignment of a iditional
work outside the general scope of the Contract; (i - )

. -- .

PART I
THE SCHEDULE

1

constitutes a change as defined in the Contract clduse
entitled "Changes;" (iii) in any manner causes an increase
or decrease in the total estimated Contract cost, the fixed
fee or the time required for Contract performance; or (iv)
changes any of the expressed terms, conditions or
specifications of the Contract.
I

\

All technical direction shall be issued in wrlting b y the
Project Officer or shall be confirmed in writing withln
five (5) working
. -- days. a'fter issuance by the ~ r-- o ~ e c t '
Officer .
z

--

-.r

The Contractor shall proceed promptly with the performance
of technical directions duly issued by the Project Offlcer
in the manner prescribed within his authority under this
provision.
If, in the gpinion of the Contractor any instructidn or
direction x.sued by the Project Officer is within &ne of
the categaries as defined in (i) through (iv) above, the
Contractor shall not proceed but shall notify the ' 1
Contracting-OPf icer in writing within five (5) working days
after the receipt of any such instruction or direckion and
I
shall request the Contracting Officer to modify the
I := .-:= =
contract accordingly. Upon receiving such nbtif ication for
the Contractor, the - Contracting Officer shall issue an
appropriate contract modification or advise the cohtractor
in kriting that, in his opinion, the technical direction is
within-the scope of this art-icle and does not .con.siituteg
change under the Changes Clause of the contract. The
Contractor shall thereupon proceed immediately with the
direction given. A failure of the parties to agreL upon
the nature of the instruction or direction or upon the
contract action to be taken with respect thereto shall be
subject to the provisions of the Contract clause
..
"Disputes."
.

..

- . . .

==

.‘)

-. -. .
....

PART I1
CONTRACT CLAUSES
SECTION I

-

CONTRACT CLAUSES

1.

ACQUISITION REGULATIONS (FAR) 4 8 cFR CHAP=&
-

CLAUSES)
..

.~

.

I. 1

5 2 - 2 5 2 - 2 CLAUSES INCORPORATED BY REFERENCE. ( FEB 149 8 )
.
I

--

This contract incorporates one or more clauses by
:~
reference, with the same force and effect as if they
were
given i n fui-1 L e t . Upon request, the Contracf=kfig,
df~icer-will make their full text available. Also, the-fidT't-ext of
a clause may be accessed electronically at this/these
address (es):

-

...
.--.

~

h t tp ://www. a r n e t .gov/fa r /

Clause

Title and Date
-4'
"

x:.

.
L

I

::Definitions.
(DEC 2001)
52.202-1
52.203-3
Gratuities. (APR 1984)
52.203-5
Covenant Against Contingent Fees.
(A~R
1984)
.
;-g""'. ... Restrictions on Subcontractor Sales to:the
Government.
(JUL 1995)
52.203-7 - - 'Anti-KickbackProcedures.
(JvLJ1995j.;-.
=
,
Car~cellation,Rescission, and ~ e c o v e r
of~ Funds
52.203-8
for Illegal or Improper Activity. (JAN 1997)
52.203-10
Price or Fee Adjustment for Illegal or;Improper
Activity. (JAN 1997)
52.203-12 ---Limitation
on Payments to Influence -Cqtain.,.
Federal Transactions. (JUN 2003)
*I
52.204-4
Printed or Copied Double-Sided on Recyled
Paper. (AUG 2000)
,
Protecting the Government's Interests ,When
52.209-6
Subcontracting with Contractors ~ebarrLd,
Suspended, or Proposed for Debarment.
. ..
(JUL 1995)
52.215-2
Audit and Records - Negotiation. (JUN ,1999)
52.215-8
Order of Precedence - Uniform Contract, Format.
(OCT 1997)
52.219-8
Utilization of Small Business Concerns1.(May
2004)
Convict Labor. (JUN 2003)
52.222-3
Prohibition of Segregated Facilities. (FEB
52.222-21
1999)

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HHSP23320042201TC
Page 14 of 15

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PART I1
CONTRACT CLAUSES

1
I

I

Clause

Title and Date
-

52.222-26
52.222-35

Equal Opportunity. (APR2002)
Equal Opportunity for Special Disabled
Veterans, Veterans of the Vietnam Era, and
Other Eligible Veterans. (DEC 2001)
52.222-36
Affirmative Action for Workers with
Disabilities. (JUN 1998)
52.222-37
Employment Reports on Special Disabled
-Veterans, Veterans of the Vietnam Era, and
other- Eligible Veterans. (DEC 2001)
52.222-38
Compliance with Veterans Employment ~edortlng
Requirements. (DEC 2001)
52.223-6
Drug-Free Workplace. (MAY 2001)
Toxlc Chemical Release Reporting. (JUN 2003)
52.223-14
52.225-13
Restr~ctionson Certain Foreign Purchases.
(JAN 2004)
authorization and Consent. (JUL 1995)
52.227-1 ;52.227-2
xotice and Assistance Regarding Patent and
Copyright Infringement. (AUG 1996)
52.227-14
Rights in Data - General. (JUN 1987)
52.227-17" Rig-hts in Data - Special Works. (JUN 1907)
52.229-4
Federal, State, and Local Taxes (State and
Local Adjustments) . (APR 2003)
- -52.232-1
Payments. (APR 1984)
52.232-8
Discounts for Prompt Payment. (FEB 2002)
52.232-23
Assignment of Claims. (JAN 1986)
52.232-25
Prompt payment. (FEB 2002)
52.232-33
Payment by Electronic Funds Transfer - GentraL
Contractor Registratlon. (OCT 2003)
52.233-1
Disputes. (JUL 2002)
52.233-3
Protest after Award. (AUG 1996)
52.242-13
Bankruptcy. (JUL 1995)
52.243-1
Changes - Fixed-Price. (AUG 1987) - Alt
(APR 1984)
Competition In Subcontracting. (DEC-1994
52.244-5
Subcontracts for Commercial Items. (MAY12004)
52 -244-6
52.249-4
Termination for Convenience of the Government
(Services) (Short Form) . (APR 1984)
52.249-8
Default (Fixed-Price Supply and
1984)
52.249-14
ExcusableDelays. ( ~ ~ R 1 9 8 4 )

-

__

-

I

--

--

-

AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT

1

2 AMENDMENTlMODlFlCATlON NO

MODIFICATION #

1

6 ISSUEDBY

3 EFFECTIVE DATE

1 CONTRACT ID CODE

11

4 REOUISITIOWPURCHASE RE0 NO

05/02/2005

PAGE

OF

PAGES

1-

1

5 PROJECT NO i,:aod 3 3 , .

N/A
7 ADMINISTERED BY (Ilother than Item 6)

'I1

CODE

DHHSlProgram S u p p o r t C e n t e r
D i v i s i o n o f A c q u i s ~ t o nM a n a g e m e n t , SAS
5600 F i s h e r s L a n e
Parklawn Build~ng,Room 5-101
R o c k v i l l e , MD 20857

1
I-

I -

-

CODE

OMB No. 0990-01 15

8 NAME AND ADDRESS OF CONTRACTOR ( N o . sfreel, county. Slate, andZIP Code)

9A

AMENDhIENT OP SOLICITATION NO

90

DATED (SEE ITEM 11)

American Urban Radio Networks
432 Park Avenue, South, 14th Floor
New York, NY 10016

EM:
DUN

I

-

I

10A MODIFICATIONOF CONTRACTIQRDER NO

--

~

10B DATED (See Item 13)

0611 112004

CODE

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
The above numbered sol~cltatlonIS amended as set forth In Item 14 The hour and date spectbed for recelpt of Offers

IS

extended,

d

-IS

not extended

Offersmust acknowledge receipt of this amendment prior to the hour and date specified in the solidtation or as amended. by one of the follo$lng methods
coples of the amendment. (bi By acknowledgmg rece~ptof th. amendment on edch copy of the offer subm,
or ( c )
(a) By completing Items 8 and 15, and retumlng
By separate letter or telegram whlch Includes a reference to the sol~c~tat~on
and amendment numbers FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE
PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If by vlrtue of thls
amendment you des~reto change an offer al&q@ubm~tted such change may be made by telegram or letter, provlded each telegram or letter makes reference to the sollc~tat~on
and th~samendment, and IS recelved pnor to the openlng hour and date spec~fied

1

12 ACCOUNTING AND APPROPRIATION DATA (If repu~red)

Appro. No.:

CAN:

---

~

OBI. Class:

-EtrWSiTEMAPPLlES ONLY TO MODIFICATIONS OF CONTRACTSIORDERS.
IT MODIFIES THE CONTRACTMRDER NO. AS DESCRIBED IN ITEM 14.

--- _ _

A THIS CHANGE ORDER IS ISSUED PURSUANT TO (Speafy aufhonfyl THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN M E CONTRACT ORDER NO IN ITEM 10A
I

I

B THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (Such as changes tn payrng ofice, appwnatron date e l c ) SET FORTH IN
ITEM 14 PURSUANT TO THE AUTHORITY OF FAR 43 103(b)

x

1I

1
/I
I

C.THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORllY OF-

I

Mutual Ageement o f the Parhes
-

1 D. OTHER (Specify fype o l m o d ~ f i c a t ~aad
n authonfyL
E. IMPORTANT: Contractor

is not.

is required to sign this document and return

-.

A

I

3 copies to the issuing office.

-I

14. DESCRIPTION OF AMENOMENT/MODIFICATION ( O y a n ~ z e dby UCF seclron headtngs. tnduding soliwlalionfcontrad subject matter where leasrble.)
Subject contract

-

k

:...

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. ...

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I

i s modified as follows:

il

1. Section F.1 - Period o f Performance, i s modified to change the period o f performance from June 1 1,2004 through June 10,2005 to
June 1 1,2004 through August 3 1,2005.
1 9

2. Section F.2 - Schedule o f Deliverables, i s modified as follows:

I

See Attachment A.

3. The total contract amount and all other terms and conditiohs remain unchanged by reason o f this modifica~ion.

1

Except as provided herein. all terms and conditions of the document referenced in item 9A or 10A, as heretofore changed, remains unchanged an'd in full force and effect.
16A. NAME AND TITLE OF CONTRACTING OFFICEP (Type or print)

15A. NAME AND TITLE OF SIGNER (Type or print)

Janet H. Miller

/

158. CONTRACTOFUOFFEROR

1 5 C DATE SIGNED

1

1 6 B UNITED STATES OF AMERICA

.

1 1 6 ~ .DATE SIGNED

~IGNEL~~

I

STAFDARD FORM 30 (REV. 10-83)

NSN 7540-01-152-8070
PREVIOUS EDITION UNUSABLE
IEF G c n d b) Elcruon!r Davnlcnl ~~~~~VSDHHS

- . ,--

Presmbeo by GSA
. ... .ldR
,. CERI
-.. . 57 .7A7
.FAR

0011441.2454

,I

{.<&

DEPARTMENT OF HJ3"TH

& """1"

SERVICES

6
-4
14-,,,

Proprr
Dl\ lslon
Room 5

rppon Cmrsr

5600 FIS
Rock\ 111

Mr. Basil Murrain
American Urban Radio Networks
432 Park Avenue - South, 14th Floor
New York, NY 10016
Subject: Modification No. 1, Contract No. HHSP23320042
.

,

-

.

.

/

.-

Dear Mr. Murrain:

_

- --

There is transmitted herewith one completely executed cl
Contract Number HHSP23320042201TC, Modification No. 1 e:
into between the Program Support Center and your organi
Please ensure that this modification is attached to and nade
part of the cogtract file.
\-

If you have any-questions, please call me on (301) 443Sincerely yours,

Paula Conner
Contract Specialist

Enclosures

-

..-

Message

I

Page 1 of 1

Conner, Paula (PSC)
From:

Conner, Paula L. (PSC)

Sent:

Tuesday, May 24,2005 1.21 PM

To:

'EDoherty@aurn.com'

I1
L

1/j

Subject: RE: Help

Thanks Ed, I understand from Basil that
faxed back to me.

.
-

-

/

: this week. He will take care ofi gett~ngthat s~gnedand

53

I

/

Paula
-----Original Message----From: Ed Doherty [mailto:edoherty@aurn.com]
~.
Sent: Tuesday, May 24,2035 1 1 3 7 AM
To: Conner, Paula L. (PSC-) - - -Subject: RE: Help

..

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1

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a
I, ;
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Jorgeann Tamburo (412) 456 401 5, Fax (412) 456 4022 E- mail jtamburo@sbcol.com . .Main #1I (412) 456 4000 ...Ed
-----Original Message----From: Conner, Paula L. (PSC) [mailto:PConner@psc.gov]
Sent: Tuesday, May 24, 2005 10:15 AM
To: 'edoherty@aurn.cqml
Subject: Help
L \=.

/1 that the number is not
Hi Edward, I just tried to call Jeorgianne on the number you gave me but the operator says
set up. Can you please provide me with a new number.

-.-

-

4
.

_-

Thanks

I

I
I

- About American Urban Radio Networks -

,1

American Urban Radio Networks reaches 25 million weekly listeners, which makks it tlie largest network
reaching Urban American. AURN broadcasts news, entertainment, and sports p r o g r a d i n g to more than 475
radio stations nationwide. It is the only African-American owned network radio c 0 m ~ a in
4 ~the United States.
The contents of this email are the property of the American Urban Radio Networks and b e to be viewed only
by the email's addressed recipient(s). If you have received this email in error, please notify the email's sender.
Do not forward or copy this email or any attachment from this email without the permiskion of the sender. If
you would like to be opted out of future emails from this sender, please email your requbst to
noemail@sbcol.com.

i

.-

-_.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Proyram support Center
Dlvislon (f ~ c ~ u l s ~hlanagemeni
t~on
S .\\
Room 5 - 101. Parh1av.n Bu~ldlng
5600 ~ I s h i r sLane
Rockvllle~MD 20857

APR 2 5 2055

li

Mr. Ed Doherty,Regional Director
American Urban Radio Networks..
Fl.oor
432 Park Avenue - South,
New ' ~ o r kNY
, 10016
-

Subject :

.

.

--

H
Contract Number: HHSP23320042201TCI Modification
1

I/
Dear Mr. Doherty:

)

Enclosed are four copies of Modification 1 to Contract
HHSP2332004220JTC for signature by an authorized offi .A1 of
I
your organiza&G.. Upon acceptance by the Government gne
f
. be returned to you for your files.
executed copy .will
...
If additional-2anformation is required, please contact the
II
undersigned at the above address, or by phone at (301) 443-2475.
.

il

.. -

Sincerely yours,

-

Paula Conner
Contract Specialist
. . .,

Enclosure

-.. .

.

(+#<$

..

I

DEPARTMENT OF HEALTH & HUMAN SE"CES

Pro,pm;Suppon Center
~ ~ \ ~ ~ s i o n ~ o i ~ c a uhlanarcmtr,r.
i s i r ~ o r i S..\.<

~.

Koclrn 5jll01. Parklaurn Buildln;

-+

8

5600 Fishers L n e
~ockville.MD 20s-7

B*a.

I

-

Mr. Ed Doherty, Regional Director
American Urban Radio Networks
432 Park Avenue - South, 14th Floor
New York, NY 10016
\

Subject:

Contract Nurnber: HHSP23320042201TC
..

.-

-

Dear Mr. Doherty:
This is to inform you that the designated Project officer for this
project has been changed.
I

i

The new Project Officer respons=ble for the acceptance of work is Ms.
Monique La Rocque, Department of Health and Human servites, Off ice of
Minority HealtN<kOffice of Public Health and Science, 1i01 Wootten
Parkway, Suite 600, Rockville, MD 20850. Ms. La Rocque may be
contacted on (3-01)443-3471 for any technical questions jwhich may
arise.
.
...
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:.
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..A- .A,.

.
A
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To ensure proper administration of this contract as well as to protect
the interest of- both .-theContractor and the Government,-;la1
kcorrespondence relating to contractual terms of this contract should be
prepared in duplicate, addressed to the attention of the Contracting
I
Officer,-.andmailed to the address indicated above.
i
-

.

-

..

:

Thank you for
assistance, and we look forward to.tl
completion of this requirement.

Paula L. Conner

. ...

..

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DEPARTMENT OF HEALTH & HUMAN SERVICES

P r o m Support Center
D ~ \ i s ~ oofn Acqu~s~non
hima:emen~. S 4s
1

Room 5-10]. ParMaxn Bu~ldinr

JUN 2 5

2304

American Urban Radio Networks
Attn: Mr. Ed Doherty
~ ~
432 Park Avenue, South, 1 4 Floar
New York, NY 10016

.

-.

Dear Mr. Doherty:
.--.

.
.

I

There is transmitted-herewith.one completely executed copy df
Contract Number-HHSP233ZD042201TC entered into between-~~hi?&~qram
I
Support Center and your organization.
1

1

Please ensure that this contract is attached to and made part of
the contract file.

I
I have been assigned as the Contract Administrator to assis7
in any administration problems which may arise. I may be
I
contacted on (30$.&;43-2475, Fax (301) 443-1004, for any matders
1I

yo^

which involve contractual decisions.
-.

It is the desire of this office, as I am sure it is your de&ire,
to adhere striZtYy towthe terms and provisions of the contr$ct . Close cooperation between you and the Contract ~dministratodwill
facilitate this adherence, as well as the satisfactori.rom~eti~-~
1
of the contract.
*
2
I *,
'I

The Project Officer responsible for the acceptance of work is Ms.
Love11 ~rieham,Office of Minority Health, 1101 Wootton ~ a r k w a ~ ,
Suite 600, Roekvil&e MD 20852. Ms. Brigham may be contacted --on
--(301) 443-3386 for any technical questions which may arise. (I
1
I

1
11

To ensure proper administration of this contract as well as !to
/I
protect the interest of both the Contractor and the Government,
(I
all correspondence relating to contractual terms of this contract
should be prepared in duplicate, addressed to the attentionlof the
Contracting Officer, and mailed to the address indicated
.. abo~e.

/I

Thank you for your assistance, and we look forward to the
successful completion of this requirement.

I1

!
1

Paula Conner
Contract Specialist
Attachment

--.

.

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/I

ORDER FOR SUPPLIES OR SERVICES

(I1

IMPORTANT: Mark all-packages and papen with contract andlor order numbers
2 CONTRACT NO (//any)

1 DATE OF ORDER

PAGE OF PAGES

1

1

6 SHIP TO

2

a N4ME OF CONSIGNEE

09/29/2004
3 ORDER NO.

HHSP233200400822P

,I

1

Ii

5 ISSUING OFFICE (Address correspondence lo)

b STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

233 N. MICHIGAN AVE, SUITE 13001

I

-

I
I

1

-

C

CrrY

7 TO

APARNA SEN-YELDANDI

APNA GHAR, INC

8 TYPE OF ORDER

Ea

b COMPANY N4ME
-

c STREET ADDRESS

4753 NORTH BROADWAY
SUITE 518

-

-

1

PURCHASE

*

~ x c d pla
l b l l q tnslrucucns on the
m+-rn~s
ae(~wryader 1s
sub){n lo ~nstrucuonsnnmtnec or
this &de only of ~ h l sl a m and us
~ u u J subject
d
lo the terms and
c o n d j t l w ol Ihe abovenumbered
ccntbct

--=.

Please furnish tne ~ ~ l ~ on
w the
n gt e n s
and condibons specdied on boIh sides d
I~IS a d w and on Ihe attadled sheets, a
any. ~ n d u d ~ nddiveryas
g
irdiiled.

f. ZIP CODE

1,

60640

9 ACCOUNTING AND APPROPRIATIONS DATA

10. REQUISITIONINGOFFICE

HHS/OPHS/OWH/REGION

7540120

?I

v

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11. BUSINESS CLASSIFICATION (Check appropriale box(es))

-

I

c. DISADVANTAGED

a. SMLL

Destination

12. F O B POINT

I

- 11

b DELIVERY

Quote Attached

IL

14. GOVERNMENT BNNO.

b. ACCEPTANCE

~estiriiri%n-

SUPPLIES

;7

. .-

Net 30
.

I

QUANTln
OSDEREC u N m l
Ic)

ORSERVICES
'

lbl

Tax ID Number:
DUNS Number: '

d WOMEN€IWNED

Il

-"+

;I

17 SCHEDULE (See reverse lor Rqedrons)

ITEM NO
la)

j!

I
1

ON OR BEFORE (Dale)

13. PLACE OF

Destination

i
' I 6 DlSCOUplTTERMS

15 DELIVER TO F 0.0. POINT

.. ..

a. INSPECTION.

e ZIP CODE

60601

REFERENCE YOUR

--

e. STATE

d CITY

CHICAGO

IL

I

f SHIP VLA

-

a NAME OF CONTRACTOR

d STATE

'!

CHICAGO

UNIT
PRICE

1 *-

'-

-

auouGj;(

QUANTITY
ACCEPTED

d

Questions Concerning this order should be re

--

h

PLEASE REFERENCE PAGES 1 THOUGH 6 OF THE ATT CHED
Continued . . .

I

. .,

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19. GROSS SHIPPING WEIGHT

10. SHIPPING POINT

I

17(hI

TOTAL
I

1

I

21 MAIL INVOICE TO

a NAME
SEE BILLING

INSTRUCTIONS
ON REVERSE

b. STREET ADDRESS
(or P 0. Box)

I

20. INVOICE NO

$4..

1

500.80

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM..16A-12
5600 FISHERS LANE

17(1).

d STATE

CITY

ROCKVILLE

n

4

I

iI

C

pages)

MD

e ZIP CODE

GRAND
TOTAL

$4,500.00

20857

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,I

22 UNITED STATES OF AMERICA

23 NAME (Typed)

I

JACQUELINE R. JONES

BY (S~gnature)

TITLE CONTWCTINWORDERING OFFICER

( OPTIONAL FOW 347 (R-

NSN 754C-01-152-8083
PREVIOUS EDITION NOT USABLE

v

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_

>

-ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

PAGE OF PAGES

21

1

2

Proposed fee is detaile?

--

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--.$4,500.00
Project Officer:
Michelle Hoersch
Phone: (312) 353-8122

1.

INVOICE INFORMATION

NUMBER) OR SOCIAL SECURITY NUMBER.

~

REGISTRATION (OCT 2003)

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 754G01-152-8082

5oYCIOI

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O P ~ W L
FORM 348 I R n t-951
R-OVGY
F M I48 WRI 53 213lrJ

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page 1 of 6

U.S. DEPARTMENT OF HEALTH AND HLJMANSERVI
OFFICE OF WOMEN'S HEALTH - REGION V

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STATEMENT OF WORK

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Awareness Program
PROJECT TITLE: ~ e a l t h

11.

BACKGROUND: Domestic violence has a profoundly negative impac,; on the
health and well-being of millions of American women and children. While
i
awareness of the domestic violence epidemic has been increasing over the
past
'I
decade or so, it is still kept nearly silent in many immigrant communities.
Domestic violen-ce has been a socio-cultural taboo for centuries in the ~ h u t h
Asian co-mmunity. Hi_storically, bringing up the issue of domestic-vio~encehad
-;.
been considered as "speaking t h e ~ n s ~ e a k a b l e Aware
."
of this problem, ' h d
recognizing the high incidence of domestic violence going unreported in: the
/I
South Asian Community in Chicago, a group of activist women undertook
to
address this problem. .
.

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Apna Ghar, which translates to "Our Home," was founded in 1990 to privide
supportive services to South Asian victims of domestic violence, primariily
women andyc&ldren. Apna Ghar has established itself as an institution inIl
Chicago's South Asian Community where mentioning domestic violencd
traditionallyis a socio-cultural taboo. Apna Ghar's mission is to providk
comprehensive- multi-lingual, multi-cultural services including shelter tolSouth
Asian women a a t h e i r children seeking lives free from violence.
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Today, Apna Ghar helps these women who have been victims of-domes$ - - violence pave their way to "Self-Empowerment" through the provision o,ka homelike shelter, counseling, life-skills development developing and sharpening their
1
job skills, legal advice and extending affordable housing. From the time women
enter the emergency shelter, trained case managers work with and pro;ide support
for the clients-for an average of twenty months, to get them to a point w h F they
lives are away from violence and self sufficient. Apna Ghar also runs other
1
programs for this population. All services are free of charge.
I

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One of the major needs of this population is basic women's health and hygiene
education. Often times due to lack of health and sex education and manybultural
barriers in the countries where they grew up the women are not aware of basic
/I
health and hygiene issues. This impacts them in their everyday living as well as
/I
their long-term health maintenance. Apna Ghar helps these women prepafe
for an
independent life with various life-skills development from maintaining a bank
account to becoming familiar with public transportation. Providing knowledge
and awareness about their health to the women will complete the life-skilils
development program and help them live a healthy life.
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111.

PURPOSE: The purpose of this contract is to assist Apna Ghar in impl'ernenting
a "Health Awareness Program" - a 12-month health education program bn health
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and hygiene for their clients who reside in the emergency shelter and suqportive
housing. The Contractor shall develop twenty-four culturally-sensitive I
information sessions for the 12-month program. The primary focus of theY program
will be in the areas of personal hygiene, knowledge of woman's own boby.
reproductive health; child-birth and child care. Additionally, in light of &me
1I
HIV positive clients that the agency is receiving and the total lack of knowledge
about HIVIAIDS in their community, Apna Ghar shall schedule information
sessions on HIVIAIDS. The Contractor shall also develop a manual on bbsic
health and hygiene for their clients for reference purposes.

IV.

PERIOD OFPERFORMANCE: The Period of Performance sh-al-1 &em
September 30,2004 through September 29,2005.

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V.

TYPE OF CONTRACT: This is a Firm, Fixed-Price purchase order.

VI.

DELIVERABLES AND TIMEFRAME: The Contractor shall coordi*ate with
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the Project Officer of thls effort in order to:

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~oordi&it$ develop and implement all aspects of the "Health Awareness
Program," which is a 12-month health education program on health &d
hygiene for their clients;
Resea&, develop and implement a culturally-sensitive cuniculum on
.. .. .
personal hygiene, knowledge of woman's own body, reproductive he'alth,
Il
HIVIAIQS, childSbirth and child care;
-,,- ..- . _ _
.. ..Develop and provide educational materials for instructors and participants in
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the 12-month program;
(I
- Develop and implement an evaluation tool to assess the effectivenessof the
Health Awareness Program on their client population;
/j -Develop and provide a manual on basic health and hygiene for client$
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reference;
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Schedule and administer 12-month program for clients in the emergehcy shelter
and supportive housing;
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Develop and provide program progress reports to the Project Officer [PO);
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Develop and provide a final program evaluation report to the PO.

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The due dates and delivery methods for these deliverables are to be decided
following the award of this effort.
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VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized agent of the
Contracting Officer is responsible for the review and acceptance of all 1
deliverables.
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100822P
;e3 o f 6
VIII. INVOICE SUBMISSION: Upon inspection and acceptance of the dell erables
described in Section VI., the Contractor shall submit an original and two
copies of its proper invoices to the PO. For payment, the PO shall submi .he
invoice and a signed receiving report to:
Department of Health & Human Services
PSC/Financial Management Service
Division of ~inancialOperations
Parklawn Building, Room 16A-12
5600 Fishers Lane
Rockville, Maryland 20857Telephone: (301) 443-3020
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The invoice mast contain the following minimum information:

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Contractor's name and address;
Purchase order number;
Description and price of services provided;
f

;

1nvoick.period; and
.-

The Contractor's Internal Revenue Service (IRS) ~ a x p a ~Identi
er
cation
Fhlmber. -,-

IX. GOVERNMENT-FURNISHED MATERIALS: The Government wil
furnish any materials to the Contractor for this requirement.

X.

RIGHTS TO DATA: The Contractor is prohibited from using data pro(
obtained under this contract for any purpose without prior, written appro7
-the PO.-

XI. TECHNICAL MONITORING:

A.

Performance of the work under this purchase order shall be subjec to the
technical monitoring of the Project Officer. The term "Technical
Monitoring" is defined to include, without limitation, the followir
.-,

1.

Technical directions to the Contractor, which redirect the 1 lrchase
order effort, shift work emphasis between work areas or ta KS,
require pursuit of certain lines of inquiry, fill in details or
otherwise serve to accomplish the contractual scope of wo

/I

2.

providing information to the Contractor for assistance in the
interpretation of drawings, specifications or technical podions of
the work description.

3.

Review and, where required by the purchase order, approjal of
technical reports, drawings, specifications and technical
information to be delivered by the Contractor to the ~ o v e ! n m e n t
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under the purchase order.

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B.

Technical direction must be within the general scope of work stated in the
purchase order. The Projeciofficer does not have the authority tb and
may not issue any technical direction which (i) constitutes an assil'gnment .of additional work outside the general scope of the purchase orde/; (ii)
constitutes a Aange as defined in the purchase order clause en&
"Changes;" (iii) causes, in any manner, an increase or decrease in/the total
estimated purchase order cost, the fixed fee or the time required for
purchase order performance; or (iv) changes any of the
conditions, or specifications of the purchase order.

C.

All technical direction shall be issued in writing by the Project
Officer or shall be confirmed by himiher in writing within 5
worR-g days after issuance.
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D.

/

The contractor shall proceed promptly with the performance of
technical-duection duly issued by the Project Officer in the manner
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prescribed by this clause and within hisher authority under the
provisions of this clause.
-1il .- - . 11
If, in the opinion of the Contractor, any instruction or direction issued by
the Project Officer is within one of the categories as defined in (i)lthrough
(iv) above, the Contractor shall not proceed but shall notify the; 1
C o n t r a i n g Officer in writing within 5 working days after the rekipt of
il
any such instruction or direction and shall request the Contracting Officer
to modify the purchase order accordingly. Upon receiving such
notification from the Contractor, the Contracting Officer shall isshe an
appropriate purchase order modification or advise the Contractor in
writing that, in histher opinion, the technical direction is within t$ scope
of this clause and does not constitute a change under the changes/c1ause
of the purchase order. The Contractor shall thereupon proceed immediately with the direction given. A failure of the parties to
agree upon the nature of the instruction or direction or upon the purchase
order action to be taken with respect thereto shall be subject to thd
provisions of the purchase order clause entitled "Disputes."

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HHSP23320(
P,?i
XII.

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POINTS OF CONTACT:
The Project Officer (PO) for this effort is:
Ms. Michelle Hoersch, M.S.
Office on Women's Health U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 1300
Chicago, lllinois 60601
Phone: (312) 353-8122
Fax: (312) 353-7800
Email: ~hoersch@osophs.dhhs.o,o~~

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The Contracting Offigr (CO) for this effort is:

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Ms. Jacqueline R. Jones
Program Support Center
U.S. Department of Health and Human Services
Parklawn Building, Room 5- 101
5600 Fishers Lane
Rockville, MD 20857
Phone: (30l'$4$3-6413
Fax: (301) 443-8488

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The Con^t%t.Specialist for this effort is:

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Mr. Gene H. Calvert
Program Support ~ e r k e r
Phone: (301) 443-7077

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FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEI&

XI.

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This contract incorporates one or more clauses by reference, with the samIe force
and effect as if they were given in full text. Upon request, the Contracting (3fficer

4
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will make their full text available. Also, the full text of a clause may be acc: :essed
1
electronically at thislthese address(es): l~ttp://\~\c~v.an~et.gov/far.
The following FAR contract clauses are incorporated by reference:

1

No.

CLAUSE NO.

TITLE AND DATE

1I

1.

FAR 52.204-6

2.

FAR 52.204-7

Data Universal Numbering
System (DUNS) Number !
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(OCT 2003)
!1
Central Contractor Registrat.i'o
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(OCT 2003)
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HHSP233200300822P
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Page 6 of 6

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No.
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CLAUSE NO.

TITLE AND DATE

FAR 52.212-1

Instructions t o Offerors Commercial Items (JAN 2004)
I
Contract Terms and Conditions Commercial hems (OCT 20'03)
Convict Labor (June 2003)
Child Labor-Cooperation w l ~ h
Authorities and Remedies
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(June 2004)
I/ . . .
Prohibition of Segregated Facllltles
(Feb 1999).
Equal Opportunity (Apr 200:2)
Drug Free WorkplacE-(MW.200
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Buy American Act-Supplies(
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(June 2003)
1
Restrictions on Certain Foreign
Purchases (JUN 2003)
Payments (APR 1984)
Payment by Electronic Funds
Transfer-Central
Registration (Oct 2003)
Disputes (JUL 2002)
Protest After Award (AUG 1996)

1'

FAR 52.212-4

1

FAR 52.222-3
~ A k 5 2 . 2 2 219
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FAR 52.222-21
FAR 52.222-26
FAR-5-2.223-6
FAR 52.225-1
FAR 52.225-1 3
FAR 52,232-1
FAR 52.232-33

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FAR 52.233-1
FAR 52.233-3

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* * *END OF STATEMENT OF WORK * *..*-

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Crown. Ruth
From:
Sent:
To :

Subject:

Hoersch, Michelle
Friday, September 03,2004 3:53 PM
Crown, Ruth
Another DUNS#

Importance:

High
-

.

HI Ruth,

.

4

The DUNS# for requisition #s OWHV05 and OWHV12 are the same:

I hope this is all you need for this contract.
. .

Thanks,
M

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Michelle D. Hoersch, M.S.
Office o n Women's Health Region V
U.S. Department o f Health and Human Services
233 N. Michigan Ave, Suite 1300
Chicago, lL 60601
.;<J,
312-353-8122
312-353-7800 fax
.mhoersch@osophs.dhhs.gov

-

-

-!.-.-.A.

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..>A

Please visit the National Women's Health Information Center at www.4woma
,

.*

-----Original Message----From: Aparna Sen [mailto:asen@apnaghar.org]
.Sent: Friday, September 03;-2004 2:33 PM
To: Hoersch, Michelle
Subject: FW: U.S. Government Customer DLlNS Number Request LlNlTED
AMERICA Apna Ghar, Inc.(Our Home)
Importance: High

-

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'ATES OF

. - 4

Michelle
rt we received o n August 06, and had sent to you
Here is the. DUNS numbel
pL/
immediatey. I-also left you a msg t o tollow u p o n the funding and next steps ' any to be taken,
but never heard from you. I know you must be incrediblly busy, but please Ic me know where
are we i n the process.
'Thank you,

Aparna Sen
Executive Director

Apna Ghar, Inc.
Tel: 773.334.01 73 X(229)
email: asen@apnaghar.org
-----Original Message----From: customerservice@dnb.com [mailto:customerservice@dnb.com]
I
Sent: Friday, August 06,2004 9:12 AM To: asen@apnaghar.org
Subject: RE: U.S. ~overnment-customerDUNS Number Request UNITED STATES OF
I
AMERICA Apna Ghar, Inc.(Our Home)

!

