36C24618R0507-A00001000.docx

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Solicitation for Home Oxygen Delivery Services for VISN 6
Solicitation number
36C24618R0507
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This solicitation requests proposals for home oxygen delivery services within Veterans Integrated Service Network 6, which covers facilities in North Carolina and Virginia. The contractor must provide equipment transportation, setup, maintenance, patient education, safety management, and recovery services for approximately 5,000 oxygen-using veterans. The contractor must be Joint Commission accredited for home care and maintain that certification throughout the contract period. Services are required 24/7 including holidays. A single award will be made for an initial base year with four one-year option periods starting January 2019. This is a 100% set-aside for Service-Disabled Veteran-Owned Small Businesses under NAICS code 532283 with a size standard of $32.5 million. Offerors must register in the System for Award Management and Vendor Information Pages.

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36C24618-R-0507 / A00001

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE

OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO:

Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS

ENTERED INTO

PURSUANT TO AUTHORITY OF:

D. OTHER

BY

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) A00001 07-19-2018 N/A Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 To all Offerors/Bidders

36C24618R0507 07-09-2018 A00001 X X X ** HOUR & DATE for Receipt of Offers is EXTENDED to:

X

AMEND SOLICITATION 36C24618R0507 AS FOLLOWS:

All changes and or revision are highlighted in

RED

for easier reading.

1. To answer the attached vendor's questions.

2. To incorporate revised Schedule of Supplies and Services price tables.

3. To reflect a change on the "Best Value" award languague. Please see attached revised Best Value award language as listed on page 164 of the RFP document under Section E.14 - "Evaluation-Commercial Items"

4. All other terms and conditions remain the same.

Marchelle Peyton Contracting Officer

CONTINUATION PAGE

ANSWER TO VENDOR’S QUESTIONS

1. Has the solicitation been completely Set-Aside for SDVOSB or VOSB vendors only or both?

Answer: This is a tiered evaluation limited to SDVOSB’s or VOSB’s concerns. If no offers are submitted by an SDVOSB concern, or if none of the offer submitted by an SDVOSB would result in an award at the fair and reasonable price that would offer the best value to the United States Government, the SDVOSB Set- Aside will then be withdrawn and the Set-Aside for VOSB concerns will then be in effect. Please see revised “Best Value” language stated on page 164 of the RFP document under Section E.14 “Evaluation-Commercial Items.

2. On Section B.3 - Schedule of Supplies and Services of the Request For Proposal (RFP) document under Location B - Salisbury, NC, CLIN number 0001 Rental Concentrator System (Initial Setup & Monthly Maintenance) Concentrator Must Have Flow Rate Up To 5 LPM, E1390 section is missing.

Answer: CLIN number 0001 has been added. Please see attached revised Schedule of Supplies and Services tables below for additional details.

3. On Section B.4 - Performance Work Statement of the Request For Proposal (RFP) under sub -heading 2.2 - Initial Set-Ups – Oxygen Systems and sub-heading - 2.2.1.9 (Page 49); 2.2.1.10 (Page 50); 2.2.1.11 (Page 50); 2.2.1.12 (Page 50); and 2.2.1.13 (Page 50), all of the above reference the use of Thermal Fuses. Specifically, 2.2.1.10 states “Two (2) thermal fuses must be provided and installed in each home oxygen delivery system (one at the patient end and one at the oxygen source). This must be done for the patient’s primary oxygen therapy equipment as well as any portable oxygen therapy.” There is no CLIN for Thermal Fuses in B.3 Schedule of Supplies or Services. Was this an oversight and will a CLIN be added for Thermal Fuses?

Answer: Additional CLIN numbers have been added for the “Thermal Fuses” throughout the schedule tables as required. Please see attached revised Schedule of Supplies and Services tables below for additional details.

4. On page 21 under Area # 1, Location A: Asheville, NC: It appears Option Year 2 is missing in its entirety for this location from the schedule provided. Will the Government provide an updated schedule, to include estimated quantities?

Answer: The Asheville location has been added. Please see attached revised Schedule of Supplies and Services tables below for additional details.

5. On Page 8 under Area # 1, Location B: Salisbury, NC: It appears CLIN 0001 “Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 5 LPM. E1390” is missing from the schedule provided. Will the Government provide an updated schedule, to include estimated quantities?

Answer: CLIN number 0001 has been added. Please see attached revised Schedule of Supplies and Services tables below for additional details.

6. On page 8 under Area # 1, Location B: Salisbury, NC: It appears a CLIN for the “Annual Maintenance of VA owned concentrators may be missing from the schedule provided for all periods of performance (Base Year and Option Years 1 – 4). Will the Government provide an updated schedule, to include estimated quantities?

Answer: Additional CLIN numbers have been added for both the “Annual Maintenance of VA owned concentrators and ventilators” throughout the schedule tables as required. Please see attached revised Schedule of Supplies and Services tables below for additional details.

7. It appears that CLIN 0001 for Salisbury in the Price Schedule missing. Can you please clarify?

Answer: CLIN number 0001 has been added. Please see attached revised Schedule of Supplies and Services tables below for additional details.

