Solicitation/contract form — DABV01-03-Q-0100

PAGE 1 OF 7. REQUISITION NUMBER SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 2 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 5. SOLICITATION NUMBER 3. AWARD/EFFECTIVE 6. SOLICITATION ISSUE 14. ORDER NUMBER Z. CONTRACT NO. DATE DATE 10/01/2003 DABV01-03-Q-0100 8. OFFER DUE DATE/ b. TELEPHONE NUMBER (Na collect a. NAME calls) LOCAL TIME 7. FOR SOLICITATION INFORMATION CALL: MAJOR SHARON ORLANDO 781-280-6382 10/07/03 5:00pm 12. DISCOUNT TERMS 110. THIS ACQUISITON IS 111. DELIVERY FOR 9. ISSUED BY CODE FOB DESTINATION UNLESS BLOCK IS CPA - CONTRACTING ACTIVITY I UNRESTICTED MARKED % FOR I SET ASIDE: REPUBLICAN PRESIDENTIAL COMPOUND • SEE SCHEDULE | ] SMALL BUSINESS BAGHDAD, IRAG I HUBZONE SMALL APO AE 09335 BUSINESS 130. ODER CODER FAS A5 0TE 200) 13b. RATING NAICS: 14. METHOD OF SOLICITATION SIZE STANDARD: _ RFP DIFB II RFO 16. ADMINISTERED BY 15. DELIVER TO CODE CODE L REPUBLICAN PRESIDENTIAL COMPOUND, CMATT/C4 SAME AS BLOCK 9 BAGHDAD, IRAQ 7a. CONTRACTOR/ CODE 18a. PAYMENT WILL BE MADE BY CODE OFFEROI CMATT C-4 ATTN: S. ELLIS REPUBLICAN PRESIDENTIAL PALACE APO AE 09335 TELEPHONE NO. 186. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW D176. OFFCK IE REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN IS CHECKED ] SEE ADDENDUM AMOUNT UNIT QUANTITY UNIT PRICE SCHEDULE OF SUPPLES/SERVICES ITEMINO. 11 EA 0001 POLAROID 100 SYM. W/CARDMAKER II, MODEL #22001026 EA 33 0002 TABLETOP SLOT PUNCH MODEL #3943-1500 EA 11 0003 VERIFIER 300 FINGER ID MODEL #V300USB (Use Reverse and/or Attach Additional Sheets as Necessary) 25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only) JARE NOT ATTACHED 27a, SOLICITATION INCORPORATES BY REFERENCE FAR 2.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA _ARE JARE NOT ATTACHED JARE 276. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 62.212-4. FAR 62.212-5 IS ATTACHED. ADDENDA OFFER J 29. AWARD OF CONTRACT: REF. 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND — . YOUR OFFER ON SOLICITATION DATED - ELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON AN (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE DDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED HEREIN SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS: 731a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30a. SIGNATURE OF OFFEROR/CONTRACTOR 30c. DATE SIGNED 31c. DATE SIGNED 316. NAME OF CONTRACTING OFFICER (Type or print) 30b. NAME AND TITLE OF SIGNER (Type or print) STANDARD FORM 1449 (REV. 4/2002 AUTHORIZED FOR LOCAL REPRODUCTION Prescribed by GSA - FAR (48 CFR) 53.21 Reset PREVIOUS EDITION IS NOT USABLE UNIT UNIT PRICE QUANTITY AMOUNT SCHEDULE OF SUPPLES/SERVICES ITEM NO. 0004 EA TOPAZ 4X5 SIGNATURE PAD/MODEL #T-5751-B 11 EA 0005 PRINTHEAD REPLACEMENT KIT MODEL #076733700 EQUIVALENT ITEMS MAY BE SUBSTITUTED, HOWEVER OFFEROR MUST PROVIDE SUPPORTING DOCUMENTS TO JUSTIFY DELIVERY WILL BE REQUIRED 30 DAYS AFTER CONTRACT AWARD. SEE APPENDIX B FOR TERMS AND CONDITIONS. 0 32a. QUANTITY IN COLUMN 21 HAS BEEN • RECEIVED • INSPECTED L ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: 732c. DATE 732d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE REPRESENTATIVE 324. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE 32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE 737. CHECK NUMBER 134. VOUCHER NUMBER 33. SHIP NUMBER 35. AMOUNT VERIFIED 36. PAYMENT CORRECT FOR _ FINAL I COMPLETE [ PARTIAL PARTIAL, JFINAL 38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY 742a. RECEIVED BY (Print) 41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 41b. SIGNATURE AND TITLE OF CERTIFVING OFFICER 41c. DATE 426. RECEIVED AT (Location) 42c. DATE REC'D (YY/MM/DD) T42d. TOTAL CONTAINERS STANDARD FORM 1449 (REV. 4/2002) BACK Reset