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The assignp--' -'
3&B DUNS Number has been completed. Your D&B/DUNS
Number is
hq
'This number wilt become active i n our system
tomorrow morning. If you have -any questions please contact D&B at 7366-5-5711.
I
Sincerely,

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Kalel Edward
Internet Customer Support
emaii: customerservice@dnb.com.
www.dnb.com

[Message #855908]

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S~P-20-04 12:31pn

Frolrm-U S DEPT

W

'4 HS

31 2-353-0718

Awareness Program on their client population. Co
health and hygiene for climrs' reference.

il

Tasks:

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4
The contractor will be risponsible for the following activiues:
I
Research current health and hygiene information for Pmgam marenalsj
I
r Develop 24-session Health Awareness P r o p
1
8
Develop evaluanon t w l for progrim
1(1
Develop manual on basic health and hygene for clients' reference.
Schedule wd &mister 12;menrh program for clients in the emergency shelter and
supporcivr housing --- -- I -

i[

X-session Health Awuencss Program curriculum and materials. mncludng
evaluation tool
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Manual on basic healdl and hygiene
1
Progress reports on program
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Final report & program and evaluanon

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Period uf Frrbutmauce:,
Award of conuact - September 30,2005

-

p!$iTiE-

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~14tifirn~(~=~$

'YI

.Aps m
s a co&&t$:based
organization rhar is rmsted by the commuqity and has a
long h~storyserving South Asian women m rhc Chcago metropolitan area. Apna Ghar has earned the m a of South Asian women and as such has access ro a populatToii of
women in rremendous need, thar no orher communitqlbased organization can ctaim. This
organization also has strong ties to the community and good worlung relarionshlps wirh
other social service providers servmg rhc Soulh Asian community. Wirh the exberience
and quality of s*rvices. Apna Char has earned a leadership role in the commwli1[:ychat
provides services to the victims of domestic violence. Apha Ghar his been indyted into
the finr class of Asian American Hall of Fame. Thc lacallsuperstation television sranon,
WGN,has recognized Apna Ghar as one of the 2002 "unsung Heroes." Apna Ghar's
supervised visitation center was featured in the New Y ork Times and more recently in the
Chcago Tribune. Apna Ghar has been honored with an "Excellence in Services' award in
2004 by rhr ~ n o r n c yGeneral of lllinois and was recenrly chosen ilr one of rhe bilor snes
for "safe havens" program by b e Ciry of Chicago, Mayor's Office for Violence
R v w t i ~ n' .h s valuable integration in the community will greatly facilirate rde efficient
and cost-effccuve planning ad implementation of this Health Awareness program which
will result in substantial cost savings ro the government.
i;

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Message

Page 1 of 2

Calvert, Gene
From:

Calvert, Gene

Sent:

Tuesday, September 21,2004 12:OO PM

To:

'info@apnaghar.orgl

-

Subject: Request for Quotation (RFQ) From the U.S. Department of Health & Human Serv es. Office on
Women's Health - Health Awareness Program
~.

Good day,
Attached is a Request for Proposal (RFQ) package for contractor support for the Depart lent of Health
and Human Services, Office on Women's Health, Region V, Health Awareness Prograrr
This email contains three files:

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-==a

Cover Letter - Apna ~ h a r . d o c-- Contains contact information and directions on s
completed RFQ.
SF-1 8 Apna Ghar.doc -- Is the SF-1 8 to be used to note your quoted price for this
Michelle Hoersch -- Health Awareness Program RFQ SOW.doc -- Is the Statemei
this effort. It contains the Scope of Work, invoicing information, and other infon
to this effort.
%
c,

bmitting your
ffort.
of Work for
ation pertaining

The files are are MS-Word.documents. In order to expedite the process, feel free to pro ide
responses directly into the necessary documents and email them back to me. If you prel r, you may also
print out the documents;md &-,back the completed package to my attention at (301) 41 r-8488.--~..
If your organization has not already done so, please register your organization inthe Ce :ral Csntractor
Registration (CCR) database. Registration is easy to complete and can be accomplishec ~nlineat
http://www.ccr.go_~.Active registration in the CCR is required to be awarded procurem nts with the
Federal Government.
The RFQ package may seema little intimidating, but it really isn't. The questionsare VI
straightforward, and you should not have any trouble completing the package.
We are hoping to make this award by the end of our fiscal year with is September 30th.. f you have any
questions at all, please feel free to contact me by return email, or by phone at (301) 443. '077.
When you have an opportunity, please confirm receipt of this package by sending me a
.-

Regards,
Gene
Gene Calvert
Contract Specialist
Department of Health and Human Services
Program Support Center
Phone: (301) 443-7077
Fax: (301) 443-8488

..

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DEPARTMENT OF HEAL', -- & HUMAN SERVICES

I

Pro-eram Support Center

I

I h b ~ s ~ o nf A c q u ~ s ~ t ~blanaeerneni
on
.\AS
Room 5-101. ~ i h k l a a mB u ~ l d l n ~
5600 F ~ s h e r sLa!ne
Rockv~lle.M D 20857

September 2 1, 2004
Apna Ghar, Inc.
Attn: Aparna Sen-Yeldaridi
4753 North Broadway, Suite 5 18
Chicago, Illinois 60640
SUBJECT: Request for Quote (RFQ) No. 04T0000 12
-

Ms. Sen-Yeldandi,

-

.

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The United States Department of Health and ~ u m a nServices, Office on Womed's Health,
Region V has a requirement for Contractor support regarding their project titled b//ice of
Women's Health, Region V-- Health Awareness Program. Your firm has been identified as
having the predominant capabilities required to provide the required solutions fof this project.
You are invited to submit a quotation in response to the enclosed Request for Qdotation
(WQ). The Government anticipates making an award based on your technical dbderstanding
of the requirement &?he reasonableness of your proposed price.

1i

Please submit your quotation for the services as described in the attached ~tatemkntof Work
to Gene Calvert,,C9~tracJ$pecialist, Department of Health and Human Services,!
i
Program Support Center, Division of Acquisition Management, Room 5-101, Pa!klawn
Building, 5600 Fishers Lane, Rockville, Maryland, 20857 by no later than
, -*3:00 RI.M.
1
Eastern Standard Time, Thursday, September 23, 2004.

---_

__

1

Your quote must include a detailed description of the work to be accomplished a; described
in the refefenced Statement of Work, and it must also include a detailed explanation of the
your price breakdown; -If you have recently performed work of a similar nature described
in the referenced Statement of Work, please include a copy of the invoice for that effort.
Disclosure of your client's identity is not required on the invoice.

4

Please submit your completed Request for Quotation Standard Form 18, and your; completed
Offeror Representations and Certifications - Commercial Items. To expedite the process,
your completed quotation package may be sent via email to me, Gene H. Calvert,
Contract Specialist, at qcalvert6)psc.gov, or via fax to my attention at (301 744323488.

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If jmur organization has not already registered with in the Central Contractor Registration
(CCR), please do so as soon as possible. Registration is easy and can be accomp(ished online
at ht~p:,iwwwt.ccr.gov.Registration in the CCR is required in order to be awarded
procurements with the Federal Government.
/I
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Questions concerning this RFQ shall be referred to Gene Calvert by phone at
or by email at gcalvertfi~psc.u,ov.

Sincerely,

Gene H. Calvert
Contract Specialist

REQUEST FOR QUOTATION
1. REQUEST NO.

1

OY-

0 IS

THIS RFQ

(THIS IS NOT AN ORDER)

X

IS NOT A SMALL BUSINESS SET-ASI!E

2. DATE ISSUED

3. REQUISTIONIPURCHASE REQUEST NO.

September 21,2004

04T000012

5.a ISSUED BY
DHHSIPSCIAOSISASIDAM, PARKLAWN BUILDING, ROOM 5-101.5600 FISHERS LANE, ROCKVIUE. MD 20857

4. CERT. FOR NAT. DEF
UNDER BDSA REG 2
AND/OR DMS REG. 1
6. DELIVER BY (Date)

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PAGE

OF

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1 PAGES

RATING

1

See Attached Statement of Work
1
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5.b. FOR INFORMATION CALL (NO COLLECTCIILLS)
TELEPHONE NUMBER
AREA CODE
NUMBER

NAME

Gene H. Calvert, Contract Specialist

(301)

443-7077

8. TO:.

1

7. DELIVERY
X FOB DESTINATION

9.i DESTINATION
a. NAME OF CONSIGNEE 1

I

b. COMPANY

Apama Sen-Yeldandi, Executive Director

Apna Ghar, Inc.

233 North Michigan Avenue, Suite 1300

c. STREET ADDRESS

c. CITY

Chicago

Chicago

.

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10. PLESE FURNISH QUOTATIONS TO THE
ISSUING OFFICE IN BLOCK 5a ON
OR BEFORE CLOSE OF BUSINESS (Date)

.

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b. STREET ADDRESS

4753 North Broadway, Suite 518
..

e. STATE --

f. ZIP CODE

d. STATE

Illinois'

60640

Illinois

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e. ZIP CODE

. .60601!i-

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IMPORTANT: This is-arequest for information, and quotations furnished are not officers. Iliyou are unable to quote.
please so indicate on thii form and retum it to the address in Bkck Sa. This request does not commit the Government to
pay any costs inarmed in the preparation of the submission of this quotation or to contact f & s u w l i or service.
Supplies are of domestic origin unless otherwise indicated by qwter. Any representabonshd/or certifhtions attached
To this Request for Quotation must be completed by the qwter.

3100 PM EST 'Thursday, September 23, 2004

1

11. SCHEDULE (Include applicable Federal, state and local taxes)
ITEM NO.
(a)

-

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Ms. Michelle Hoersch, 1M.S.

a. NAME

d. CITY

OTHER
(See schedule)

QUANTITY
(c)

SUPPLlESlSERVlCES.
(b)

UNIT
(d)

UNIT PRICE
(e)

1

1

AMOUNT

(9

The Contrad'4pr shall
provide assistance in
implementing a "Health
Awareness Program"
in
- ..,accordance with the
Attached Statement of
Work titled-"Offi'ce of
Women's Health, Regi0.n V
- Health Awareness
Progxam.
.*+-.-.,A,.

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12. DISCOUNT FOR PROMPT PAYMEKT

*

a. 10 CALENDAR DAYS

NOTE: Additional provisions and representations
X are
'13. NAME AND ADDRESS OF QUOTER
a. NAME OF QUOTER

b. 20 CALENDAR DAYS

c. 30 CALENDARQAYS

1

d. CALENDAR DAYS
PERCENTAI

(%)
I

are not attached.

I

14. SIGNATURE OF PERSON AUTHORIZED TO
SIGN QUOTATION

15. DATE OF QUOTATION

(II
16. SIGNER

b. STREET ADDRESS
a. NAME (Type or print)

c. COUNTY

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b. TELEPHONE
AREACODE

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d. CITY

AUTHORIZED FOR LOCAL REPRODUCTION
Previous edition not usable

e. STATE

f. ZIP CODE

c. TITLE (Type or print)

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NUMBER

STANDARD FORM l a (REV 6-95
Presaibei by GSA-FAR (48 CFR) 53.215-1(a'

1

U.S. DEPARTMENT OF HEALTH AND HUMAN S E R V I ~ E S
OFFICE OF WOMEN'S HEALTH - REGION V I
STATEMENT OF WORK

I

I.

PROJECT TITLE: Health Awareness Program

11.

BACKGROUND: Domestic violence has a profoundly negative impaction the
health and well-being of millions of American women and children. While
ri
awareness of the domestic violence epidemic has been increasing over the past
decade or so, it is still kept nearly silent in many immigrant communities\
Domestic violence has been a socio-cultural taboo for centuries iathe
Asian community. Historically, bringing up the issue of domestic violencie had
been considered as "speaking the unspeakable." Aware of this problem, y d
recognizing the high incidence of domestic violence going unreported in the
South Asian Community in Chicago, a group of activist women undertook to
1
address this problem.
Apna Ghar, which translates to "Our Home," was founded in 1990 to supportive Sepices to South Asian victims of domestic violence, primarity
women and children. Apna Ghar has established itself as an institution in
Chicago's South Asian Community where mentioning domestic violence,
traditionalp
is-a .socio-cultural
taboo. Apna Ghar's mission is to provide11
-'.
comprehensive multi-lingual, multi-cultural services including shelter to South
1
Asian women and their children seeking lives fiee from violence.

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Today, Apna Ghar helps these women who have been victims of domestic
violence pave their way to "Self-Empowerment" through the provision of a homelike shelter, counseling, life-skills development developing and sharper& their
job skills, legql, advice and extending affordable housing. From the time women
enter the emergency shelter, trained case managers work with and provide support
I/
for the clients for an average of twenty months, to get them to a point where they
lives are away from violence and self sufficient. Apna Ghar also runs other
programs for this population. All services are free of charge.

II
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One of the major needs of this population is basic women's health and hygiene
education. Often times due to lack of health and sex education and many kultural
barriers in the countries where they grew up the women are not aware of basic
I
health and hygiene issues. This impacts them in their everyday living as well as
It
- their long-term health maintenance. Apna Ghar helps these women prepTe
for an
independent life with various life-skills development fiom maintaining a bank
(I
account to becoming familiar with public transportation. Providing knowledge
and awareness about their health to the women will complete the life-skil'/s
development program and help them live a healthy life.
I
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111.

PURPOSE: The purpose bf this contract is to assist Apna Ghar in implbmenting
I
a "Health Awareness Program" - a 12-month health education program on
health
Y
and hygiene for their clients who reside in the emergency shelter and supportive
housing. The Contractor shall develop twenty-four culturally-sensitive
information sessions for the 12-month program. The primary focus of thy program
will be in the areas of personal hygiene, knowledge of woman's own body,
reproductive health, child-birth and child care. Additionally, in light of sbme
HIV positive clients that the agency is receiving and the total lack of kndwledge
about HIVIAIDS in their community, Apna Ghar shall schedule informalion
sessions on HIVIAIDS. The Contractor shall also develop a manual on b s i c
health and hygiene for their clients for reference purposes.

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IV.

PEFUOD OF PERFORMANCE: The Period of Performance shall be&m the
date of award through September 30,2005.
'1I

V.

TYPE OF CONTRACT: The Government anticipates the award of a ~ j r m ,
Fixed-Price purchase order as a response to this Request for Quote (RFQ$.

VI.

DELIVERABLES AND TIMEFRAME: The Contractor shall coordinate with
the Project Officer of this effort in order to:

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Coordinate, develop and implement all aspects of the "Health Awareriess
Prograni," which is a 12-month health education program on health A d
1
hygiene
for-their
----*- clients;
/1
Research, develop and implement a culturally-sensitive curriculum on
personal hygiene, knowledge of woman's own body, reproductive hehth, - HIVIAIDS, child-birth and child care;
1
Develop and provide educational materials for instructors and particibants in
the 12-month program;
-Develop and implement an evaluation tool to assess the effectivenessi:ofthe
1 Health Awareness Program on their client population;
Develop and provide a manual on basic health and hygiene for client
reference;
Schedule and administer 12-month program for clients in the emerge
1
and supportive housing;
~ e v e l oand
i provide program progress reports to the Project Officer PO);
Develop and provide a final program evaluation report to the PO.
.. .

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The due dates and delivery methods for these deliverables are to be decided
following the award of this effort.

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VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized agent of the
Contracting Officer is responsible for the review and acceptance of all !
deliverables.
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RFQ - 0 h ~ 0 0 0 12
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Page 3 of 18
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MII. INVOICE SUBMISSION: Upon inspection and acceptance of the deliverables
described in Section VI., the Contractor shall submit an original and two
copies of its proper invoices to the PO. For payment, the PO shall submit the
invoice and a signed receiving report to:

I

Department of ~ e a l t h& Human Services
PSC/Financial Management Service
Division of Financial Operations
Parklawn Building, Room 16A-12
5600 Fishers Lane
Rockville, Maryland 20857
Telephone:. (301) 443-3020
.
The invoice must contain the following minimum information:
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Contractor's name and address;
Purchase order number;
Description and price of services provided;
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\>.

Invoice
period; and
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TheLontractor's Internal Revenue Service (IRS) Taxpayer Identilification
Number.
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==

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IX. GOVERNMENT-FURNISHED MATERIALS: The Government will1I not
fimish any materials to the Contractor for h s requirement.
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X. RIGHTS TO DATA: The Contractor is prohibited from using data pro1 luced or
obtained under this contract for any purpose without prior, written-appro la1 from
the PO.

XI. . TECHNICAL MONITORING:
A.

Performance of the work under this purchase order shall be subje :t to the
technical monitoring of the Project Officer. The term "Technical
Monitoring" is defined to include, without limitation, the followil g:
1.

Technical directions to the Contractor, which redirect the purchase
order effort, shift work emphasis between work areas or tasks,
1I
require pursuit of certain lines of inquiry, fill in details or 1
otherwise serve to accomplish the contractual scope of work.
1

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2.

3.

B.

RFQ - 0;4~000012
Page 4 o f 18
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1
Providing information to the Contractor for assistance in the
interpretation of drawings, specifications or technical po
the work description.
Review and, where required by the purchase order, app
technical reforts, drawings, specifications and t e c h c a l
information to be delivered by the Contractor to the G
under the purchase order.

Technical direction must bewithin the general scope of work staded in the
purchase order. The Project Officer does not have the authority and .
may not issue any technical direction whlch (i) constitutes an assignment
of additional work outside the general scope of the purchase or&;jii)
constitutes a change as defined in the purchase order clause entitl'ed,
"Changes;" (iii) causes, in any manner, an increase or decrease ini the total
estimated purchase order cost, the fixed fee or the time required for
purchase order performance; or (iv) changes any of the expressed terms,
conditions, or specifications of the purchase order.

$

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All technical direction shall be issued in writing by the Project
OffiCqar shall be confirmed by h i d e r in writing within 5
working days after issuance.

C.

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The Contractor shall proceed promptly with the performance of ,II
technical .d?rection duly issued by the Project Officer in the mannbr
I
prescribed by this clause and within hisher authority under
. .- the -1 .provisions of this clause.

D.

-'*-I-.*..

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E.

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If, in the opinion of the Contractor, any instruction or direction issued by
the Project Officer is within one of the categories as defined in-(ijI through
(iv) abgye, the Contractor shall not proceed but shall notify the -. - Contracting Officer in writing within 5 working days after the reclkiptof
any such instruction or direction and shall request the ~ontractindOfficer
1
to modify the purchase order accordingly. Upon receiving such
notification fiom the Contractor, the Contracting Officer shall issje an
appropriate purchase order modification or advise the Contractor in
writing that, in hisher opinion, the technical direction is within the scope
of this clause and does not constitute a change under the Changes Clause
of the purchase order. The Contractor shall thereupon proceed 'I
immediately with the direction given. A failure of the parties to II
agree upon the nature of the instruction or direction or upon the pirchase
order action to be taken with respect thereto shall be subject to the11
U
provisions of the purchase order clause entitled "Disputes."

1

XII.

POINTS OF CONTACT:

The Project Officer (PO) for t h s effort is:
Ms. Michelle Hoersch, M.S.
Office on Women's HealthU.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 1300
Chicago, Illinois 6060 1
Phone: (312) 353-8122
Fax: (312) 353-7800
Email: rnhoersch@osophs.dhhs.gov
The ~onkictingofficer (CO) forthis effort is:
Ms. Jacqueline R. Jones
Program Support Center
U.S. Department of Health and Human Services
Parklawn Building, Room 5-101
5600 Fishers Lane'
Rockville, MP;20857
Phone: (301) 443-6413
Fax: (301) 443-8488
The contiact Spec<alistfor this effort is:
,

Mr. Gene H. Calvert
Program Support Center
Phone: (301) 443-7077

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XI.

FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (&

T h s contract incorporates one or more clauses by reference, with the s a ~:force
and effect as if they were given in full text. Upon request, the Contractin Officer
will make their full text available. Also, the full text of a clause may be i cessed
electronically at thislthese address(es): http:ll~v.arnet.govlfar.
The following FAR contract clauses are incorporated by reference: .
No.
-

CLAUSE NO.

1.

FAR 52.204-6

2.

FAR 52.204-7

'

TITLE AND DATE

Data Universal Numbering
System (DUNS) Number
(OCT 2003)
Central Contractor Registrz
(OCT 2003)

I

RFQ - 04T000012
Page6of
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18
No.
-

CLAUSE NO.

I

FAR 52.212-1
FAR 52.2 12-4
FAR 52.222-3
FAR52.222-19

FAR 52.222-21
.

.

- F m 52.222-26
FAR 52.223-6
. FAR 52.225-1
FAR 52.225-13
FAR 52.232-1
FAR 52.232-33
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14.
15.

- - FAR 52.233-1

-..-.-...
. -FAR
- 52.233-3
-,

Instructions to Offerors Commercial Items (JAN 2004)
Contract Terms and ~ondi!jons Commercial Items (OCT 2003)
Convict Labor (June 2003)l
Child Labor-Cooperation with
Authorities and Remedies I
(June 2004)
Il
Prohibition of Segregated fiacilities (Feb 1999).
Equal Opportunity (Apr 2@2-J
Drug Free Workplace (MAR 2001)
Buy American ~ c t - ~ u ~ ~ l i e k
(June 2003)
Restrictions on Certain ~ o r & i ~ n
I
Purchases (JUN 2003)
Payments (APR 1984)
Payment by Electronic Funds
Transfer-Central Contractor1
Registration (Oct 2003)
li
Disputes (JUL 2002)
Protest After Award (AUG 996)

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FAR 52.212-3 OFFEROR REPRESENTATIONS AND CERTFICATI~NSCOMMERCIAL ITEMS (MAY 2004)
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a) Definitions. As used in this provision:

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"Emerging small business" means a small business concern whose size is no
greater than 50 percent of the numerical size standard for the NAICS code1
designated.
"Forced or indentured child labor" means all work or service.

-.

(1) Exacted fiom any person under the age of 18 under the menace of any
penalty for its nonperfo&ance and for which the worker does nodoffer
'I
himself voluntarily; or
1
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(2) Performed by any person under the age of 18 pursuant to a codtract the
enforcement of which can be accomplished by process or penaltieb.
"Service-disabled veteran-owned small business concernw-

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CONTRACT CLAUSES
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(1) Means a small business concern-

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(i) Not less than 51 percent of which is owned by one or more
service-disabled veterans or, in the case of any publicly
owned business, not less than 5 1 percent of the stock of wlhich
is owned by one or more service-disabled veterans; and
.
(ii) The management and daily business operations of which are
controlled by one or more service-disabled veterans or, inlthe case
of a service-disabled veteran with permanent and severe disability,
the spouse or permanent caregiver of such veteran.
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(2) Service-d&abled veteran means a veteran, as defined in 38 UJS;IC.
101(2), with a disability that is service-connected, as defined in 38 U.S.C.

,.

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"Small business concern" means a concern, including its affiliates, that is/
independently owned and operated, not dominant in the field of operation in
which it is bidding onsGovernmentcontracts, and qualified as a small business
under the criteria in 13 CFR part 121 and size standards in this solicitation.
? ,,,?
I
"Veteran-owned small business concern" means a small business concern-'/

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(1) Not. less than 5 1 percent of which is owned by one or more veterans
(as defined at 38 U.S.C. 101(2)) or, in the case of any publicly odned
business, not less than 5 1 percent of the stock of which is owned bjy one or
=,I
moreireterans; and
-4-

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(2) The management and daily business operations of which are controlled
by one or more veterans.
_ (1
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"Women-owned business concern" me& a concern which is at least 5 1 bercent
owned by one or more women; or in the case of any publicly owned busi
least 5 1 percent of its stock is owned by one or more women; and whos
management and daily business operations are controlled by one or mor

-

*

"Women-owned small business concern" means a small business concern"--*

I

(1) That is at least 51 percent owned by one or more women; or, in the
case of any publicly ownid business, at least 5 1 percent of the stobk of
which is owned by one or more women; and

!

(2) Whose management and daily business operations are control1:~dby
one or more women.
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RFQ - 04T0000 12
Page8of 18

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(b) Taxpayer IdentificationNumber (TIN) (26 U.S.C.
6109, 31 U.S.C.
7701). (Not applicable
if the offeror is required to provide this information to a central contractdr
registration database to be eligible for award.)
1

(1) All offerors must submit the information required in paragraphs (b)(3)
through (b)(5) of this provision to comply with debt collection
requirements of 3 1 U.S.C. 770 1(c) and 3325(d), reporting requirements of
26 U.S.C. 6041,6041A, and 6050M, and implementing re gulatiohs issued
(I
by the Internal Revenue Service QIRS).
I/

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(2) The TIN may be used by the Government to collect and report on any
delinquent amounts arising out of the offeror's relationship with the
Govergnent (31 U.S.C. 7701(c)(3)).
--. 1 If the resulting contract is subject to the payment reporting requirements
described in FAR 4.904, the TIN provided hereunder may be madFhed
with IRS records to verify the accuracy of the offeror's TIN.

1
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:

(3) Taxpayer Identification Number (TIN).
il
[ ] TIN:
[ ] TIN has been applied for.
[ ] :2@Jis not required because:
[ ] Offeror is a nonresident alien, foreign corporation, or foreign,
partnership that does not have income effectively connected with ?he
conduct.. of
. a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States;
(1
[ ] Offeror is an agency or instrumentality of a foreign government;
[ ] Offeror iS an agency or instrumentality of the Federal ~ o v e r i $ n e n'
i

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(4) Type of organization.
[ ] Sole proprietorship;
1 ] Partnership;
[ ] Corporate entity (not tax-exempt);
[ ] Corporate entity (tax-exempt);
[ ] Government entity (Federal, State, or local);
[ ] Foreign government;
[ ] Lntemational organization per 26 CFR 1.6049-4;
[ ] Other
* - ,

( 5 ) Common parent.
[ ] Offeror is not owned'or controlled by a common parent;
[ ] Name and TIN of common parent:
Name
TIN

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(c) Offerors must complete the following representations when the resul'ting
contract will be performed in the United States or its outlying areas. ~ h J c kall that
apply.

I

(1) Small business concern. The offeror represents as part of its @er
that it [ ] is, [ ] is not a small business concern.

1

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(2) Veteran-owned small business concern. [Complete only ifthelofferor
represented itselfas a small business concern in paragraph (c)(l?)of thrs
provision.] The offeror represents as part of its offer that it [ ] is,i [ ] is not
a veteran-owned small business concern.

i

(3) Sevice-di~abledveteran-owned small business concern. [C&plete
only i f the offeror represented itselfas a veteran-owned small buimess
1
concern in paragraph (c)(2) of this provision .]
'I
The offeror represents as part of its offer that it [ ] is, [ ] is not a servicedisabled veteran-owned small business concern.

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(4) Small disadvantaged business concern. [Contplete only i f the bferor
represented itselfas a small business concern in paragraph (c)(l) of this
proldq&n.] The offeror represents, for general statistical purposes\ that it
[ ] is, [ -1 is not a small disadvantaged business concern as define'd in 13
1
CFR-I 24.1002.
1
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(5) Women-owned small business concern. [Complete only ifthe q?fferor
represented itselfas a small business concern in paragraph (c)(l) of
this provision.] The offsror represents that it [ ] is, [ ] is Kot a women: =
owned small business concern.

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~ o t e Complete
:
paragraphs (c)(6) and (c)(7) only if this solicitatibn is
I
expected to exceed the simplified acquisition threshold.
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(6) Women-owned business concern (other than small business c
[Complete only if the offkror is a women-owned business concer
did not represent itself as a small business concern in paragrap
of this provision.] The offeror represents that it [ ] is a womenbusiness concern.
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(7) Tie bid priority for labor surplus area concerns. If this is an invitation
for bid, small business offerors may identify the labor surplus are&
in which costs to be incurred on account of manufacturing or production
(by offeror or first-tier subcontractors) amount to more than 50 percent of
i
the contract price:
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WQ - O ~ T O O O O12
Page 10 of 18

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(8) Small Business Size for the Small Business Competitiveness
Demonstration Program and for the Targeted Industry Categories under
Y
the Small Business Competitiveness Demonstration Program. [Complete
only if the oferor has represented itselfto be a small business cohcern
under the size standards for this solicitation.]

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1%

(i) [Complete only for solicitations indicated in an addendum as bezng setaside for emerging small businesses in one of thefour designated
1
industry groups (DIGs).] The offeror represents as part of its offer that it
[ ] is, [ ] is not an emerging small business.
(ii) [Complete only for solicitations indicated in an addendum as
one of the targeted industry categories (TICS) or four designated
industry groups (DIGS).]Offeror represents as follows:
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(A) Offeror's number of employees for the past 12 months
in
Employees column if size standard stated in the solicitation is exdressed
1
terms of number of employees); or

II
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(B) Offeror's average annual gross revenue for the last 3 fiscal ye+rs
(check&e Average Annual Gross Number of Revenues column i( size
standard stated in the solicitation is expressed in terms of annual receipts).

1

.2.--.A...

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(Check one of the following):

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Number of Employees Average Annual Gross Revenues_
- 50 or fewer

51-100
i -

:

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101-250

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1 - $1 million or less

1 -$1,000,001-$2 million
1 -$2,0.00,001-$3.5million

1

i. - 501-750
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- 751-1,000

;. -Over 1,000

iI - $10,000,001-$I7 million

!, -Over $17 million

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( 9 ) [Complete only zfthe solicitation contains the clause at FAR 52.21923, Notice of Price Evaluation Adjurtment for Small ~ i s a d v a n t a ~ e ~ b
I
Business Concerns, or FAR 52.219-25, Small Disadvantaged Business
Participation Program-Disadvantaged Status and Reporting, and !he
offeror desires a benefit based on its disadvantaged status.]
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(i) General. The offeror represents that either-

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( - $3,500,001-$5 million

$5,000,001-$lo million

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-25 1-500

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pag+ 11 o f 1 8

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(A) It [ ] is, [ ] is not certified by the Small Business Administration as a
1
small disadvantaged business concern and identified, on the date of
this
representation, as a certified small disadvantaged business concerh in the
database maintained by the Small Business Administration ( P R O ~ N ~ ~ ) ,
'I has
and that no materialchange in disadvantaged ownership and control
occurred since its certification, and, where the concern is owned dy one or
more individuals claiming disadvantaged status, the net worth of each
individual upon whom the certification is based does not exceed $,750,000
after taking into account theapplicable exclusions set forth at 13 CFR
124.104(~)(2);or

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(B) It [ rhas, ] has noGubmitted a completed applicati~nto tESmall
~ ; s i n e s~dministration
~
or a Private Certifier to be certified as a $mall
disadvantaged business concern in accordance with 13 CFR 124, Subpart
B, and a decision on that application is pending, and that no mate4al
change in disadvantaged ownership and control has occurred sinc: its
application was submitted.

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(ii) [ ] Joint Ventures under the Price Evaluation Adjustment for small
D i s d _ntagedBusiness Concerns. The offeror represents, as
offer, t at it is a joint venture that complies with the
13 CFR 124.1002(f) and that the representation in paragraph (c)(9)(i)
of this provision is accurate for the small disadvantaged business /
iiiriiem thaf is participating in the joint venture. [The offeror shalljenter
the name of the small disadvantaged business concern that is
1,
.- --participating in the joint venture:

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(10) HUBZone small business concern. [Complete only ifthe offeibr
represented itself as a small business concern in paragraph (c)(l) I,of
this provision.]
The offeror represents, as part of its offer, that- 1
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(i) It [ ] is, [ ] is not a HUBZone small business concern listed, on the
date of this representation, on the List of Qualified HUBZone Small
Business Concerns maintained by the Small Business Administrati
no material change in ownership and control, principal office, or
HUBZone employee percentage has occurred since it was certi
the Small Business Administration in accordance with 13 CER p
and
(ii) It [ ] is, [ ] is not a joint venture that complies with the requ
of 13 CFR part 126, and the representation in paragraph (c)(10)
provision is accurate for the HUBZone small business concern
that are participating in the joint venture. [The offeror shall enter the name
or names of the HUBZone small business concern or concerns thatiare
participatzng in thejoint venture:
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RFQ - 0 4 ~ 0 0 0 102
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Each HUBZone small business concern participating in the joint venture
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shall submit a separate signed copy of the HUBZone representation.

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(d) Representations required to implement provisions of Executive 0rde4 11246-

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(1) Previous contracis and compliance. The offeror represents that.

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(i) It [ ] has, [ ] has not participated in a previous contract or subcontract
subject to the Equal Opportunity clause of this solicitation; and

1

(ii) It [ ] has, [ ] has not filed all required compliance reports.
,

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(2) ~ f i + a t i v- e Action Compliance. The offeror represent~lhat--*-

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(i) It [ -1 has developed and has on file, [ ] has not developed and Foes not
have on file, at each establishment, affirmative action programs required
by rules and regulations of the Secretary of Labor (41 CFR parts 60-1 and
60-2), or

1

/I

(ii) It [ ] has not previously had contracts subject to the written affirmative
acticm~ograrnsrequirement of the rules and regulations of the se.kretary
of Labor,

I

--

(e) Certificat~onRegard~ngPayments to Influence Federal Transactions (31 U.S C 13512).
(Applies-CiTy if the' contract is expected to exceed $100,000.) By submission of
/I
its offer, the offeror certifies to the best of its knowledge and belief that no
Federal appropriated funds have been paid or will be paid to any prson fir- - =
'I
influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress or an employeelof a
Member of Congress on his or her behalf in connection with the award ofiany
resultant contract.
- -

I

<

(9 BUY American ~

il

*-

cCertificate.
t
(Applies only if the clause at Federal ~ c ~ u i s l t i o n

Regulation (FAR) 52.225-1, Buy American Act-Supplies, is included in
solicitation.)
(1) The offeror certifies that each end product, except those listed in
1
paragraph (f)(2) of this provision, is a domestic end product .and that the
1
offeror has considered components of unknown origin to have been
mined, produced, or manufactured outside the United States.
The offeror shall list as foreign end products those end products
manufactured in the United States that do not qualify as domestic end
products. The terms "component," "domestic end product," "end p:oduct,"
i
"foreign end product," and "United States" are defined in the clause of this
i
solicitation entitled "Buy American Act-Supplies."

