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PAGE 1 OF
7. REQUISITION NUMBER
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
Z-00122
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
DABV01-03-Q-2154
10NOV2003
b. TELEPHONE NUMBER (Na collect
8. OFFER DUE DATE/
a. NAME
calls)
7. FOR SOLICITATION
LOCAL TIME
Barbara Heald
INFORMATION CALL:
914-360-5599
19NOV2003 17:00
12. DISCOUNT TERMS
110. THIS ACQUISITON IS
111. DELIVERY FOR
9. ISSUED BY
CODE
FOB DESTINATION
UNLESS BLOCK IS
MARKED
UNTESTRICTED
% FOR
IsET ASIDE:
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:
[ RFP
DIFB
[X1 RFO
16. ADMINISTERED BY
15. DELIVER TO
CODE
CODE
MOE Warehouse
Same as Block 9
Baghdad, Iraq
CODE
18a. PAYMENT WILL BE MADE BY CODE 17a. COMEROCTORT TELEPHONE NO.
186. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW [176. GEECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN IS CHECKED SEE ADDENDUM QUANTITY UNIT UNIT PRICE AMOUNT SCHEDULE OF SUPPLIES/SERVICES ITEM NO.
PUMPS, BOILER FEEDWATER - BAGHDAD
SOUTH
GENUINE REPLACEMENT PARTS - DO NOT
SUBSTITUTE
See continuation pages for list of line items.
(Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA
26. TOTAL AWARD AMOUNT (For Govt. Use Only) 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 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
ELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON AN
DDITIONAL SHEETS SUBJECT ТО THE TERMS AND CONDITIONS SPECIFIED HEREIN
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
QUANTITY
AMOUNT
UNIT
SCHEDULE OF SUPPLIES/SERVICES
UNIT PRICE
ITEM NO.
Manufactured by:
Pacific Pump (Flowserve)
Ghassan Assi
Phone: 00961 5 95 11 91 or 92 Fax: 00961 5 95 11 93 Mobile: 00961 3 23 20 92 Email: GAssi@flowserve.com Delivery: CIF (Cost, Insurance, Freight) to Baghdad, Iraq, via ground transportation Instructions:
1. All shipments shall be marked "BAGHDAD SOUTH PLANT", "Iraq Reconstruction Program" and "Shipment in Transit for Humanitarian Purposes".
2. The contract number shall be clearly and visibly 32a. QUANTITY IN COLUMN 21 HAS BEEN LI ACCEPTED, AND CONFORMS O THE CONTRACT, EXCEPT AS NOTED:
• RECEIVED
• INSPECTED
732d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT 732c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE REPRESENTATIVE 32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE
324. TELPHONE NUMBER OF AUTHORZED 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