36C10G18R0003-009.xlsx
XLSX spreadsheet 18 KB Posted
- Attached to
- 36C10G18R0003 Biologics
- Solicitation number
- 36C10G18R0003
About this file
This document contains a modification request form and details of a federal contract opportunity for biologics. The modification request form allows a contractor to request updates to contracted items under a federal contract for biologics numbered 36C10G18R0003. The contractor must provide documentation including a list of items to be updated, product literature describing differences from original items, and suggested new pricing. The form requires certification that statements are true and requests contractor signature.
The related federal contract opportunity will issue as a request for proposal to establish multiple-award contracts for various types of biologics and biological implants to be used in surgeries and medical procedures by the Department of Veterans Affairs. The anticipated period of performance is a one-year base period with four one-year options. The agency intends to award up to 30 contracts from the resulting solicitation. The draft RFP will be posted on December 15, 2017 for industry feedback, and the final RFP will be posted on December 31, 2017. The solicitation will remain open through 2018 for proposal submissions in February, May, August and November to be evaluated.
36C10G18R0003 Attachment 7 - Modification Request Form v.1.xlsx
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Text version
Mod Request Form
| Yes | |
| No | Contract Number |
| X | Company Name |
| POC | |
| Phone |
| X | ||
| Modification Type | Product Refresh | |
| Technology Refresh | ||
| New Addition | ||
| Other: Insert Modification Request |
Product literature for the new items and a detailed description of the differences between the awarded items and the new items, and a specific analysis of the comparative advantages/disadvantages of the items involved:
Explanation of how new product is upgrade of technology in existing CLIN:
| TABLE BELOW TO BE COMPLETED FOR PRODUCT REFRESH/TECHNOLOGY REFRESH | ||||||||||
| CLIN to be Modified | Replacement Item | |||||||||
| (If Applicable) | Part Number | Identification of Manufacturer or Distributor | TAA Compliant (Y/N) | Contractor's Catalog List Price | Unit Price (w/o SLA fee) | Discount | Government Pricing (w/ SLA Fee) | |||
| $ 1,000.00 | 25% | $ 750.00 | ||||||||
| $ 897.00 | 26% | $ 663.78 | ||||||||
| $ 10.00 | 50% | $ 5.00 | ||||||||
| $ - 0 | 0% | $ - 0 | ||||||||
| $ - 0 | 0% | $ - 0 | ||||||||
| $ - 0 | 0% | $ - 0 | ||||||||
| $ - 0 | 0% | $ - 0 | ||||||||
| $ - 0 | 0% | $ - 0 | ||||||||
| $ - 0 | 0% | $ - 0 | ||||||||
| $ - 0 | 0% | $ - 0 |
| Please mark the boxes below to certify that the items have been submitted for consideration of the Modification request. | |||
| Product Refresh | X | Technology Refresh | X |
| (1) A list of specific awarded items to be updated (Attachment 1 and Attachment 2 with changes proposed); | (1) A list of awarded items which shall be updated. | ||
| (2) Product literature for the new items and a detailed description of the differences between the awarded items and the new items, and a specific analysis of the comparative advantages/disadvantages of the items involved; and | (2) Suggested new Item pricing | ||
| (3) Proper identification of any new product requirements and/or procedures related to those new products. | (3) Product literature for the new items and a detailed description of the differences between the awarded items and the new items, and a specific analysis of the comparative advantages/ disadvantages of the items involved. | ||
| I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify my firm from receiving the requested modification and may result in Termination or Partial Termination of our Agreement or Contract with the Government. | |||
| Name: | |||
| Title: | |||
| Date: | Requestor Signature |
New Additions
| TABLE TO BE COMPLETED FOR NEW ADDITIONS | ||||||||||||||||
| CLIN # | Product Name | Brand Name /Description | Description/ Salient Characteristic | HCPCS | TAA COMPLIANT (Yes/No) | Quantities Historically Purchased in VA (last 12 months) | Model Number | Name of Manufacturer | Manufacturer Part Number | Contract/Part Number | Unit of Issue (UOI) | Quantity per UOI | Maximum Quantity | Unit Price ($) | Unit Price Discount % | Extended/SLA Price |
Sheet1
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