11
I

i
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(2)

Foreign End Products:

[List as necessary]

I

(3) The Government~wi~~-evaluate
offers in accordance with the policies
4....
and procedures of FAR Part 25.
~

:
:
:

1

-.

(g)(l ) Buy Anterican Act-Free Trade Agreements-Israeli Trade Act Certhcate.
(Applies only if the clause at FAR 52.225-3, Buy American Act-Free Trade
!
Agreements-Israeli Trade Act, is included in this solicitation.)

II/

(i) The offeror certifies that each end product, except those listed in
par?p?ph (g)(l)(ii) or (g)(l)(iii) of this provision, is a domestic ebd
p r o d ~ a n dthat the offeror has considered components of u n k n o h origin
to have been mined, produced, or manufactured outside the unites States.
The terms "component," "domestic end product," "end product," "foreign
endproduct," and "United States" are defined in the clause of this/
solicitation entitled "Buy American Act-Free Trade ~greements-1braeli
Trade Act."
-- -- -

-I

1

(ii) The offeror certifies that the following supplies are FTA c o u n b end
products or Israeli end products as defined in the clause of this sol'icitation
'I Act":
entitled "Buy American Act-Free Trade Agreements-Israeli Trade1(
-..-

. ..

..

1/I

..-

'

- .. - .

1

FTA Country or Israeli End Products:

[List as necessary].
.

.

II
1
I
I

(iii) The offeror shall list those supplies that are foreign end
1
products (other than those listed in paragraph (g)(l)(ii) of this pro~ision)
as defined in the clause of this solicitation entitled " B UAmerican!
~
Act-

..

.-. .

-

.--

Free Trade Agreements-Israeli Trade Act." The offeror
foreign end products those end products manufactured in the ~ d t e States
d
that do not qualify as domestic end products.

Other Foreign End Products:

[List as necessary]

1

(iv) The Govemhent will evaluate offers in accordance with the policies
I)
and procedures of FAR Part 25.
/I

I

(2) Byy American Act-Free Trade Agreements-Israeli Trade Act Certificate, Alternate I
(Jan 162).If Alternate I to the clause at FAR 52.225-3 is included in this
solicitation; substitute the following paragraph (g)(l)(ii) for para*aph '
(g)(l)(ii) of the basic provision:

:.-.-..,..

.+

1
I

..,+

1
(g)(l)(ii) The offeror certifies that the following supplies are Canadian edd
products as defined in the clause of t h s solicitation entitled " ~ u ~ . ~ m e r i fAct;
ian
Free Trade Agreements-Israeli Trade Act":
1It
li

-

Canadian End Products:

..

-

II/
l

iI
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I
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--/

[L~stas necessary]

1

1

(3) Buy American Act-Free Trade Agreements-lsraelr Trade Act Certificate, A(ternate I1
(Jan 2004). If Alternate I1 to the clause at FAR 52.225-3 is included in this
solicitation, substitute the following paragraph (g)(l)(ii) for para6aph
(g)(l)(ii) of the basic provision:
I
I

,

1,

I

RFQ - C
Pai

'0000 12
15 of 18

(g)(l)(ii) The offeror certifies that the following supplies are Canadian c
products or Israeli end products as defined in the clause of this solicitati
"Buy American Act-Free Trade Agreements-Israeli Trade Act":

entitled

Canadian or Israeli End Products:
-

-

a

.

~

. .

[List as necessary]

( 4 ) Trade Agreements Certificate. (Applies only if the clause at I
52.225-5, Trade Agreements, is included in this solicitation.)

(i) TJe offeror certifies that each end product, except those listec
para'ghljlh (g)(4)(ii) of this provision, is a U.S.-made, designated
Caribbek Basin country, or FTA country end product, as define
clause of this solicitation entitled "Trade Agreements."
-.
(ii) The offeror shall list as other end products those end product
not U.S.-made, designated country, Caribbean Basin coun&y, or
country end products.
-*-r*

4

R

-

lat are

'A - -

Other End Products:

[List as necessary]

(iii) The Government will evaluate offers in accordance with the llicies
and procedures of FAR Part 25.
For line items subject to the Trade Agreements Act, the Governr It
will evaluate offers of U.S.-made, designated country, Caribbear asin
country, or FTA country end products without regard to the rest tions of
the Buy American Act.

/I
The Government will consider for award only offers of U.S.-made,
designated country, Caribbean Basin country, or FTA country end
products unless the Contracting Officer determines that there are ho offers
for such products or that the offers for such products are
fulfill the requirements of the solicitation.

(h) Certfication Regarding Debarment, Suspension or Ineligibilrqfor ~ i v a r d
1
(Executive Order 12549). (Applies only if the contract value is expected to exceed
the simplified acquisition threshold.) The offeror certifies, to the best of
knowledge and belief, that the offeror and/or any of its principals-

I

(1) [ ] Are, I ] are not presently debarred, suspended, proposed for
-debarment, or declared ineligible for the award of contracts by any'I Federal
agency; and- -!

(2) [ ] Have, [ ] have not, within a three-year period preceding this offer,
been convicted of or had a civil judgment rendered against them for:
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a Federal, state or local goveniment
I
contract or subcontract; violation of Federal or state antitrust statutes
r e l a t w o the submission of offers; or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, makhg false
statements, tax evasion, or receiving stolen property; and
(3) [ ] Are, [ ] are not presently indicted for, or otherwise
cGfly chaeed by a Government entity with, commission of any
offenses.

I

-.-

-

.

(i) Certification Regarding Knowledge of Child Labor for Listed End
Products (Executrve Order 13126). [The Contracting Officer
paragraph (i)(l) any end products being acquired under this
solicitation that are included in the List of Products Requiring - - ~ertfi&tionas to Forced or Indentured Child Labor, unless
excluded at 22.1503(b) .]

tractor

,

(1 ) Listed end products.

I
d

1

1
I

(2) Certfication. [Ifthe Contracting Ojficer has identljied endpro~ucts
and countries of origin in paragraph (i)(l) of this provision, then the
oferor must certrfi to either (i)(2)(0 or (i)(2)(ii) by checking the j:
appropriate block.]
11
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i

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A

RFQ - 0 4 ~ 0 0 0 12
0
Page 17 of 18
!I
[ ] (i) The offeror will not supply any end product listed in parag$aph
(i)(l) of this provision that was mined, produced, or manufacturedr in the
corresponding country as listed for that product.
iI
[ 1 (ii) The offeror may supply an end product listed in paragraph/(i)(l) of
this provision that was mined, produced, or manufactured in the 1
corresponding country as listed for that product. The offeror certifies that
it has made a good faith effort to determine whether forced or indkntured
child labor was used to mine, produce, or manufacture any such ehd
product furnished under this contract. On the basis of those
offeror certifies that it is not aware of any such use of child

I

2.

P.L. 103-227 THE PRO-CHILDREN ACT OF 1994 CERTIFICATION
R E G ~ I N G
EN\~@ONMENTAL TOBACCO SMOKE
-[

1

-

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1

Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), *quires
that smoking not be permitted in any portion of any indoor facility owned or
leased or contracted for or by an entity and used routinely or regularly fo? the
I or
provision of health, day care, early childhood development services, educ,ation
library services to children under the age of 18, if the services are funded
Federal p r o g r F s either directly or through State of local governments, b$ Federal
grant, contract,' loan, or loan guarantee.
!I
The law also-applies to children's services that are provided in indoor facilities
that are constructed, operated, or maintained with such Federal funds. T& law
services provided in private residences; porti&nsof
does nof~~~j5Tyto~Children's
facilities used for inpatient drug or alcohol treatment; service
whose
sole source of applicable Federal funds is Medicare or Medicaid; -mfaciEties---=
where WIC coupons are redeemed.

by

,

I

Failure to comply with the provisions of the law may result in the imposition of a
civil monetary penalty of up to $1000.00 for each violation andor the irndosition
-. - of an administrative compliance order on the responsible entity.
1I11
1

1

By signing this certification, the offeror/contractor (for acquisitions) or I
applicant/grantee (for grants) certifies that the submitting organization wi1,l
comply with the requirements of the Act and will not allow smoking within any
portion of any indoor facility used for the provisions of services for childrkn as
'I
defined by the Act.
._..
1I
(1

The submitting organization agrees that it will require that the language of this
certification be included in any subawards which contain provisions for children's
:I
services and that all subrecipients shall certify accordingly.
1

I

RFQ - 04T000012
pagk 18 of18
;I
[ ] The following certification to be completed bv the Offeror:

(The Representations and Certifications must be executed by an
individual authorized to bind the Offeror.)
The Offeror makes the following Representations and Certifications as
part of its proposal.
-

-

I
1
II

(Name of Offeror)

(Signatufe of- Authorized
-Individual)

(TypedlPrinted Name of Authorized Individual)

Note: The penalty for making false statements in offers is prescribedl in 18

il

/I

ORDER FOR SUPPLIES OR SERVICES
2 CONTRACT NO (If
any)

1 DATE OF ORDER

PAGE OZ PAGES

11

b.dPORTANT: Mark all packages and papers with contract andlor order numbers

!

-

1

6 SHIP TO

I

a NAME OF CONSIGNEE

09/29/2004

I

I

3. ORDER NO.

HHSP233200400828P

I

Ii

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5 l5SUlNG OFFICE (Adhess correspondence lo)

b STREET ADDRESS

DHHS/PSC/SAS/DAM
P W W N BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

233 N. MICHIGAN AVE, SUITE 1300 1

-

-

I IL

c ClTY

d STATE

CHICAGO
DIA SATORI

7 TO:

)

e ZIP CODE

60601

I.SHIP VIA

a NAME OF CONTRACTOR

SATORI AND ASSOCIATES
E

-

c STREET ADDRESS

5921 DUPONT AVENUE S

-

7

a PURCHASE

,

REFERENCE YOUR

Quote Attached

.-

.

/-

STATE

d ClTY

MINNEAPOLIS

MN

CODE

Please furnish the fdlamng cn the terms
and cmdlbms speofied m both s~desof
t h s wder and on the attached sheets, d
any. lndudlng dellvery as lndraled

.

HHS/OPHS/OWH/REGION
..

,g

a. SMALL

L b . OTHER THAN SMALL

Destination

C.

v

- i1l
1

1

.

.-

....,

I

I /I

SUPPLIES OR SERVICES

QUANTITY
ORDERED UNIT
(d)
IC)

.,

(a)

UNK
PRICE

(el

.

- . . . ..

.

--AMoum-l

/I

-

QUANTITY
ACCEPTED

-..=

/!

(1)

(9)

b;'
~

.

Questions concerning this order should be referred to Gene Calvert at (301)--443-7C77.
.-..
~. jJ
PLEASE REFERENCE PAGES 1 THROUGH 6 OF THE ATTACHED STATEMENT OF WO:<K TITLED ""FFICE
0
!i
Continued . . .
i

--

18. SHIPPING POINT

19. GROSS SHIPPING WElGKT

1

20 INVOICE NO

21. MAIL INVOICE TO

SEE BILLING
INSTRUCTIONS
O N REVERSE

b STREET ADDRESS

(or P O BOX)

I
I

17(h)
TOTAL
(Con!.

I

pages)

I

a. NAME

4

SP_,.?S5.~OO

/I

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

I

I

j

170)

GRAND
TOTAL

1

c. CITY

ROCKVILLE
22. UNITED STATES OF AMERICA
BY (Signature)

d STATE

M D

e. ZIP CODE

/I
il

4

$4,985.00

20857

I
It

23 NAME (Typed)

JACQUELINE R. JONES

i;!

TITLE: CONTRACTINWORDERINGDFF~CER;~
NSN 7540D1.152-8083
PREVIOUS EDITION NOT USABLE

-- .

1

17. SCHEDULE (See rwerse lor Rqeu~ons)

d

-

Net 30

b ACCEPTANCE

Tax ID Number:
DUNS Number:

d. WOMEN-OWNED

i 6 . OISCOUYT T E ~ M S

15. D E L M R TO F.0.8 POINT
ON OR BEFORE (Dale)

-

1DestinUn

ITEM NO.

on the

debve~
crder 1s
sub&cl lo ,nslrucllw m b l n e d on
ths sjde only d ttus l a m and 0s

1
I

DISADVANTAGED

14. GOVERNMENT BRMO.

..

13 PLACE OF

Destination

frr blrllng ~nsrruca*-s

&%

~ssuebsubect to me terms and
condtbm 01me abovenumbered
mtract

1 1 BUSINESS CLASSIFICATION (Check a ~ ~ r. o ~ nbox(esJJ
ale

a INSPECTION

=

(I
~xcebl

10 REQUISITIONINGOFFICE

7540120

12. F 0 . B POINT

l

b DELIVERY

55419-2110

9 ACCOUNTMG AND APPROPRIATIONS DATA

D

jl

LI WPE OF ORDER

b COMPANY NAME

!OPTIONAL FORM 147 (Rrr

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/I
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II

!

D* Oswm (a~

R Y J2l24.j

...

I

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

P A ~ EOF PAGES

-

I
1

IMPORTANT: Mark all packages and papers mlh conlrad and/or a d e r numbers

DATEOFORDER CONTRACTNO
09/29/2004

ORDER NO
I~~~~23320040082~~

1

QUANTITY UNIT
ORDERED

SUPPLIEYSERVICES

ITEM NO

(A)

(C)

(8)

(Dl

UNm

AMOUNT

QUANTIT,
ACCEPTED
IG)

PRlCE

(E)

(F)

ON WOMEN'S HEALTH, REGION v - HEART TRCTH CAYPAIGN, FOR SCOPE OF WORK, INVOICING
PROCEDURES, AND TERMS AND CONDITIONS REGARDI'JG THIS E 'FORT.
CAN: 1990110 FY: 2004
-Period of Performance: 09/30/2004 to 09/29/2305

1

1

I

1 LT
The Contractor shall provide support ~n
4,985.00
4,985 00
promoting the "Heart Truth Campalgnu In
accordance wlth the attached Statement of
I
Work tltled "Office on Women's Health, Reglbn V - - Heirt Truth Cam>algn."
I
[

Proposed fee is detailed as follc,=.
Event Coordinator
Transporatlon & Parklng
Postage
Supplies

I

..

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-----

- - $4,965.00

Total
Project Officer:
Michelle Hoersch
Phone: (312) 353-8122,+,>.--

.-

= , .., .

1.

INVOICE INFORMATION

NUMBER) OR SOCIAL SECURITY NUMBER.
.-

t

FEDERAL ACQUISITION REGULATION (48 CFR CHAP
FAR 52.232-33 PAYMENT BY ELECTRONIC FUNDS
REGISTRATION (OCT 2003)

R 1)

TSFE

TOTAL CARRIED FORWARDTO 1ST PA
NSN 754001-152-8082

50348-101

~~~~23320$008?8~
Page 1 of 6

1

1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVIC!ES
OFFICE ON WOMEN'S HEALTH - REGION V

I:

STATEMENT OF WORK

PROJECT TITLE: Office on Women 's Health, Region V - Heart Truth
Campaign

I.

I

I

BACKGROUND: The Office on Women's Health (OWH) is the focal +nt for
women's health within the Department of Health and Human Services (HHS).
The OWH, under the direction of the Deputy Assistant Secretary for ~ e a l / h
(Women's Health), improves the health and well-being of women across the
lifespan by coordinating women's health programs, promoting health edu&tion
and disease prevention, and leading efforts and fostering partnerships to eliminate
health disparities.

11.

--

1

The Heart Truth Campaign, sponsored by the National Heart, Lung, and $lood
I/
Institute (NHLBI) and partner organizations is intended to make women more
aware of the danger of heart disease. The campaign's goal is to give womdn a
personal and urgent wake-up call about their risk of heart disease. The caApaign
.+'...
is especiallye-d
at women ages 40 to 60, the time when a woman's risk!of
'I
heart disease starts to rise. But its messages are also important for younger
women, sinceheart disease develops gradually and can start at a young a g1 e ~ v e n
in the teej-a~eyears.
.- Older women have an interest too-it's
never too late!to take
action to prevent and control the risk factors for heart disease. Even those b h o
have heart disease can improve their heart health and quality of life.
. - - --

-

- I

1

- -

'I

PURPOSE: The purpose of this contract is to provide contractor support [o help
promote the Heart Truth Campaign by coordinating a series of activities in the
Mimeapolis/St. Paul area. These events will include a symposium on wo4en and
heart disease and the Heart Truth Campaign for health care providers, and training -on the Heart Truth Speakers Kit for lay women from community-based I
'I
organizations. The participants will be taught how to use the speakers' kit fnd
they will then be expected to do presentations in their respective communities.

111.

'I

B

PEFUOD OF PERFORMANCE: The Period of Performance shall be from the
September 29, 2004 through September 30, 2005.

IV.

...

TYPE OF CONTRACT: This is a Firm, Fixed-Price purchase order.

V.
VI.

I

-

(

DELIVERABLES AND TIMEFRAME: The Contractor shall work in
collaboration with the Project Officer (PO) to create the referenced Heart Truth
Campaign
- - events. This will include convening and planning conference calls,
coordinating logistics, identifying other potential partners and sponsors and
managing all aspects of the events.
i

-.

1
To ensure coordination with the goals and policies of the Office on Women's
Health and the Department of Health and Human Services, the Contractor1 shall
provide regular progress reports to the PO and shall submit all proposed {vritten
materials to the PO for appropriate Departmental clearances.

I
The Contractor shall coordinate with the PO of this effort and provide theI

I

following services and deliverables:
Symposium for health care providers;
I)
Contact organizations and companies to identify additional partners akd
It
sponsors;
Coordinate all volunteers and committee activities and keep all partners
I/
informed of progress and time line;
_ _
IIConvene weekly meetings via conference call;
Act as local contact in Minneapolis for the Region V OWH staff;
a
Establish timeline and assign responsibilities as appropriate;
il
a
Develop and implement marketing and media efforts;
a Coordinate logisticsfor symposium/training;
1
Regular project updates with timeline, logistics and partner confirmations;
A partner roster;
I
Use netyo& connections for maximize community involvement;
aj
Contract with vendors to supply services and equipment as needed, such as,..
but not limited to, the following:
o Audio visual
o MSEfials-pieparation
- .
o Speakers
- .. --o Training kits ..
I
a
On-site coordination for the events;
Speaker's training kits;
a
Post-event summary report.
j
IL/ - - --The due dates and delivery methods for these deliverable~are to be 1'
determined following the award of this effort.

I

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1

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VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized agent of the
Contracting Officer is responsible for the review and acceptance of all
deliverables.
.

VIII.
-

..

1

PAYMENT SCHEDULE: The Contractor shall submit a proper invoick for
services performed related to the first planning conference call, submissic!:n of
partner roster, and confirmation of the venue's logistics to the PO within P o
weeks of the PO'S acceptance of those deliverables. The Contractor shalllsubmit
a proper invoice for the balance of the proposed fee within two weeks of (he PO'S
acceptance of the completed event and post-event summary.
!

(I
,I

.

--

..:

IX.

INVOICE SUBMISSION: Upon inspection and acceptance of the delkerables
described in Section VI., the Contractor shall submit an original and two
copies of its proper invoices to the PO. For payment, the PO shall submit; the
invoice and a signed receiving report to:

I
I
1
I

Department of Health & Human Services
PSCFinancial Management Service
Division of Financial Operations
Parklawn Building, Room 16A-12
5600 Fishers Lane
Rockville, Maryland 20857
Telephone: (30 1) 443-3020
..
. .. .
- The invoice must contain the following minimum information:

I

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,

--

I

.

. -

i l -

-7;
..

:I

Contractor's name and address;
Purchase order number;

!I

1
1
1

Description
-a
and price of services provided;

- <=::

Invoice period; and

(I

j

T-heCmtractor's Internal Revenue Service (IRS) Taxpayer Identification
Number.
I)
.--7X. GOVERN~~ENT-FURNISHED
MATERIALS: The Guvrnlrncn~willlnot
!I
hrnish any materials to the Contractor for this requirement.

1

I

XI.

RIGHTS TO DATA: The Contractor is prohibited from using data prodiked or
obtained underthis contract for any purpose without prior, written .appro<al--from ~4
the PO.
!I

XII. TECHNICAL MONITORING:
A.

Performance of the work under this purchase order shall be subjeci to the
technical monitoring of the Project Officer. The term "Technical I
'I
Monitoring" is defined to include, without limitation, the following:
1.

I
1

Technical directions to the Contractor, which redirect the purchase
order effort, shift work emphasis between work areas or taAks,
require pursuit of certain lines oiinquiry, fill in details or
otherwise serve to accomplish the contractual scope of w o ~ k .
1
I

..

--.

-:.-..

2.

Providing information to the Contractor for assistance in tl
interpretation of drawings, specifications or technical port
the work description.

3.

Review and, where required by the purchase order, appro\
technical reports, drawings, specifications and technical
inhrmation to be .delivered by the Contractor to the Gove~ ment
under the purchase order.

Technical direction must bewithin the general scope of work statc
purchase order. The Project Officer does not have the authority tc
may not issue any technical direction which (i) constitutes an ass]
of additional work outside the general scope of the purchase o r b
constitutes a change as defined in the purchase order clause entitlc
"Changes;" (iii) causes, in any manner, an increase or decrease in
estimated purchase order cost, the fixed fee or the time required fi
purchase order performance; or (iv) changes any of the expressed
conditions, or specifications of the purchase order.

in the
ind
-.
lment
-ti;) .
3

le total

All technical direction shall be issued in writing by the Project
0ffi$@%r shall be confirmed by himher in writing within 5
w o r k i n ~ d a y safter issuance.
The_~~,ontra~tor
shall proceed promptly with the performance of
technical direction duly issued by the Project Officer in the mannl
prescribed by this clause and within hisher authority under
the
.. .-provisions of this ciause.
If, in the opinion of the Contractor, any instruction or direction is!
the Project Officer is within one of the categories as defined in (i)
(iv) above, the Contractor shall not proceed but shall notify. the
Contracting Officer in writing within 5 working days after the rec
any such instruction or direction and shall request the Contractin!
to modify the purchase order accordingly. Upon receiving such
notification from the Contractor, the Contracting Officer shall iss'
appropriate purchase order modification or advise the Contractor
writing that, in hisher opinion, the technical direction is within tl- scope
of this clause and does not constitute a change under the Changes llause
of the purchase order. The Contractor shall thereupon proceed
immediately with the direction given. A failure of the parties to
agree upon the nature of the instruction or direction or upon the p chase
order action to be taken with respect thereto shall be subject to thc
provisions of the purchase order clause entitled "Disputes."

-

-. .

XIII. POINTS OF CONTACT:
The Project Officer (PO) for this effort is:
Ms. Michelle Hoersch, M.S.
Office on Women's Health
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 1300
Chicago, Illinois 6060 1
Phone: (3 12) 353-8122
Fax: (3 12) 353-7800
Email: mhoersch@osophs.dhhs.~ov
-

v-

The Contracting Officer (CO) for this effort is:
Ms. Jacqueline R. Jones
Program Support Center
U.S. Department of Health and Human Services
Parklawn Building, Room 5-101
5600 Fishers Lane
Rockville, NfQ52085 7
Phone: (301) 44.3-6413
Fax: (301) 443-8488
.s=-,-.

. -.. ... ,-

The Contract Specialist for this effort is:
- --

Mr. Gene H. Calvert
Program Support Center
Phone: (301) 443-7077

-

XIV. FAR 52.252-2.GLAUSES INCORPORATED BY REFERENCE (FEI
This contract incorporates one or more clauses by reference, with the sarr force
and effect as if they were given in full text. Upon request, the Contracting )fficer
will make their full text available. AIso, the full text of a clause may be ac essed
electronically at thisithese address(es): http://\\ww.arnet.ov/far.
The following FAR contract clauses are incorporated by reference:-.'
'

No.

CLAUSE NO.

1.

FAR 52.204-6

2.

FAR 52.204-7

TITLE AND DATE
-

Data Universal Numbering
System (DUNS) Number
(OCT 2003)
Central Contractor Registrat
(OCT 2003)

~~~~233206400828~
R
Page 6 of 6

I

No.

CLAUSE NO.

TITLE AND DATE

3.

FAR 52.212-1

4.

FAR 52.212-4

5.
6.

FAR 52.222-3

Instructions to Offerors Commercial Items (JAN 2064)
Contract Terms and ~ o n d l t i b n s
Commercial Items (OCT 2003)
Convict Labor (June 2003) I
Child Labor-Cooperation uri:)h
Authorities and Remedies
(June 2004)
Prohibition of Segregated ~acilities .(Feb 1999).
-Equal Opportunity (Apr 2QQ.Q
Drug Free Workplace (MA$ 2001)
Buy American Act-Supplies1
(June 2003)
h
Restrictions on Certain Foreign
Purchases (JUN 2003)
Payments (APR 1984)
Payment by Electronic Funds
Transfer-Central Contractor
Registration (Oct 2003)
Disputes (JUL 2002)
Protest After Award (AUG 996) -

FAR52.222-19

7.

8.
9.
10.

FAR' 52.222-21

FAR.-52222-26
FAR 52.223-6
.FAR 52.225-1

.

11.

FAR 52.2.25-13

12.
13.

FAR 521232-1
FAR 52.232-33

14.
15.

-,
;

.+'

-'.

-L

FAR 52.233-1
...FAR
...- 52.233-3

..Ad-.

I

1

1
1

i

i

I

I

.-

--

ORDER FOR SUPPLIES OR SERVICES

PAGE OF PAGES

/I

IMPORTANT: M a r k all p a c k a g e s a n d p a p e r s with c o n t r a c t a n d l o r o r d e r n u m b e n
2 CONTRACT NO (Ifany)

1 DATE OF ORDER

I

a NAME OF CONSIGNEE

09/29/2004
3. ORDER NO.

4. REQUlSlTlONlREFERENCE NO.

HHSP233200400832P

04T000014

2

/j

6 SHIP TO

Y

I

5 ISSUING OFFICE {Address correspondence to)

b STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5- 101
5600 FISHERS LANE
ROCKVILLE MD 20857

233 N. MICHIGAN AVE, SUITE 1300

'I

c CITY

11

1

-

CHICAGO

I

PURCHASE

r

b? DELNERY

REFERENCE YOUR:

..

3010 HENNPIN AVENLTE S
SUITE NO. 121

MN

Please furnish h e f d l m n g on the terms
and condllims speofied m both sides d
Lhis Order and on lbe anached sheets, il
any. ~ndudingdellvery a5 indicated

!.,ZIP CODE

-

HHS/OPHS/OWH/REGION V

11. BUSINESS CLASSIFICATION {Check appmpriale Dox(es))

a

a. SMALL

12 F o B POINT

%&%.
-

Destinatlon
b ACCEPTANCE

Destin.2TT"o.f
--'
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Destlnation
-

-

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c DISADVANTAGED

OTHER THAN SMALL

.'

I 3 PLACE OF
a INSPECTION

114 GOVERNMENTB/UNO

Net 30
17 SCHEDULE (See reverse lor Rejeclrons)
I

SUPPLIES OR SERVICES

ia)

(b)

d WOMEN-OWNED

l 6 DISCOUW TERMS

15 DELIVER TO F 08 . POINT
O N OR BEFORE (Dale)

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ITEM NO

(

-

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-

QUANTITY
ORDERED UNIT
(d)
(c)

UNIT
PRICE
(el

-

.-

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.- - -

AMOUNT

QUANTITY
ACCEPTED

(0

(g)

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472700738

-..

Questions concerning thls order should be re
-.-

PLEASE REFERENCE PAGES 1 THROUGH 6 OF THE AT
Continued . . .
..

..

18. SHIPPING POINT

19 GROSS SHIPPING WEIGHT

I

20. INVOICE NO.

'7(h)

TOTAL

21. MAIL INVOICE TO

a NAME
SEE BILLING
INSTRUCTIONS b. STREET ADDRESS
ON REVERSE (or P.O. B ~ X )

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE
TOTAL

c CITY

ROCKVILLE

d STATE

MD

22. UNITED STATES OF AMERICA

e ZIP CODE

$4,975.00

I

20857

ii

23 NAME (Typed)

I

BY (Signature)

NSN 754&01-152-8083

PREVIOUS EDITION NOT USABLE

.

10. REQUISITIONING OFFICE

,

7540120

.

:
-

1

55408-2641

9 ACCOUNTING AND APPROPRIATIONS DATA

--

~xceaf
t mbrlltng lnslructlons m Ihe
rew?e. this delbery crder 4s
Subjecd to !nSlNdlonS conlalned on
th~sSjide only 01t h ~ sI- and Is
sssueb subject l o h e terms and
~ M d l l l m S01 the acme-numbered
cmtract

Quote Attached

T
-

e. STATE

d. CITY

MINNEAPOLIS

-

60601

'1

8 TYPE OF ORDER

c STREET ADDRESS

-

I

BLACK HEART, INC

Ea

e ZIP COPE

/I

a NAME OF CONTRACTOR

b. COhqPANY W M E

IL

1

f SHIP VIA

DIA SATORI

7 TO

d STATE

-

JACQUELINE R. JONES
TITLE: CONTRACTlNGlOROERlNG OFFICER

I,
,I

OPTIONAL FORM 347 R
(.I
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-

I

1

by

6351

GYIFbB((ICFRlS32131.)

. ..

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ORDER FOR SUPPLIES OR SERVICES

P ~ G EOF DAGES

g
i

IMPORTANT: Man all packages and papers mth anvan and/a a d e r numbers

CONTRACT NO

DATE OF ORDER

09/29/2004

HHSP233200400872P
a u m m UNIT

SUPRIESISERVICES

ITEMNO

UNIT
PRICE
(E)

ORDEREC
(Dl

i

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I

lThe Contractor shall provide support in
Iprbrnoting the "Heart Truth Campaign" in
laccordance with the attached Statement of
Work titled "Office on Women's Health,
America Venue."

,

.

.

<

..

.

<-

.

Event Coordinator
Materials
-.
AV Technician / Disc Jockey
-In-Town Transporation & Parking . -

1 LT

1

4,975.00

I
1

4,975.00
/I
!I

I

He: rt Truth Carn:,aign, Mall/of
1

1

I

--

lThe proposed price is detailed as follows:
.

1G)

rIorrs REGARDING THIS EFFORT,.

..

. ,

1
!I

OF WORK, INVOICING PROCEDURES, AND TZRMS
CAN: 1050116 FY: 2004
-

l"OYM
(F)

QUANTITY
ACCEPTED

MALL OF AMERIC.; VENUE" FOR SCCPE

,

---.

. .. . - + .
~

.

I=..

..

bS

- - $4,975. I

otal
roject Officer:
ichelle Hoersch
hone (312) 8122
29

1H

ORDER NO

f

t-

\.*.

--

-

INVOICE INFORMATION/CLAUSES
INCORPOW ID BY RE 'ERENCE
-r<-.-.*-'i

. INVOICE INFORMATION
N ADDITION TO THE INFORMATION.'REQUIRED BY E .232-!5 PROMPT PAYME IT), .YOUR &QI
k
KJST CONTAIN TEE FOLLOWING: TAX IDENTIFICATI
m 3ER (EMPLOYER'S DENT1FICAT1;ON
1
'UMBER) OR SOCIAL SECURITY NUMBER.
11

.

CLAUSES IflCORPORATED BY REFERENCE (FAR E
'HIS CONTRACT INCORPORATES ONE OR MORE CLAWS
:FFECTAS IF THEY -WERE @WEN IN FULL TEXT.
[ILL MAKE THEIR FULL TEXT AVAILABLE. ALSO,
CCESSED ELECTRONICALLY AT THIS ADDRESS: H1
.

.252-? ) (
; BY ZEF
?ON R 2QI:
-IE:FU JL
? : //W J W .

II

'EB 1998)
I
:RENCE, WITH 'HE SAME FO+E
:ST,THE C O N ACTING OFFICER
'EXT OF A CLI ISE MAY BE
XNET .GOV/FAF

I

..

'EDERALACQUISITION REGULATION (48 CFR CHAPl i 1) :LP
'AR 52.232-33 PAYMENT BY ELECTRONIC FUNDS 'I WSFE t - CENTRAL CON7 ACTOR

:EGISTRATION (OCT 2 003 )
.

'otal amount of award: $4,975.00. The oblige ion f )r
7(i).

..

his award is shown in box

!
TOTAL CARRIEDFORWARD TO (STPAGE(ITEM
I~(H))
NSN 754G01-152-8082

e
OPTIONAL FORM l48 (b6 9 5 )

nne-101

!'II
1
!I

R . d bvGY
FAR ( I 8 CFRI %
213(c!
I

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE ON WOMEN'S HEALTH - REGION V

1a
1il

STATEMENT OF WORK

1
i

I.

PROJECT TITLE: Office on Women 'sHealth, Region V - Heart Trzrth
Campaign, Mall of ~rnericaVenue.

TI.