8. It appears that Option Year 2 for Ashville in the Price Schedule is missing. Can you please clarify?

Answer: The Asheville location has been added. Please see attached revised Schedule of Supplies and Services tables below for additional details.

REVISED - BASE YEAR SCHEDULE

Period of Performance – 01 Jan 2019 through 30 Sept 2019

AREA # 1 (LOCATIONS A & B)

Location A
Asheville, NC

CLIN

Item Description

Est. Qty.
Unit
Unit Price
Total Price
0001
Initial setup and monthly maintenance for Government

furnished concentrators

8,676

EA

$ ______
$ ______
0002
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$ ______
$ ______
0003
Missed Patient Visit/Patient Refusal at Home
36
EA
$ ______
$ ______
0004
Emergency Visit
12
EA
$ ______
$ ______
0005
Cylinder, size M or H set-up (primary)
24
EA
$ ______
$ ______
0006
Cylinder, size M or H refill - E0443
60
EA
$ ______
$ ______
0007
Cylinder, size E refills E0443
4,644
EA
$ ______
$ ______
0008
Cylinder, size D refills E0443
4,812
EA
$ ______
$ ______
0009
Cylinder, size M6 refills E0443
804
EA
$ ______
$ ______
0010
Compressor - 50 psi - rental
12
EA
$ ______
$ ______
0011
Humidifier, Heated - Rental
12
EA
$ ______
$ ______
0012
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$ ______
$ ______
0013
Pulse Conserver Device (purchase)
12
EA
$ ______
$ ______
0014
Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education.

EA

$ ______
$ ______
0015
Recovery of VA owned equipment
12
EA
$ ______
$ ______
0016
Relocation of equipment due to change in beneficiary’s residence
24
EA
$ ______
$ ______
0017
Annual Maintenance of VA owned concentrators
425
EA
$ ______
$ ______
0018
Annual Maintenance of VA owned ventilators
8
EA
$ ______
$ ______
0019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,400
KT
$ ______
$ ______
ASHEVILLE BASE YEAR COST:
$ ______
Location B
Salisbury, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price
0001
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 5 LPM. E1390
6012
EA
$ _______
$ ________

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$ ______
$ ______
0003
Rental liquid oxygen system (initial setup & monthly

maintenance)

996
EA
$ ______
$ ______
0004
Initial setup and monthly maintenance for Government

furnished concentrators

2,136

EA

$ ______
$ ______
0005
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$ ______
$ ______
0006
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$ ______
$ ______
0007
Missed Patient Visit/Patient Refusal at Home
12
EA
$ ______
$ ______
0008
Emergency Visit
12
EA
$ ______
$ ______
0009
Cylinder, size M or H set-up (primary)
60
EA
$ ______
$ ______
0010
Cylinder, size M or H refill - E0443
120
EA
$ ______
$ ______
0011
Cylinder, size E refills E0443
11,184
EA
$ ______
$ ______
0012
Cylinder, size D refills E0443
1,296
EA
$ ______
$ ______
0013
Cylinder, size M6 refills E0443
7,176
EA
$ ______
$ ______
0014
Liquid oxygen per pound for item E0444
119,856
LB
$ ______
$ ______
0015
Compressor - 50 psi - Rental
60
EA
$ ______
$ ______
0016
Humidifier, Heated - Rental
24
EA
$ ______
$ ______
0017
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$ ______
$ ______
0018
Pulse Conserver Device (purchase)
12
EA
$ ______
$ ______
0019
Recovery of VA owned equipment
12
EA
$ ______
$ ______
0020
Relocation of equipment due to change in beneficiary’s residence

EA

$ ______
$ ______
0021
Annual Maintenance of VA owned concentrators
200
EA
$ ______
$ ______
0022
Annual Maintenance of VA owned ventilators
6
EA
$ ______
$ ______
0023
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
4,000
KT
$ ______
$ ______
SALISBURY BASE YEAR COST:
$ ______
AREA # 1 (ASHEVILLE & SALISBURY) BASE YEAR TOTAL COST
$ ______

AREA # 2 (LOCATIONS C & D)

Location C
Durham, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

3,528

EA

$ ______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$ ______
$ ______
0003
Rental liquid oxygen system (initial setup & monthly

maintenance)

EA

$ ______
$ ______
0004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$ ______
$ ______
0005
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$ ______
$ ______
0006
Missed Patient Visit/Patient Refusal at Home
12
EA
$ ______
$ ______
0007
Emergency Visit
12
EA
$ ______
$ ______
0008
Cylinder, size M or H set-up (primary)
360
EA
$ ______
$ ______
0009
Cylinder, size M or H refill - E0443
120
EA
$ ______
$ ______
0010
Cylinder, size E refills E0443
12,516
EA
$ ______
$ ______
0011
Cylinder, size D refills E0443
2,628
EA
$ ______
$ ______
0012
Cylinder, size M6 refills E0443
5,280
EA
$ ______
$ ______
0013
Liquid oxygen per pound for item E0444
25,236
LB
$ ______
$ ______
0014
Compressor - 50 psi - rental
120
EA
$ ______
$ ______
0015
Humidifier, Heated - Rental
24
EA
$ ______
$ ______
0016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$ ______
$ ______
0017
Pulse Conserver Device (purchase)
12
EA
$ ______
$ ______
0018
Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education.

