Simplified
Acquisition
Worksheet
Instructions
(
EPA
Form
1900­
13)

This
worksheet
applies
to
simplified
acquisitions
between
$
2,500
and
$
100,000,
and
up
to
$
5,000,000
when
simplified
acquisition
procedures
are
used
to
acquire
commercial
items
using
the
Test
Program
for
Certain
Commercial
Items
(
FAR
Subpart
13.5).

Block
1:
Insert
name
of
each
vendor/
offeror
contacted.
At
a
minimum,
three
vendors/
offerors
must
be
solicited.

Block
2:
Insert
street
address
for
each
vendor/
offeror
contacted.

Block
3:
Insert
city,
state
and
zip
code
for
each
vendor/
offeror
contacted.

Block
4:
Check
type
of
business
associated
with
each
vendor/
offeror.
(
check
all
that
apply)
Indicate
the
NAICS
code
and
size
standard
pertaining
to
the
acquisition.
(
see
FAR
19.303)

Block
5:
Indicate
number
of
days
required
for
delivery.
Include
exact
date
for
delivery
on
the
purchase
order.
(
see
FAR
13.302­
1(
b)(
2))

Block
6:
Check
point
of
delivery
for
supplies.
(
see
FAR
Part
47)

Block
7:
Include
GSA
Federal
Supply
Schedule
contract
number
if
applicable.

Block
8:
Check
 
oral 
or
 
written 
to
indicate
how
the
quote/
offer
was
received.
Include
written
quote/
offer
received
in
file.

Block
9:
Indicate
the
name
of
the
person
providing
the
quote/
offer.

Block
10:
Indicate
the
telephone
number,
facsimile
number,
and
E­
mail
address
for
the
person
providing
the
quote/
offer.

Block
11:
Indicate
the
date
requested
the
quote/
offer
and
the
date
received
quote/
offer.

Block
12:
Indicate
the
prompt
payment
discounts
identified
by
the
vendor/
offeror.
(
see
FAR
13.302­
1(
b)(
5)
and
14.408­
3)

Block
13:
Briefly
describe
the
items
being
purchased
in
accordance
with
the
Procurement
Request
(
PR).
Continue
on
page
2
of
the
worksheet
if
necessary.
Each
item
must
be
precisely
identified
on
the
purchase
order.
(
see
FAR
13.302­
1)

Block
14:
Identify
discounts
associated
with
each
item
in
Block
13.
Provide
explanation
in
Block
13
or
on
separate
sheet.

Block
15:
Identify
shipping
charges
if
FOB
Origin.

Block
16:
Identify
total
price
quote/
offer
from
each
vendor/
offeror.

Block
17:
The
contracting
officer
and
the
reviewing
or
approving
official
(
if
any)
signs
and
dates
the
Simplified
Acquisition
Worksheet
to
identify
who
completed
and
reviewed
or
approved
the
documentation
for
award.

Block
18­
23:
Self­
explanatory.
This
data
refers
to
the
vendor/
offeror
who
receives
the
award.
Page
1
of
3
EPA
Form
1900­
13
(
Rev.
9­
02)
Previous
editions
are
obsolete.
Simplified
Acquisition
Worksheet
Reference
PR
No.

1.
Name
of
Vendor/
Offeror
2.
Street
Address
3.
City,
State,
Zip
Code
4.
Type
of
Business
NAICS
Code
Size
Standard
Q
Small
Business
Q
SDB
Q
8(
a)
Q
Woman­
Owned
Q
HUBZone
Q
Service
Disabled
Veteran
Q
Other
Q
Small
Business
Q
SDB
Q
8(
a)
Q
Woman­
Owned
Q
HUBZone
Q
Service
Disabled
Veteran
Q
Other
Q
Small
Business
Q
SDB
Q
8(
a)
Q
Woman­
Owned
Q
HUBZone
Q
Service
Disabled
Veteran
Q
Other
5.
Days
Required
for
Delivery
6.
FOB
Point
Q
Destination
Q
Origin
Q
GBL/
CBL
Q
Destination
Q
Origin
Q
GBL/
CBL
Q
Destination
Q
Origin
Q
GBL/
CBL
7.
GSA
FSS
Contract
Number
8.
Type
of
Quote/
Offer
Q
Oral
Q
Written
Q
Oral
Q
Written
Q
Oral
Q
Written
9.
Person
Providing
the
Quote/
Offer
10.
Telephone
Number
Fax
Number
E­
mail
Address
11.
Date
Requested/
Received
Quote/
Offer
12.
Prompt
Payment
Discounts
Net
%
days
Net
%
days
Net
%
days
13.
Item
Description
Qty/
Unit
Unite
Price
Total
Unit
Price
Total
Unit
Price
Total
14.
Less
Discounts
15.
Plus
Shipping
Charges
(
If
FOB
Origin)

