This is an SDVOSB set-aside. Underestimated cost offers will not be considered. Costs will be evaluated for reasonability. PAGE 1 OF 1. REQUISITION NO. 2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL TIME 9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR: SMALL BUSINESS HUBZONE SMALL BUSINESS SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER THE WOMEN-OWNED SMALL BUSINESS PROGRAM EDWOSB 8(A) NAICS: SIZE STANDARD: 11. DELIVERY FOR FOB DESTINA- TION UNLESS BLOCK IS MARKED SEE SCHEDULE 12. DISCOUNT TERMS 13a. THIS CONTRACT IS A RATED ORDER UNDER DPAS (15 CFR 700) 13b. RATING 14. METHOD OF SOLICITATION RFQ IFB RFP 15. DELIVER TO CODE 16. ADMINISTERED BY CODE 17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE TELEPHONE NO. DUNS: DUNS+4: PHONE: FAX: 17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED SEE ADDENDUM 19. 20. 21. 22. 23. 24. ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT (Use Reverse and/or Attach Additional Sheets as Necessary) 25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 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 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND 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 (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED AUTHORIZED FOR LOCAL REPRODUCTION (REV. 2/2012) PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212 7. FOR SOLICITATION INFORMATION CALL: STANDARD FORM 1449 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 41 None 550-18-3-354-0276 36C25218Q0868 04-10-2018 Pauline Ludwig 414-844-4868 0069D Great Lakes Acquisition Center (GLAC) Department of Veterans Affairs 115 S 84th St, Suite 100 Milwaukee WI 53214-1476 x 100 x N 324110 1500 Employees N/A 0069D Department of Veterans Affairs VA Illiana Health Care System 1900 E Main St Danville IL 61832 0069D Great Lakes Acquisition Center (GLAC) Department of Veterans Affairs 115 S 84th St, Suite 100 Milwaukee WI 53214-1476 Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 Fuel Purchase Order 550-C8 Please reference all correspondence and invoices with the above number The Contracting officer is the only person authorized to modify or make changes to this contract. 550-3680162-354-852100-2654-550-C8 010020168 x x x 1 Pauline Ludwig Contracting Officer SECTION B - CONTINUATION OF SF 1449 BLOCKS CONTRACT ADMINISTRATION DATA (Continuation from Standard Form 1449, block 18A.) 1. Contract Administration: All contract administration matters will be handled by the following individuals: A. CONTRACTOR: B. GOVERNMENT: Pauline Ludwig, Contract Specialist Great Lakes Acquisition Center 115 S 84th St. Milwaukee, WI 53214 (414) 844-4868 2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: [X] 52.232-33, Payment by Electronic Funds Transfer System for Award Management (Jul 2013) 3. INVOICES: Invoices shall be submitted in arrears in accordance with: a. 852.232-72 Electronic Submission of Payment Requests (Nov 2012) b. Upon Acceptance of Items FACSIMILE, E-Mail, and Scanned Documents are Not Acceptable forms of Submission for Payment Requests. For assistance setting up e-Invoice, the below information is provided: *OB10 e-Invoice Setup Information: 1-877-489-6135 *OB10 e-Invoice email: [email protected] *FSC e-invoice contact information: 1-877-353-9791 *FSC e-invoice email: [email protected] BASIS OF AWARD: The Government will make the award to the most fair and reasonably priced offer. SCHEDULE OF SUPPLIES/SERVICES AND PRICES/COSTS (SF 1449, Continuation of Blocks 19 24) Contractor shall provide the following fuel for the VA Illiana Health Care System, Danville, IL. All fuel shall be delivered to the designated destination by close of business the next business day. Delivery times are M-F, 8am-2pm. Delivery orders will be e-mailed to a dispatch address provided by the contractor. Offeror shall provide the following fuel: Item No. Description QTY UNIT UNIT PRICE EST TOTAL PRICE 1 #2 Summer blend diesel fuel for on road vehicle use (no dye) 1300 gallon 2 Regular unleaded gasoline 2600 gallon 3 E-85 Ethanol 1500 gallon TOTAL Salient Characteristics: Inspection of Supplies: Supplies delivered on this contract shall conform to all Federal, State, and Local environmental requirements applicable to the geographic location of receiving activity on the date of delivery. The Contractor shall provide and maintain an inspection SYSTEM ACCEPTABLE TO THE Government covering supplies under this contract and shall tender to the Government, for acceptance. Inspection records will be provided if requested by the Contracting Officer. The Government has the right to inspect and test all supplies called for in this contract, to the extent practicable at all places and times, including manufacture and in any event before acceptance. The Government shall perform inspections and test in a manner that will not unduly delay work. The Government has the right to reject or to require correction on nonconforming supplies. Supplies are nonconforming when they are defective in material or workmanship or are not in conformity requirements. The Government may reject nonconforming supplies with or without disposition instructions. Inspection and test by Government does not relieve the Contractor of responsibility for defects or other failures to meet contract requirements discovered before acceptance. Delivery Requirements No multiple day deliveries; delivery must be made in one day Quantities will be ordered as requested by the Government exact quantities will be confirmed with the Contracting Officer. Deliveries must be made Monday through Friday between the hours of 8am and 2pm. Tanker trucks must be equipped with 100ft of hose. Annotation of Shipping Documents: For deliveries when temperature compensating meters are used to determine quantity, the shipping documents shall be annotated with API gravity (or density), net quantity and a statement that a temperature compensating meter was used to determine quantity. For deliveries when quantity is determined without volume correction to 60°F, the shipping document shall be annotated with API gravity (or density), gross quantity, and a statement that volume correction was not required. Upon completion of each delivery, the contractor shall provide manifest report for supplies delivered. Measurement Standards: All measurement and calibrations made to determine quantity should be in accordance with the most recent edition of API Manual of Petroleum Measurement Standards. Shipment: 1. The Contractor shall furnish serially numbered seals and effectively seal transport trucks. Placards, as required by 49 CFR 172.506 and 49 CFR 172.508 shall be furnished and affixed to all tank trucks by the Contractor unless placards are already affixed. The Contractor shall inspect all shipping conveyances prior to loading to insure product loaded will not be lost or contaminated by condition of equipment. Tank truck inspections must be performed by qualified Contractor personnel. Delegation of this responsibility shall not be passed on to the tank truck operator/driver. Contractor Fuel Spills on Government Property: 1. Contractor shall clean up any of the fuel spills caused by a Contractor on Government property is the responsibility of the contractor. B.1 DELIVERY SCHEDULE ITEM NUMBER QUANTITY DELIVERY DATE 1-3 SHIP TO: VA Illiana Health Care System 1900 E Main St Danville, IL 61832 USA All Within 48 hrs of call-in

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