Solicitation

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30.

3. AWARD/EFFECTIVE

DATE

2. CONTRACT NUMBER

7. FOR SOLICITATION

INFORMATION CALL:

4. ORDER NUMBER

a. NAME

9. ISSUED BY

CODE

HT0014

DEFENSE HEALTH AGENCY

HCD NORTHEAST, 8111 GATEHOUSE ROAD, 2ND FLOOR

FALLS CHURCH, VA 22042

UNITED STATES

Philip Atwell, Email: [email protected] Telephone: 703 275 6349

11. DELIVERY FOR FREE ON

BOARD (FOB) DESTINATION

UNLESS BLOCK IS MARKED

12. DISCOUNT TERMS

SEE SCHEDULE

15. DELIVER TO

17a. CONTRACTOR/

OFFEROR

CODE

FACILITY

CODE

CODE

1. REQUISITION NUMBER

PAGE 1 OF

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE

DATE

b. TELEPHONE NUMBER (No collect
calls)

8. OFFER DUE DATE/

LOCAL TIME

10. THIS ACQUISITION IS

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

100 % FOR:

UNRESTRICTED OR

SET ASIDE:

WOMEN-OWNED SMALL

BUSINESS (WOSB)

NORTH AMERICAN

INDUSTRY CLASSIFICATION

STANDARD (NAICS):

ECONOMICALLY

DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

8(A)

SIZE STANDARD:

13b. RATING

13a. THIS CONTRACT IS A

RATED ORDER UNDER

14. METHOD OF SOLICITATION

THE DEFENSE PRIORITIES

INVITATION

REQUEST

AND ALLOCATIONS

FOR BID

FOR QUOTE

SYSTEM - DPAS (15 CFR 700)

(IFB)
(RFQ)

16. ADMINISTERED BY

CODE

18a. PAYMENT WILL BE MADE BY

REQUEST

FOR

PROPOSAL

(RFP)

CODE

TELEPHONE NUMBER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

OFFER

BELOW IS CHECKED

SEE ADDENDUM

19.

ITEM NUMBER

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Government Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH

AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND

ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS

SPECIFIED

30a. SIGNATURE OF OFFEROR/CONTRACTOR

30b. NAME AND TITLE OF SIGNER (Type or print)

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

ARE

ARE NOT ATTACHED

ARE

ARE NOT ATTACHED

29. AWARD OF CONTRACT: REFERENCE

OFFER

DATED .

. YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE