PRCHQM2 ;WISC/KMB-MANUAL PRINT OF RFQ ;7/23/99 15:58 ;;5.1;IFCAP;;Oct 20, 2000 ;Per VHA Directive 10-93-142, this routine should not be modified. S P=1 U IO D HEADER^PRCHQM3 ;print RFQ, vendor, PA, delivery info U IO W ! F I=1:1:90 W "_" W !,"REQUEST FOR MANUAL QUOTATIONS | The Notice of Small Business-Small Purchase Set-Aside" W !," (this is not an order)",?31,"| on the last page of this form" W !,?31,"| _____is _____is not applicable." W ! F I=1:1:31 W "_" W "|" F I=1:1:58 W "_" W !,"1. REQUEST NO. |2.DATE ISSUED |3.REQUISITION/PURCHASE REQUEST |4.CERT.FOR.NAT. |RATING" W !,?15,"|",?31,"| NO.",?63,"| DEF. UNDER BDSA |" W !,?15,"|",RDATE,?31,"|",?33,RFQNUM,?63,"| REG.2 AND/OR DMS|" W !,?15,"|",?31,"|",?63,"| REG.1->",?81,"|" W ! F I=1:1:15 W "_" W "|" F I=1:1:15 W "_" W "|" F I=1:1:31 W "_" W "|" F I=1:1:17 W "_" W "|" F I=1:1:8 W "_" W !,"5A.ISSUED BY ",ISS(1),?63,"|6.DELIVER BY (Date)" W !,?15,ISS(2),?63,"|" W !,?15,ISS(4),",",ISS(5)," ",ISS(6),?63,"|",?65,ADATE W !,?63,"|" F I=1:1:26 W "_" W ! F I=1:1:63 W "_" DELIV ; W "|7.DELIVERY" W !,"5B.FOR INFORMATION CALL:(Name & phone no.) (No collect calls) |(unless otherwise" W !,?63,"| specified)" W !?4,PA,?31,"PHONE: ",PPHONE,?63,"| FOB",?83,"OTHER" W !?33,"FAX: ",$G(PAFAX),?63,"|",FOB1," DESTINATION",?81,FOB2,"(See",! W:$G(PRCEMAIL)'="" ?4,"E-MAIL: ",PRCEMAIL W ?63,"|",?81,"schedule)" W ! F I=1:1:63 W "_" W "|" F I=1:1:26 W "_" W !,"8.TO: NAME AND ADDRESS, INCLUDING ZIP CODE",?63,"|9.DESTINATION (Consignee" W !,?10,SRC(1),?63,"| and address, using ZIP)" W !,?10,SRC(2),?63,"| ",$E(FDES1,1,21) W !,?10,SRC(3),?63,"| ",FDES2 W !,?10,SRC(6),",",SRC(7)," ",SRC(8),?63,"| ",FDES3 W !,"PHONE: ",VENPH,?33,"FAX: "_$G(VENFAX),?63,"| ",FDES4,! F I=1:1:63 W "_" W "|" F I=1:1:26 W "_" W !,"10.PLEASE FURNISH QUOTATIONS TO",?32,"|11.BUSINESS CLASSIFICATION (check appropriate boxes)" W !," THE ISSUING OFFICE ON OR BE-",?32,"|",?34,BC1,?36,"_SMALL",?58,BC2,?60,"_OTHER THAN SMALL" W !," FOR CLOSE OF BUSINESS (date)",?32,"|",?34,BC3,?36,"_VIETNAM VETERAN-OWNED",?58,BC4,?60,"_WOMEN-OWNED" W !,?5,CBDATE,?32,"|",?34,BC5,?36,"_DISADVANTAGED",?58,BC6,?60,"_DISABLED VETERAN-OWNED" W ! F I=1:1:32 W "_" W "|" F I=1:1:57 W "_" W !!,"IMPORTANT: This is a request for information, and quotations furnished are" W !,"not offers. If you are unable to quote, please so indicate on this form and" W !,"return it. This request does not commit the Government to pay any costs " W !,"incurred in the preparation of the submission of this quotation or to " W !,"contract for supplies or services. Supplies are of domestic origin unless " W !,"otherwise indicated by quoter. Any representations and/or certifications" W !,"attached to this Request for Quotations must be completed by the quoter." W ! F I=1:1:90 W "_" SCH ; W !,?10,"12.SCHEDULE (Include applicable Federal, State and local taxes)",! F I=1:1:90 W "_" ; W !,"ITEM #",?7,"| DELIVERY LOCATION &",?35,"|"," QTY ",?42,"| UNIT ",?47,"| UNIT PRICE ",?54,"| AMOUNT ",?62,"| DEL. DATE " W !,?7,"| DESCRIPTION",?35,"|",?42,"|",?49,"|",?62,"|",?75,"|" W !,"__(a)__",?7,"|_____________(b)___________",?35,"|_(c)__",?42,"|_(d)__",?47,"|_____(e)____",?54,"|_____(f)____",?62,"|_____(g)_____" S LN="" F S LN=$O(^TMP($J,LN)) Q:LN="" D .S LD=0 F S LD=$O(^TMP($J,LN,LD)) Q:LD="" D ..I $Y>60 D HEADER^PRCHQM3 ..W ! I LD=1 W $P(^TMP($J,LN,LD),"^") ..W ?7,"|",$P(^TMP($J,LN,LD),"^",2),?35,"|",$P(^TMP($J,LN,LD),"^",3),?42,"|",$P(^TMP($J,LN,LD),"^",4) ..W ?49,"|",?62,"|",?75,"|",$P(^TMP($J,LN,LD),"^",6) .D ITEMS^PRCHQM3 D HEADER^PRCHQM3,METRIC^PRCHQM3 DISC ; W !,"13.DISCOUNT FOR PROMPT",?22,"|10 CALENDAR DAYS",?40,"|20 CALENDAR DAYS",?58,"|30 CALENDAR DAYS",?76,"|CALENDAR DAYS" W !,?6,"PAYMENT--->",?22,"|",?39,"%|",?57,"%|",?75,"%| %" W !,?22,"|",?40,"|",?58,"|",?76,"|" W ! F I=1:1:90 W "_" W !,"NOTE: Last page must also be completed by the quoter." W ! F I=1:1:90 W "_" W !,"14.NAME AND ADDRESS OF QUOTER (Street, |15.SIGNATURE OF PERSON AUTHORIZED |16.QUOTATION" W !," city,county, State and ZIP code)",?40,"| TO SIGN QUOTATION",?76,"| DATE" W !,?40,"|",?76,"|",!,?40,"|" F I=1:1:35 W "_" W "|_____________" W !,?40,"|17.NAME AND TITLE OF SIGNER (Type |18.PHONE NO." W !,?40,"| or print)",?76,"| (area code)" W !,?40,"|",?76,"|" W ! F I=1:1:40 W "_" W "|" F I=1:1:35 W "_" W "|_____________" Q