Attachment 3 QSR Reporting Tool.xlsx
XLSX spreadsheet 42 KB Posted
- Attached to
- 6515--Patient Lifts and Slings for in home use
- Solicitation number
- 36C10G21R0009
About this file
This document includes a federal contract solicitation for electric and hydraulic patient lifts and slings for in-home use. The Department of Veterans Affairs seeks to establish an indefinite delivery, indefinite quantity contract over five years for these medical devices. Offerors must meet minimum technical requirements and provide competitive pricing. Proposals are due by April 15, 2021. The North American Industry Classification System codes for this procurement are 339113, with a small business size standard of 750 employees. Offerors must register in the System for Award Management database. The contract will cover delivery of equipment to multiple Department of Veterans Affairs locations across the continental United States, Hawaii, and U.S. territories.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 7 - RFP Questions complied.xlsx | XLSX spreadsheet | |
| 36C10G21R0009 0001.docx | DOCX document | |
| Attachment 5 - HIPAA-Business Associate Agreement.docx | DOCX document | |
| Attachment 7 - RFP Questions.xlsx | XLSX spreadsheet | |
| Attachment 8 - Past Performance Questionnaire.docx | DOCX document | |
| Attachment 2 Contractor Discrepancy Report.pdf | ||
| Attachment 4 - Pay.gov Vendor Submittal Instructions.pdf | ||
| 36C10G21R0009_1.docx | DOCX document | |
| Attachment 9 - Pricing Schedule Template.xlsx | XLSX spreadsheet | |
| Attachment 1 - Invoice Inquiry Tracker 02.xlsx | XLSX spreadsheet | |
| Attachment 6 - Cross Reference Index.xlsx | XLSX spreadsheet |
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Sheet2
| 11 | 7 | 9 | 32 | 6 | 6 | 9 | 20 | 30 | 10 | 10 | 25 | 25 | 14 | 26 | 13 | 21 | 11 | 15 | 7 | 5 | 5 | 7 | 10 | 5 | 10 | 18 | 26 | 7 | 31 | 15 | 21 | 33 | 5 | 16 | 7 | 12 | 11 | 21 | 14 | 14 | 18 | 16 | 14 | ||||||
| 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 2 | 2 | 2 | 2 | 2 | 3 | 3 | 3 | 3 | 3 | 3 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 5 | 5 | 5 | 5 | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 7 | 7 | 7 | ||||||
| 402 | 405 | 518 | 523 | 608 | 631 | 650 | 689 | 528 | 528A5 | 528 A6 | 528A7 | 528 A8 | 526 | 561 | 620 | 630 | 630A4 | 632 | 460 | 503 | 529 | 540 | 542 | 562 | 595 | 642 | 646 | 693 | 512 | 512A5 | 613 | 688 | 517 | 558 | 565 | 590 | 637 | 652 | 658 | 659 | 508 | 509 | 521 | ||||||
| Togus | White River Jct | Bedford | Boston (Roxbury and Brockton) | Manchester | Northhampton | Providence | VA Connecticut (Newington) | 1 | Buffalo (Batavia) | Canadaigua | Bath | Syracuse | Albany | 2 | Bronx | VA New Jersey (Lyons and East Orange) | VA Hudson Valley (CastlePoint and Montrose) | New York | Brooklyn | Northport | 3 | Wilmington | Altoona | Butler | Clarksburg | Coatesville | Erie | Lebanon | Philadelphia | VA Pittsburgh (Pittsburgh HD) | VAMC Wilkes-Barre | 4 | VA Maryland | Perry Point | Martinsburg | Washington | 5 | Beckley | Durham | Fayetteville | Hampton | Asheville | Richmond | Salem | Salisbury | 6 | Atlanta | Augusta | Birmingham (posted stock purchased and reported by Tuscaloosa) |
Sheet3
| Contractor |
| Contract Number: |
| Reporting Quarter: __ Qtr FY2018 | Line Item(s) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | |
| CLIN Number: | ||||||||||||||||||||||||
| Description/Salient Characteristics | ||||||||||||||||||||||||
| Contract/Part Number: | ||||||||||||||||||||||||
