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Solicitation/Contract/Order for Commercial Items 1 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE 1 OF 73 0011648309 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30 2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE W9114F21Q0105 11-Jun-2021 7. FOR SOLICITATION a. NAME b. TELEPHONE NUMBER (No Collect Calls) 8. OFFER DUE DATE/LOCAL TIME INFORMATION CALL: ROGER V. LEAKE 314-590-4098 12:00 PM 22 Jun 2021 9. ISSUED BY CODE W9114F 10. THIS ACQUISITION IS X UNRESTRICTED OR SET ASIDE: % FOR: WOMEN-OWNED SMALL BUSINESS (WOSB) W40M RHCO USAHCA EUROPE SMALL BUSINESS ELIGIBLE UNDER THE WOMEN-OWNED KIRCHBERG KASERNE BLDG 3705 SMALL BUSINESS PROGRAM LANDSWEILER STRASSE HUBZONE SMALL NAICS: LANDSTUHL 66849 EDWOSB BUSINESS 621910 SERVICE-DISABLED TEL: SIZE STANDARD: VETERAN-OWNED 8(A) FAX: SMALL BUSINESS $16,500,000 11. DELIVERY FOR FOB DESTINA- 12. DISCOUNT TERMS 13b. RATING TION UNLESS BLOCK IS 13a. THIS CONTRACT IS A RATED ORDER UNDER MARKED DPAS (15 CFR 700) 14. METHOD OF SOLICITATION SEE SCHEDULE X RFQ IFB RFP 15. DELIVER TO CODE W812BX 16. ADMINISTERED BY CODE SHAPE HEATLHCARE FACILITY SHAPE HEATLHCARE FACILITY BLG 401 AVENIE D'OSLO SHAPE 7010 TEL: FAX: 17a.CONTRACTOR/ CODE FACILITY 18a. PAYMENT WILL BE MADE BY CODE OFFEROR CODE TELEPHONE NO. 17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK SUCH ADDRESS IN OFFER BELOW IS CHECKED SEE ADDENDUM 19. 20. 21. 22. 23. 24. ITEM NO. SCHEDULE OF SUPPLIES/ SERVICES QUANTITY UNIT UNIT PRICE AMOUNT SEE SCHEDULE 25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Gov t. Use Only ) 0 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 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 X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 29. AWARD OF CONTRACT: REF. COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND OFFER 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 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED (TYPE OR PRINT) TEL: EMAIL: AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (REV. 2/2012) PREVIOUS EDITION IS NOT USABLE Prescribed by GSA – FAR (48 CFR) 53.212 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS PAGE 2 OF73 (CONTINUED) 19. 20. 21. 22. 23. 24. ITEM NO. SCHEDULE OF SUPPLIES/ SERVICES QUANTITY UNIT UNIT PRICE AMOUNT SEE SCHEDULE 32a. QUANTITY IN COLUMN 21 HAS BEEN RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________ 32b. SIGNATURE OF AUTHORIZED GOVERNMENT 32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE REPRESENTATIVE 32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE 33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED 36. PAYMENT 37. CHECK NUMBER CORRECT FOR COMPLETE PARTIAL FINAL PARTIAL FINAL 38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY 41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print) 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE 42b. RECEIVED AT (Location) 42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (REV. 2/2012) BACK PREVIOUS EDITION IS NOT USABLE Prescribed by GSA – FAR (48 CFR) 53.212 W9114F21Q0105 Page 3 of 73 Section SF 1449 - CONTINUATION SHEET ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 160 Each AMBULANCE SERVICE FOR SHAPE/BRUSSELS FFP Non-personal Ambulance Services during High School Sporting Events such as football, basketball, wrestling, soccer, cheerleaders, etc.). The Contractor shall furnish all personnel, equipment, vehicles, supplies, management and supervision necessary to provide/coordinate emergency medical service during DoDDS interscholastic contact sports events within the SHAPE and Brussels Healthcare Facilities geographical areas of responsibility. The Contractor shall provide, at a minimum, a properly equipped ambulance vehicle, an ambulance driver and a trained/qualified Emergency Medical Technician, EMT I-85, or Belgian equivalent as described in the Walloon Government’s executive decision dated 12 May 2005 as to the application of the decree dated 29 April 2004 on the organization of medico- sanitary transport (Royal Decree #78 dated 11/10/1967; Belgian Official Journal (Moniteur belge) 27 May 2005, p.24764), for the duration of all scheduled contact sports events. All services provided by the Contractor shall be covered by the terms and conditions of this contract, performed in accordance with the Performance Work Statement (PWS), all applicable United States (U.S.) and local laws, regulations, standards, provisions and directives. The unit of measure “Each” is defined as a 60-minute period, or the fraction thereof. Base Period of Performance: 01 October 2021 - 30 September 2022 FOB: Destination PURCHASE REQUEST NUMBER: 0011648309 PSC CD: V225 NET AMT W9114F21Q0105 Page 4 of 73 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0002 20 Each Surcharge for Sport Events in Brussels FFP The Contractor is entitled to a surcharge fee when Ambulance Services are performed in the Brussels area, 75 kilometers away from the Contractor business location, Mons. FOB: Destination PURCHASE REQUEST NUMBER: 0011648309 PSC CD: V225 NET AMT W9114F21Q0105 Page 5 of 73 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 1001 160 Each OPTION AMBULANCE SERVICE FOR SHAPE/BRUSSELS FFP Non-personal Ambulance Services during High School Sporting Events such as football, basketball, wrestling, soccer, cheerleaders, etc.). The Contractor shall furnish all personnel, equipment, vehicles, supplies, management and supervision necessary to provide/coordinate emergency medical service during DoDDS interscholastic contact sports events within the SHAPE and Brussels Healthcare Facilities geographical areas of responsibility. The Contractor shall provide, at a minimum, a properly equipped ambulance vehicle, an ambulance driver and a trained/qualified Emergency Medical Technician, EMT I-85, or Belgian equivalent as described in the Walloon Government’s executive decision dated 12 May 2005 as to the application of the decree dated 29 April 2004 on the organization of medico- sanitary transport (Royal Decree #78 dated 11/10/1967; Belgian Official Journal (Moniteur belge) 27 May 2005, p.24764), for the duration of all scheduled contact sports events. All services provided by the Contractor shall be covered by the terms and conditions of this contract, performed in accordance with the Performance Work Statement (PWS), all applicable United States (U.S.) and local laws, regulations, standards, provisions and directives. The unit of measure “Each” is defined as a 60-minute period, or the fraction thereof. First Option Period: 01 October 2022 - 30 September 2023 FOB: Destination PSC CD: V225 NET AMT W9114F21Q0105 Page 6 of 73 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 1002 20 Each OPTION Surcharge for Sport Events in Brussels FFP The Contractor is entitled to a surcharge fee when Ambulance Services are performed in the Brussels area, 75 kilometers away from the Contractor business location, Mons. FOB: Destination PSC CD: V225 NET AMT W9114F21Q0105 Page 7 of 73 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 2001 160 Each OPTION AMBULANCE SERVICE FOR SHAPE/BRUSSELS FFP Non-personal Ambulance Services during High School Sporting Events such as football, basketball, wrestling, soccer, cheerleaders, etc.). The Contractor shall furnish all personnel, equipment, vehicles, supplies, management and supervision necessary to provide/coordinate emergency medical service during DoDDS interscholastic contact sports events within the SHAPE and Brussels Healthcare Facilities geographical areas of responsibility. The Contractor shall provide, at a minimum, a properly equipped ambulance vehicle, an ambulance driver and a trained/qualified Emergency Medical Technician, EMT I-85, or Belgian equivalent as described in the Walloon Government’s executive decision dated 12 May 2005 as to the application of the decree dated 29 April 2004 on the organization of medico- sanitary transport (Royal Decree #78 dated 11/10/1967; Belgian Official Journal (Moniteur belge) 27 May 2005, p.24764), for the duration of all scheduled contact sports events. All services provided by the Contractor shall be covered by the terms and conditions of this contract, performed in accordance with the Performance Work Statement (PWS), all applicable United States (U.S.) and local laws, regulations, standards, provisions and directives. The unit of measure “Each” is defined as a 60-minute period, or the fraction thereof. Second Option Period: 01 October 2023 - 30 September 2024 FOB: Destination PSC CD: V225 NET AMT W9114F21Q0105 Page 8 of 73 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 2002 20 Each OPTION Surcharge for Sport Events in Brussels FFP The
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