BACKGROUND: The Office on Women's Health (OWH) is the focal
n tHealth and Human Services (HYS).
women's health within the ~ e ~ a r t m kof
The OWH, under the direction of the Deputy Assistant Secretary for Health
(Women's Health), improves thehealth and well-being of women across the
lifespan by coordinating women's health programs, promoting heiifih e d a ~ i o n
and disease prevention, and leading efforts and fostering partnerships to
health disparities.
I

eliminate

The Hean Truth Carnpai& sponsored by the National Heart, Lung, and ~ l l o o d
Institute W L B Q and partner organizations is intended to make women mbre
aware of the danger of heart disease. The campaign's goal is to give womek a
1
personal and urgent wake-up call about their risk of heart disease. The campaign
is especially"a~edat women ages 40 to 60, the time when a woman's risk pf
heart disease starts to rise. But its messages are also important for younger'
women, since-heart disease develops gradually and can start at a young agg-even
in the tee-years
Older women have an interest too-it's never too late )totake action to prevent and control the risk factors for heart disease. Even those yI h o
=/ =
have heart disease can improve their heart health and quality of l i f e

1

.
-

111.

i

PURPOSE: The purpose of this contract is to provide contractor support to help
promote the Heart Truth Campaign by coordinating a two-part event at the llMall
of America in the MinneapolisISt. Paul area. This Heart Truth event win include
an afternoon of-heart health screenings followed by a Red Dress Fashion Show;
The Red Dress is the symbol for the Heart Truth Campaign. On an averagelday,
over 100,000 people pass through the Mall of America. By having Heart '1
Truth/Red Dress events in this high traffichigh visibility venue, we increaJe the
number of women we can screen for heart disease risk factors and the total/
number of individuals we can educate about women and heart disease. Further,
'r
by having a high visibility event such as the Red Dress fashion show,
- . .we increase
-11
the chances that the media will pick up on the story and further increase
awareness of women and heart disease.
I'

1i

IV.

V.

-PERIOD OF PERFORMANCE: The period of performance shall be froh
September 30, 2004 through September 29, 2005.

1I

TYPE OF CONTRACT: This is a Firm, Fixed-Pnce purchase order.

1

I

!

-

VI.

DELIVERABLES AND TIMEFRAME: The Contractor shall work i4
collaboration with the Region V Office on Women's Health Project 0fdcer (PO)
. il
to create these Heart Truth Campaign events. This shall include convening
planning conference calls, coordinating logistics, identifying other poteitial
partners and sponsors and manage all aspects of the events. To ensure
coordination with the goals-and policies of the Office on Women's Health and the
Department of Heakh and Human Services, Contractor shall provide reghar
progress reports to the Region V Office on Women's Health and submit ~ I I
'I
proposed written materials to the Office for appropriate Departmental clearances.

1

II
I

1

In coordination with the PO, the Contractor shall provide the following services
and deliverables:
. .. ,

-

.

. -

1

:.
-

. ..

-

11

-

./I

-.:.:

.

.

Contact drganizations and companies to identify additional partners and .dponsors;
I/
Coordinate allvolunteers and -committee activities and keep all partners informed
of progress and time line;
Oversee the work of subcommittees to plan the screenings and fashion sdow;
Secure vendor to conduct cholesterol screenings;
Act as local contact in -Minneapolis for the OWH, Region V staff;
Function as a liaison with the Mall of America Community Relations
~oordinatoE
;.\'
Function as a liaison with Macy's department store;
Develop and-implement marketing and media efforts;
I
Coordirnebgistics for screenings and fashion show;
I
Use network connections in order to maximize community involvement;
Coordinate with vendors to supply services and equipment as needed, suc4:as,&ut
!I
not limited to, the following:
i
Audio visual
0
Materials preparation
Speakers
Floral, tfecoration, etc.
Gift bags
Health screenings
Fashion show
Music
Photography
Models
Speakers
Provide on-site coordination for the events;
1
Identify and coordinate advertising of events with a major media sponsor {either
broadcast or print);
6 '!Ii
Provide regular project updates with timeline and logistics confirmations as
specified by the PO;
Provide screening event at Mall of America;
i
Coordinate and execute Red Dress Fashion Show at Mall of America
{

!

11

1

I

,I
I

Provide program for the Red Dress Fashion Show;
Provide post-event summary report with data on screenings to PO.

j

The due dates and delivery methods for these deliverables are to be
determined following the award of this effort.

!i

I

VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized adent of the
Contracting Officer is responsible for the review and acceptance of all
deliverables.
VIII. PAYMENT SCHEDULE: Within two weeks of acceptance by the PO for
1
services related to the confirmation of logistics with the Mall of America?
securing pf the vend?! for cholesterol screenings and the d e l i v e w f fu&mgress
report, the contractor shall submit a proper invoice for those related services.
The Contractor shall submit a proper invoice for the balance of the propoked fee
within two weeks of the PO'S acceptance of the completed event and post-event
summary.

-

I1/

IX. INVOICE SUBMISSION: Upon inspection and acceptance of deliverdbles,
I
the Contractor shall submit an original and two copies of its proper invoices to the
I
PO. For p a q q t , the PO shall submit the invoice and a signed receiving report
to:
..
Department of Health &: Human Services
1
PSCFinancial Management Service
'I
Ev'sioiiof~inancialOperations
Parklawn Building, Room 16A-12
'-..
5600 Fishers Lane
Rockville, Maryland 20857
1
Telephone: (301) 443-3020

1

1

..+

+,

I- 1

r .

i

..

- i

The invoice
must
- contain the following minimum information:
..

..

<

.

>

1

-

Ij

Contractor's name and address;
.

1
I

I

..

Purchase order number;
Description and price of services provided;
Invoice period; and

1

...

!
I/

1

I

The Contractor's Internal Revenue Service ( R S ) Taxpayer Identification
Number.
111
11

Y

X.

.

GOVERNMENT-FURNISHED MATERIALS: The Government will iot
li
furnish any materials to the Contractor for this requirement.

!

--

.

XI. RIGHTS TO DATA: The Contractor is prohibited from using data produced or
obtained under this contract for any purpose without prior, written appro;al from
the PO.

I

;I

XII. TECHNICAL MONITORING:
A.

Performance of the work under this purchase order shall be subje{t to the
technical monitoring of the Project Officer. The term "Technical
Monitoring" is defined to include, without limitation, the f~llowin"'~:

1

I

Technical directions to the Contractor, which redirect the purchase.
order effort, shift-work emphasis between work areas or tasks,
require pursuit of certain lines of inquiry, fill in det.ails.0~1.othe-&se serve to accomplish the contractual scope of

1.

--

.

Providing information to the Contractor for assistance
interpretation of drawings, specifications or technical
the work description.

2.

Review and, where required by the purchase order,

3.

r aechnical reports, drawings, specifications and technical
\:

--

mformation to be delivered by the Contractor to
under the purchase order.

I
-. .

B.

.

Ec%iEaStTirection must be within the general scope of work
purchase order. The Project Officer does not have the
may not issue.any technical direction which (i)
of additional work outside the general scope of the purchase order) (ii)
I/
constitutes a change as defined in the purchase order clause entitled,
"Changes;" (iii) causes, in any manner, an increase or decrease in ihe total
estimated purchase order cost, the fixed fee or the time required
fo!... . - .
burchase order performance; or (iv) changes any of the expressed (ems,
I
1
I
conditions, or specifications of the purchase order.
~

1
I,

C.

All technical direction shall be issued in writing by the Project
Officer or shall be confirmed by himher in writing within 5
working days after issuance.
- ..

D.

-

1

11

1
I

I

The Contractor shall proceed promptly with the performance of
technical direction duly issued by the Project Officer in the manner
prescribed by this clause and within hisher authority under the
provisions of this clause.

I

-

I

If, in the opinion of the Contractor, any instruction or direction issued by
the Project Officer is within one of the categories as defined in (ijthrough
(iv) above, the Contractor shall not proceed but shall notify the
Contracting Officer in writing within 5 working days after the receipt of
any such instruction or direction and shall request the ~ o n t r a c t i n ~ \ ~ f f i c e r
to modify the purchase order accordingly. Upon receiving such 1
notification from the Contractor, the Contracting Officer shall issde an
appropriate purchase order modification or advise the Contractor in
writing that, in hisher opinion, the technical direction is within the scope
of this clause and does not constitute a change under the Changes
of the purchase order. The Contractor shall thereupon proceed
immediately with the direction given. A failure of the parties to
agree upon the nature ofihe instruction or direction or upo-Q.
ofder a i i o n t 6 b e takenwith respect thereto shall be subjeit
provis,ons of the purchase order clause entitled "Disputes."

1

XIII. POINTS OF CONTACT:
The Project Officer (PO) for this effort is:
Ms. MichelLg H-oersch, M.S.
Office on WO>&'s Health
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 1300
Chicago,TWhois 6060 1
Phone: (312) 353-8122
Fax: (312) 353-7800
Email: rnhoersch@osophs.dhhs..ov
The Contracting Officer (CO) for this effort is:
Ms. Jacqueline=. Jones
Program Support Center
U.S. Department of Health and Human Services
Parklawn Building, Room 5- 10 1
5600 Fishers Lane
Rockville, MD 20857
Phone: (301) 443-641 3
Fax: (301) 443-8488
The Contract Specialist for this effort is:
Mr. Gene H. Calvert
Program Support Center
Phone: (301) 443-7077

XIV. FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

I

i
This contract incorporates one or more clauses by reference, with the saqe
force
and effect as if they were given in full text. Upon request, the Contractink Officer
will make their full text available. Also, the full text of a clause may be abcessed
electronically at this/these address(es): http://www.arnet.~ov/far.
The following FAR contract clauses are incorporated by reference:
1

I
I

No.
-

CLAUSE NO.

1.

.

FAR 52.204-6 - -

.

...

TITLE AND DATE

n

j

Data Universal Numbering
System (DUNS) Number I I
(OCT 2003)
Y
Central Contractor Registration
(OCT 2003)
Instructions to Offerors Commercial Items (JAN 2004)
Contract Terms and ~onditidnsCommercial Items (OCT 2003)
Convict Labor (June 2003)
Child Labor-Cooperation wi\h
Authorities and Remedies
(June 2004)
Prohibition of Segregated Fadilities
(Feb 1999).
1
Equal Opportunity {Apr 2 0 d f - -Drug Free Workplace ( ~ ~ ~ 1 2 ~ 0 1 )
Buy American Act-Supplies I1
(June 2003)
Restrictions on Certain Foreign
Purchases (JUN 2003)
Payments (APR 1984)
Payment by Electronic ~undsl
Transfer-Central Contractor 1
Reglstratlon (Oct 2003)
Disputes (JUL 2002)
Protest After Award (AUG 1q96)
-7

2.

-

FAR 52.204-7

3.

FAR 52.212-1

4.

FAR 52.2 12-4

1

!
1

1

FAR 52.222-26
FAR 52.223-5
FAR 52.229-1
FAR 52.225-13

--..

FAR 52.232-1
FAR 52.232-33

;

1

1

FAR 52.233-1
FAR 52.233-3

H

j(
1

ORDER FOR SUPPLIES OR SERVICES
IMPORTANT: Mark all packages and papers w ~ t hcontract andlor order numbers
r DATE OF ORDER

4

HHSP233200400837P

)04T000016
I

5 ISSUING OFFICE (Address correspondence lo)

b STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

233

I

N.

MICHIGAN AVE, SUYTE
I

I

.-

I

.

-

:/

c CITY

CHICAGO
DR. STEPHANIE COVINGTON

..

a NAME OF CONTRACTOR

CENTER FOR GENDER AND JUSTICE
.- ~.
..

7946 IVANHOE AVENUE, #201B.

.

..

. . ... .

.

. . . .--

-.-

1

I. ZIP CODE

e. STATE

CA

9. ACCOUNTING AND APPROPRIATIONS DATA

/

-

--

REFERENCE YOUR.

sutject to instructtons contalnea on
thls/side only of lhcs form and IS
lssued subject to the terms and
co"h1110nsof lhe above-numbered

cOnr'c:

and condit~onsspecified on bolh s~desof
l h ~ sorder and on the allached sheets. lf
any. lncludlng delivery as ~nd~cated.

d

I

10 REQUISITIONING OFFICE

-

1

HHS/OPHS/OWH/REGION V

7540120
11 BUSINESS CLASSlilCATlON (Check appropriate box(es)i

fl

:":L@:~~b OTHER THAN SMALL

a. SMALL

.

-

Destination

15 DELIVER TO F o B POINT
ON OR BEFORE (Date)

14. GOVERNMENT BIUNO

..
13

-!I1I
E!il

c DISADVANTAGED

.

..

DE,IVER\

-lib

92037
.

60601

I
8 TYPE O r ORDER

Please furnish the following on Ihe terms

d CITY

)

a WOMEN-OWNED

16 DSCQUNT TERMS

PLACE OF

a INSPECTION

Net 30

I b ACCEPTANCE

Des~ination

-

e ZIP CODE

Quote Attached

.

LA JOLLA

IL

1

f SHIP VIA

G a PURCHASE

c. STREET ADDRESS

d STATE

)

-

b COMPANY NAME

12. F o B POINT

2;:;;

I

REQUISITIONREFERENCE NO

3 ORDER NO.

-

C:

a NAME OF CONSIGNEE

09/29/2004

7 TO

'

1

6 SHIDTO

2 CONTRACT NO (11 any)

F'-:
7---

Dest in*'orr-

i

...+
'
17. SCHEDULE (See reverse for Rejectrons)

- .

il
- AMo"-NT;i

- - .

.

A ? .

-)I

QUANTITY
ORDERED UNIT
(d)
(c)

..

SUPPLIES OR-SERVICES

ITEM NO

UNIT
PRICE
tei

.:.-

QUANTITY
ACCEPTED
(g)

..

DUNSNumber:
Questions .ccecerning this order should be referred to Gene Calvert at (301) 443-7C77.

.

I

PLEASE REFERENCE PAGES-1-THROUGH 6 OF THE AT
WOMEN'S HEALTH, REGION V - - ISSUES OF INCARC
Continued . . .

/

1 1 8 SHIPPING POINT

19 GROSS SHIPPING WEIGHT

I

I

I

a NAME

pages)

1

24 MAIL INVOICE TO

SEE BILLING
INSTRUCTIONS b STREET ADDRESS
ON REVERSE
(or P 0 Box)

171h)
TOTAL
(Con1

2 0 INVOICE NO

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE
ROCKVILLE MD 20857

. $5,995

.'b0
/I

I GRAND
TOTAL

1

i

Id

c ClTY

I

I
22 UNITED STATES OF AMERICA

BY (Signature)

NSN 754C-01-152.8083
PREVIOUS EDITION NOT USABLE

b

STATE

1

!I

e. ZIP CODE

I

-$5,995.00
1/I
I
I

23 NAME (Typed)

JACQUELINE R. JONES

11

I

(I

1

1 TITLE CONTRACTINGIORDERING OFFICER
I

OPTIONAL FORM 147 IRDW

6351

~ ! s s m . a n ~ G148
~ cFR)
r ~ ~53 Zlx.,

:,.

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

/

IMPORTANT: Mark all packages and papers w ~ t hcontract andlor order numbers

t

DATEOFORDER CONTRACTNO
09/29/2004
ITEM NO
SUPPLIESISERVICES
(A)

ORDER NO
HHSP233200400637P
QUANTI
ORDER

is)
(C)
INVOICING PROCEDURES, AND TERMS ANG CONDITICNS RE
CAN: 1050116 FY: 2004
Period of Performance: 09/30/2004 to 09/29/2005
Dellvery Location code: 60601F
HHS/OPHS/OWH/REGION v
233 N. MICHIGAN AVE, SUITE 1300
CHICAGO Ii 60601

1

i

The Contractor shall provide training servic s
and materials in accordance-with the-attache
Statement of Work titled "Office on Women's
men
Health, -Region'V..:-. Issues bf-Incarcerated

I

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-

.-.dl,=
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I I

I

Proposed price is detailed as follows:

Pre-Meeting Planning with OWH Region V
Materials on Trauma and Substance Abuse
Planning and Preparation for t~heRegion

-

sium."

a
.

\-=.
Project Officer:
Michelle Hoersch
Phone: (312) 353-8122
929

+ It

INVOICE II?@o-R"~A~I~~~-/cLAusEs
INCORPO

ED BY RE

it

1. INVOICE INFORMATION
IN ADDITION TO THE INFORMATION REQUIRED BY 5 .232- 5
MUST CONTAIN THE FOLLOWING: TAX IDENTIFICATI N NUM ER
NUMBER) OR SOCIAL SECURITY NUMBER.

i ii

2. CLAUSES -INCORPORATED BY REFERENCE (FAR 5
THIS CONTRACT IKORFORATES ONE OR MORE CLAUS
EFFECT AS IF THEY WERE GIVEN IN FULL TEXT.
WILL MAKE THEIR FULL TEXT AVAILABLE. ALSO,
ACCESSED . ELECTRONICALLY
AT THIS ADDRESS: H
.

.252-

) (

S BY

EF

PON R QU
HE FU L
P://W W.

TR" ILA!

FEDERAL ACQUISITION REGULATION (48 CFR CHAP
FAR 52.232-33 PAYMENT BY ELECTRONIC FUNDS
REGISTRATION (OCT 2 003)

TOTAL CARRIED FORWARD TO I S T PAGE (ITEM17(H))
NSN 754&01.152-8082

!!

5l2-48-101

OPTIONAL FORM 148 law ~
1
I

5
R.so8b.d by G5"

F A R I48 CFRI51 2lxcl

,

-

I

AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT

(4

3 EFFECTIVE DATE

2 AMENDMENT/MODIFICATION NO

0001
6 ISSUED BY

CODE

1 CONTRACT ID CODE

I
REOUlSlTlOtVPURCHASE R E 0 NO

A

5 PROJECT h0 (Ilappr~caoie)

I

U

108/09/2006
DAM

7 ADMINISTERED BY (I1 olner rnan /!em 6)

CODE

IDA

DHHS/PSC/SAS/DAM
PKLN. BLDG., ROOM 5-101
5600 FISHERS iANE
ROCKVILLE MD 20857

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

8 NAME AND ADDRESS OF CONTRACTOR (No srreel counry StaleandZIP CWel

I

I1

N g 4 AMENDMENT OF SOLICITATION NO

/I

CENTER FOR GENDER AND JUSTICE
Attn: DR. STEPHANIE COVINGTON
7946 IVANHOE AVENUE, #201B
LA JOLLA CA 92037

9B DATED (SEE ITEM 17)

/i

IOA. MODIFICATION OF CONTRACTIORDER NO

!I

HHSP233200400837P
. -

565506892

'ODE

-

I

-

-

I

10B DATED (SEE ITEM 11)

FACILITY

do6F

I

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-

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<

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09/29/2004

:I

I

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

2 Tne above numbered sol~olal~on
0s amended as sel fonh'ln

3

1s no! extended
Item 14 The hour and dale speofled for rece~plof Offers
IS extended
Olfers musl acknowledge recelpl of l h ~ amendment
s
pnor lo the hour and dale speul~edIn the sol~alat~on
or as amended by one of the follow!ng methods (a) By comblelmg
Items 8 and 15, and relumrng
mples of Ine amendmen! (b) By acknowledg~ngrecetpt of lh!s amendment on each m p y of ttte offer subm~ltedor (lc) By

AT

separate letter or telegram which Includes a reference to the sollotallon and amendment numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED
THE PLACE DESIGNATED FORTHE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If i y
vtnue of thts amendment you destre 10change an oner already subm~ned.sucn change may be made by telegram or letter, provlded each telegram or lener makes
reference to Ihe soltc~tal~on
and thls amendment, and 1s recetved pnor to the openlnq hour and date specified
12 ACCOUNTING AND APPROPRIATION DATA (I1 required)

1
I

i
1

See Schedule
13 THlS ITEM ONLY APPLIES TO M&&TION
-

Z&Z/i/

-

-

OF CONTRACTSIORDERS IT MODIFIES THE CONTRACTIORDER NO AS DESCRIBED IN l T E ~ y 1 4

-

A T H s CHANGE ORDER I s ISSUED PURSUANT T o ( s p ~ 1 1ausonty)
y
THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT?
ORDER NO IN ITEM 10A

I

1

B THE ABOVE NUMBERED C U L T C T I Q R D MODIFIED
~
TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes inpayingofice.
approprialron dale, etc.) SET FORTH IN ITEM 14. PURSUANTTO THE AUTHORITY OF FAR 43103(b).

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1

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1
II

C. THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANTTO AUTHORITY OF:

(
X

1

-!I

.- .-

E IMPORTANT

Contractor

-

/I:i

- FAR 52.243-1 CHANGES-FIXED-PRICE (AUG 1987)
L l s not
I?1s requ~redto slgn thls document and return
copies l o the lssulng olfice

14 DESCRIPTION OF AMENDMENTlMODlFlCATlON /Oman!zed by UCF seclron headfngs, rncludrng solrc~latron/contraclsubjecl maner where leasrble )

Tax ID Number:

.. .-

I
/I

D. OTHER (Specily type 01 modificalfon and authonly)

1 UNILATERAL

--

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1
-

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The above referenced Purchase Order is hereby modified as follows:
/I

1. Reference the Statement of Work, item IV. Perlod of Performance 1s changed F R ~ M
11
"September 30, 2004 - September 29, 2005" TO "September 30, 2004 - December 31, 2006".
2. The total obligated amount of $5,995.00 remains unchanged.

1
1

Except as provlded here~nall lerms and cond~llonsol the document referenced In llem 9A or 10A as heretofore changed remalns unchanged and In full force and effect'
15A NAME AND TITLE OF SIGNER (Tyoe or onnr)

16A NAME AND TITLE OF CONTRACTING OFFICER (Tyoe orpnnl)

I

1

JACQUELINE R. JONES
155 CONTRACTOWOFFEROR

15C DATE SIGNED

168 UNITED STATES OF AMERICA

16;

DATE SIGNED
I

ISignalure olperson aulharrzed lo srpni
NSN 7540-01-152-8070
Prevlous ed111on
unusable

lSlgnature of Cootracbng Dficerj

;,8/09/2006
I
STANDARD FORM130 (REV 10.83)
Prescribed by GSAl
FAR (48 CFR) 53 2f3

1

PAGE O i PAGES

HHSP233200400846P

HHS/OPHS/OWH/REGION V

04T000017

b STREET ADDRESS

5, ISSUING OFFICE (Address correspondence lo)

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

233 N. MICHIGAN AVE, SUITE

--

I
1300

-

c CITY

d ST4TE

CHICAGO
1

7. TO:

..

a. NAME OF CONTRACTOR

CHICAGO HEALTH CONNECTION

~

.

....

~

954 W WASHINGTON BLVD

..

. . . . .

-

CHICAGO

.

. . .

CODE

Please fumlsh (he lollmwng m Ihe terms
and conditions specified on t v l h sides d
this ader and on the attached sheea, d
any, indudlng deCvery as indicated.
. - .
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.
.

.

60607

IL

.

9 ACCOUNTING AND APPROPR(ATI0NS DATA

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.+' &
-.. -. OTHER THAN SMALL

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14. GOVERNMENT

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C.

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Destination
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d. WOMEN-OWNED

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16. DISCOUNT TERMS

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"

GIJANTITY
ORDERED UNIT
(dj
(c)

,.

Net- 30
.-

17 S C H E W t E /See reverse lor Reledrons)
.

[

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.-

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15. DELIVER TO F.O B POINT
ONOR BEFORE (DaleJ

ACCEFTPJ@,C4,.
~estinatlon'

b

.

D I ~ \ D ~ A. ~ ~ .~ A- .G E.D

BR/NO
.

13 PLACE OF
a INSPECTION
-

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. . .

.

.

Destination

12. F.O.B. POIKT
.

II

. .

HHS/OPHS/OWH/REGION

7540120

. . .. .

.

10,~REQUlSlTlONlNGOFFlCE

1 1 BUSINESS CLASSIFICATION [Check appropnale box(es)j
a. SMALL

b~ll~ng
lnslr~cbmsm the
y+;se.
Ih&-ddivery order 1s
subject 10 InSIrUmms mntalned m
ttn: side only of lhis f m and IS
idbed subjen to \he terms and
.
txridlt~msof me above-num,bered
U
antract

EX'&I~
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~.....

Quote Attached

...

e. STATE .

d . CITY

b. DELIVERY
I

I

REFERENCE YOUR

.

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Cl

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Ea. PURCHASE
-

.

I

i
8. TYPE OF ORDER

c. STREET ADDRESS

60601

i

1. SHIPVIA

I

b. COMPANY NAME

-

IL

e ZIP CODE

.....
.

-

UNIT

.

- /I

-..,. .-

,

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OUANTm'
ACCEPTED

AMOUY

PRICE
(e)

(1)

1)

----

-<

-

(9)
<-

-.

. . . . . .

-

1

Questions concerning this
order should be re
-.-

PLEASE REFERENCE PAGES 1 THROUGH 7 OF THE AT
Continued . . .

I
18 SHIPPING POINT

19 GROSS SHIPPING WEIGHT

1704
TOTAL
(Con1

20 INVOICE NO

pages)

21 MAIL INVOICE TO

SEE BILLING
lNsTRuC7rONs b STREET ADDRESS
ON REVERSE (or P 0 Box)

4

i;

a NAME

-$@,500.00

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM. 16A-12
5600 FISHERS LANE

11

11

1U

17(1)
GRAND

1
I.

c CITY

ROCKVILLE
22 UNITED STATES OF AMERICA

B y (S~gnature)

d STATE

MD

e ZIP CODE

20857

1

TOTAL

4

$4,500.00
II

23 NAME (Typed)

JACQUELINE R. JONES

I

II
I

]

TITLE CONTRACTINGIORDERING OFFICER
NSN 754001.152.8083
PREVIOUS EDITION NOT USABLE

f
R!&

OP-L

/I
I1
Il

FORM Y 7 IRN -51
4 MU(

I- CFRI 53 1131.1

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

PAGE

-

2

(A)

2

I

IMPORTANT: Mark all packages and papers with mbad and/ororder numbers.

DATE OF ORDER CONTRACTNO
09/30/2004
YTEM NO.