16.
Total
Price
(
include
total
from
page
2)

17.
Contracting
Officer's
Signature
Date
Signature
of
Person
Reviewed/
Approved
Date
Page
2
of
3
EPA
Form
1900­
13
(
Rev.
9­
02)
Previous
editions
are
obsolete.
Continuation
for
Block
13
Name
of
Vendor/
Offeror
13.
Item
Description
(
continued)
Qty/
Unit
Unite
Price
Total
Unit
Price
Total
Unit
Price
Total
Total
Price
(
include
on
page
1)
Page
3
of
3
EPA
Form
1900­
13
(
Rev.
9­
02)
Previous
editions
are
obsolete.
18.
Cross
Reference
Documentation
A.
PO/
DO/
TO/
BPA
Contract
Number:
B.
Name
of
Vendor/
Offeror:
C.
TIN
for
Vendor/
Offeror:
D.
Date
Verified
Excluded
Parties
List
System:

19.
Competition
Requirements
Q
Competitive
____
no.
vendors
solicited
no.
vendors
responded
Q
Competitive,
low
offer
Q
Competitive,
other
than
low
offer
(
see
file
for
explanation)
Q
Other
(
see
file
for
explanation)

Q
Non­
competitive
Q
Sole
Source
Justification
(
included
in
file)

20.
Method
of
Procurement
(
check
all
that
apply)

A.
Mandatory
Source
(
FAR
Part
8)
Q
Agency
Inventories
Q
Excess
from
other
agencies
Q
Federal
Prison
Industries
Q
Committee
for
Purchase
From
People
Who
Are
Blind
or
Severely
Disabled
Q
Wholesale
Supply
Sources
Q
Federal
Supply
Schedules
Q
Commercial
Sources
Q
Public
Utility
Services
Q
Printing
and
Related
Supplies
Q
Leased
Motor
Vehicles
Q
Strategic
and
Critical
Materials
from
Inventories
Exceeding
Defense
National
Stockpile
Requirements
Q
Helium
Q
None
B.
Other
Contracts
Q
GWAC
No.
Q
EPA
Contract
No.
Q
GSA
FSS
No.
Q
BPA
No.
Q
None
C.
Commercial
Item
Acquisition
Q
Streamlined
procedures
(
document
procedures
per
FAR
12.602)
Q
Test
Program
for
Certain
Commercial
Items
(
document
procedures
per
FAR
13.501)
Q
None
21.
Electronic
Commerce
Utilized
(
check
all
that
apply)

Q
FedBizOpps
Q
FedBid.
com
Q
SPEDI
Q
ICMS
Q
EPA's
sources
sought
announcements
Q
Office
of
Small
Disadvantaged
Business
Utilization
Database
Q
Small
Business
Administration's
PRO­
Net
database
Q
General
Services
Administration
Advantage
Q
Other
Q
None
22.
Reasonableness
of
Price
(
FAR
13.106­
3(
a))

The
price
for
this
award
is
fair
and
reasonable
based
upon
the
following:
(
check
all
that
apply)

Q
Independent
Government
Estimate
Q
Effective
competition
from
sources
obtained
Q
Price
set
by
statute
or
tariff
Q
Other
contract
determined
price
fair
and
reasonable
Q
Current
price
list,
catalog,
advertisement
(
attach
copy)
Q
Market
research
conducted
(
see
file
for
details)
Q
Comparisons
with
prices
of
same/
similar
items
in
related
industry
(
see
file
for
details)
Q
Value
analysis
(
see
file
for
explanation)
Q
Contracting
officer's
personal
knowledge
of
item
(
see
file
for
explanation)
Q
Other
(
see
file
for
explanation)
Q
Comparison
with
prices
found
reasonable
based
on
previous
purchases
as
stated
below:

Order
No.
Vendor/
Offeror
Date
Unit
Price
Paid
23.
Justification
for
Not
Using
Small
Business
Set­
Aside
(
FAR
19.501(
d))

This
acquisition
is
not
set­
aside
for
small
business
because:
(
check
all
that
apply)

Q
The
order
is
awarded
to
a
mandatory
source.
Q
The
order
is
issued
against
a
FSS
or
other
Government
contract.
Q
The
award
is
non­
competitive.
(
see
file
for
explanation)
Q
The
award
is
a
foreign
purchase
pursuant
to
FAR
25.
Q
There
is
no
reasonable
expectation
of
obtaining
quotes/
offers
from
two
or
more
responsible
small
business
concerns
that
will
be
competitive
in
terms
of
market
price,
quality,
and
delivery.
(
FAR
19.502­
2(
a))
Q
No
reasonable
quotes/
offers
were
received
from
small
businesses.
(
FAR
19.502­
2(
a))
