PAGE 1 OF 1. REQUISITION NO. 2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL TIME 9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR: SMALL BUSINESS HUBZONE SMALL BUSINESS SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER THE WOMEN-OWNED SMALL BUSINESS PROGRAM EDWOSB 8(A) NAICS: SIZE STANDARD: 11. DELIVERY FOR FOB DESTINA- TION UNLESS BLOCK IS MARKED SEE SCHEDULE 12. DISCOUNT TERMS 13a. THIS CONTRACT IS A RATED ORDER UNDER DPAS (15 CFR 700) 13b. RATING 14. METHOD OF SOLICITATION RFQ IFB RFP 15. DELIVER TO CODE 16. ADMINISTERED BY CODE 17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE TELEPHONE NO. UEI: EFT: PHONE: FAX: 17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED SEE ADDENDUM 19. 20. 21. 22. 23. 24. ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT (Use Reverse and/or Attach Additional Sheets as Necessary) 25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED. 27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS: 30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021) PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212 7. FOR SOLICITATION INFORMATION CALL: STANDARD FORM 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 12 550-23-1-985-0022 36C25223Q0583 05-09-2023 Mack Taylor 224-610-3648 05-22-2023 11:59PM CDT 36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 3001 Green Bay Road North Chicago IL 60064 X 100 X 339112 1000 Employees N/A X 36C550 William S. Middleton VAMC 2500 Overlook Terrace Madison, WI 53705 36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 3001 Green Bay Road North Chicago IL 60064 Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 877-353-9791 512-460-5540 See CONTINUATION Page EXAM CHAIR WITH STAND and accessories Please send quotes to mack.taylor2@va.gov or upload to eBUY See CONTINUATION Page x X Mack Taylor VA-VHA-SAOC-2018-E710785A 36C25223Q0583 Page 1 of Page 43 of 43 Page 1 of SECTION B - CONTINUATION OF SF 1449 BLOCKS SECTION B - CONTRACT ADMINISTRATION DATA B.1 CONTRACT ADMINISTRATION All contract administration matters will be handled by the following individuals: A. CONTRACTOR: ________________________________ (Contractor s Name) ________________________________ (Address) ________________________________ (City-State-Zip) ________________________________ (Point of Contact/Title) ________________________________ (Phone/FAX Number) ________________________________ (E-Mail Address) ________________________________ (DUNS Number) ________________________________ (Federal Tax ID) ________________________________ (GSA/FSS Contract) B. GOVERNMENT: MACK TAYLOR, CONTRACTING OFFICER DEPARTMENT OF VETERANS AFFAIRS GREAT LAKES ACQUISITION CENTER 115 S. 84TH ST., SUITE 100 MILWAUKEE WI 53214-1476 PHONE NUMBER: 224-610-3648 EMAIL: MACK.TAYLOR2@VA.GOV B.2 CONTRACTOR REMITTANCE ADDRESS All payments by the Government to the contractor will be made in accordance with: 52.232-33, Payment by Electronic Funds Transfer - System for Award Management B.3 INVOICES Invoices shall be submitted in arrears in accordance with: a. 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018) b. UPON ACCEPTANCE OF ITEMS B.4 GOVERNMENT INVOICE ADDRESS All invoices from the contractor shall be submitted electronically in accordance with 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018) FACSIMILE, E-MAIL, AND SCANNED DOCUMENTS ARE NOT ACCEPTABLE FORMS OF SUBMISSION FOR PAYMENT REQUESTS.  For assistance setting up e-Invoice, the below information is provided: * Vendors must register online at http://www.tungsten-network.com/veteransaffairs/ * Tungsten Network Setup Information: 1-866-340-4980 * Tungsten Network email: VA.Registration@tungsten-network.com * FSC Vendor Support Section Contact: 1-877-353-9791 * FSC Vendor Support Section email: vafsccshd@va.gov Vendors can inquire on the status of payments by accessing VIS at: https://www.vis.fsc.va.gov/login.aspx?ReturnUrl=%2fDefault.aspx INVOICES: Invoices shall be submitted in arrears: a. Quarterly _______ b. Semi-Annually _______ c. Other X Upon Receipt of Equipment GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be mailed to the following address: DEPARTMENT OF VETERANS AFFAIRS FINANCIAL SERVICES CENTER PO BOX 149971 AUSTIN, TX 78714-9975 Vendor inquires: Toll Free Number 1-877-353-9791 B.5 BASIS OF AWARD The Government will make the award to the lowest price technically acceptable offer. B.6 SECURITY & PRIVACY CONTROL The Certification & Accreditation (C&A) requirements of VHA Handbook 6500.6 do not apply to this requirement; therefore, a Security Accreditation package is not required. No C&A or MOU/ISA is required. Sensitive information exposure as part of this contract involves applicable security controls within the facility as part of the VA Information Security Program. If there are any questions related to privacy, please have a member of your staff contact the VA Privacy Service at 202-461-6309. If there are any questions related to the information security, please have a member of your staff contact the Office of Cyber Security at 304-262-7733. BRAND NAME OR EQUAL (EXAM CHAIR WITH STAND) Salient Characteristics: Marco Encore Automatic Exam Chair (black, standard headrest) 2 -Fingertip switches, as well as corded foot switch, that automatically control chair elevation, recline, and auto-return functions. -Hydraulic system for smooth, quiet reliable adjustments -Single-handed headrest -Foot activated rotation lock -Not to exceed 46 length fully reclined, 24 in width (arm to arm), and 24 width of base -Must be compatible with wheelchair glide system Marco Deluxe 2 Instrument Stand 2 -Electronic release button and chair elevation switches located on the lower slit lamp arm -Slit lamp arm range must accommodate wheel chair patients -A counterbalanced refractor arm allowing one-handed, immediate three-way locking of the refractor. -A full-featured flat overlay switch panel to control the slit lamp, chart projector, accessory instrument, overhead lamp, chair elevation, and voltage for a corded instrument -Overhead lamp with multiple adjustments, rotation stops and an on/off switch -Three rechargeable instrument wells and three 115V electrical receptacles -Scuff-resistant, high-impact base cover -Wheelchair accessible -Base must not exceed 23 x23 ; height must not exceed 75 (not including lamp) B.7 PRICE/COST SCHEDULE ITEM INFORMATION ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 2.00 EA __________________ __________________ Marco Encore Automatic Recline Chair QT (Part Number: 1220_BLACK) 0002 2.00 EA __________________ __________________ Marco Deluxe Stand Warm Gray GRAND TOTAL __________________ B.8 DELIVERY SCHEDULE ITEM NUMBER QUANTITY DELIVERY DATE 0001 2.00 Specify Delivery Date BRAND NAME OR EQUAL (Marco Encore Automatic Recline Chair with Stand)