1/

OF PAGES

!I

ORDER NO.
1
~~~~2332004008$6~
SUPPLlESlSERVlCES

QUANTWU
ORDERED
(C)

(0)

N ~

(0)

UNIT
PRICE

(E)

AMOuNi
fF)

/

OUAICTITY
ACCEPTED
(Gi

II

ON WOMEN'S HEALTH REGION V - - INDIANA PERINATAL N E W 0 K D O U U MODE', PROGRAM.;'

!1I

CAN: 1050116 FY: 2004
Period of Performance: 09/30/2004 to 09/29/2005

-

.~

The Contractor shall provide support to
assist in initiating a community-based
doula model program in accordance with the

1 LT

4,500.00

!
I

Perinatal Network Doula Model Program."
Project Officer:
Michelle--Hoersch .- Phone (312) 353-8122

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TOTAL CARRIEDFORWARD TO ISTPAGE (ITEM
I~(H))
NSN 7YDOl-152-8082

Wl4blOl

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!I

OPTIONAL FORY YI i R r -11
~ . l o . ~ bGyY
FAB (48 ffRl53 2131c:

U.S. DEPARTMENT OF HEALTH AND HUMAN S E R V I ~ E S
OFFICE OF WOMEN'S HEALTH - REGION V
STATEMENT OF WORK

i

I/
PROJECT TITLE: Ofice of Women 's Health, Region V - Ind~anaPerlnatal
Network Doula Model Program.
1

I.

11

'I

11.

BACKGROUND: Research shows that the time immediately surrounding labor
'I
and delivery is a critical period in thedevelopment of a young family. Women
in
I
difficult circumstances (adolescents, women experiencing violence, women
in .low-income communities) are particularly vulnerable during this period, but may =
also be openduring this time to interventions which support t h e i m e w . 4 .and
~
competencies. Programs which use doulas for support in childbirth have
demonstrated Tewer labor and delivery complications, fewer medical
interventions, and increased well-being for both mothers and babies. h others
who receive emotional and educational support during pregnancy, labor, helivery
andtheearly postpartum period are more knowledgeable and confident, &d are
better able to bond and care for their children. Doula support has also bekn shown
to increase beastfeeding rates, facilitate optimal mother-infant interactiot,
. . .
decrease rate&f p - t e r n j birth, and delay
subsequentpregnancy.
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~ h i c a ~ o ~ e z t h c o n n e ~initiated
t i o n the:Chi&go Doula ~ i o j e c inJuly
t
of;1996 . . . . . . . .
whenit +ee&ved a-four-year:grant from TheRobert Wood J o b s o n Foundation.
. . .
. .
and four-years of funding from The Hams Foundation. In collaboration yith
.:. ,'
...
threechicago-community-based organizations; ~ a r i l l a ~ouse,.~&ristop.h~.
c
=.i
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House, and Alivi6 Medical. Center, and with assistance from The Ounce df
. .
Prevention Fund, CHC conducted a four-year pilot proJect in pennatal subport fbi-.''
pregnant
teens in low-income communities. The model is based on
..
..
components:
-..
. . . . . - . . ....
.-.
.'
I
It is community-based: doulas are lay women recruited from the communities
being served
It is relationship-based: the intervention begins as early as possible in
pregnancy, and is based on a long-term, trusting, nurturing relationshib
between the doula and the pregnant woman (and her family)
It is collaborative: the project requires active partnerships of community
members, social service providers, health care providers, and donator$ to be
successful.
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Research about doula support shows that when doulas provided continuous
li
emotional support to young, low-income mothers, the women had significantly
shorter labors, were more likely to be awake after labor, and were more likely to
interact and talk to their babies immediately following labor than women kho had
not received doula support. In a study of 229 births in the Chicago ~ o u l a ! ~ r o j e c t ,
II

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.

C-section rates were 8% for single births (compared to 14.5% for US teehs and
12.8% for Chicago teens), epidural rates were 11.4% (compared to 50%
nationwide), and only 10.5% of participants received inadequate prenatal care
I 80%
(compared to 17.6% for Chicago teens). Breastfeeding initiation rates were
A
(compared to 47.3% for US teens and 42% for all Illinois women). The pilot
sites report that their teen moms are holding their babies more, talking
more, and are more-comfortable talking about their births.
/1
Chicago Health Connection's community-based doula model is rooted in/the
service community and is a cultura!ly sensitive approach to pregnancy, c$ildbirth,
infant development and family support. The doula intervention provides (
opportunities prior to labor and delivery to enhance the mother's knowledge of
-proper prenatal c%re,early braindevelopment and the critical role they plky in
shaping the emotioiiaf; social and cognitive development of t h e i i ~ h i l d & : ~ c
i
Doula program is one component of an array of support services that are offered
to pregnant a i d birthing women by the partner agency In many cases, ddula
participants are also receiving health services, pre-natal care and social sekvices.
$1
Follow-up services by the partner agencies are provided, such as l o n g - t e ~home
visiting, post-natal care and Head Start programs.
"

/I
1
PURPOSEil The purpose of this contract is to provide contractor supper( to assist
I

in initiating albmmunity-based doula model program with the Indiana ~trinatal
Network, in two sites in Indianapolis, serving Hispanic and Ahcan-American
- teen mothers. This collaborative project will develop creative partnershiis in the
area of womerr's-health in Region V, specifically for women ofchildbearing age,
with the ultimate goal of integrating and improving behavioral health sedices to
women of childbearing age.
._-I-- - --

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Establishment of this program will:
..

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peri-natal oiitcomes. Access to high quality and affordable prevention7 *.. -..measures, including screening and appropriate follow-up, is essential if we are
to save lives and reduce medical care costs.
Promote a health and wellness program in community-based settings.
Community-based programs are effective in getting people culturally
appropriate health information and changing behaviors.
Educate the public effectively about maternal and child health-including
necessary prevention messages.

1

- These objectives reflect priorities identified in the Steps to a Healthier
would help to further the prevention and public education agenda of
initiative.

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IV.

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Help to eliminate racial, ethnic and socioeconomic health disparities ip

PEFUOD OF PERFORMANCE: The Period of Performance shall be f{?m
(I
September 29,2004 through September 30,2005.

I

--.

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V.

TYPE OF CONTRACT: This is a Firm, Fixed-Price purchase order.

V1.

DELIVERABLES AND TIMEFRAME: The Contractor shall work i i
collaboration with the Project Officer (PO) to provide a one-day Program
Workshop and a two-day Training of Trainers for the Indiana Perinatal 1
Network in Indianapolis. The Contractor shall also work collaboratively kith the
Indiana Perinatal Network to develop a project plan, form a local
body, provide hiring and training advice for program supervisor and
provide other technical assistance as required.
In coordination with the PO, the cdntractor shall provide the following skrvices
and deliverables:
-

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- .

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.

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Collabdrate with f i e Indiana Perinatal Network to establish tliE'C6riikUriityI
Based Doula Model program in Indianapolis;
.
Provide one-day Program Workshop in Indianapolis, Indiana;
I
i Provide two-day."Training of Trainers"' in Indianapolis,3ndiana;
. Provide technical assistance by telephone; e-mail andlor fix'for the fdrmation
of a local project advisory body and development o f program plan;
* provide technical assistance by telephone, e-mail and/or fax for the 1
r e c r u i m q Q n d the
hiring of pro:gram
.supervisor and
doulas;
1 . . . . . ... .
......
. . .. . . . . . . .
. .
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. ..
pfoviaelo& project 'ad~is&ry'~~dyparticipant
listto &&PO;
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determined followidg the award of thii effort.

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hed due dates abd .delivery iet'hodsf o r these deliverables are.-to be

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VII.

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INSPECTION AND ACCEPTANCE: The PO as a duly authorized
Contracting Officer is responsible for the review and acceptance of.-all,
deliverables.

,--

--.,

VI11. PAYMENT SCHEDULE: Within two weeks of the completion and acdeptance
of the one-day Program Workshop to be conducted in Indianapolis, Indida, the
Contractor shall submit a proper invoice for those related services to the PO.
Upon completion and acceptance of the two-day "Training of Trainers"
workshop, the Contractor shall submit a proper invoice to the PO for the b 1
of the proposed amount.
.

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~~~~23320q400846~
Page 4 of 7

I

X.

INVOICE SUBMISSION: Upon inspection and acceptance of deliverdbles,
I to the
the Contractor shall submit an original and two copies of its proper invoices
PO. For payment, the PO shall submit the invoice and a signed receiving Ireport
to:
Department of Health & Human Services
PSCFinancial Management Service
Division of Financial Operations
Parklawn Building, Room 16A-12
5600 Fishers Lane
Rockville, Maryland 20857,
I
Telephone: (301) 443-3020
1

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The invoice must contain thefonowing minimum information:
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-,

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:

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Contractor's name and address;
Purchase order number;

I

Description and price of services provided;

Invofqperiod; and
\

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The Contractor's Internal Revenueservice (IRS) Taxpayer
Number.
- .A

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X. GOVERNMENT-FURNISHED MATERIALS: The Government willinot
- - -furnish any materials&._t_heContractor for this requirement.
--- - --

I

.

XI. RIGHTS TO DATA: The Contractor is prohibited from using data produced or
I
obtained under this contract for any purpose without prior, written approval from
the PO..
--.
.
..

.

..

XII. TECHNICAL MONITORING:
A.

Performance of the work under this purchase order shall be subjectI to the
technical monitoring of the Project Officer. The term "Technical
Monitoring" is defined to include, without limitation, the following:
- ,-

1.

-

I

Technical directions to the Contractor, which redirect the purchase
I
order effort, shift work emphasis between work areas or tasks,
require pursuit of certain lines of inquiry, fill in details or
otherwise serve to accomplish the contractual scope of wbrk.

I

1

2.

Providing information to the Contractor for assistance in the
interpretation of drawings, specifications or technical portibns of
I]
the work description.
(I
Il

I
II/

..

400846P
ge5of7
3.

B.

Review and, where required by the purchase order, appro! i1 of
technical reports, drawings, specifications and technical
information to be delivered by the Contractor to the Gove nment
under the purchase order.

Technical direction must be within the general scope of work stat d in the
purchase order. The Project Officer does not have the authority t and
may not issue any technical direction whlch (i) constitutes an ass] w e n t
of additional work outside the general scope of the purchase orde (ii)
constitutes a change as defined in the purchase order clause entitl d,
"Changes;" (iii) causes, in any manner, an increase or decrease In he total
estimated purchase order cost, the fixed fee or the time required f r
purchaserder performance; or (iv) changes any of the expressed .ems,
conditions, or'specifications of the purchase order.

-

-=-

C.

All technical direction shall be issued in writing by the Project
Officer or shall be confirmed by himher in writing within 5
working days after issuance.
The Contractor shall proceed promptly with the performance of
tecbicgl direction duly issued by the Project Officer in the mann
pres&6ed by this clause and within hisher a;thority under the
provisions of this clause.

I ~ ~the
I Topinion of the Contractor, any instruction or direction is
- -.
the Project Officer is within one of the categories as defined in (i) through
>.
(iv) above, the Contractor shall riot proceed but s h d l notif-y the - -- ---Contracting Officer in writing wlthin 5 working days after the rec ipt of
any such instruction or direction and shall request the Contractini Officer
to modify the purchase order accordingly. Upon receiving such
notification from the Contractor, the Contracting Officer shall iss
approp5ate purchase order modification or advise the Contractor
writing that, in hisher opinion, the technical direction is within tl : scope
of this clause and does not constitute a change under the Changes Zlause
of the purchase order. The Contractor shall thereupon proceed
immediately with the direction given. A failure of the parties to
agree upon the nature of the instruction or direction or upon the p rchase
order action to be taken with respect thereto shall be subject~o
.
thl
provisions of the purchase order clause entitled "Disputes."
.

.

XIII. POINTS OF CONTACT:
The Project Officer (PO) for this effort is:
Ms. Michelle Hoersch, M.S.
Office on Women's Health -U.S. Department of Health and Human Services
233 N. Michlgan Avenue, Suite 1300
Chicago, Illinois 60601
Phone: (3 12) 353-8122
Fax: (3 12) 353-7800
Email: n~hoerscl~@,osophs.dhhs.gov
.

. . . . .

.

--

--- -

The Contracting Offic~r(CO) for this effort is:
Ms. Jacqueline R. Jones
Program Support Center
U.S. Department of Health and Human Services
Parklawn Building, Room 5- 101
5600 Fishers Lane
Rockville, MD,20857
Phone: (301j'a3-6413
Fax: (301) 443-8488
....

..
.: . . . . -.
. ... . . . . .. .

.......
.. .. . . . . . . .
. . .
.. .
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::. . .

:The con^-Specklistfor this effort is: . .:
.

. .

.
.

.
.

.

.

~

.

.

.
.
. . .

.

M - ~ . - G & ~.calve*
H.
..
Program Support Center
Phone: (301) 443-7077

- -

r'

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.
.

.

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.

.
.

.
.. . . .

.

.

.. ..

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...
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'.
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X I . ~ ~ ~ ' 5--2 . 2 5.CLAUSES
2-2
INCORPORATED BY REFERENCE (FEI
-..
. . . . . - .. . .

This contract incorporates one or more clauses by reference, with the Sam force
and
. .
effect as if they were given in full text. Upon request, the Contracting Ifficer
will make their full text available. Also, the full text of a clause may beac essed
electronically at thislthese address(es): http://www.arnet.zovifar.
The following FAR contract clauses are incorporated by reference:,

No.

CLAUSENO.

..

TITLE AND DATE

..

1.

FAR 52.204-6

2.

FAR 52.204-7

Data Universal Numbering
System (DUNS) Number
(OCT 2003)
Central Contractor Registrati
(OCT 2003)
5

I

HHSP233200400846P
11
Page 7 of 7

U

&

CLAUSE NO.

3.

FAR 52.2 12- 1

4.

FAR 52.212-4

5.
6.

FAR 52.222-3
~Ak52.222-19

7.

FAR 52.222-2 1

8.
9.
10.

FAR 52.222-26
Fm52.223-6
FAR 52.225-1

11.

FAR 52.225-13

-

12.
13.

-

.4/

14.
15.

-

.^'--X.

FAR 52.232-1
FAR 52.232-33
%
.&
:.

FAR 52.233-1
FAR 52.233-3
-.. ..

-

TITLE AND DATE
Instructions to Offerors - b1
Commercial Items (JAN 2004)
Contract Terms and Conditilpns Commercial Items (OCT 2003)
Convict Labor (June 2003)
Child Labor-Cooperation with
Authorities and Remedies I
(June 2004)
Prohibition of Segregated ~acilities
(Feb 1999).
Equal Opportunity (Apr 2002)
Drug Free ~ o r k ~ l a c ~ ~ ( ~ ~ ~ 0 0 1 )
Buy American Act-Supplies;
(June 2003)
Restrictions on Certain Foreign
Purchases (JUN 2003)
Payments (APR 1984)
1
Payment by Electronic Funds
Transfer-Central Contractor1
Registration (Oct 2003)
Disputes (KTL 2002)
i
1
Protest After Award (AUG 1996)

1

--

I1

I
1

I

I

-

W

1
I

ORDER FOR SUPPLIES OR SERVICES
IMPORTAHT: Mark all packages a n d papers with c o n h a c t andlor order numbers
2. CONTRACT NO (llany)

1 DATE OF ORDER

4. REQUlSlTlONlREFERENCE NO.

HHSP233200400853P

04T000013

2

I

a. NAME OF CONSIGNEE

3 ORDER NO

1

I

6SHlPTO

09/30/2004 .

PAGE OF PAGES

--

5 ISSUING OFFICE (Address comspondenca to)

b. STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
li
5600 FISHERS LANE
ROCKVILLE MD 20857

233 N. MICHIGAN AVE, SUITE 130

-

il--F~;ATE-]
-

11

I SHIPVLA

Jason Jacobs

7 TO

!I

1

a NAME OF CONTRACTOR

UNIVERSITY OF MINNESOTA

8 TYPE OF ORDER

b COMPANY NAME

..

-

.

.-

-

.

University of Minnesota
Sponsored Projects ~dministration
200 Oak Street SE, Suite 450

-

MN ..

f. ZIP CODE

!I

/I

1

10 REQUISITIONING OFFICE

I

HHS/OPHS/OWH/REGION V

7540120

*?$?

$1

tl- WSINESS CtASSlFlCATlON (Checkappmpnale

a SMALL
12 F o B POINT

b OTHER THAN SMALL

Destination
-

.

13 W C E O F

L

-

c DISADVANTAGED

14 GOVERNMENT BNNO

I

.. -

b ACCEPTANCE

a INSPECTION

Destination

Destination

(a)

(b)

'

--

16 DISCOUNT TERMS

/j
11

--.

. Net 30

QUANTITY
ORDERED UNIT
(d)
ic)

SUPPLIES OR SERVICES

d WOMENOWNED

1s DELIVER TO F o B POINT
ON OR BEFORE (Dale)

-

17 SCHEDULE (See reverse lor Releclrons)

ITEM NO

.
-

~ui

Please furmsh the fdl&ng on the terms
and cmdibons speafied on both wdes d
this Order and on Ihe atlached sheets, d
any, ~ndvdingdellvery as ~ndmted.

55455-2070

9 ACCOUNTING AND APPROPRIATIONS DATA

--

-

Except fabln~ng~nsl~cIJons
cn the
re?ene tha dellvery crdw IS
sublea to ~nsmc~~cms
mntalned on
s~deonly 01 ths Iand a
sutqec( lo the terms and
c$d~ttcmsof the abe-numbered
dtraa

Quote Attached

e. STATE

d. CITY

MINNEAPOLIS

b DELIVERY

.-.--. . 1

REFERENCE YOUR-

.-

'1

I Tji

a PURCHASE

c. STREET ADDRESS

e. ZIP CODE

UNIT
PRICE
le\

-111

--.

!I
AMOUY
(1)

-QUANTITY
ACCEPTED

I[

(9)

Tax ID Number:
DUNS Number:

k I STATEMENT
I

Questions concerning this order should be re erred to Gene Calvert

PLEASE REFERENCE PAGES 1 THROUGH 6 OF THE AT~ACHED~
continued . . . .
18 SHIPPING POINT

7
17(h)
TOTAL
(Cont
pages)

20 INVOICE NO

19 GROSS SHIPPING WEIGHT

1

OF W O ~ KTITLED ~ " O F F I ~ E

21. MAIL INVOICE TO

a. NAME

PSC/FMS

SEE BILLING
INSTRUCTIONS
ON REVERSE

b. STREET ADDRESS
(W

p 0 8~

(301) 443-3029

PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE
GRAND
TOTAL

I

d STATE

c CITY

ROCKVILLE
22 UNITED STATES OF AMERICA

BY (Slgnafure)

NSN 7 5 4 0 0 1 152 8083
PREVIOUS EDITION NOT UWBLE

-

-

e ZIP CODE

i)mm
u

rl

MD

$4,500/.
00

20857

23 NAME (Typed)

[-

U

JACQUELINE R. JONES

I

I

I
/I

i

\

TITLE CONTRACTINWORDERINGOFFICER
1
I

OPTIONAL FORM Y 7 (Rr, 6951

1

1
I

R.M

b 1 G s M u 7 I48 CIRI 5 1 llL.1

I

j
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

PAGE OF PAGES

"I

-

2 11

DATE OF ORDER

7

1

IMPORTANT: Ma& all padcages and p a w rnlh anlracl andlor order numbers

1

CONTRACTNO

ORDER NO
HHSP233200400853P

09/30/2004
ITEM NO.

ON WOMEN'S HEALTH, REGION V - HEART
FOR SCOPE OF WORK, INVOICING PROCEDURES,
h
EFFORT.
CAN: 1050116 FY: 2004
Period of Performance: 09/30/2004 to

TERMS

-

The Contractor shall provide support in .
promoting the "Heart Truth Campaign" in
accordance with the attached Statement of
Work tltled "Office on Women's Health,Regi
- St. Paul Venue
- -Project Officer:
Michelle Hoersch
Phone (312) 353-8122

: :1

"T

INVOICE INFORMATION/CLAUSES INCORPO

ED Bk

INVOICE INFORMATION
IN ADDITION TO THE INFORMATION REQUIRED BY 5
MUST CONTAIN THE FO~QOP;MG: TAX IDENTIFICATI

FAR 52.232-33 PAYMENT BY ELECTRONIC FUNDS
REGISTRATION (OCT 2003)

SFE

--

TOTAL CARRIED FORWARD TO ? S TPP
NSN 754001-152-8082

WMB.IOI

lM 17(H))

!
!

OPTIONAL FORM 141 ( R n M O

HHS~233200400853~
Page 1 of 6

il

1

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE ON WOMEN'S HEALTH - REGION V
1

!I

STATEMENT
OF WORK
I.

IIi/

I

PROJECT TITLE: Oflce on Women 's Health, Region V - Heart Truth
I
Campaign, Minneapolis - St. Paul Venue.

11.

I'I

BACKGROUND: The Office on-Women's Health (OWH) is the focal/~ointfor
women's health within the Department of Health and Human Services (HHS). .
The OWH, under the direction of the Deputy Assistant Secretary for ~ e s l t h
(Women's Health)., igproves the health and well-being of women acrossl the
lifespan by coordinating women's health programs, promoting health gucation
and disease prevention, and leading efforts and fostering partnerships toleliminate
health disparities.

I

1
I

/I
The Heart Truth Campaign, sponsored by the National Heart, Lung, and Blood

Institute (NHLBI) and partner organizations is intended to make womed more
aware of the danger of heart disease. The campaign's goal is to give wo$en a
personal *!gent
wake-up call about their risk of heart disease. The campaign
is especially aimed at women ages 40 to 60, the time when a woman's rihk of ..
heart disease starts to rise. But its messages are also important for younder
women,
.,---.,.,..
since...heart
..._ disease develops gradually and can start at a young age-even
in the teenage years. Older women have an interest too-it's never too lite to take
/I
action to prevent and control the risk factors for heart disease. Even those who
1
have heart disease can improve their heart health and quality of Me. II ;------=

111.

1

I
i

.-

I1

PERIOD OF PERFORMANCE: The Period of Performance shall beifrom
September 30, 2004 through September 29,2005.
I
I

V.

.

.---.

...

1I

PURPOSE: The purpose of this contract is to provide contractor suppdlrt to help
il
.promote the Heart Truth Campaign coordinating a series of activities tolbe held in
the Mi.nneapfis-St. Paul metropolitan area. These events will include
symposium on women and heart disease and the Heart Truth CampaignBor health-.
care providers. The events will also include training on the Heart ~ r u t h i s ~ e a k e r s
/I
-.Kitfor lay women from community-based organizations. The participants will be
taught how to use the speakers' kit and they will then be expected to do
'I
presentations in their respective communities. Also included will be an /afternoon
of screening of women at the Mall of America for heart disease risk fac& and a
Red Dress fashion show to heighten awareness of women and he4l-t dis<ase.

4

IV.

-

TYPE OF CONTRACT: This is Firm, Fixed-Price purchase order.

,

0
(1,I

-

. ..

.:-_.

DELIVERABLES AND TIMEFRAME: The Contractor shall work ih
collaboration with the Region V Office on Women's Health Project 0ffiCer (PO)
to create these Heart Truth Campaign events. The Contractor's tasks sha1:linclude
chairing the screening subcommittee; coordinating logistics with the
of
America; securing materials; and identifyng and coordinating speakers $Id
1
models from the University. To ensure coordination with the goals and policies
of
the Office on Women's Health and the Department of Health and Humanll
Services, the Contractor shall provide regular progress reports to the PO And
submit all proposed written materials to the PO for appropriate ~ e ~ a r t m e h a l
clearances.
II

VI.

all

1
In coordination with the PO, .the.Contractor shall provide the following strvices
and deliverab 1es.i. .. ..--

_ _ %

.. .

-:,.

il .--

!I

.

-

--

..

...

;I

a
a

a

a

Function as the initial contact with the Mall of America and secure date for
use of the Mall for events;
l
Provide a chairperson for the screening subcommittee;
I
Identify and provide speakers for the health care provider symposium]
Identify and secure-apresenter for the fashion show;
Secure materials
%..
and items to be provided to screening participants anb
volunteei*?::
iI!
Contact organizations
-.
and companies to identify additional partners a(id
.
sponsors;
Part-ieipate-on:-theoverall planning committee;
..
I
Use community networks to maximize community involvement;
ij
Serve as a liaisonwith the CME office at the University of M-knesotd~ ---Recruit participants from the community to participate in Heart Truth
Speaker's Kit training;
'I
Confirrn date to use the Mall of America for activities;
.
Provide regular project updates for the screening subcommittee;
1/I
-.
..-.
~ o n L e n eregular screening subcommittee planning conference calls; I
I
Provide the necessary training materials for the program's participants;
/I
Provide keynote speaker for the symposium;
. i
Provide speaker for the fashion show;
Secure the participation of at least two "high-profile" women from
University to model in the fashion show.

1
1

,+I

i

!

a
a

/

j

-

a
a
.a.
a

.

..-..

The due dates and delivery methods for these deliverables are to be
determined following the award'of this effort.

.:
..

..

. *

VII.

\ of the
INSPECTION AND ACCEPTANCE: The PO as a duly authorized dgent
Contracting Officer is responsible for the review and acceptance of all
deliverables.

1"

I

VIII. PAYMENT SCHEDULE: Within two weeks of acceptance by the P 4 of
services related to securing the use of the Mall of America, confirming the
symposium's keynote speaker and convening the first screening subconhittee
meeting, the Contractor shall submit a proper invoice for those related skrvices.
The Contractor shall submit a proper invoice for the balance of the pro&sed fee
within two weeks of the PO'S acceptance of the completed event.
I/

1
1

IX.

INVOICE SUBMISSION: Upon inspection and acceptance of deliverables,
the Contractor shall submit an original and two copies of its proper invdces to the
PO. For payment, the PO shall submit the invoice and a signed receiving report
to:
Department of Health & Human Services
PSCFinancial Management Service
Division of Financial Operations
Parklawn Building, Room 16A-12
5600 Fishers Lane
~ o & $ % l lMaryland
e,
20857
Telephone: (30 1) 443-3020
-1

j

II

1i

The in.vsis=e.must-contain the following minimum information:
Contractor's name and address;

.- --s

I

Z

'I

_-

_ =

Purchase order number;
..

-

.

Description and price of services provided;
Lnvoice period; and
The Contractor's Internal Revenue Service ( R S ) Taxpayer Ide
Number.

X.

GOVERNMENT-FURNISHED MATERIALS: The Government will not
-furnish any materials to the Contractor for this requirement.
..-

XI.

RIGHTS TO DATA: The Contractor is prohibited from using data produced or
l
obtained under this contract for any purpose without prior, written approval from
the PO.

I

I

II
I

=

I

i
(I

0:p
fi,a

II

TECHNICAL MONITORING:

Performance of the work under this purchase order shall be sub].I4c t to the
technical monitoring of the Project Officer. The term "Technic;a1
.I/
Monitoring" is defined to include, without limitation, the follom'In
g:

A.

I

Technical directions to the Contractor, which redirect thl=!I:burchase
order effort, shift work emphasis between work areas or ta!sks,
require pursuit of certain lines of inquiry, fill in details or
otherwise serve to accomplish the contractual scope of vv01-k.

1.

1
I/

2.

I/

P~ovidinginformation to the Contractor for assistance in tih e
- internretation of drawings, specifications or t e c k a 1 . p
-rtl~I .onsof
the work description.
/
. Review and, where required by the purchase order, apprcIVi11 of
technical reports, drawings, specifications and technical /
1 nrnent
information to be delivered by the Contractor to the Gob'er
1
under the purchase order.
5-

3.

-

I/

B.

1

Technical direction must be within the general scope of work st;~ tdein the
pudl$$se order. The Project Officer does not have the authorityt o and
may not issue any technical direction which (i) constitutes an ass:ilw e n t
of additional work outside the general scope of the purchase orcler; (ii)
constitutes
:d,
-:--.
-*- - -. a change as defined in the purchase order clause enti tie
I
"Changes;" (iii) causes, in any manner, an increase or decrease :in the total
estimated purchase order cost, the fixed fee or the time required falr
purchase order performance; or (iv) changes any of the.eXpressird:I ferrfis,
conditions, or specifications of the purchase order.
I
1

.

-G All technical direction shall be issued in writing by the Project
-

D.

Officer or shall be confirmed by himher in writing within 5
working days after issuance.

I
iIl

,...

1
I
The Contractor shall proceed promptly with the performance of
(I

technical direction duly issued by the Project Officer in the marme:r
prescribed by this clause and within hislher authority under the
provisions of this clause.
.

E.

-

..

If, in the opinion of the Contractor, any instruction or direction !I ued by
the Project Officer is within one of the categories as defined in I(1) through
(iv) above, the Contractor shall not proceed but shall notify the 1
1
Contracting Officer in writing within 5 working days after the r ect:ipt of
any such instruction or direction and shall request the Contracti nk Officer
11
to modify the purchase order accordingly.

,

I

I

/I
1

1I/

iJ

I/

11

----

.-

Upon receiving such notification from the Contractor, the Cont:
Officer shall issue an appropriate purchase order modification
the Contractor in writing that, in hisher opinion,-thetechnical c
within the scope of this clause and does not constitute a change
Changes Clause of the purchase order. The Contractor shall-thr
proceed immediatel; with the direction given.
-

ling
idvise
ction is
der the
lpon

.. .

A failure of the parties to agree upon the nature of the instructic )r
direction or upon the purchase order action to be taken with res] t
thereto shall be subject to the provisions of the purchase order c .se
entitled "Disputes."
P
.

-

The Project Officer (PO) for this effort is:
Ms. Michelle Hoersch, .M.S.
Office on Women's Health
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 1300
Chicago, 1lGqbis 60601
Phone: (3 12) 353-8 122
Fax: (3 12) 353-7800
Email: ~_mhoersch@osophs.dhhs.ov
..
The Contracting Officer (CO) for this effort is:

,. .-

Ms. Jacqueline R. Jones
Program Support Center
U:S. Department of Health and Human Services
Parklawn Building, Room 5- 10 1
5600 Fishers Lane
Rockville, MD 20857
Phone: (301) 443-6413
Fax: (301) 443-8488
The Contract Specialist for this effort is:
.

--

Mr. Gene H. Calvert
Program Support Center
Phone: (301) 443-7077

-..

I

XIV. FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEE? 1998)
'I

/I
This contract incorporates one or more clauses by reference, with the same
force
and effect as if they were given in full text. Upon request, the Contracting Officer
will make their full text available. Also, the full text of a clause may be dbcessed
electronically at thislthese address(es): http:llv.w~.arnet.gov/far.
-. ..

The following FAR contract clauses are incorporated by reference:

No.
-

TITLE AND DATE

CLAUSE NO.

1.

FAR 52.204-6-

..-

.-

-

Data Universal Numbering
System (DUNS) Number
(OCT 2003)
Central Contractor Reghalion
(OCT 2003)
Instructions to Offerors Commercial Items (JAN 2004)
Contract Terms and ~onditibnsCommercial Items (OCT 2q,03)
Convict Labor (June 2003)
Child Labor-Cooperation with
Authorities and Remedies
(June 2004)
Prohibition of Segregated ~acilities(Feb 1999).
)I
Equal Opportunity (Apr 20027 ---Drug Free Workplace (MA$ 200 1)
Buy American Act-Supplies
(June 2003)
Restrictions on Certain ~or(ign
7 -- - - -Purchases (JUN 2003)
1
Payments (APR 1984)
i
Payment by Electronic Funds
Transfer-Central ~ontractod
1
Registration (Oct 2003)
Disputes (JUL 2002)
Protest After Award (AUG ,1996)
11

2.

FAR 52.204-7

3.

FAR 52212-1

4.

FAR 52.2 12-4

I
1

1
I

8.
9.
10.

--

FAR'52.222-26
FAR 52.223:6
FAR 52.225-1

->

11.

..

--FAR 52.225-1 3

12.
.13.

FAR 52.232-1
FAR 52.232-33

14.
15.

FAR 52.233-1
FAR 52.233-3

1
I

1

* * * END OF STATEMENT OF WORK * * *

I

1)

ORDER FOR SUPPLIES OR SERVICES
2 CONTRACT NO (I1 any)

1 DATE OF ORDER

I

a NAME OF CONSIGNEE

09/30/2004
4 REQUlSlTlOtVREFERENCE NO

HHSP233200400883P

04T000019

i

v

HHS/OPHS/OWH/REGION

/

;/

6 SHIP TO

3 ORDER NO

PASE O= PAGES

Ill1

IMPORTANT: M a r k all packages a n d p a p e r s with c o n t r a c t and/or order numbers

1I

i

5. ISSUING OFFICE (Address correspondence to)

b. STREET ADDRESS

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

233 N. MICHIGAN AVE, SUITE 1300

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a. NAME OF CONTRACTOR

NORTHPOINT HEALTH

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to Gene Calvert at (301) 443-7C77.
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PLEASE REFERENCE
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STAYEMENT OF WORK TITLED

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I 8 SHIPPING POINT

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SEE BILLING

b. STREET ADDRESS

INSTRUCTIONS

(w P.O. Box)

ON REVERSE

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ROCKVILLE

NSN 754@01-152-8003
PREVIOUS EDITION NOT USABLE

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MAIL INVOICE TO

-154. 990 100

PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

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Net 30

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8 TYPE OF ORDER

PURCHASE

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R . W sv W L R 148 CFRJ53 21X.1

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1.1 11

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

PAGE OF PAGES

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IMPORTANT: M a n au packages and papers Hnth anma andfa- a d e r numbers

DATE OF ORDER

CONTRACT NO

~ ~ ~ ~ 2 3 3 2 0 0 4 0 0 ~ ~ 8 3 ~

SUPPLIEYSERVICES

ITEM NO.

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ORDER NO

09/30/2004

2

QUANTITY UNIT
ORDERED

UNIT
PRICE
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OUANTITY

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ON WOMEN'S HEALTH, REGION v - HEART TRUTH CAYPAIGN NORTH POINT.HEALTH & WELLNESS
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CENTER" FOR SCOPE OF WORK, INVOICING PROCEDURES, XJIJ TERMS AND C0N:IITIONS REGARDIKZ
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THIS EFFORT.
CAN: 1 0 5 0 1 1 6 Fy: 2 0 0 4
Period of Performance: 0 9 / 3 0 / 2 0 0 4 to 0 9 / 2 9 / 2 0 0 5
(8)

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The Contractor shall provide training in
accordance with the attached Statement of
Work titled "Office on Women's Health,

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4,990.00

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4,990.00

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REGISTRATION (OCT 2 0 0 3 )
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TOTALCARRIED FORWARDTO I S T PAGE (ITEM 17(H))
NSN

754G01-152.8082

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U.S DEPARTMENT OF HEALTH AND HUMAN SERVIC;ES
OFFICE ON WOMEN'S HEALTH - REGION V

I1

STATEMENT OF WORK

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PROJECT TITLE: Office on Women 's Health, Region V - Heart Truth
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Campaign, North Point Health & Wellness Center.

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BACKGROUND: The Office on.Women7s Health (OWH) is the focal ioint for
women's health within the Department of Health and Human Services (HHS).
.The OWH, under the direction of the Deputy Assistant Secretary for ~ e a i t h
-(Women's Health), improves the health and well-being of women acrossithe
lifespan by cdordilialing women's health programs, promoting hG1th d ~ a t i o n
and disease prevention, and leading efforts and fostering partnerships to kliminate
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health &spa&es.

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The Heart Tmth c a m i i g n , sponsored by the.Nationa1 Heart, Lung, and blood
Institute (NHLBI) and partner organizations is intended to make women bore
aware of thedanger of heart-disease. The campaign's goal is to give w o d F a
personal a@ qrgent wake-up call about their risk of heart disease. The ca,mpaign
is especially%med at women ages 40 to 60;the time when a woman's risk of
heart disease starts to rise. But its messages a_re also important for young&
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women, since heart disease develops gradually and can start at a young age--even
in the tecn3geyears.-Older- women have-an interest t o e i t ' s never too laic to take, action to prevent and control-the risk factors for heart disease. Even thost! who
-- = have heart disease can improve their heart healih and quality of life.
1
In 2001, The Office on Women's Health awarded the first four National
Cpmmunity Centers of Excellence in Women's Health (CCOEs) to provibe
integrated health and social services to women in their communities.
CCOEs
coordinate alraspects of issues related to women's health at every stageq'f-iifk,
including active management of socioeconomic and cultural obstacles to equality
.,health care for underserved women. The centers of excellence provide r(al help
to women who otherwise would face serious challenges in getting needed health
care and social services," Secretary Thompson said. These projects are intended to
serve as models for how best to meet the health needs of women in local
communities.
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,111. PURPOSE: The purpose of this contract is to provide contractor suppod to train
lay women from community-based organizations to conduct Heart Truth!/
Campaign presentations in their respective communities. To achieve thi4
objective this contract shall support the efforts of the North Point Health ki
Wellness Center, a national Community Center of Excellence (CCOE) id!
Women's Health in Minneapolis, to partner in the Heart Truth campaign:/
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Minnesota activities and specifically to coordinate a training for lay wom'en
from
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community-based organizations to become familiar with the Hearth Truth

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HHSP2332004OOSS3P
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Page 2 of 6
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Speaker's Kit and ultimately generate at least 20 community presentations on the
Heart Truth Campaign. The CCOE will follow up with these
to
ensure that community presentations are conducted. This training and subsequent
presentations, will be part of a larger series of activities and events to be :held in
the Minneapolis-St. Paul metropolitan area to promote the Heart Truth Campaign.

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IV.

PERIOD OF PERFORMACE: The Period of Performance shall be from
Y
September 30, 2004 through September 29,2005.
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V.

TYPE OF CONTRACT: This is.a Firm, Fixed-Price purchase order. 1

VI.

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The Contractor shall work in

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DELIVERABLES AND TIMEFRAME:
collaboration with the Region V Office on Women's Health Project offiber (PO) =
to create these Heid-Truth Campaign events. The Contractor sh3l co&hate and
convene the-training of 20 women from community-based organizationsj These
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women will then be expected to;.and will commit to-conducting a presentationin
their respective communities. The Contractor shall identify appropriate \$omen to
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- p'articipate in the training and shall also conduct the training. and follow up on
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the progress of.those:trained;-To-ensurecoordination with the goals-andpolicies.
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:..oftheOffice on Women,s -Healthand the Department of Health and H d a n : . . . . . .
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Services, tke Contractor shall provide.regulai progresS.repofs .to the ~ e h o V:
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:.I. . :.:: I . -':Office on . w o ~ e n ' s H e a l t h
subm~tial.l.propos~d:wr~~~en~~ate~als..
to the Office . .

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Provide trainers to conduct the trainingdn the Heart ~ r u i hspeakei7s/IQt;
Recruit appropriate participants from the community to participate id the
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. training;
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Identify, Secure and provide an appropriate venue for conducting theitraining
-.. program;
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Secure materials and items to be provided to participants;
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Monitor the implementation of community presentations following the
training;
Provide a stipend to the participants and their respective organizatioqs for
their participation and subsequent community presentations;
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Provide a chairperson to the training subcommittee;
Participate on the overall planning committee;
Use community networks to maximize community involvement;
Train 20 Community based presentation on the Heart Truth Campaign;
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Provide regular project updates to the training subcommittee;
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Provide training agenda;
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Provide final report on community presentations to PO.
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The due dates and delivery methods for these deliverables are to be
determined following the award of this effort.

VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized abent of the
Contracting Officer is responsible for the review and acceptance of all I)
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deliverables.

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VIII. PAYMENT SCHEDULE: Within two weeks of acceptance by the PO of
services related to acquiring the trainer's names, list of program particlp'ants, and
training agenda, the Contractor shall submit a proper invoice to the PO
those
services. The Contractor shall submit a proper invoice for the balance of the
proposed fee within two weeks of the PO'S acceptance of the completedl event and
final report on the .community
presentations.
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IX.

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INVOICE SUBMISSION: Upon inspection and acceptance of delivelables,
the a n t r a c t o r shall submit an original and two copies of its proper invoices to the1I
PO. For payment, the PO shall submit the invoice and a signed receiving report
to: -mDepartment of Health & Human Services
-PSC/Financial Management Service
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Diyisbn of Financial Operations 5'I
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parkTim Building, Room 16A-12
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-5600 Fishers Lane
.
Rockville, Maryland 20857
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The invoice must contain the following minimum information: .-

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Contractor's name and address;
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Description and price of services provided;

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Invoice period; and
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The Contractor's Internal Revenue Service (IRS) Taxpayer Identification
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Number.

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GOVERNMENT-FURNISHED MATERIALS: The Government will not
furnish any materials to the Contractor for this requirement.
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RIGHTS TO DATA: The Contractor is prohibited from using data prdduced or
obtained under this contract for any purpose without prior, written appr4val fiom
the PO.
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HHSP23320p400883P
Page 5 of 6

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Upon receiving such notification fiom the Contractor. the ~ o n t r d c t i n ~
Officer shall issue an appropriate purchase order modification or advise
the Contractor in writing that, in hisher opinion, the technical
direction is within the scope of this clause and does not constitute a
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change under the Changes Clause of the purchase order. The Contractor
shall thereupon proceed immediately with the direction given. A(
failure ofthe parties to agree upon the nature of the instruction o!
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direction or upon the purchase order action to be taken with respect
thereto shall be subject to the provisions of the purchase order clluse
entitled "Disputes."
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XIII. POINTS OF CONTACT:
The Project Officer (PO) for this effort is:
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:MS.~ i c h e l l ~
k o e r s c hM.S.
,
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Office on Women's Health .
U S . Department.of Health and Human Services
2 3 3 N. Michigan b . n u e ; Suite 1300
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Chicago, Illinois-6b601. .
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Phone:,(-3w 453.8122- . . . , I - : ..;.i: .:.: >.. . . . . .
-.Fax::(3 12)'3 3-7800,..;- ~:: ........ < ',::...
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.Ms;-JacquelineR. .ones . . . . . .
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Program Support Center
U.S. Department of ~ea1t.hand Human Services
. Parklawn Building, Room 5-101
5600 Fishers Lane
~ockville,
.MD 20857
Phone: (301) 443-6413
.,Fax:(301) 443-8488

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The Contract Specialist for this effort is:
Mr. Gene H. Calvert
Program Support Center
Phone: (301) 443-7077

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XIV. FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)
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I force
This contract incorporates one or more clauses by reference, with the same
and effect as if they were given in fill text. Upon request, the ~ontracti&Officer
will make their full text available. Also, the full text of a clause may be Accessed
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electronically at this/theseaddress(es): h t t p : l l ~ v . a m e t . ~ o v l f a r .

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The following FAR contract clauses are incorporated by reference:

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CLAUSE NO.

TITLE AND DATE

-FAR
52.204-6
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(OCT 2003)
Central Contractor

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Comm6rcial Items (JAN 20b4)
Contract T W s and ~ondit.{ons- ...
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52.222-3 . . . . .. . . . .. . . . . .+;.Convicf-Labor(June
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: - . FAR52.222-19 ::; . i . : ; .
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FAR 52.222-26
FAR 52.223-6
FAR 52.225-1
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13.

FAR 52.232-1
FAR 52.232-33

14.
15.

FAR 52.233-1
FAR 52.233-3

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Equal Opportunity (Apr 2092)
Drug Free Workplace (MAR 2001)
I
Buy American Act-Supplies
(June 2003)
-. . .- - ..
Restrictions oncertain ForCign
Purchases (JUN 2003)
Payments (APR 1984)
Payment by Electronic Funds
Transfer-Central Contract0
Registration (Oct 2003)
Disputes (KJL 2002) ..
Protest After Award (AUG g996)

* * * END OF STATEMENT OF WORK * * *.

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Main Content

Page 1 of 1

I

Summary Report
Requested by: JULIA SAVOY
Award Number: HHSP23320042807MB
Award Date: 08!26/2004
EffectiveDate: 08/26/2004
Expiration Date: 09/30/2004
Closeout Date:
- ..
Period of Performance: 10/01/2003 to 09/30/2004
Vendor: 165567914 ROBJN L. CLEMENS
Contact:
Phone: 717-236-6850
Buyer: JULIA SAVOY - Phone: 30;-4-43-1386
Contracting Officer:
SAVOY
Phone: -301-443-1386
Minimum Amount Per Call: $0.00
Maximum Amount Per Call: $0.00
.
Total Calls Not to Exceed: $195,000.00
Number of Modifications: 5
Last Modification Date: 08/26/2004
Modification ~umb&\b005
Invoiced Amount: $0.00

JULIA

:
+
,..--

.

Call Summary

;..

Order Number Award Date

-

..-

Buyer

.

'

Total Amount

Total Obligation
-_ I1, --Amount
$0.00
$0.00
$1 1,000.00
$20,900.00
-'

00
00 1
002
003
004
005
006
007
008
009
010
01 1
012
013
Totals
Total Number of Orders:

JO LASKO
JO LASKO
JULIA SAVOY
JULIA C SAVOY
JULIA C SAVOY
JULIA SAVOY
JULIA SAVOY
JULIA SAVOY
JULIA SAVOY
JULIA SAVOY
JULIA SAVOY
JULIA SAVOY .
JULIA SAVOY
JULIA SAVOY

-

i,:

%

1

--

:

II

ORDER FOR SUPPLIES OR SERVICES
IMPORTANT: Mark all

acka es and apers with contract andlor order numbers

1

----I-1 DATE OF OPDER

2 CONTRACT NO (If any)

HHSP23220042807MB

I

10/30/2003

3 ORDER NO

6 SHIP TO

a NAME OF CONSIGNEE

-

1

Phi:
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1

1

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-

7

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1

4 REQUISlTlOhUREFERENCE NO

SAMHSA/OA

00
5 ISSUING OFFICE (Address correspondence to)

b STREET ADDRESS

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5 -101
5600 FISHERS LANE
ROCKVILLE MD 20857

PARKLAWN BLDG . , ROOM 6 - 101
5600 FISHERS LANE
-

-

/I

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I1

c CIW

I

d STATE

/

ROCKVILLE

e ZIP CODE

20857

f SHIP VIA

7 TO
a NAME OF CONTRACTOR

ROBIN L. CLEMENS?

8.TYPE OF ORDER

\

b. COMPANY NAME
.. .,

c STREET ADDRESS

3205 NORTH FRONT STREET APT. # 5

.

-

.

.

d ClW

-

M_i b. DELIVERY

PURCHASE

REFERENCE YOUR

---.
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Please furnish lhe f d l o l n g M me lm
and c ~ d i t l m specified
u
on both s~desof
this a d e r a n d M the anached sheels, if
any, including dellvery a s lndicaled.

1. ZIP CODE

e. STATE

KARRISBURG

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PA

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E x g p l for blldng ~ n s & n i m s c n the
U - 6 dellwry order IS
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thjs side m l y d this form and IS
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& n d ~ t O(
i ~me above-numbem

<%wse,

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17110

9. ACCOUNTING AND APPROPRIATIONS DATA

10 REQUISITIONING OFFICE

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11. BUSINESS CLASSIFICATION (Check appropriate box(es))

I$

b. OTHER THAN SMALL

Destination

12. F 0.B POINT

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a. SMALL

C.

DISADVANTAGED

14 GOVERNMENT B/UNO.

15. DELIVER TO F.O.B. POINT
ON OR BEFORE (Date)

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13 PLACE OF

Ib

a INSPECTION

Destination

d WOMEN-OWNED

//II

16. DISCOUNT TERMS

1

Net 15

1

09/30/2004

ACCEPTANCE

Destirfi3tl6'n ' +

-

1

17 SCHEDULE (See reverse for Relections)
UNIT

QUANTITY
ACCEFTED

(b)

(a)

Tax ID Number
DUNS Number:
CAN: OOOODOO Ob]. Class:' 0000 FY: 2004
Period of Performance:

A

If you have questions,
I

I
18 SHIPPING POINT

I

I

19 GROSS SHIPPING WEIGHT

1

I
17(h)
TOTAL

20 INVOICE NO

I

21 MAIL INVOICE TO

SEE BILLING
INSTRUCTIONS
ON REVERSE

1

a NAME

PSCIFMS

(301) 443-3020

b. STREET ADDRESS
(or.P.0. Box)

PARKLkWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

1

ROCKVILLE

-

NSN 754041-152-8083
PREVIOUS EDITION NOT USABLE

d STATE

MD

1
1

22 UNITED STATES OF AMERICA
BY (S~gnalure)

17(1).
GRAND
TOTAL

)

CIRIGNAL SIGNED

e ZIP CODE

$0.00

20857
23 NAME (Typed)

I

TITLE
JOCONTRACTIN~ORDERING
LASKO
OFFICER

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

PAGE O r GASES

-

--

IMPORTANT: Mark all packages and papen w~thcontract andlor order numbers
DATEOFORDER

CONTRACTNO

ORDER NO

10/30/2003 HHSP23320042807MB

1

ITEM NO

SUPPLIEYSERVIC~S

(A1

(B)

00
OUANTITY UNIT
ORDERED
:C1
(Dl

UNIT
PRICE
(E)

Renew Blanket Purchase Agreement for the
period October 1, 2003 through September
30, 2004.
IMPORTANT NOTE:

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A~CEDTE>

AMO~NT

(G)

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000

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YOUR BPA NUMBER HAS C ~ G E D
FROM i0418M TO HHSP2312001280~WB.

1

This BPA is for speech writing and editorial servi :es for the SAMH,;A ~dmihstratcr
. ilI
on an as needed basis.

the following authorized callers:
Mark Weber and-Daryl -Kade-Call Limitation:

$2500.00

invoices for payment.

A.

Name of Supplier

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 754001-152-8082

50348 I D !

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OPTIONAL FORM 344 (b-51
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ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

,

-

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CONTRACT NO.

ORDER NO

10/30/2003 HHSP23320042807MB
ITEM NO

00

SUPPLlESiSERVlCES

QUANTITY UNIT
ORDERED
(C)
(D)

(B)

(A)

CF C ~ E L I

j'3

10

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IMPORTANT: M a h all packages and papers wlth mntran andlor order numbers
DATE OF ORDER

PAGE

UNIT
PRICE
(E)

,

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OU;h'iiT?
ACZSDTEG

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1F1)

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C.
Date of purchase
D.
Call order number
..
,
E.
An itemized list of supplies or services fu:-nished
F.
Quantity,unit price & extension of each .ten, less applizable discounts
G.
Date of delivef-y
7. Services/supplies not covered by Block #17 of :hi:; BPA shall not be procured
under this BPA. In doubtful cases, the Contractor is encouraged t, confer'with tte
Contracting Officer prior to performing any servic2s or providing iny articles in
quest ion.

I

.,

I

I

. .
--

(A)

METHOD OF PAYMENT. (1) ALL- PAYMENTS BY

>.

THE CONTRACTOR A G R & ~ ~ O .
EITHER (I) ACCEPT PAYMENT BY CHECK OR SOME OTHER

-- .--

-- -. .

PENALTIES APPLY.
(E) LIABILITY FOR UNCOMPLETED OR ERRONEOUS
ERRONEOUS TRANSFER OCCURS BECAUSE THE GOVE

(11) PAYING ANY PROMPT PAYMENT PENALTY DUE;
continued . . .

NSN 756&01-152 8082

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

I/

5
a
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O P ~ O M LFORM ud IRH a 5 1

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ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

DATEOFORDER

CONTRACTNO

ORDER NO

10/30/2003 ~ ~ ~ ~ 2 3 3 2 0 0 4 2 8 0 7 ~ ~
ITEM NO

00

SUPPLIEYSERVICES

(A)

QUANTITY UNIT
ORDERED
(D)
(C)

(6)

II
I

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UNIT
PRICE
(El

PAC

4

O= ?-CEC
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8.

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au~~.-,-\
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(111) RECOVERING ANY ERRONEOUSLY DIRECTED FUDS.
( 2 ) IF AN UNCOMPLETED OR ERRONEOUS TRANSFER 3CCURS BECXUSE THE CON'7RACTOR'S EFT
INFORMATION WAS INCORRECT, OR WAS REVISED WITHIN 3 1 DirYS OF GOVERKdENT RELEASE OF
THE EFT PAYMENT TRANSACTION INSTRUCTION TO TXE F E D ~ F W IRESERVE SYSa-EM,
AND/(1) IF THE FUNDS ARE NO LONGER UNDER THE CONTROL OF T1.E PAYMENT OF'ICE, THY
GOVERNMENT IS DEEMED TO HAVE MADE PAYMENT AND THE ZOKIRACTOR IS REjPONSIBLE FOR
RECOVERY OF ANY ERRONEOUSLY DIRECTED FUNDS; 3R
(11) IF THE FUNDS REMAIN UNDER THE CONTROL OF THE 'AITIENT OFFICE, THE GOVERNMENT
SHALL NOT MAKE PAYMENT, AND THE PROVISIO~SOF PARA:RA.)H (D) OF THI,; CLAUSE SHALL
APPLY.
(F) EFT AND PROMPT PAYMENT. A PAYMENT SHALL BE DEE4ED TO HAVE BEEN MADE I N , A TIMELY
=
MANNER IN ACCORDANCE WITH THE PROMPT PAYMENT TERMS OF THIS CONTRAC': IF, IN
EFT
PAYMENT TRANSACTION IFISTRUCTlON RELEASED TO THE FE.IERIL RESERVE SY,;TEM, --DATE
SPECIFIED FOR SETTLEMENT OF THE PAYMENT IS ON OR B.:FOILETHE PROMPT PAYMENT
DATE,
PROVIDED THE SPECIFIED PAYMENT DATE IS A VALID DAT: WDER THE RULE,; OF THE /FEDERAL
RESERVE SYSTEM.
1
(GI EFT AND ASSIGNMENT OF CLAIMS. IF THE CONIRACTO:? XiSIGNS THE PROCEEDS OF;THIS
CONTRACT AS PROVIDED FOR IN THE
CONTRACTOR SHALL REQUIRE AS A CONDITION OF ANY
SHALL REGISTER SEPARATELY IN THE CCR DATABASE
ACCORDANCE WITH THE TERMS OF THIS CLAUSE. NOTWI
THIS CONTRACT, PAYMENT-TO AN UL
FINANCIAL INSTITUTIO? PROPERLY
SUBPART 32.8, IS NOT PERMITTED. IN ALL RESPEZT
SHALL APPLY TO THE ASSIGNEE AS
THE ULTIMATE RECIPIENT OF THE T
ABSENCE OF A PROPER
EFT INFORMATION WITHIN THE MEAN
(H) LIABILITY FOR CHANGE OF EFT
NOT LIABLE FOR ERRORS RESULTING
CONTRACTOR'S FINANCIkL AGENT.<P>
(I) PAYMENT INFORMATION. THE PAYMENT OR DISB
CONTRACTOR4VAILABLE PAYMENT INFORMATION THA
DATE OF RELEASE OF THE EFT INST
MAY REQUEST THFCONTRACTOR TO DESIGNATE A
OF PAYMENT INFORMATION FROM A L
CAPABLE OF EXECUTING. HOWEVER, THE GOVERNMENT DOES NO:' GUARANTEE T:WT ANY PFTICULAR
FORMAT OR METHOD OF DELIVERY IS AVAILABLE AT ANY P.ZRT::CULARPAYMEN'? OFFICE P D
THE
RETAINS THE LATITUDE TO USE THE FORMAT AND DELIVER[ M~THODMOST CUJVENIENT O;
GOVERNMENT. IF THE GOVERNMENT MAKES PAYMENT BY CHETK :N ACCORDANCE WITH P Y G R A P H
(A) OF THIS CLAUSE, THE GOVERNMENT SHALL MAIL THE ?AYr'IENT1NFORMAT:ON TO THE
REMITTANCE ADDRESS CONTAINED IN THE CCR DATABASE.
(END OF CLAUSE)

I

ITHE

--

/IDUE

_- ASSIG~ENT
*

L

---- -

C

52.204-7 CENTRAL CONTRACTOR REGISTRATION. (3CT 2013)
AS PRESCRIBED IN 4.1104, USE THE FOLLOWING CLAUSE:
Continued . . .
I,

I

/-

il

1
I

li
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 754&01-152-8082

50246101

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1

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OPnONAL FORM U( (

R r &951

R.urDcd by G Y
FI\R141 C F R 1 5 3 2 l l c :

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ORDER FOR SLIPPLIES OR SERVICES
SCHEDULE - CON'TINUA'I'ION

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1

ORDER NO

10/30/2003 I HHSP23320042807MB

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SUPPLIEYSERVICES

QUANTITY UNIT
ORDERED
(01
(Cl

(6)

(A1

-. ^

1

CONTRACTNO

ITEM NO

5- ' ; C 5

I

IMPORTANT Mark ail pa&ages and papers wltn m n v a n anuor order numbers
DATEOFORDER

psr,

UNIT
PRICE
!El

00
I

OUAk-IT,
ACC5qTE3
tG

AhQUhT
IF1

CENTRAL CONTRACTOR REGISTRATION (OCT 2003)$1
(A) DEFINITIONS. AS USED IN THIS CLAUSE-CENTRAL CONTNCTOR REGISTRATION (CCR ) DATAB9SE M E W S THE PRIMARY GOVERNMENT
REPOSITORY FOR CONTRACTOR INFORMATION REQUIRED FOR TH.: CONDUCT OF :3USINESS'WITH TEE
GOVERNMENT.
DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER MEAN; T .E 9-DIGIT NLT4BER ASSIGNED BY
DUN AND BRADSTREET, INC. (D&B) TO IDENTIFY U\JIQUE.3US::NESS ENTITIES.
DATA UNIVERSAL NUMBERING SYSTEM +4 (DUNS;+4) . W B E R MEiNS THE DUNS IJUMBER ASSIGNED BY
3&L!PLUS A 4 -CHARACTER SUFFIX THAT MAY BE ASSIGNED BY A BUSINESS CIINCERN. (D&B HAS

*

.ACTI'JE ' ' .

PERFORMANCE, AND THROUGH FINAL PAYMENT OF

(1) AN OFFEROR MAY OBTAIN A DUNS NUMBER--

BRADSTREET OFFICE.
(

I ) COMPANY LEGAL BUSINESS.

RECOGNIZED.
(IV) COMPANY MAILING ADDRESS, CITY, STATE
(V) COMPANY TELEPHONE NUMBER.
(VI) DATE THE COMPANY WAS STARTED.
(VII) NUMBER OF EMPLOYEES AT YOUR LOCATION.
(VIII) CHIEF EXECUTIVE OFFICER/KEY MANAGER.
(1x1 LINE OF BUSINESS (INDUSTRY).
Continued

...

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)1
NSN 754C-01 152 BOB2

SOY8 101

I
OPTIONAL FORM l4M I R n 6'351
F 7 . d b" Gsa

FARI48CFR)53213(c)

/

ORDER FOR SUPPLIES OR SERVICES

0- PAGES

1

IMPORTANT: Mark all packages and papen with mnuacl andla order numbers
DATEOFORDER

PAGE

CONTRACTNO

ORDER NO

1 0 / 3 0 / 2 0 0 3 HHSP23320042807MB

00

I

( 2 ) THE COWfRACTOR SHALL NOT CHANGE THE

CLAUSE OF THIS CONT&CT.

1 - 8 8 8 - 2 2 7 - 2 4 2 3 , OR 2 6 9 - 9 6 1 - 5 7 5 7 .
(END OF CLAUSE)

continued

NSN 754&01-152.8082

...

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

/

$3~.101

1
I

!i

OPTIONAL FORM 2.48 Ir(n -51
R . d b" GSPi
F A R ( I 8 CFRI53 I l X r i

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

PAGE

OF

DA,GES

w;

12724, 13059, 13067, 13121, 13129).
(V) 52.233-3, PROTEST AFTER AWARD (AUG 19
(2) LISTED BELOW ARE ADDITIONAL CLAUSEST
(I) 52.232-1, P A Y M E ~ S ' ~ ( A P R ~ ? ~- -~ ~ ) :
(11) 52.232-8, DISCOUNTS FOR PROMPT PAYME
(111) 52.232-11, EXTRAS (APR 1984) .
(IV) 52.232-25, PROMPT PAYMENT (FEB 2002).
(V) 52.233-1, DISPUTES (JUL 20.02).
(VI: 52.244-6, SUBCONTRACTS FOR COMMERCIAL
(VII) 52.253-1, COMPUTER GENERATED FORMS (
(B) THE CONTRACTOR SHALL COMPLY WITH THE F
REFERENCE, UNLESS THE CIRCUMSTANCES DO NOT
(1) THE CLAUSES LI&~.BELOW IMPLEMENT PRO
(I) 52.222-19, CHILD LABOR--COOPERATIONWI
(E.O. 13126) . (APPLIES TO CONTRACTS FOR SU
THRESHOLD.)

-

..
--.

.

.:

..

.

--

.
.

U.S. VIRGIN ISLANDS).
(111) 52.222-35, EQUAL OPPORTUNITY FOR SFE
VIETNAM ERA, AND OTHER ELIGIBLE'VETERANS (
C0N''RACTS OF $25,000 OR MORE) .
.
.~

VIRGIN ISLANDS, AND WAKE ISLAND.)

CONTRACTS OF $25,000 OR MORE).

TOTAL CARRIED FORWARD TO I S T PAGE (ITEM 171H))
NSN 7540.01-152.8082

YIYB.101

!

OPTIONAL FORM

Ma ill-

6%)

R . L . ~b" G s
FAR148 CFR153 2131ri

.

. .. - .

ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION

-

1

1

1

6

CONTRACT NO

10/30/2003

HHSP23320042807MB

c; ~ 4 ~ : s

-.,-

1

IMPORTANT: Mark all packages and papers w ~ l hw n t r a n and/or order numbers
DATE OF ORDER

PAGE

I

ORDER NO

00

SUPPLIE3SERVICES

.CI I T I E S ) .
004) ( 4 1 U.S.C.

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EXCEED $ 2 5 , 0 0 0 )

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1
THE FURN'ISHING
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CENTRAL CON RACTOF!
ELECTRONyIC FUN
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NTRU C O ~ R A C T
EFT AND HE
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, VZSSELS/ (APR
EAN VESSlELS

( X ) 5 2 . 2 3 2 - 3 4 , PAYMENT BY ELECTRONIC FUNDS
REGISTRATION (MAY 1 9 9 9 ) . ( A P P L I E S WHEN THE
PAYMENT O F F I C E DOES NOT U S E THE CCR DATAE

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I N G WITH;
9 5 ) ( A P P L I E S 'I
CONTRACTS OVER $ 2 5 , O 0 0 !-.
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SUPPLIES)

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( A P P L I E S TO FIXED:;-PRICE
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AT T H I S / T H E S E A D D R E S S ( E S ) :
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FOR ACCEPT? ICE ONLY (THOSE

'RA T . THE GOVEF IMENT

RESILRVES
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:P CEMENT O F NC JCONFORM ING
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HAVE BEEN DISCOVERED; AND

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J D I I O N O F THE I
CHANGE I S DUE TO THE DEFECT I N THE I T E M .

AE
Continued

...

I

OR DEFAULT I

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 754C-01-152-8082

Y)YbtOI

1
;I

O P l W M A L FDRM M i R u M S )

,
ORDER FOR SLIPPLIES OR SERVICES
SCHEDULE - CONTINUATION

I~IPAGE

C= PAGE5

II

SHALL REMEDY SUCH OCCURRENCE WITH A L L R

HEREOF,

T

FOR CAUSE I S T H E EVENT O F ANY D E F

--

CONTRACT FOR DEFAULT,

SUCH TERMINATION S

(END OF CLAUSE)'NOTICE.

ORDER.
CONTACTS ARE AS
PSC
JEANETTE PANG
FDA
DAVID CAINE
CDC.
PATTY EVERETTE
--MICHELLE SHORTER
NIH
Continued ...

..

FOLLOWS:
(301) 443-3020
(301) 827-5090
(404) 639-7441"
(301) 496-6088

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 7540-01-152-8082

5QYClOI

I
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!i

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OPTIONAL FORM 2 4 I&

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R.wrM by G S

FARIdB C F R i 5 3 2 l Y ~ )

..

ORDER FOR SLIPPLIES OR SERVICES
SCHEDULE - CONTINUATION

MS) (JUNE 2003)

NOTICE. . .

NTACTS ARE AS FOLLOWS:
(301) 443-3020
C JEANETTE PANG
A DAVID CAINE
(301) 827-5090
C CUSTOMER SERVICE --4404) 687-6666
H MICHELLE SHORTER (301) 456-6088

NSN 754001-152-8082

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

1

%Ha-I01

11

I

II

OPTIONAL FORM 344 ( R n b95!
Reurcde)~
GSA
FAR 148 CFR) 53 2(3!cl

1

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IMPORTANT: M a r k a l l packages a n d papers with c o n t r a c t and/or o r d e r n u m b e r s
2 CONTRACT NO (Ilany)

1 DATE OF ORDER

6 SHIPTO

HHSP23320042807MB

I

QZ

2;;:s

1

I

a NAME OF CONSIGNEE

12/02/2003

1
I

PAGf

3 ORDER NO

001
5 ISSUING OFFICE (Address conespondence lo)

b STREET ADDRESS

PARKLAWN BLDG . , ROOM 6 - 101
5600 FISHERS LANE

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

I
;I

c CITY

d STATE

ROCKVILLE

MD

e ZIP CODE

20857

f SHIP VIA

7 TO.

1/

a NAME OF CONTRACTOR

ROBIN L . CLEMENS

8 TYPE OF ORDER

b COMPANY NAME

m a . PURCHASE
-

c STREET ADDRESS

3205 NORTH FRONT STREET. APT. # 5

2

d CITY

.

-

,

!I

REFERENCE YOUR

/I

--

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e STATE

HARRISBL'YG

-

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f ZIP CODE

Please furnish the fdlcming on me terms
and m d ~ t ~ o speafied
ns
on bom sldes of
th~sOrder and on the attached sheets. 11
any, lndud~ngdellvery as lndlcaled

1
i/

10 REQUISITIONING OFFICE

I

SAMHSA/OC

7541362

11

1

11 BUSINESS CLASSIFICATION (Check appmpriale box(esjj

I?

.

a SMALL

Destination

12 F 0 B POINT

15 DELIVER TO F 0 B POINT
ON OR BEFORE (Dale)

14 GOVERNMENT BlVNO

-

Net 3G

1

( b . ACCEPTANCE

Destination

d WOMEN-OWNED

c DISADVANTAGED

.

13 PLACE OF

a INSPECTION

U

b OTHER THAN SMALL

'I

Destination -.,

(a)

I

QUANTITY
ORDERED UNll

SUPPLIESOR SERVICES
(b)

(c)

(d)

-.

4
I/

