Brand Name or Equal Zeiss/Cirrus HD-OCT Model 5000

REQUEST FOR QUOTATIONS (THIS IS NOT AN ORDER) 1. REQUEST NO. RFQ-13-073 7. DELIVERY OTHER [XI FOB DESTINATION (See Schedule) 9. DESTINATION a. NAME OF CONSIGNEE Aberdeen, SD 57401 - 5b. FOR INFORMATION CALL (NO COLLECT CALLS) Linda.Sucss@ihs.gov 1 605 1 685-6771x17 TO: 10. PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSNESS (Date):8/27/2013 12:OOv.m. MST PAGE OF PAGES 1-2 2. DATE ISSUED RATING 08/28/2013 5A. ISSUED BY Aberdeen Area Indian Health Service, Division of Acquisition Management 115 4th Ave. SE. Room 309, Federal Building THIS IS A SMALL BUSINESS SET-ASIDE NAME Linda M. Suess, Contract Specialist IMPORTANT: This is a request for information, and quotations furnished are not offerors. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless othenvise indicated by quoter. Any representations andlor certifications attached to this Request for Quotations must be completed by the quoter. 6. DELIVER BY :09/30/2013 03. REQUISITION/PURCHASE REQUEST NO. IHS1205359 TELEPHONE NUMBER AREA CODE I NUMBER a. NAME 4. CERT.FOR NAT. DEF. UNDER BDSA REG.2 AND/OR DMS REG. 1 b. COMPANY c. CITY d. STATE DESCRIPTION OF ITEM: BRAND NAME OR EQUAL 266002-1 142-879 ZElSS 1 CIRRUS HDOCT (MODEL 5000) VERSION 6.5 WIFASTTRAC, ALL PRIOR LICENSED FEATURES, ADVANCED RPE, GCA AlVD ANTERIOR SEGMENT, PRINTER & TABLE I QUANTITY 1 UNIT I UNIT PRICE 1 AMOUNT $_____________________ (b) SIGNATURE OF PERSON AUTHORIZED TO SIGN QUOTATION B. ADDRESS c. COUNTY a. NAME (Type OR PRINT) AUTHORIZED FOR LOCAL REPRODUCTION FormFlow/Delrina Inc. STANDARD FORM 18 (REV 6-95) Previous edition not usable Prescribed by GSA-FAR (48 CFR) 53-215-1(a) 15. DATE OF QUOTATION 16. SlGNER b. TELEPHONE AREA CODE d. CITY e. STATE f. ZIP CODE c. TITLE (type orprint) NUMBER CONTINUATION FOR RFO-013- DUNS & BRADSTREET NUMBER: (The Duns & Bradstreet number is required. Provided you do not have it, you may call 866-705-5711 and obtain one.) You willneed a DUNS & BRADSTREET NUMBER to be awarded the purchase order. WHAT IS SAM? The System for Award Management (SAM) is a Federal Government owned and operated free web site that consolidates the capabilities in CCWFedReg, ORCA, and EPLS. FORMER CCR REGISTRANTS If you had an active record in CCR, you have an active record in SAM. You do not need to do anything in SAM at this time, unless a change in your business circumstances requires updates to your Entity record(s) in order for you to be paid or to receive an award or you need to renew your Entity(s) prior to its expiration. SAM will send notifications to the registered user via email 60, 30, and 15 days prior to expiration of the Entity. To update or renew your Entity records(s) in SAM you will need to create a SAM User Account and link it to your migrated Entity records. You do not need a user account to search for registered entities in SAM by typing the DUNS number or business name into the search box. FEDERAL TAX ID NUMBER: EMAIL ADDRESS: NET TERMS:________________