| Price Inclusive of SLA Fee: | ||||||||||||||||||||||||
| VISN | FACILITY | VA New England Healthcare System | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item |
| 1 | 402 | Togus | ||||||||||||||||||||||
| 1 | 405 | White River Jct | ||||||||||||||||||||||
| 1 | 518 | Bedford | ||||||||||||||||||||||
| 1 | 523 | Boston (Roxbury and Brockton) | ||||||||||||||||||||||
| 1 | 608 | Manchester | ||||||||||||||||||||||
| 1 | 631 | Northhampton | ||||||||||||||||||||||
| 1 | 650 | Providence | ||||||||||||||||||||||
| 1 | 523 | Jamaica Plain | ||||||||||||||||||||||
| 1 | 689 | VA Connecticut (Newington & West Haven) | ||||||||||||||||||||||
| New York/New Jersey VA Health Care Network | ||||||||||||||||||||||||
| 2 | 528 | Buffalo (Batavia) | ||||||||||||||||||||||
| 2 | 528A5 | Canadaigua | ||||||||||||||||||||||
| 2 | 528 A6 | Bath | ||||||||||||||||||||||
| 2 | 528A7 | Syracuse | ||||||||||||||||||||||
| 2 | 528 A8 | Albany | ||||||||||||||||||||||
| 2 | 526 | Bronx | ||||||||||||||||||||||
| 2 | 561 | VA New Jersey (Lyons and East Orange) | ||||||||||||||||||||||
| 2 | 620 | VA Hudson Valley (CastlePoint and Montrose) | ||||||||||||||||||||||
| 2 | 630 | New York | ||||||||||||||||||||||
| 2 | 630A4 | Brooklyn | ||||||||||||||||||||||
| 2 | 632 | Northport | ||||||||||||||||||||||
| VA Pittsburgh Healthcare System | ||||||||||||||||||||||||
| 4 | 460 | Wilmington | ||||||||||||||||||||||
| 4 | 503 | Altoona | ||||||||||||||||||||||
| 4 | 529 | Butler | ||||||||||||||||||||||
| 4 | 542 | Coatesville | ||||||||||||||||||||||
| 4 | 562 | Erie | ||||||||||||||||||||||
| 4 | 595 | Lebanon | ||||||||||||||||||||||
| 4 | 642 | Philadelphia | ||||||||||||||||||||||
| 4 | 646 | VA Pittsburgh (Pittsburgh HD) | ||||||||||||||||||||||
| 4 | 693 | VAMC Wilkes-Barre | ||||||||||||||||||||||
| VA Capitol Health Care Network | ||||||||||||||||||||||||
| 5 | 512 | VA Maryland | ||||||||||||||||||||||
| 6 | 517 | Beckley | ||||||||||||||||||||||
| 5 | 512A5 | Perry Point | ||||||||||||||||||||||
| 5 | 512GB | Loch Raven | ||||||||||||||||||||||
| 5 | 540 | Clarksburg | ||||||||||||||||||||||
| 5 | 581 | Hershel | ||||||||||||||||||||||
| 5 | 581 | Huntington | ||||||||||||||||||||||
| 5 | 613 | Martinsburg | ||||||||||||||||||||||
| 5 | 688 | Washington | ||||||||||||||||||||||
| VA Mid-Atlantic Health Care Network | ||||||||||||||||||||||||
| 6 | 558 | Durham | ||||||||||||||||||||||
| 6 | 565 | Fayetteville | ||||||||||||||||||||||
| 6 | 590 | Hampton | ||||||||||||||||||||||
| 6 | 637 | Asheville | ||||||||||||||||||||||
| 6 | 652 | Richmond | ||||||||||||||||||||||
| 6 | 658 | Salem | ||||||||||||||||||||||
| 6 | 659 | Salisbury | ||||||||||||||||||||||
| VA Southeast Network | ||||||||||||||||||||||||
| 7 | 508 | Atlanta | ||||||||||||||||||||||
| 7 | 509 | Augusta | ||||||||||||||||||||||
| 7 | 521 | Birmingham (posted stock purchased and reported by Tuscaloosa) | ||||||||||||||||||||||
| 7 | 534 | Charleston | ||||||||||||||||||||||
| 7 | 544 | Columbia | ||||||||||||||||||||||
| 7 | 557 | Dublin | ||||||||||||||||||||||
| 7 | 619 | CAVHCS ( Tuskegee and Montgomery) | ||||||||||||||||||||||
| 7 | 679 | Tuscaloosa | ||||||||||||||||||||||
| VA Sunshine Healthcare Network | ||||||||||||||||||||||||
| 8 | 516 | Bay Pines | ||||||||||||||||||||||
| 8 | 546 | Miami | ||||||||||||||||||||||
| 8 | 548 | West Palm Beach | ||||||||||||||||||||||
| 8 | 573 | NF/SGVHS | ||||||||||||||||||||||
| 8 | 672 | San Juan | ||||||||||||||||||||||
| 8 | 675 | Orlando | ||||||||||||||||||||||