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ITEM NO

Except for btll~ng~nstruhonson the
, w e . ltus dellvery order IS

&ntma

17110

9 ACCOUNTIkG AND APPROPRIATIONS DATA

!
@ b DELNERY

PRICE

::u
,

Tax ID Number:
N
'DUNS Number:
,:AN:
C96A5Q0 Obi. Class: 2522 FY: 2004
Perlod of Performance: 10/01/2003 to 09/30/2004
-5 CALLS COMPLETED FOR THE MONTH OF OCTOBER
continued . . .

1

.

. .

QUANTITY
ACCEPTED

(g)

;-L1

1

18 SHIPPING POINT

19 GROSS SHIPPING WEIGHT

17(h)
TOTAL
(Con1

20 INVOICE NO

pages)

21 MAIL INVOICE TO

a. NAME
SEE BILUNG
INSTRUCTIONS
O N REVERSE

-

b. STREET ADDRESS

(or P.0. Box)

PARKLAWN BUILDING, ROOM 16A-12
5600FISHERSLANE
.'

1

c ClTY

ROCKVILLE
22 UNITED STATES OF A ~ ~ E R ~ C A

BY (Slgnalurej

NSN 751&01.152-8083
PREVIOUS EDITION NOT USABLE

17(1) ,
GRAND

d. STATE

MD

e. ZIP COCE

20857
23 NAME (Typed)

)

ORIGINAL SIGNED

JO LASKO

/II

I

TITLE CONTRACTING'ORDERING OFFICER
OPTIONAL FORM 347 (bb 3 5 1
R . d b y G W A R ( 4 I C F R I 53213.1

-

-~.
.. --

TOTAL CARRIED FORWARD TO (ST PAGE (ITEM 17IH))
NSN 754C-01.152-8082

/I
1

OPTlONAL FORM W IRW

Y)M.IOI

I!

E

6951

R . . d b"OM
FAR(&5CFR)S3 212+)

0

(

ORDER FOR SUPPLIES OR SERVICES
1 DATE OF ORDER

5 SHIP TO

2 CONTRACT NO (If any)

MSP23320042807MB

)a

1

01/08/2004
3 ORDER NO

4

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Mark all packages a n d p a p e r s with c o n t r a c t a n d l o r o r d e r n u m b e r s

IMPORTANT

1

NAME OF CONSIGNEE

REOUlSlTlONiREFERENCE NO

SAMHSA/OA

003
5 ISSUING OFFICE (Address correspondence to)

b STREET ADDRESS

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

PARKLAWN BLDG . , ROOM 6 - 101
5600 FISHERS LANE

-

-

c ClTY

ROCKVILLE
f SHIP VIA

7 TO

I

a NAME OF CONTPACTOR

ROBIN L. CLEMENS

8. TYPE OF ORDER

!/

b COMPANY NAME

b. DELIVE*

c STREET ADDRESS

.

3205 NORTH FRONT STREET

REFERENCE YOUR:

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t &llong i n s t G ~ m m
s the
!Iverse.
- th!s ael~veryorder IS

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.-

APT. # 5
Please furnish the ldlomng on the terms
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d CITY

e STATE

HARRISRURG

PA

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this Order and on the anached sheets. lf

f ZIP CODE

I!

1 10. REOUlSlTlONlNG OFFICE

9. ACCOUNTING AND APPROPRIATIONS DATP.

1

11I

SAMHSA/OC

?541362

1

11 BUSINESS CLASSIFICATION (Check appropriate box(es))

-.a--

,>;,

a. SMALL

b. OTHER THAN SMALL

Destination

12. F.O.B. POINT

a INSPECTION

iI

c. DISADVANTAGED

14. GOVERNMENT B/L/NO.

15. DELIVER TO F.0.B POINT

ON OR BEFORE (Date)

...

13 PLACE OF

b ACCEPTANCE

QUANTITY
ORDERED UNIT
(d)
(c)

SUPPLIE9OR SERVICES

(a)

.

(b)

.

.

.-

1

..--

OUANTITY
ACCEPTED

AMBOW-.

(f)1

(g)

..

..

i

5CALLS COMPLETED FOR THE MONTH OF DECEMBER
Continued . . .

I

POINT.

I

I

I

I

20 INVOICE NO.

19. GROSS SHIPPING WEIGHT
I

17(h).
TOTAL

21 MAIL INVOICE TO

a

PSC/FMS

NAME

SEE BILLING
INSTRUCTIONS b. STREET ADDRESS
ON REVERSE (or p,O Box)

I

(301) 443-3020

PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE
"

I

.c. CITY

ROCKVILLE
22 UNITED STATES OF AMERICA

BY (Slgnafure)

.A

)

/7

-

d. STPTE

MD

e. ZIP CODE

TOTAL

4

$12,500.05)

20857

1 23. NAME (Typed)
JULIA C. SAVOY

I

I
11

TITLE: CONTRACTINWORDERING OFFICER
NSN 754001-152-8083
PREVIOUS EDITION NOTUSABLE

----.

.

1

--.

-.

-.

i

UNIT
PRICE
(el

I. i

i s SHIPPING

-

/I

Tax ID Number
DUNS Number:
CAV: C96A5.QO OD> class. ---L FY: 2004
Period of Performance: 10/01/2003 to 09/30/2004
1

16. D I Y ~ U N T
TERMS

II
17. SCHEDULE (See reverse for Rejectfons)

ITEM NO

d. WOMEN-OWNED

Net 30

I DesLination ...-

Destifiation

d b n d i l l w of lhe abovenumbered
I
contract

!

any, lnciudlng dellvery as l n d ~ e t e d

17110

-..
--

.

skbjecl to ~nslrudimsmn1arne3a,
Itis srde m l y ol lhts lm and 1s
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OPTIONAL FORM 34l I R m 655)

!

~.,-b~cswmtr8

VRI

~z1x.1

TOTAL CARRIED FORWARD TO tST PAGE (ITEM 17(H))
NSN 7540-01-152-8082

YIM-101

!

OPTIONAL FORM IN 1R.r -51
R.um.d
b" GLn
FAR140 C F R J 5 3 2>)(c)

/I

:f':

1 /

ORDER FOR SUPPLIES OR SERVICES
IMPORTANT. M a r k a l l p a c k a g e s a n d p a p e r s with c o n t r a e l a n d l o r o r d e r n u m b e r s
1 DATE OF ORDER

2 CONTRACT NO (11 any)

6 SHlP TO

HHSP23320042807MB
3 ORDER NO

! 1 '
I

F;;ES

I

I

a NAME OF CONSIGNEE

02/04/2004

FACIE @=

4 REQUISITIONREFERENCE NO

004
5 ISSUING OFFICE (Address correspondence to)

b. STREET ADDRESS

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

PARKLAWN BLDG., ROOM 6-101
5600 FISHERS LANE
il

-

.

1

c. CITY

7 TO

1 d STATE

I

ROCKVILLE

1 MD

e. ZIP CODE

120857

f SHIP VIA

a NAME OF CONTRACTOR

ROBIN L. CLEMENS

I

b COMPANY NAME

..

-

c. STREET ADDRESS

.

3205 NORTH FRONT STREET.
APT. # 5

.

-

.

.

.

-

,

d CITY

-... .
...-

e STATE

1

REFERENCE YOUR:

-.

HARRISBURG

8 TYPE OF ORDER
O a PURCHASE

Except f a billing 1nsl6ci1onsM the

---

...
.

.-

.

Please furnlsh the I d l w i n g on the terms
and ~ o n d ~ t ~ spenfied
ons
o n both s!deS of
this Order and on the altaded sheets, if
any. including dellvery as I n d ~ e t e d .

f ZIP CODE

mntracl.

17110

PA

9 ACCOUNTING AND APPROPRIATIONS DATA

10. REQUISITIONING OFFICE

SAMHSA/OC

!I

11 BUSINESS CLASSIFICATION (Check appropnale box(es))

.

-.. 17
-

7

L!

a. SMALL

Destination

12 F O.B. POINT

..

13 PLACE OF

c DISDVANTAGED

b. OTHER THAN SMALL
14. GOVERNMENT B U N O .

.

01/31/2004
I 7

ITEM NO.

SCHEDULE (See reverse lor Rejections)
QUANTITY
ORDERED UNIT
(d)
(c)

SUPPLIESOR SERVICES

.

I
UNIT

il

. ..-

PRICE

QUANTITY
ACCEPTED

A M ~ N

(el

Tax ID Number
DUNS Number:
CAN: C96A5QO
1

UUJ.

class: 2522 FY: 2004

4 CALLS COMPLETED FOR-THE MONTH OF JANUARY
2004
Continued . . .
2 0 . INVOICE NO.

I9 GROSS SHIPPING WEIGHT

21 MAIL INVOICE TO
-

a NAME
SEE BILLING
INSTRUCTIONS b STREET ADDRESS
ON REVERSE (or P.0 BOX)

PSC/FMS

I

I

I
1301) 443-3020

.. .$0.00
.

PARKLAWN BUILDING, ROOM 16A-12

5600 FISHERS LANE

il

c. CITY

d. STATE

MD

ROCKVILLE
22. UNITED STATES OF AMERICA

20857
23. NAME (Twed)

-JULIA

BY (Signature)

770)
GRAND
TOTAL

$9,300.00

e. ZIP CODE

C. SAVOY

(i

i/

I

TITLE- CONTRACTIN~ORDERINGOFF!CER
NSN 754001-152-8083
PREVIOUS EDITION NOT USABLE

I

-

Net 30

i

DestB.na.Lion.,

Destination

16. DlSC.OUNT TERMS

ON OR BEFORE (Date]

-

b. ACCEPTANCE

a. INSPECTION

d WOMENaWNED
1

15 DELIVER TO F.O.B. P O l N l

1

OPTIONAL FORM 347 I R r r M 5 i

.

- - ..

.

.

1
I

ORDER FOR SUPPLIES OR SERVICES
I

6.SHIP TO.

2. CONTRACT NO. (If any)

HHSP23320042807MB

12/02/2003

II

SAMHSA/OA

002
5 ISSUING OFFICE (Address conespondence lo)

b STREET ADDRESS

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

PARKLAWN BLDG . , ROOM 6 - 101
5600 FISHERS LANE

1

1

I/

1

C.

ClTY

ROCKVILLE
;I

f. SHIP VIA

7 TO:

1

a. NAME OF CONTRACTOR

ROBIN L. CLEMENS

1

b COMPANY NAME
-

3205 NORTH FRONT STREET APT. # 5

.

.

-

..

.

.-

~

/-

8.TYPE OF ORDER

PA

DELIVER^

Excepl lor blll~ngI N W > I ~ S
v l ~ sdellvery W e r

.

cm Ine
IS

~

thls S~deonly of lhls form and IS
tisued subjea lo the lerms and
dbnd~l~ons
ol lhe above-numbered
Contract

10. REQUISITIONING OFFICE

SAMHSAiOC

7541362
-

-

1

11 BUSINESS CLASSIFICATION (Check appmpnale box(es))

a SMALL

=

Destlnation

14 GOVERNMENT B

....

13 PLACE OF

I Dest-im

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c DISADVANTAGED

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16 DISCOUNT TERMS

Net 30

1I

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UNIT
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A

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INSTRUCTIONS
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b STREET ADDRESS
(or P 0 Box)

--

ACCEPTED
(g)

.

--.-

FOR THE MONTH OF

PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

I1

17(1)
GRAND
TOTAL

I

c CITY

ROCKVILLE
22 UNITED STATES OF AMERICA
BY (SfgnalureJ

d STATE

MD

e ZIP CODE

4

$20.90~0.00

20857
23 NAME (Typed)

JULIA C. SAVOY

1

(I

I
I

TITLE CONTRACTINOORDERINGOFFICER
NSN 754G01-152-8083

-- ...

QUANTITY
M

DUNS Nurnbe r :
CAN: C96A500 .C,,
class: 2522 FY: 2004
Period of-Performance: 10/01/2003 to 09/30/2304
9 CALLS COMPLETED
Continued . . .

.

1I

17. SCHEDULE (See reverse lor Rq'ections)

ITEM NO.

d WOMEN-OWNED

I1

15 DELIVER TO F o B POINT

O

I
f

Ib. ACCEPTANCE

Destination

U

b OTHER THAN s w L L

.,I,

a. INSPECTION

1

..
--.

,17110

9 ACCOUNTING AND APPROPRIATIONS DATA

12 F o B POINT

b.

REFERENCEYOUR

Please furnish the f d l m ~ r g
m the lerms
and c m d ~ b wspedhed cm bolh sldes of
1h1sOrder and m the anached sheers, Cf
any, indudlng dellvery as indlcaled

f. ZIP CODE

(/

/@

n a PURCHASE

1

e. STATE

d. CITY

HARRISBURG
-

n

1

I

4 REQUISITIONREFERENCE NO

c. STREET ADDRESS

1

-.---

--c=>

i

a NAME OF CONSIGNEE

I
3 ORDER NO

i

j/

IMPORTANT: Mark all packages and papers with contract andlor order numbers
1 DATE OF ORDER

.-.z
-.

1

O W N A L F M M lll

R-D~GW~AMI

PREVIOUS EDITION NOT USABLE

U
11

b 6351

WRI 5111Y.l

...
..

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c z -.--r-..,t>

-

] !

IMPORTANT: Mark a l l p a c k a g e s a n d p a p e r s with c o n t r a c t a n d l o r o r d e r numbers

-

i

2

1

6 SHIP TO

a NAME OF CONSIGNEE

1

4 REQUISITIONREFERENCE NG

3. ORDER NO.

005
5 ISSUING OFFICE (Address correspondence lo)

o m s /s m s A / o c
I/

b STREET ADDRESS

FARKLAWN BUILDING, ROOM 13C-05 /
5600 FISHERS LANE
./

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

. .

..

!:II

..

11

c. CITY

ROCKVILLE
a. NAME OF CONTRACTOR

8 TYPE OF ORDER

b COMPANY NAME

/

O a PURCHASE

c. STREET ADDRESS

3205 NORTH FRONT STREET ,
APT. # 5

. ...

-

..

. . . .. . .

.

..

.. .

d CITY

KWRISBURG

PA

9

.

-

--:.-..

I.ZIP CODE

17110

b DELIVERY-

REFERENCE YOUR

-

e STATE

--

Please furnish the fdlowing on the terms
and c ~ ~ t ~ specified
c n s on both s m s of
this Order and on Ihe anadwd sheell, if
any, tnduding delivery as indicated.

I

fa bill~ngi n s l r u f i w on the
e.-Kh~sdel~vevader IS
suijject to 1n5trua~ons
mta~ned
on
thl! Side 04" d lhls lam and 1s
~ssbedsublecl to the lerms and
miidtr~onsof the aDove4umbered
antract

!

1

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11

9 10. REQUISITIONING OFFICE

.

i
ij

SAMHSA/OC

7541362

;I

11 BUSINESS CLASSIFICATION (Check appmpriate boxfes))

O

.>*,

a SMALL

-- -

c DISADVANTAGED

b OTHER THAN SMALL

d WOMENOWNED

-2c

Destlnatlon

12 F O B POINT

13 PLACE OF

a INSPECTION

I( 16 D S i O U N T TERMS

15 DELIVER TO F 0 B POINT
ON OR BEFORE (Dare)

14 GOVERNMENT BUNG
. ....

i

02/29/2004

b ACCEPTANCE

1 Destinattjna ...-

Destination

e. ZIP CODE

20857

I

..

ROBIN L. CLEMENS

MD

!I

f. SHIP VIA

7 TO

L STATE

,

Net 30
I
11
(I
:I
/I

1

.

17. SCHEDULE (See reverse for Rejecl~ons)

QUAMIN
ORDERED UNIT
(d)
(c)

SUPPLIES OR SERVICES-.

ITEM NO.
(a)

(b)

UNIT
PRICE
(el

..-.-

AMTT,.-.
(0

Tax ID Number
DUNS Number:
CAN< C96A5O.Q U D J . class: z ~ Z LFY: 2004

b

I

1

.

-.---

QUANTITY
ACCEPTED

(g)

1
I,

- j j

i(

3 CALLS COMPLETED FOR-THE MONTH OF FEB 2004
Continued

...

I

i/
18 SHIPPING POINT

I

20 INVOICE NO

19 GROSS SHIPPING WEIGHT

21. MAIL INVOICE TO.

PSC/FMS

a. NAME

(301) 443-3020

17(h)
TOTAL

1

. ^$0.00
.

I

3

. /I

SEE BILLING
INSTRUCTIONS b STREET ADDRESS
ON REVERSE
(or P O . BOX)

PARKLAWN .BUILDING, ROOM 16A-12
5600 FISHERS LANE
..

..
c CITY

ROCKVILLE
22 UNITED STATES OF AMERICA

BY (S~gnaturel

!?(I).
GRAND
TOTAL

;I
d STATE

MD

e ZIP CODE

$7,500! 00

20857
23 NAME (Typed)

JULIAC.SAVOY

li

1

I/

ONTRACTINGIORDERING OFFICER
NSN 7YC-01 152-8083

'I

PREVIOUS EDITION NOT USABLE

i'Pr.-mlbSAFlS(48CFRI

/I

i

!
I;

!

OPTIONAL FORM J47 I R n

6951

U21%.,

..

i
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 754C-01-152-8082

Y)llb101

I

11

'1

OPTlONAL FORM 148 1 R n WSI
R.3orD.d b" CSJ
FAR ('8 C r R l 5 3 2 1 3 1 ~ ;

j 1

ORDER FOR SUPPLIES OR SERVICES
I

DATE OF ORDER

1

2 CONTRACT NO (Ilany)

HHSP23320042807MB
05/11/2004

1

1

6 SHIP TO

3 ORDER NO

F ~ G EC= ;i~:s
I

1

I M P O R T A N T Mark all packages and papers wlth contract andlor order numbers

a NAME OF CONSIGNEE

/I

b STREET ADDRESS

I
il
(1
I

REOUISITIONREFERENCE NO

4

00 6
5 ISSUING OFFICE (Address correspondence lo)

PARKLAWN BLDG . , ROOM 6 - 101
5600 FISHERS LANE

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

!II

1/

c ClTY

ROCKVILLE

d STATE

MD

1 e ZIP CODE
20~5i

f SHIP VIA

..

a NAME OF CONTRACTOR

ROBIN L. CLEMENS

IJa

--

c STREET ADDRESS

3205 NORTH FRONT STREET

.-

..

PURCHASE

REFERENCE YOUR
Except for blllng ~nstruslonson the
V l ~ r d d w e vaoer 4
s~$j€Ct10 lnSLTunoMs mnla~nedon
thi; slde only of lhls Imand IS
tsshed subjecl to the terms ana
coXdjltons of Ihe above-numbered
mntran

-

+tie.

APT. # 5

e STATE

d CITY

HARRISBURG

PA

Please fumlsh the f d l w l n g on me terms
and cond~t~ons
speafied on born sldes of
l h ~ sorder and on the attached shee(s, 11
any. tncludlng dellvery as ~ndlcated

1. ZIP CODE

;I

1
I

10 REOUlSlTlONlNG OFFICE

Il

1

SAMHSA/OC

7541362
BUSINESS CLASSIFICATION (Check appmpnafe box(es))

..

a SMALL

,<%J

12 F o B POINT

..

Destination

I

I

-

~estrn-on.

d WOMENQWNED

I
1

15 DELIVER TO F 0 B POINT

14 MVERNME~T B I ~ O

...

1 b ACCEPTANCE

a INSPECTION

c DISADVANTAGED

b OTHER THAN SMALL

Destlnation
13 PLACE OF

ON OR BEFORE (Dale)

ITEM NO

I

I

.

p
p

11

QUANTITY
ORDERED UNIT
(d)
(c)

(b)

UNIT
PRICE
le)

-

I/

AMOU?T-(1)

1

*-a'

QUANTITY
ACCEPTED

LQ)

1I/

1. .I

Tax ID Numbel
DUNS Number:
CAN: C96A50Q Ob]. Class: 2522 FY: 2004

11

3 CALLS COMPLETED FOR -THE MONTH OF MARCH
2004
Continued

...

18 SHIPPING POINT

19 GROSS SHIPPING WEIGHT

20 INVOICE NO

TOTAL
(Con1
pages)

21 MAIL INVOICE TO

a NAME
SEE BILLING
INSTRUCTIONS b STREET ADDRESS
ON REVERSE
(or P 0 Box)

C

PSC/FMS

ROCKVILLE
22 UNITED STATES OF AMERICA

(301) 443-3020

s p . 00
U

I/

PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

CITY

I

d STATE

--

MD

e ZIP CODE

170)

GRAND
TOTAL

:I

$6,300!00

20857
23 NAME (Typed)

/
8I

I

BY (Slgnafure)

q U L I A C. SAVOY
TITLE CONTRACTINWORDERING

NSN 754001-152 8083
PREVIOUS EDITION NOT USABLE

-

---- .

I

SUPPLIES OR SERVICES

(a)
-

16 DISCOUNTTERMS

Net 30
17 SCHEDULE (See reverse for Relecfrons)

1

-

. .
.--.

1

I

17110

9 ACCOU~TINGAND APPROPRIATIONS DATA

11

;I

8 TYPE OF ORDER

b COMPANY NAME

I
(,

OFFICIER

4

OPTIONAL FORM 147 (Rn 6 9 5 )

ORDER FOR SUPPLIES OR SERVI
SCHEDULE - CONTINUATION
IMPORTANT: Mar+ all packages and papem vnth w n l r a a andiw wder numbers
DATEOFORDER

1 21i'"'
'

1

Y

CONTRACTNO

05/11/2004 HHSP23320042807MB
ITEM NO

SUPPLIESISERVICES

amount of award: $6,300.00. .The oblige
-

TOTAL CARRIED FORWARI
NSN 754Cb01-152-8082

YIY

nOHAL FORM 348 ( R r 6951
R.by GSA
FAR (40 CFRI 51 213(cl

i

PAGE

1;

IMPORTANT: Mark all packages and papen with contract andlor order numbers
1 DATE OF ORDER

/

1;

ORDER FOR SUPPLIES OR SERVICES
2 CONTRACT NO (If any)

1

HHSP23320042807MB
05/11/2004

6 SHlP TO

1

ZZ

P.CEj

i

--

j(

i

a NAME OF CONSIGNEE

3 ORDER NO

007
-

~

-

p

p

~

~

I

b STREET ADDRESS

5 ISSUING OFFICE (Address wneqondence to)

PARKLAWN BLDG . , ROOM 6 - 101
5600 FISHERS LANE

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

1

'

II

1
I

-

-

/

j

c. CITY

ROCKVILLE

I

STATE

MD

-

-

e Z!PCODE

20557

f SHIP VIA

7 TO

a NAME OF CONTRACTOR

-

c STREET ADDRESS

3205 NORTH FRONT STREET ..
APT. # 5

.

. .

.. ..

..

. ..

.

d CITY

-

-

- .
.

=
.-

e. STATE

HARR ISBURG

REFERENCE YOUR-

PA

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f ZIP CODE

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5600 FISHERS LANE

1

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c. CITY

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1 DATE OF ORDER

6 SHIP TO

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a Nah4E OF CONSIGNEE

06/15/2004
3 ORDER NO

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5 ISSUING OFFICE (Address correspondence to)

b STREET ADDRESS

DHHS/PSC/AOS/DAI",
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

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11. BUSINESS CLASSIFICATION (Check appropnate box(es))

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06/30/2004

-

17 SCHEDULE (See reverse for Rejeclrons)

QUAMITY
ITEM NO.

SUPPLIES-OR SERVICES"

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Tax ID Number
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Z 0 lNVOCE

21. MAIL INVOICE TO

a NAME
SEE BILLING
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ON REVERSE (or P 0. Box)

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(301) 443-3020

PARKLAWN BUILDING, ROOM
16A-12
..
5600 FISHERS LANE

1 GRAND
TOTAL

c CllY

ROCKVILLE
2 2 UNITED STATES OF AMERICA

BY (Sgnature)

d. STATE

n

I

MD

NSN 7540-01-152-8083

4

e. ZIP CODE

20857
23 NAME (Typed)

JULIA C. SAVOY
/~COKTRACTINGIORDERING

PREVIOUS EDITION NOT USABLE

. .
--.
-

17110

9. ACCOUNTING AND APPROPRIATIONS DATA

a SMALL

Exceet for b~lltnglnstrunlons cn the
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tkis side only cf l h ~ sfmana 15
sublen lothe lerms and
&nd!tlons 01the aoove-numwred
contract

sued

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ns
on both s~desof
th~sa d e r and on the anached sheets. 11
any, ~ncludingdellvery as ~ndlcated.

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12. F.O B POINT

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a NAME OF COKTRACTOR

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OPTIONAL FORM 347 ( R r W5)

ORDER FOR SLIPPLIES OR SERVICES
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-

1 2 1

i

IMPORTANT' Mark all packages and paoen wlth mnrraa andlor order numbers
DATEOFORDER

CONTRACTNO

06/15/2004

HHSP23320042807MB

ITEM NO

009
QUANTITY UNIT
ORDERED
(C)
(D)

(a)

(A)

1

ORDER NO

SUPPLIESISERVICES

1 :

UNIT
PRICE

AMOUNi

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(F)

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T o t a l amount o f award:
1 7 ( 1 ).

$12,200.00.

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NSN 754C-01 152 8082

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1 DATE OF ORDER

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2 CONTRACT NO (If any)

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5 SHIP TO

HHSP23320042807MB

a NAME OF CONSIGNEE

10/30/2003

Indicated On Call

4 REOUISITIONREFERENCE NO

3 ORDER NO

See Schedule

1 b STREET ADDRESS

5 . ISSUING OFFICE (Address correspondenceto)

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

.

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REFERENCE YOUR

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e. STATE..

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22. UNITED STATES OF AMERICA

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23. NAME (7ypxIJ

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--.

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17110

9. ACCOUNTING AND APPROPRIATIONS DATA

a. SMALL

.

M II R ~
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5

1

ORDER FOR SUPPLIES OR SERVICES
IMPORTANT: M a r k a l l p a c k a g e s a n d p a p e r s with c o n t r a c t a n d l o r o r d e r n u m b e r s
I
2. C O M P A C T NO (If any)
1. DATE OF ORDER

6 SHlP TO

HHSP23320042807MB
09/27/2004

I

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a NAME OF CONSIGNEE

3. ORDER NO

011
5 ISSUING OFFICE (Address correspondence to)

b. STREET ADDRESS

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5:lOl
5600 FISHERS LANE
ROCKVILLE MD 20857

PARKLAWN BLDG . , ROOM 6 - 101
5600 FISHERS LANE

c CITY

ROCKVILLE
I.SHIP VIA

7 TO:

a. NAME OF CONTRACTOR

ROBIN L . CLZMENS

1

b COMPANY NAME
c. STREET ADDRESS

3205 NORTH FRONT STREET APT. # 5

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.

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-

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.

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f ZIP CODE

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9 ACCOUNTING AND APPROPRIATIONS DATA

-.
-.--

th~sside only 01 this form and IS
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and m o d ~ t ~ o nspecified
s
on boM s~desof
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any. lndudlng dellvery as ~ n d l m t e d

HARRISBURG

Exc_eplf a bill~nginstruntons on the
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- -

10 REQUISITIONING OFFICE

SAMHSA/OC

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1I BUSINESS CLASSIFICATION (Check appmpnale box(es))

12

': 9

.

a SMALL

Destination

F 0 B POINT

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15 DELIVER TO F 0 B FOlM

14 GOVERNMENT BUT40

O N OR BEFORE (Date)

I

13 PLACE OF

a INSPECTION

Net 30

b ACCEPTANCE

Destination

- -

I

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17. SCHEDULE (See mverse for Rejeclrons)

ITEM NO.

SUPPLIES~RSEXVICES

(a)

(b)

ACCEPTED
(9)

ORDERED UNIT

Id)

lc)

le)

I

b

Tax ID Number:
DUNS Number:
L/
CAN: C96A590 Obj. Class:' ~3~~ ,T:2004

1.

==:

I

.

..

... ..

4 CALLS COMPLETED FOR-THE MONTH OF JULY 2004Continued

...

I

I

I

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18 SHIPPING P O I M

I

i

I

19 GROSS SHIPPING WEIGHT

21. MAIL INVOICE TO:

SEE BILLING
INSTRUCTIONS
ON REVERSE

a NAME

PSC/FMS

b STREET ADDRESS
(or P O Box)

PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

C. CITY
I

ROCKVILLE

22 UNITED STATES OF AMERICA
BY (S~gnalureJ

(301) 443-3020

--

17lh)
TOTAL

/
170)
GRAND
TOTAL

e. ZIP CODE

d. STATE
I

60.00

I

MD

1

20857
I

23 NAME (Typed)

JULIA C. SAVOY

I

1
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1I
GOMRACTIN
OFFICER
NSN ~ S ~ C - O I - ~ ~ Z - B W I

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09/27/2004

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1 DATE OF ORDER

/

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IMPORTANT: M a r k a l l packages a n d papers w ~ t ch o n t r a c t a n d l o r o r d e r n u m b e r s

5 ISSUING OFFICE (Address correspondence lo)

b STREET ADDRESS

DHHS/ PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

PARKLAWN BLDG . , ROOM 6 - 10 1
5600 FISHERS LANE

(11I
1
I

c CITY

ROCKVILLE
f SHIP VIA

7 TO

a NAME OF CONTRACTOR

.

c STREET ADDRESS

32 05 NORTH FRONT STREET, ..

.

.

..

.

.

..

.

.-

/I

REFERENCE YOUR

.-

---

.

APT. # 5

d. CITY

e. STATE

HARRISBURG

PA

I

f ZIP CODE

10 REQUISITIONING OFFICE

SAMHSA/OC

7541362

/I

Il

BUSINESS CLASSIFICATION (Check appmpnale box(eS))

@

?./Q

a SMALL

9

b OTHER THAN SMALL

1 14 GOVERNMENT BAR40

Destination

12 F 0 B. POINT

--

1

17110

9 ACCOUNTING AND APPSOPRIATIONS DATA

11

Please furnish the f d l w l n g on lhe terms
w
on boVI sldes of
and c o n d ~ l ~speufied
th~sOrder and on Ihe attathed sheels. 11
any, lndud~ngdellvery as lndlcated

--

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for blllng Insmnjcns on Ine
-&me
mrs d e l ~ v e vw e r 1s
sJbjecI to !nslrunlms cmla~nedon
t+ Side only of ~ 1 1Is- and 1s
I S ~ Wsublec~
~
10 the lerrns and
od/ndlbons of the aboe-numbered
dnmct

...

d WOMEN-OWNED

115. DELIVER TO F 0 B. POINT
ON OR BEFORE (Dale)

I

13 PLACEOF
a INSPECTION

b ACCEPTANCE
t

Destination

:

t

:

6fi .
~

~
%' j ~

~

~

I

1

17 SCHEDULE (See revene lor Rejections)
I

SUPPLIES OR SERVICES'

ITEM NO

QUANTITY
ORDERED UNIT
(d)
(c)

UNIT
PRIC;

-

-

[el

A
(1)

-4

I/

I

-.-

4 CALLS COMPLETED FOR'-THE MONTH OF AUGUST
2004
Continued . . .

--

I
I 8 SHIPPING POINT

(g)

i

DUNS. Number :
CAN: C96A500 Gb]. Class: 2522 FY: 2004
1

QUANTITY
ACCEPTED

I

19 GROSS SHIPPING WEIGHT

1

I

I

20 INVOICE NO

17(h)
TOTAL

21. MAIL INVOICE TO

..

a. NAME

PSC/FMS

(301) 443-3020

b STREET ADDRESS

PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE

SEE BILLING
INSTRUCTIONS
ON REVERSE

(or P:O. Box)

1
c CITY

ROChTI LLE
22. UNITED STATES OF AMERICA
BY (Signalure)

d STATE

MD

e ZIP CODE

20857
23. NAME r y p e d )

JULIA C. SAVOY
IGf+TtFCONTRACTINWORDERING

NSN ~

s~~oI.~sz-~LM~

GRAND
TOTAL

i
'1
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OFFIFER
1
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OPTIONALFOUM 147
R.smoabrOSMU1148

m)

CFRI 53213(.)

ORDER FOR SUPPLIES OR SERVICES

.

2. CONTRACT NO (11 any)

1 DATE OF ORDER

jl

6 SHIFTO

HHSP23320042807MB
3. ORDER NO

-

I

a NAME OF CONSIGNEE

09/28/2004

/

,

( I ! :

IMPORTANT: Mark all packages a n d papers with c o n t r a c t a n d l o r o r d e r n u m b e r s

4. REOUISITIONREFERENCE NO.

SAMHSA/OA

013
5 ISSUING OFFICE (Address correspondence to)

b. STREET ADDRESS

DHHSIPSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

PARKLAWN BLDG . , ROOM 6 -101
5600 FISHERS LANE

1MD

c. ClTY

d STATE

ROCKVILLE
1. SHIP VIA

7. TO:

e ZIP CODE

---

a. NAME OF CONTRACTOR

ROBIN L. CLEMENS

I/

8 TYPE OF ORDER

Da. PURCHASE

b COMPANY NAME
-

c STREET ADDRESS

3205 NORTH FRONT STREET . . . . .
APT. # 5

-

.

-

REFERENCE YOUR
~ i c e pfor
l bill~ng~nsuubfms
on Ihe
&e:
th~s.del~very
wder IS
sdb~eclto t n s l r u n l w amtamed on

<-

th;s Slde only ot thus I- and 1s
i s i d subjed to Ihe lerms and

Please Iumlsh the f d l w n g on me lerms
and u n d t t ~ a speafied
v
on boVl sldes of
e STATE

d CITY

HARRI SBURG

PA

1. ZIP CODE

c&ddtlons

-

10. REOUlSlTlONlNG OFFICE
.

7541362

-

I/

SAMHSA/OC

/I

11. BUSINESS CLASSIFICATION (Check appropriate box(es))

[?

i~ .f"

a SMALL

Destination

c. DISADVANTAGED

I

I b ACCEPTANCE

I

..

I
17. SCHEDULE (See ravene for Rejections)

ITEM NO

SUPPLIES 8 R SERVICES-

(a)

(b)

QUANTITY
ORDERED UNIT
(dl

(c)

PRICE
(e)

1. .

AM-i(1)

It

1

OUANTITY
ACCEPTED
(9)

I
12,~OO.OO

. . . .. ..

-

6 CALLS COMPLETED FOR-THE MONTH OF
SEPTEMBER 2004
Continued . . .
r e SHIPPING POIKC

...

I
1'

1. r

Tax ID Number:
Number:
CAN: C96A50-0 Obj. Class: 2522 FY: 2004
1

16 DISCOUNTTERMS

Net 30

I

(DestFnatioa -.,

d WOMENaWNED

I/

15 DELIVER TO F 0 B POINT
ON OR BEFORE (Date)

14. GOVERNMENT BlVNO

-

13. PLACE OF
a. INSPECTION

1
I

b OTHER THAN SMALL

? ..

Destination

12 F 0 . 0 POINT

of n e above4umbered

V~ISorder and on the attached sheeb. 11
any. lncludlng delivery as lndlcated

17110

9 ACCOUNTING AND APPROPRIATIONS DATA

--

.. -.
..

...............

....

17(h)

20. INVOICE NO

19. GROSS SHIPPING WEIGHT

.-.

TOTAL
(Con!.
pages)

21. M I L INVOICE TO

PSC/FMS

a. NAME

(301) 443-3020

..

SEE BILLING
INSTRUCTIONS
ON REVERSE

~

b STREET ADDRESS
(or P,O Box)

CITY

ROCKVILLE
22 UNITED STATES OF AMERICA
BY (Signature)

.$0.00
...

4

a

I

PARKLAWN BUILDING, ROOM i6A-12
5600 FISHERS LANE

17(i).

GRAND
TOTAL

I/

C.

~

Il

d. STATE

MD

e. ZIP CODE

4

$12,80)?.00

20857
23. NAME (Typed)

JULIA C. SAVOY

1
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{I/

-TITLE CONTRACTING/ORDERINGOFFICER
OPTIONAL F M l Y 347 1RN. -1

NSN 754001-152.8083

PREVIOUS EDITION NOT USABLE

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R.-L~

G S M L d (48 CFRI 53 21Y.)

,

I

.

ORDER FOR SUPPLIES OR SERVICES

1

1

~ ~ D A G EO i PAGES

?as5 : :f

READ INSTRUCTIONS ON NEXT PAGE

I

PROCUREMENT REOUEST NO

REQUISITION

REQUISITION DATE

1 NAME PHONE NUMBER. AND ROUTING SYMBOL OF PERSON TO CONTACT

07/26/2004

HARRIET PoLSTER/301-443-8956

2 TYPE OF REQUEST (Chech one)
A N E W REOUEST

3 ORIGINATING OFFICE DATA

SAMHSA/OC

8 =CHANGE
TO
PENDING PR NO

4 ADDITIONAL INFORMATION (Suggesled supply swrces, secunly data, elc )

ii

1

I
/I
i

04M000259

il

I

I

I

1

i

I

~ M o D I F I C A T l o NTO

KHSP2 3 3 2004 26 07MB

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CONTRACT OR

5 APPROVALS
APPROVING OFFICIALS
IA)
11)

6 CONSIGNEE AND DESTiNATlOl

RWTlNG
SYMBOL
(8)

,

DATE
(CI

INERNAL RWTING
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SYUsOL (El

INTLliS
(Dl

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AUTHORIZED REOUlSlTlONER

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7. DATE(S) REOUIRED

(31

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See Schedule

1
1
ITEM NO

1

(A)

I

9.

ITEM OR &VEE

\:

(~ncludeS ~
(8)

C

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8. GOVERNMENT FURNISHED PROPERPI.

YES

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DESCRIPTIONOF ITEMS OR SERVICES
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and
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THIS MODIFICATION IS TO FOR ROBIN CLEMENTS THE AB VE REF RE CE BLANKET
AGREEMENT (BPA) IN ORDER TO INCREASE FUNDS.
.SlQ.L,
000-00
ORIGINAL
INCREASE AMOUNT $35,000.00
NEW TOTAL
$140,000.00
Period of performance: 16/01/2003 to 09/30/2004

4L ESTIMATED COST
I

10 ACCOUNTING DATA

See Schedule

$0.00

)

AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT
2 Ah~ENDhlENTIhlODIFICATlONNO

14

13 EFFECTIVE DATE

0005
CODE

/ PAGE
1 :' I

CONTRACT ID CODE

REOUISITIONPURCHASE R E 0 NO

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

-

il

I

7 ADMINISTERED BY (If otner fnan lrem 6)

DAM

PAGES

15 PROJECT P4O riiapoi~caore

04M000256

08/26/2004

6 ISSUED BY

I

1

CODE IDMj

;I

DHHS/PSC/AOS/DAM
PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

;i

1
8 NAME AND ADDRESS OF CONTRACTOR (No sueeL counly.ilaF andZIP Code)

ROBIN L: CLEMENS
3205 NORTH FRONT STREET
APT. # 5
HARRISBURG P A 17110

I
9B DATED (SEE ITEM 111

!I

1 1
-

CODE
-

9A AMENDMENT OF SOLICITATION NO

(x)

.

-

IOB DATED (SEE ITEM I f J

FACILI~ODE

I

--

.

.

.

.

I

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1

..

--a .- .-.:-:

..

.
e

10/30/2003

11. THlS ITEM ONLY APPLIES TO AMENDMENTS OF-SOLICITATIONS

qis exlended. GISnot extended
O T h e above numbered ~0llcitall0n1s amended as sel lo& ~nItem 14. The hour and date spetilied lor recelpt of O f l e ~
Offers must adtnowledge receipl of lhis amendmenl p n w l o the hour and date specified In the sdidlabon or as amended, by m e of the f o l l m n g melhods: (a) By m $ e l i n g
m p e s of the amendmenl, (b) By adtnowledg~ngreceipt d thls amendmenl on each m p y of the offer subm~aed.or (c) By
Items 8 and 15, and returning
separate letier or lelegram which indudes a reference l o the s d ~ t i t a b marid amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If dy
wnuent mis amendmenl you desire l o change an offer already submitled, such m q g e may be made by telegram w letter, probided each telegram orlener makes
reference lo the sdicitalion and th~samendment, and IS reoeived prior the openjnq hour and dale spedfied.
I
12. ACCOUNTING AND APPROPRIATION DATA (If required)

*
to

7541362 C96A500 2522

CHECK ONE

INCREASE

20,000. D O

I

F A R 5 2 . 2 4 3 - 1 CHANGES
.

B THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTWTIVE CHANGES (such as changes in pafing OfIice.
appropr~af~on
dare, elc.) SETTBPP)W IPTlTEM74, PURSUANT TO THE AUTHORITYOF FAR 43103(b)
C THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO ALITHORIW OF

.. -

,;
'I

-1 .-

-

.

A THIS CHANGE ORDER IS ISSUE0 PURSUANT TO: (Specify aufhonly) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT,
ORDER NO. IN ITEM 10A

.. . .

-

- ..

.

.

-

..

0

D UTHER (Speoly fype olmodflicat~onand authonfy)

X

(

I)

FAR 52.243-1 CHANGES - INCREASE FUNDS

E. IMPORTANT:

C,ontrador

H i s no!.

u i s required l o Sign lhls documenl and retuni

copies to the issulng once

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Orpanned by UCF section headmngs, tndudtng aol#ulatron/wnlrad subjecl mafler m e r e feasible )

,.

1

-

T a x ID Number:
.. .
-. -DUNS Number:
THIS MODIFICATION IS FOR ROBIN CLEMENS THE ABOVE REFERENCE BLANKET PURCHASE AGREEMENT
li
IN ORDER TO INCREASE FUNDS.
CAN NUMBER ~ 9 6 ~ ' 5 0 0
OBJ
, CLASS NO. 2522, APPRO NO. 7541362
i
ORIGINAL AMOUNT $175,000.
il
INCREASE AMOUNT $20,000.
NEW TOTAL
$195,000.
!!
,Z
Not T o Exceed Amount changed to: $195,000.00
.. -..
. ,, .
Period of Performance: 10/01/2003 to 09/30/2004

bj

1

.--

(BPA)

il

Except as provlded hereln. aiilerms and cond~l~ons
of the document relerenced In Item 9A a. 10A. as herelofore changed, remalns unchanged and In full force and efied,
15A NAME AND TITLE OF SIGNER (Type orpnnt)

16A NAME AND TITLE OF CONTRACTING OFFICER (Type orpnrit)

'I

,
150. CONTRACTORIOFFEROR

I

16p DATE SIGNED

iSigna(ore olperxln aurnorized (0 &oJ

NSN 754041-152-8070
Previous ed~lionunusable

WANDARD
FORM 30 (REV
Presmbed by GSA
FAR (48 CFR) 53 2 i 3

10-83)

..,.

.- .

..

I/I

READ INSTRUCTIONS ON NEXT PAGE
PROCUREMENT REQUEST NO

REQUISITION

04M000258

1. NAME. PHONE NUMBER. AND ROUTING SYMBOL O F PERSON TO CONTACT

3 ORIGINATING OFFICE DATA

07/26/2004
2

B

4. ADDITIONAL INFORMATION (Suggested supply SaJrCes, security data, etc.)

NEW REOUEST

-

-' L.-

I

!i

.Z P E OF REQUEST (Check m e )
A

SAMHSA/OC

I

'-

I

li

REQUISITION DATE

HARRIET POLSTER/301-443-8956

?azc

I/

1

E~CHANGETO1
,

PENDING PR NO

'

C, ~ M o D I F I C A T l o N To

1
I
I
II
i

I

