Solicitation/contract form — DABV01-03-Q-2105

PAGE 1 OF 7. REQUISITION NUMBER SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 2 Z-00143 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE 2. CONTRACT NO. 3. AWARD/EFFECTIVE 14. ORDER NUMBER DATE DATE 30OCT2003 DABV01-03-Q-2105 b. TELEPHONE NUMBER (Na collect 8. OFFER DUE DATE/ a. NAME calls) 7. FOR SOLICITATION LOCAL TIME Barbara Heald INFORMATION CALL: 914-360-5599 12NOV2003 17:00 12. DISCOUNT TERMS 110. THIS ACQUISITON IS 111. DELIVERY FOR 9. ISSUED BY CODE FOB DESTINATION UNLESS BLOCK IS MARKED UNTESTRICTED ISET ASIDE: % FOR CPA-Contracting Activity SMALL BUSINESS • SEE SCHEDULE | Republican Presidential Compound I HUBZONE SMALL Baghdad, Irag BUSINESS 130. ODER CODER FAS A5 0TE 200) APO AE 09335 13b. RATING NAICS: 14. METHOD OF SOLICITATION SIZE STANDARD: DIFB [ RFP IX/ RFO 16. ADMINISTERED BY 15. DELIVER TO CODE CODE MOE Warehouse Same as Block 9 Baghdad, Iraq 17a. CONTRACTOR/ CODE 18a. PAYMENT WILL BE MADE BY CODE OFFEROF TELEPHONE NO. 186. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW [176. OHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN IS CHECKED SEE ADDENDUM QUANTITY UNIT AMOUNT UNIT PRICE ITEM NO. SCHEDULE OF SUPPLES/SERVICES AMBERLITE RESINS LI 0001 36000 Amberlite (C100) strongly acid cation resin LI 0002 25000 Amberlite (A200) strongly basic anion resin LI 25000 0003 Amberlite (A100) weakly basic anion resin (Use Reverse and/or Attach Additional Sheets as Necessary) 26. TOTAL AWARD AMOUNT (For Govt. Use Only) 25. ACCOUNTING AND APPROPRIATION DATA X ARE 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 X ARE NOT ATTACHED 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 ELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON AN DDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED HEREII 731a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30a. SIGNATURE OF OFFEROR/CONTRACTOR 30c. DATE SIGNED 731C. 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 AMOUNT UNIT UNIT PRICE QUANTITY SCHEDULE OF SUPPIES/SERVICES ITEM NO. 6000 LI 0004 Amberlite (H.M.B.C100) strongly cation resin 0005 LI 6000 Amberlite (H.M.B.A) strongly basic anion resin Terms of Sale: CIF (Cost, Insurance, Freight) via ground transportation to Baghdad, Iraq Delivery: MOE Warehouse, Baghdad, Iraq Instructions: 1. All shipments shall be marked "Iraq Reconstruction Program" and "Shipment in Transit for Humanitarian Purposes". 2. The contract number shall be clearly and visibly printed on each package, bundle, pallet and container. 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 134. VOUCHER NUMBER 33. SHIP NUMBER 737. CHECK 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