| 8 | 673 | Tampa and Annex | ||||||||||||||||||||||
| VA MidSouth Healthcare Network |
| 9 | 596 | Lexington |
| 9 | 603 | Lousiville |
| 9 | 614 | Memphis |
| 9 | 621 | Mountain Home |
| 9 | 626 | VA Tennessee |
| VA Health Care System | ||
| 10 | 538 | Chillicothe |
| 10 | 539 | Cincinnati |
| 10 | 541 | Cleveland |
| 10 | 552 | Dayton |
| 10 | 757 | Columbus |
| 10 | 506 | Ann Arbor |
| 10 | 515 | Battle Creek |
| 10 | 553 | Detroit |
| 10 | 583 | Indianapolis |
| 10 | 610 | VA Northern Indiana |
| 10 | 655 | Saginaw |
| VA Great Lakes Health Care System | ||
| 12 | 537 | VA Chicago Healthcare |
| 12 | 556 | North Chicago |
| 12 | 578 | Hines |
| 12 | 550 | Danville |
| 12 | 585 | Iron Mountain |
| 12 | 607 | Madison |
| 12 | 676 | Tomah |
| 12 | 695 | Milwaukee |
| VA Heartland Network | ||
| 15 | 452 | Wichita |
| 15 | 543 | Columbia |
| 15 | 589 | Kansas City |
| 15 | 609 | Marion |
| 15 | 647 | Poplar Bluff |
| 15 | 657 | St. Louis |
| 15 | 677 | VA Eastern Kansas ( Leavenworth) |
| South Central VA Health Care Network | ||
| 16 | 502 | Alexandria |
| 16 | 520 | VA Gulf Coast |
| 16 | 564 | Fayetteville |
| 16 | 580 | Houston |
| 16 | 586 | Jackson |
| 16 | 598 | Central Arkansas |
| 16 | 629 | New Orleans |
| 16 | 635 | Oklahoma City |
| 16 | 667 | Shreveport |
| VA Heart of Texas Health Care Network | ||
| 17 | 549 | North Texas (Dallas and Bonham) |
| 17 | 504 | Amarillo |
| 17 | 671 | South Texas ( San Antonio and Kerrville) |
| 17 | 756 | El Paso |
| 17 | 519 | Big Spring |
| 17 | 740 | Harlingen |
| 17 | 674 | Central Texas ( Temple, Waco and Marlin) |
| Rocky Mountain Network | ||
| 19 | 442 | Cheyenne |
| 19 | 554 | Denver |
| 19 | 567 | Southern Colorado |
| 19 | 575 | Grand Junction |
| 19 | 623 | Muskogee |
| 19 | 660 | Salt Lake City |
| 19 | 666 | Sheridan |
| Northwest Network | ||
| 20 | 463 | Alaska |
| 20 | 531 | Boise |
| 20 | 648 | Portland |
| 20 | 653 | Roseburg |
| 20 | 663 | VA Puget Sound ( Seattle and American Lake) |
| 20 | 668 | Spokane |
| 20 | 687 | Walla Walla |
| 20 | 692 | White City |
| Sierra Pacific Network | ||
| 21 | 358 | Manila |
| 21 | 459 | Honolulu |
| 21 | 570 | C. California |
| 21 | 612 | N. California |
| 21 | 640 | Palo Alto (Livermore) |
| 21 | 654 | Sierra Nevada |
| 21 | 662 | San Francisco |
| Desert Pacific Healthcare Network | ||
| 22 | 593 | Southern Nevada |
| 22 | 501 | Albuquerque |
| 22 | 600 | Long Beach |
| 22 | 605 | Loma Linda |
| 22 | 664 | San Diego |
| 22 | 519 | West Texas |
| 22 | 644 | Phoenix |
| 22 | 649 | Northern Arizona (Prescott) |
| 22 | 678 | Southern Arizona (Tucson) |
| 22 | 691 | Greater Los Angeles ( Sepulveda and Los Angeles) |
| VA Midwest Health Care Network | ||
| 23 | 437 | Fargo |
| 23 | 438 | Sioux Falls |
| 23 | 568 | BHHCS (Black Hills and Hot Springs) |
| 23 | 618 | Minneapolis |
| 23 | 656 | St Cloud |
| 23 | 636 | NWIHCS (Omaha, Grand Island and Lincoln) |
| 23 | 636A4 | Grand Island |
| 23 | 636 A6 | CIHCS ( DM & Knx) |
| 23 | 636 A8 | Iowa City |
| Total Quarterly Quantity Sold | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Total Quantity Sold of All Items | 0 | |||||||||||||||||||||
| Total Quarterly Quantity Sold x Price | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Total Quarterly Sales inclusive of theSLA | $0.00 | |||||||||||||||||||||
| Anticipated SLA | $0.00 | |||||||||||||||||||||
| Total Sales amount without the SLA(Figure uploaded in Pay.gov) | $0.00 | |||||||||||||||||||||
| SLA Received (For HINES FISCAL ONLY) |
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