~~~~23320042807~5

i

CONTRACT OR
ORDER NO.

1I
6 CONSIGNEE AND

5 APPROVALS
ROUTING
SYMBOL
(0)

APPROVING OFFICIALS
(A)

DESTINATION^

1

IKTERNAL ROUTING

I

I

P

( I ) AUTHORIZED REOUISITIONER

.

.

-.

.

..

.

..

(2)

SHERI KRETSCHMAIER

-

PSc

08/06./2004

SAMHSA

08/04/2004

7 DATE(S) REOUIRED

(3)

ANNA MARSH

1

UYES
UNU

I/

1

8 GOVERNMENT FURNISHED PROPE<N

(4)

CYNTIIIA COOKE

See Schedule

SAMHSA

- 08/03/2004
9. DESCRIPTION OF ITEMS OR SERVICES

I

(nw,.-&

a , . ~ . m n n D s i

1

I/
1

AMENDMENT OF SOLlCITATIONIMODIFICATlON OF CONTRACT

CONTRACT ID CODE

PAGE 3'

11

: :I

I

2 AMENDMENTiMODlFlCATlON NO

1 4 REOUlSlTlONiPURCHkSE REQ NO

3 EFFECTIVE DATE

CODE

I

7 ADMINISTERED BY (11 ofner lnan lrem 6)

DM

1

15 PROJECT YO ill aDD,icab c

04M000214
6 ISSUED BY

PAGES

COE

,&

DHHS/ PSC/AOS./DAM
PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

1
8. NAME AND ADDRESS OF COWRACTOR (No.. sbeel. counry, State and ZIP Code)

1

9A. AMENDMENT OF SOLICITATION NO.

(x,
-

1

ROBIN L. CLEMENS
3205 NORTH FRONT STREET
APT. # 5
HARRISBURG PA 17110

!I

98.DATED (SEE ITEM II)

1il
/.

1OA MOClFlCkTlON OF CONTRACTIORDER NO

I

HHSP23320042807MB
-

..

-

, .

CODE

.

.

-

.

..

PAClLlTYCOBE

.:

1

.
.

.
-

1(I..-

lOB.DATED(SEElTEM11)
* 7 = ~

10/30/2003

-5:

11. M I S ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

*
.

I
11

The above numbered sol~cilationIS amended as set foim in ltem 14. The hour and date specified for receipt of Offers
0 1 s extended. 0 1 s nol extenoea.
Oilers must acknmledge receipt of lhis amendment pnor to the hour and date speahed In the sd~cimtionor as amended. by m e of the fdlomng methods. (a) By mirjpleung
Items 8 and 15, and returning
copies of the amendment; (b) By ackndedging receipt of this amendment on each copy of the offer submitled, o/(c) By
11

separate letter or telegram which indudes a reference l o the sdidtation and amenamenl numbers. FAILURE OF YOUR ACKNOWLEDGEMEW TO BE RECEIVEDIAT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND D A l E SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER (by

'1

wnue of this amendment you desire l o change an offer already submlned, such change may be made by telegram or lenw, prowded each telegram or lener makes
reference to the sdicitat~onand this amendment, and is recelved p n w i o the operlinq hour and dale s~eclfied
!I
12. ACCOUNTING AND APPROPRIATION DATA (If requrred)

7541362 C96A500 2522

I

INCREASE $35,000.00

13. THlS ITEM ONLY APPLIES TO h 6 q ~ ~ T
OF lCONTRACTSIORDERS.
~ ~
IT YlODlFlESME CONTRACTIORDER NO. AS DESCRIBEDIN ITEM 14.

..

B THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying offrcel
approprialron dale, eft.) S W O R H it4 l T E h 4 l 4 PURSUANT TO THE AUTHORITY OF FAR 43703(b).

il

1

I/
C THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF

-

I
I

X

/

I)

**

-11

I FAR

E. IMPORTANT:

52.243-1 CHANGES

Contractor

@is not.

-

, ,
,

'1

D OTHER (Speoly lype o/rnodrlrcalron and aulhonly]

INCREASE FUNDS
is required to sign thls document and return

/I

copies to the Issuing ofllce.

1
- - - . . . - - .3 . . - . - .

I4 DESCRIPTIONOF AMENDME~TIMODIFICATION(Oqanized by UCF seclron headmgs, including Sobdlalron/mnlrad subject maner m e r e leasible.)

b?

.....

_

T a x ID Number:
,.
-DUNS Number:
I
THI s MOD1 FI CATION 1 s FOR ROB IN CLiEMENs FOR T H E m o m REFERENCE B m N K E T PURCHASE AGREEMENT
I
( B P A ) IN ORDER T O INCREASE FUNDS :
1
ORIGINAL AMOUNT "$140,000.00
INCREASED AMOUNT $35,000.00
NEW TOTAL AMOUNT $175,000.00
CAN NUMBER C96A500, OBJ CLASS # 2522, APPRO # 7541362
Not T o Exceed Amount changed to: $175,000.00
_-.. R e q ' n . Total changed t o : 35000.00
i
Period of Performance: 10/01/2003 t o 09/30/2004

l,

I

i3
i

:!

II

Except as provlded herein a l l terms and m d l t ~ o n sof the document referenced In ltem 9A or IOA as heretofore changed remains unchanged and In full force and effhcl

I

1-C.

SAVOY

NSN 7540-01-152-8070
Previous edition unusable
FAR (48 CFR) 53 243

/I
i

--

. ..

I

READ INSTRUCTIONS ON NEXT PAGE

r

I

pz.ze

:
-

c:- --

I(

PROCUREMENT REOUEST NO

04M000214

;/II

REOUlSlTlON DATE
1 NAME PHONE NUMBER. AND ROUTING SYMBOL OF PERSON TO CONTACT

06/08/2004

HARRIET POLSTER/301-443-8956

!

2 TYPE OF REOUEST (Check m e ,
A
REOUEST

3 ORIGINATING OFFICE DATA

SAMHSA/OC

B

4 ADDITIONAL INFORMATION (Suggested supply sources, secunty &la, etc )
I

EINEW
CHANGE TO

1

i

I

PENDING PR NO

MODIFICATION TO

I

H H S F 3~3 2 0 0 4 2 8 0 7 M B

1

CONTRACT OR
ORDER NO

'I

1

I

6 CONSIGNEE AND DESTINATION

5 APPROVALS
APPROVING OFFICIALS
(A)
(1)

,

RWTING
SYMBOL
(B)

DATE

tC)

INERNAL RWTlNG

,

L 1 T W

I

RWlNG

SY-(El

10)

:(1I

AUTHORIZED REQUISITIONER

-.&wH&

H A R R I E T POLSTER
.

'

-.. .-

.

.

06/28/2b;04
.

6.

-

12)

ANNA

-

I

I -

-;.-

!I

1

(3)

141.

-

MARSH

1

S ~ H S A/06/17/2004

1
1

7 . DATEIS) REQUIRED

1
:I

See S c h e d u l e

1

I

9. DESCRIPTION OF ITEMS OR SERVICES

1 8 GOVERNMENT FURNISHED Pl'r,PERTY

;

I

--

1
1 CONTRACT ID CODE

AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT

-

I

2 AMENDMENTIMODIFICATION NO

3

EFFECTIVE DATE

10/30/2003

0003
CODE

6 ISSUED BY

DAM

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

1 4 REQUISITIONPURCHASE REQ NO

/ 5 PROJECT~~NO
/I/ aoobiaD:r

1

04M000065

(

7 ADMINISTERED BY (I( other than Ifem 6:

CODE

jD&

. .

DHHS/PSC/AOS/DAM
PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

1:

ROBIN L.. CLEMENS
3205 NORTH FRONT STREET
APT. # 5
HARRISBURG PA 17110

ij

9B. DATED (SEE ITEM 1 1 )

/I
11
10A MODIFICATION OF CONTRACTIORDER NO

HHSP23320042807MB

I/
100 DATED (SEE ITEM 11)

CODE

--

10/30/2003

11

11. THIS ITEM ONLY APPUES TO AMENDMENTS OF SOLICITATIONS
The above numbered sol~otabonIS amended as set fuXh ln Item 14 The h w r and date spwAed for recelpt d Offers

0 1 sextended

f i l s n i l extended

Offers must acknowledge recelpl of lhls amendmenl pnor to the h w r and dale spwRed In the sdlolabon w as amended by one of the ldlornng methods (a) By azynpletlng
Items 8 and 15. and retumlng

mptes of the amendment. (b) By ackndedglng recelpt of l h ~ samendment on each mpy of the offer subm~ttedor (c) By

n amendmenl numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT
separate letter or telegram whim ~ndudesa reference to the s d ~ o t a t ~ oand
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If by
wrtue of th~samendment you deslre to mange an offer already submlned, s u m thange may be made by telegram a lener, pmvlded each telegram or lener makes

7541362 C96A500 2522

1

1
I

reference to the sol~c~tatton
and this amendment, and is recelved pnof l o the openlnq h w r and date specrfied
12 ACCOUNTING AND APPROPRIATION DATA (Ilrequrredj

I

1

INCREASE $35,000.00

13. THlS ITEM ONLY APPUES TO'X;Q~CATION OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTIORDER NO. AS DESCRIBED IN ITEM 14
C H E C K O ~ E A THIS CHANGE ORDER IS ISSUED PURSUANT TO (Speofyaulhontyj THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

ORDER NO IN ITEM 10A

FAR52.243-1

CONTRA^;^

CHANGES

I/

B THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes In payng offrc2,
appropnalfon date, elc) SFTfORlktTN I W 1 4 . PURSUANT 10 THE AUTHORITY OF FAR 43 103(b)

.

.

j/

I

I

1

C THlS SUPPLEMENTALAGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF

'I

-,

-..*

I

D OTHER (Speafy l p e of modrfication and aulhonty)

I

FAR 52.243 - 1 CHANGES

E. IMPORTANT

Contractor

E j s not

-

I
>

- ..

:
-

I

1

INCREASE FUNDS

'I

cnples to the Issuing office

1s requlred to sign thls document 2nd return

14 DESCRIPTION OF AMENDME~TIMODIFICATION (Organized by UCF section headings. includ~ngsolfulalron/mntrad subject matier where leasfble.)

1
_

.

j

T a x ID Number:
DUNS Number:
( B P A ) IN ORDER T O INCREASE FUNDS.
ORIGINAL AMOUNT' $105,000.00
INCREASE AMOUNT $35,000.00
NEW TOTAL
$140,000.00
Not T o Exceed Amount changed to: $140,000.00
Perlod of Performance: 10/01/2003 to 09/30/2004

11

11
Except as provlded herem,-all lerms and condltlms of the document referenced In llem 9A or 10A. as heretofore changed, remalns unchanged and In full f
15A NAME AND TITLE OF SIGNER (Tjpe or pnntj

m and effect

16A NAME AND TITLE OF CONTRACTING OFFICER ( T p e or ~ n n l )
*
I

$UlY€+
/

,

C. SAVOY

;I

16C. DATE SIGNED

158 CONTRACTORsOFFEROR

-/2004
(bgnafvre 01person aurhorrzed lo sign]

NSN 754061 -152-8070
Previous edil~onunusable

//

s~U&D
FORM 30 (REV 1083)
Presmbed by GSA
FAR (48 CFR) 53.243

..

.

.

READ INSTRUCTIONS ON NEXT PAGE

Pas-? - :r . :

J

REQUISITION
1

NAME PHONE NUMBER AND ROUTING SYMBOL OF PERSON TO CONTACT

1

04M000153

/1

REQUISITION DATE

1

NEW
B GCHANGE
TO

SAMHSA/OC
ADDITIONAL INFORMATION (Suggesled supply scurces, secunly data, elc )
-

1

PENDING PR NO

(8)

( I ) AUTMORIZED REOUISITIONER

HARRIET PoLsTER

1

I

1

I

il
il

1

6. CONSIGNEE AND DESTINATION ''

5 APPROVALS
(A)

1

I

~ ~ ~ ~ 2 $ 3 2 0 0 4 2 8 0 7 ~ ~

CONTRACT OR
ORDER NO

ROUTING
SYMBOL

1i!
j

I

~ M O D I F I C A T I O NTO

APPROVING OFFICIALS

I

1

2 TYPE OF REQUEST (Check m e )
A
REQUEST

3 ORIGINATING OFFICE DATA

I

i

04/02/2004

HARRIET POLSTER/301-443-8956

4

H

PROCUREMENT REQUEST NO

IhmRNAL ROUTING

DATE
tC)

SMHSA0 6 / 2 8 , 2 o a n l

1

RUING

lNUN.3
(D!

1

s v m a (€1

!I

1

I

7 DATE(S) REQUIRED

(3)

~AMHSA 0 4 / 1 2 / 2 0 0 4

ANNA MARSF
(4)

t

!?EM NO
(A)

I

04/12/2004

SAMHSA

ci'NTHIA COOKE

B GOVERNMENT FURNISHED ?ROYERTY

DYESNO

(

H

h

.

QUANTITY UNIT

ITEM OR SS$VIg (Include SmofcaI~nsand Special lratrudons)
(0)

1

(C)

I T h i s t h i r d m o d i f.-.
i c a t i o n i s t o i n c r e a s e t h i s BPA f o r - R o b i r
i w h l c h w i l l give a t o t a l o f $ 1 4 0 , 0 0 0 . 0 0 .

WIT

(Dl

IEI

T h e period o f p e : r f c r m a n c e

~

s

~

m

~

-

Ms.

Clemens/

~....
W 111
,

.

be

II

C u r i e , SWHSA ~ ~ k i n i s t r a t o r .
Il

1
I

1I

. - - .

-

.

m

thk~ugh

IS

1

..

. -.

I

..

1

.-.

.

..

..

-

.

JB

..

1

1
See Schedule

.

I/

I

10 ACCOUNTING DATA

~

.youKI
IFI

i/

T h e o b j e c t c l a s s code i s 2 5 . 2 2 .

s e r v i n g i n t h e c a p a c i t y b f doing s p e e c h w r i t i n g f o r M r .

.

Clemens b y anokher $35,000

10/01/2003 t o 09/30/2004

T h e CAN n u m b e r i s C 9 6 A 5 0 0 .

Y

(1

09/30/04frq~--t,&e~date+of t h e a p p r o v a l o f thisrecyest.
Period o f Performance:

~

I)
ESTIMATED COST
,

9 DESCRIPTION OF ITEMS OR SERVICES

1

-.

I

See Schedule

-

1
I

$0.00

:

--

2 AMENDhfENTlMODIFlCATION NO.

0 0 02
6. ISSUED BY

REOUISITIONPURCHASE REO NO

O= PAGE5

I

l,i

15 PRC)JECT[NO.lliaopi~caons:

04M000065

10/30/2003
DAM

CODE

I

14

13. EFFECTIVE DATE

I

I Pr*,Zf

1 CONTRACT ID CODE

AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT

7. ADMINISTERED BY 111otner than Item 6;

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE ME 20857

CODE

DHHS/PSC/AOS/DAM
PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857
I

8. NAME AND ADDRESS OF CONTRACTOR jbio.. sneer, counry: Slate and ZIP Code)

9A. AMENDMENT OF SOLICITATION NO

I

. .

ROBIN L . CLEMENS
3205 NORTH FRONT STREET
APT. # 5
HARRISBURG PA 17110

-

.

CODE

, .

I
90 DATED (SEE ITEM f 1 )

I

.

.

,

-

.

-

F A C I L ~CODE

I

.

1OA. MODIFICATION OF CONTRACTORDER NO.

HHSP23320042807MB

i~
*

10B DATED (SEElTEM 11)

10/30/2003

. --

.
.

....:;-

.

I
I
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

I

:I

n i s extended. 3 0 snbt exlendel
The above numbered solicitabon IS amended as set f o m ~nItem 14. The hoor and dale spedfied for receipt of Ofiers
Offers must a&nmledge recelpt of this amendment pnor to the hour and date spedfied In the sditilabon or as amended, by m e ol the fdlwnng methods: (a) By mmpleting
Items 8 and 15, and returning
copies of lhe amendment; (b) By a&nowledglng receipt of this amendmenl m each copy of the offer submitted. or (c) By

RECEIVE^

separate letter or telegram h i c h indudes a reference to the sdiatatim and amendment numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE
AT
THEPLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If by
virtue of this amendment you desire to change an olfer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes ,
18
reference to the solicilalion and thls amendment, and is received pnor!o the openlnq hour and date specified
I
12. ACCOUNTING AND APPROPRIATION DATA (Ilrequired)

7541362 C96A500 2522

INCREASE $35,000.00

13. THIS ITEM ONLY APPLIES

TOG S CATION OF CONTRACTSIORDERS. IT MODIFIESTHE CONTRACT~ORDERNO. AS DESCRIBED IN ITEM 14.
q.
I

-1

A

g&CH;;q:ppp:Eof 1SSUE.D PURSUANT TO: (Specifya~!lhor~?y)THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRAC'T

B. THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in papng office.
appropnal~ondale, elc.) 9eTPORTHlN ITEM 14. PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

.- ..

.

.

..

.

.

-

c..

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

I
X

.. --

-:I

!I
1

- '. - -

D. OTHER (Specrly lype 01 modilication and aulhonfy)

1 FAR

E. IMPORTANT:

52.243 - 1 CHANGES - INCREASE -FUNDS

,Co~tractrr

m i s not.

copies to the issuing olftce.

1s rewired to sign th~sd o ~ u m ~ .and
n t return

-.

14. DESCRIPTION OF AMENDMN/MODIFlCATION (Oyanizedby UCF section heaolngs, including Solic!lafion/cuntrad subjecl matter where leasible.)

T a x ID Number:
DUNS Number:
ORIGINAL AMOUNT
INCREASE AMOUNT'$
NEW TOTAL:

.- .

$

..

..

'

-Y - . -

.-.

1

70,000.00
35,000.00
$105,000.00

I
Not T o Exceed Amount changed to: $105,000.00
.--

Period of Performance: 10/01/2003 t o 09/30/2004

.
,

..

..

'

9

1
I

Excepl as provlded herem: all terms and c m d ~ t ~ofmIhe document referenced In llem 9A or 10A. as herelofme changed, remalns unchanged and In full force and eflect
15A NAME AND TITLE OF SIGNER (Type orpnnf)

16A NAME AND TITLE OF CONTRACTING OFFICER (Type orpnnl)

C . SAVOY

NSN 754001-1528070
Previous ed~t~on
unusable

Seer

30 (RW 1043)

FAR (48 CFR) 53 243

.- *

READ INSTRUCTIONS ON NEXT PAGE

Page 1 cf 2
( R 9 m u R E M N T REQUEST N o .

n

REQUISITION DATE
I NAME PHONE NUMBER AND ROLlTlNG SYMBOL OF PERSON TO CONTACT

12/16/2003

HARRIET POLSTER/301-443-8956

1

I
I1

2 Y E OF REQUEST (Check one)
A U N E W REQUEST

3 ORIGINATING OFFICE DATA

SAMHSA/OC

B

4 ADDITIONAL INFORMATION (Suggested supply s u m s , secunty data, elc )

ECHANGE
TO
PENDING PR NO

MODIFICATION TO

.

1
I

~

~

ROUTING
SYMBOL
(8)

1-1

~ 0 021 2 38 0 3 72

6 CONSIGNEE AND DESTINATION

5 APPROVALS
APPROVING OFFICIALS

~

1li

CONTRACT OR
ORDER NO

OATE
ICI

,

INTERNAL ROUTING

- 0HllU.S
(Dl

RanrnG
SYUBOL (€1

(11 ArnHORIZED REQUISITIONER

HARRIET

-S&SA

POLSTER
.

.

06/28/2004

-

I

li
'=*

,-

(2)

SHERI KRETSCHMAIER

1

1 4:, : ..

-

I

1

12/24/2003

PSC

..

-

i

I

7. DATE(S) REQUIRED

I

See S c h e d u l e

i

8.GOVERNMENT FURNIP~EDPROPERTY

SAMH~A

-

12/23/2003
9.D E S C R I P T I O N O F I T E M S O R S E R V I C E S

DYESNO

,nys:&

~ . t ~ m u m m . ~ ~ -

~

~

AMENDMENT

1

OF SOLlClTATlONlMODlFlCATlON OF CONTRACT

2 AhlENDMENlMODlFlCAT10N NO

14

13 EFFECTIVE DATE

0001
6 ISSUED BY

10/30/2003
DAM

'ODE

CONTRACT ID CODE

PAGE

1
REQUISITIONPURCHASE REQ NO

5 PROJEC.

7 ADMINISTERED BY (If other than Item 6:

DHHS/ PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

DJ

CODE

DHHS/PSC/AOS/DAM
PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

8 NAME AND ADDRESS OF CONTRACTOR (No s u e e ~counry. Stare am ZIP Codej

9A AMENDMENT OF SOLICITATION NO

ROBIN L: CLEMENS
3205 NORTH FRONT STREET
APT. # 5
HARRISBURG PA 17110

1CA MODIFICATON OF CONTRACTIORDER NO

'HHSP23320042807MB
-

.

.

. --

108 DATED (SEE ITEM II)

P

.

CODE

.

.

FACILITY CQBE

..

.

---

10/30/2003

I

:.

-

I

11. THIS ITEM ONLY APPUES TO AMENDMENTS OF SOUCITATIONS
The above numbered s d ~ o t a t ~ o
ISnamended as set f&

In Item 14 The hour and date speofied for recelpt of Ofiers

IS

extended

G 1s r

Offers must admawledge recelpt of UIS amendment pnor to (he hour and date speofied In lhe sd10laDonor as amended, by one of the f d l m n g methods (a) By a
coples of the amendment. (b) By admcmledglng recelpt of lhls amendment on each copy of the offer submlned.

Items 8 and 15, and relumlng

separate letter w telegram wh~chlndudes a reference lo the s d ~ o t a t ~and
m amendment numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVE
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER
v~nue'of(his amendment y o u deslre to change an offer already subm~ued,such change may be made by telegram w letter, prowded each telegram or letter makes
reference to the sol~cilat~on
and t h ~ samendment, and 1s rece~vedprior io the openlna hour and date specified
12 ACCOUNTING AND APPROPRIATION DATA (Ilrequrred)

7541362 C96A500 2522
13. THIS ITEM ONLY APPUES TO

OF CONTRACTSIORDERS. r'f MODIFIES THE CONTRACTIORDER NO. AS DESCRIBED IN ITE

A THlS CHANGE ORDER IS ISSUED PURSUANl TO: (Speufyaulhontyl THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRA(
ORDER NO IN ITEM 10A
-TrlE ABOVE NUhlBERED COhTRACTKlRDER IS MODIF.ED TO REFLECT THE ADMIKISTFWTIVE CHANGES (such a s changes
appropnaoon dale. erc, SW-F0!3Tfi I h I T E L l 4 . PURSUAhT TO TrlE AUTrlORITY OF FAR 43 103(0)

.

-*

G OTHER (Specify type of modifiwlron and aulhonly)

X:

FAR 52.243-1 CHANGES - INCREASE FWIIS

E IMPORTANT

Contranor

IS not

1s requ~redl o slgn lhls doc1 nent and return

wples to the lssulng ofice

14 DESCRIPTION OF AMENDMEHT/MODIFICATION(Organized by UCF section headings rnclud~ngsolictfatron/mntracf sub~ectmaner where leasrble )

Tax ID Number:
DUNS Number: .
THE ABOVE REFERENCED BPA IS HEREBY MODIFIED TO INCREASE FUNDS IN THE AMOiTNT OF

. .

ORIGINAL AMOUNT ON THIS BPA: $35,000.00
INCREASE AMOUNT ON THIS BPA: $35,000.00
NEW TOTAL AMOUNT ON THIS BPA: $70,000.00

...
ALL OTHER TERMS AND CONDITIONS ON THIS BPA REMAIN UNCHANGED.
Continued

.

Except as prov~dedhereln, all terms and cmdltlons of the document referenced In Item 9A w 10A. as herelofwe changed. remalns unchanged and in full force and el
15A NAME AND TITLE OF SIGNER (Type or pnnl)

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or

I JO
15B CONTRACTORIOFFEROR

1K: DATE SIGNED

LASKO
iC DATE SIGNED

16B UNITED STATES OF AMERICA

(Srgnatvre d p e r m aulhonzed to ygn)

NSN 754001-1528070

STANDARD F(

Prev~ouse d ~ l ~ ounusable
n

Presmbed by (
FAR (48 CFR)

d 30 (REV 1083)

REFERENCE NO OF M3CUMENT BEING CONTINUED

cONT'NuAT'On s"EET~HHSP23320012807MB/OO01
NAME OF OFFEROR OR CONTRACTOR

ROEIN L . CLEMENS

N S N 754N1-152-8061

OPTIONAL
FAR

FORM 336 (4-06)
IlSmnsored by GSA
( 4 8 CFR153 110

READ INSTRUCTIONS ON NEXT PAGE
PROCUREMENT REQUEST NO

PENDING PR NO

~ H O D I F I C A T I O NTO
CONTRACT OR
ORDER NO.

I
ROVTING
SYMBOL

(A)
I

DATE
(C)

.

( 8 1.

!j

\I

i/

ROVTING
.. emm.sINTERNAL
.

I

ROUTUKi

SIUsOL (El

ID)

I

11

(I)
AUTHORIZED REQUISFIONER

H A R R I E T POLSTER

i

1 6 CONSIGNEE AND DESTINATION

5.APPROVALS
APPROVING OFFICIALS

H H S ? ~ ?3 7 004 2 8 0 7 ~ 5

!
S-~HSA

.

--

06/28/2%04

(2)

I
P A T R I C I A BRANSFORD

'-11/21/2003

SAMHSA

14)

1 CYNTHIA

I

7 DATE(S) REQUIRED

(3)

COOKE

1

(SAMHSA

-

11/21/20031

See Schedule

1

I

9 DESCRIPTION OF ITEMS OR SERVICES

10 ACCOUNTING DATA

See Schedule

8 GOVERNMENT FURNISHED PROPERTY

BYES
DNO

i

,H~...+.~

11

!I

a,nsuramsmna-r

I
I

READ INSTRUCTIONS ON NEXT PAGE
PROCUREMENT REQUEST NO

REQUISITION

04M000005
REQUISITION DATE

1 NAME PHONE NUMBER AND ROUTING SYMBOL OF PERSON TO CONTACT

12/16/2003

HARRIET P O L S T E R / 3 0 1 - 4 4 3 - 8 9 5 6

I

I'I

2 TYPE OF REQUEST (Check ax,
A ~ I N E W
REQUEST

3 ORIGINATING OFFICE DATA

SAMHSA/OC

B [?CHANGE TD
PENDING PR NO

4 ADDITIONAL INFORMATION (Suggested supply sources. secunty dab. etc )

~ M O D I F l c A T I O NTO
CONTRACT OR
ORDER NO

ROUTING
SYMBOL

DATE

H H S P 320042807M9
~~

Y

1

/I

INTERNAL ROUTING

'.

(c)

(B)

I

6 CONSIGNEE AND DESTINATION

5 APPROVALS
APPROVING OFFICIALS
IA)

I

1

RMLYS

SVU%X(E)

(Dl

1

(1)AUMORIZEDREOUlSlTlONER

HARRIET POLSTER

SHERI KRETSCHMAIER

PSC
I

1
CYNTSIA COOKE

SAMHSA

-

N, :

(8)

This second modification
is to increase this BPA
..
$35,000 which will give a total of $105,000.00.
through 09/!,P.(,9,4. f.?o.m+the date of the approval of
Period of Performance: 10/01/2003 to 09/30/2004
The CAN number is C96A500. The object class code
serving in the cdpacity'of doing speech writing f

See Schedule

DYES
=NO

-.

sot..-m.-.*-~

I

SERVICES

ITEM OR T R V Y E ilnckde S p e d f ~ ~ a~r dn Speaal
r )R
II~IV
U
~
(I

10 ACCOUNTING DATA

/

1

12/23/2003
9.DESCRIPTION OF ITEMSOR

ITEM NO
(A I

:I

See Schedule

I 8 GOVERNMENT FURNISHED PROPERTY

I

(4):

17 DATE(S) REQUIRED

SAMHSA .12/24/2003

I

QUANTITI

UNIT

(C)

(D)

1 ESTIMATED COST

;II

*WI)HT
IF)

or Rob n Clemens by another
I,
he per od of performance is
11
this r quest.
I
11

I

l
is 25. z . ] MS. ~ e e n i l be
r Mr. ur e, 'SRMHSA Ad riisfrator.

1

ORDER FOR SUPPLIES OR SERVICES

1

IMPORTANT Mark all packages and papers wlth contract and/or order numbers

PC
::

I

CZ

1 '

2-3:s

I

2 CONTRACT NO (If any)

1 DATE OF ORDER

HHSP23320042807MB
10/30/2003
I

4 REQUISITIONREFERENCE NO

3 ORDER NO

Indicated On Call

See Schedule
b STREET ADDRESS

5 ISSUING OFFICE /Address correspondence to)

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

i
-

c CITY
I

f SHIP VIA

7 TO

a. NAME OF CONTRKTOR

ROBIN L. CLEMENS

8 TYPE OF ORDER

b. COMPANY NAME
-

c STREET ADDRESS

.

32 05 NORTH FRONT STREET,..
APT. # 5

..

..

.

d CITY

. .-

.

..

.

f ZIP CODE

HARRISBURG
9 . ACCOUNTING AND APPROPRIATIONS DATA

DELIVE~~Y
.

REFERENCE YOUR.

--

e STATE

:I

1
1
0

m a PURCHASE

1

Please fumlsh the f d l w i n g on the t e n s
and ccmd~konsspec~fiwon both sides 01
lnls order and on the attached sheell ~f
any, tnclud~ngdellvery as lndlcaled

lExcepl lor billtng ~ r & u n l o n son Ihe
m e . m~sdel~veryorder 1s
subject to InSINcllOnS contained on
illhis stde only of th~slam and 1s
!issued suPlect
I -n !he lenns and
,
;mndttlons of lhe above-numbered
ic~nlrac~

.

--

..
. --

10. REQUISITIONING OFFICE

SAMHSA/OC

Indicated On Call
11 BUSINESS CLASSIFICATION (Check appmpnate box(es))

td

12 F

oB

..

..rr*

a SMALL

..

b OTHER THAN SMALL

Destination

POINT

1
0

c DISADVANTAGED

I

15 DELIVER TO F o B POINT

14 GOVERNMENT B I ~ O

d WOMEN-OWNED
16 DISCOUNTTERMS

ON OR BEFORE (Date)
13 PLACE OF

a. INSPECTION

b. ACCEPTANCE
17. SCHEDULE (See reverse for Rejeclions)

ITEM NO.

QUANTITY
ORDERED UNIT
(dl
(c)

SUPPLIES OR SERVICES

(a)

;b)

UNIT
PRICE
fe)

dt

(g)

(f)

Tax ID Number:
DUNS Number:
beriod

t

-., ..

~erfirmance:10/01/2003 to 09/30/2b01

---

I

.-..

I

1 . ..

I

-

.-

1
18. SHIPPING POINT

19. GROSS SHIPPING WEIGHT

'1

pages)

1

Indicated On Call
....a

SEE BILLING
INSTRUCTfONS

$35,
or&. 00
. .

!

b, STREET ADDRESS

c CITY

....

17(h)
TOTAL
(Cont.

11

2 0 INVOICE NO.

21 MAIL INVOICE TO

a NAME

QUANTITY
ACCEPTED

A ~ ( O U F- :-I-.: I

--

d. STATE

1

TOTAL
e ZIP CODE

$35,000.00
I

22 UNITED STATES OF AMERICA
BY (Signarure)

1 23. NAME (Typed)
JO LASKO
TITLE. CoNTrncTlNWoRDERlNG OiFIcER

NSN 754601-152.8083

PREVIOUS EDITION NOT USABLE

OPTIONAL FORM 347

(an€a51

R.u.W by O W A R l a 8 CFR) U 211.1

READ INSTRUCTIONSON NEXT PAGE
PROCUREMENT REQUEST NO.

PENDING PR NO. '.

ROBIN L. CLEMENS
c

MODIFICATION TO
C O N r n C T OR

1 6 CONSIGNEE AND DESTINATION

II

5 APPROVALS

BLDG., R O ~ M6 - 1 0 1
( I ) AUTHORIZED REOUiSlTlONER

5600 FISHERS LANE

I

HARRIET POLSTER

SAMHSA

06/28/2504

psc

49/15/2003

(

ROCKVILLE MD 20857

,

7 DATE(S) REOUIRED

(3)

SHY-:RIKRETSCHMAIER

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8. GOVERNMENT FURNISHED PROPERN

(4)--

~AMHSA

ANNA MARSH

-

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09/12/2003

:

DYES
ENOl+~Y.:-Lsd-rn--,

9.DESCRIPTION OF ITEMS OR SERVICES
ITEM NO

ITEM OR S e f f V c E (Incue Speafmuom and Speml Imrmaam)

'8"

(A)

(B)

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Mum

(C)

IF1

RENEWAL OF BPA 50438M
FOR MS. ROBIN CLEMENS WHO I A FOR
...
HAS FIRSTHAND KNOWLEDGE OF SAMHSA AND IS QUALIFIE I TO PE
JUSTIFICATIOE-THERE,+IS AN URGENT NEED FOR SPEEC WRITER
ADMINISTRATOR. HE HAS NUMEROUS SPEAKING ENGAGEME 'TS ANI:
TO SPEAK. IT IS CRUCIAL THAT WE ESTABLISH THIS E 'A WITH
SAMHSA ISSUES. .CAN: C96A500 Obj. Class: 2 5 2 2 FY: 2004
FOB: Destination
-Period. of
Performance: 10/01/2003 to 09/30/2004
..
1

SAMHSA AND

. --

-.

-35,0.M. 0 0

BY THE

PLACE

TOTAL ESTIMATEDCOST

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$35,000.00

1

10 ACCOUNTING DATA

Accounting Info

:

7541362

..

REQUESTS
ZED WITH

RENEWAL OF BPA TO-DO SPEECHWRITING FOR THE SAMHSP
ADMINISTRATOR
Period of Performance: 09/30/2003 to 10/01/2004
GOVERNMENT IS OBLIGED ONLY TO THE EXTENT OF ORDEE
FOLLOWING: MARK WEBER-OA, DARYL KADE - OPPB
COST LIMIT NTE $ 2 , 5 0 0 .
Subject to Availability of FY "04" Funds

I
TIMATED COST

OUANTIT'I

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