1,200

EA

$ ______
$ ______
0019
Recovery of VA owned equipment
12
EA
$ ______
$ ______
0020
Relocation of equipment due to change in beneficiary’s residence

EA

$ ______
$ ______
0021
Annual Maintenance of VA owned ventilators
8
EA
$ ______
$ ______
0022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,400
KT
$ ______
$ ______
DURHAM BASE YEAR COST:
$ ______
Location D
Fayetteville, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

4,284

EA

$ ______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$ ______
$ ______
0003
Rental liquid oxygen system (initial setup & monthly maintenance)
108
EA
$ ______
$ ______
0004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$ ______
$ ______
0005
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$ ______
$ ______
0006
Missed Patient Visit/Patient Refusal at Home
60
EA
$ ______
$ ______
0007
Emergency Visit
36
EA
$ ______
$ ______
0008
Cylinder, size M or H set-up (primary)
24
EA
$ ______
$ ______
0009
Cylinder, size M or H refill - E0443
60
EA
$ ______
$ ______
0010
Cylinder, size E refills E0443
8,064
EA
$ ______
$ ______
0011
Cylinder, size D refills E0443
3,552
EA
$ ______
$ ______
0012
Cylinder, size M6 refills E0443
6,900
EA
$ ______
$ ______
0013
Liquid oxygen per pound for item E0444
21,240
LB
$ ______
$ ______
0014
Compressor - 50 psi - rental
156
EA
$ ______
$ ______
0015
Humidifier, Heated - Rental
12
EA
$ ______
$ ______
0016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$ ______
$ ______
0017
Pulse Conserver Device (purchase)
12
EA
$ ______
$ ______
0018
Delivery of VA provided CPAP and BiPAP equipment,

including setup and patient education.

EA

$ ______
$ ______
0019
Recovery of VA owned equipment
12
EA
$ ______
$ ______
0020
Relocation of equipment due to change in beneficiary’s residence

EA

$ ______
$ ______
0021
Annual Maintenance of VA owned ventilators
8
EA
$ ______
$ ______
0022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,000
KT
$ ______
$ ______
FAYETTEVILLE BASE YEAR COST:
$ ______
AREA # 2 (DURHAM & FAYETTEVILLE) BASE YEAR TOTAL COST:
$ ______

AREA # 3 (LOCATIONS E & F)

Location E
Hampton, VA
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

3,588

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
0003
Rental liquid oxygen system (initial setup & monthly

maintenance)

288
EA
$______
$ ______
0004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
0005
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
0006
Missed Patient Visit/Patient Refusal at Home
12
EA
$______
$ ______
0007
Emergency Visit
12
EA
$______
$ ______
0008
Cylinder, size M or H set-up (primary)
24
EA
$______
$ ______
0009
Cylinder, size M or H refill - E0443
120
EA
$______
$ ______
0010
Cylinder, size E refills E0443
7,308
EA
$______
$ ______
0011
Cylinder, size D refills E0443
1,620
EA
$______
$ ______
0012
Cylinder, size M6 refills E0443
7,560
EA
$______
$ ______
0013
Liquid oxygen per pound for item E0444
21,984
LB
$______
$ ______
0014
Compressor - 50 psi - rental
108
EA
$______
$ ______
0015
Humidifier, Heated - Rental
48
EA
$______
$ ______
0016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
0017
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
0018
Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education.

EA

$______
$ ______
0019
Recovery of VA owned equipment
12
EA
$______
$ ______
0020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
0021
Annual Maintenance of VA owned ventilators
6
EA
$ _____
$ ______
0022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
2,800
KT
$ _____
$ ______
HAMPTON BASE YEAR COST:
$______
Location F
Richmond, VA
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price
0001
Initial setup and monthly maintenance for Government

furnished concentrators

5,700

EA

$______
$ ______
0002
Rental ventilator system (initial setup and monthly

maintenance)

EA

$______
$ ______
0003
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
0004
Missed Patient Visit/Patient Refusal at Home
84
EA
$______
$ ______
0005
Emergency Visit
12
EA
$______
$ ______
0006
Cylinder, size M or H set-up (primary)
36
EA
$______
$ ______
0007
Cylinder, size M or H refill - E0443
120
EA
$______
$ ______
0008
Cylinder, size E refills E0443
12,888
EA
$______
$ ______
0009
Cylinder, size D refills E0443
11,520
EA
$______
$ ______
0010
Cylinder, size M6 refills E0443
7,164
EA
$______
$ ______
0011
Humidifier, Heated - Rental
12
EA
$______
$ ______
0012
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
0013
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
0014
Recovery of VA owned equipment
96
EA
$______
$ ______
0015
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
0016
Annual Maintenance of VA owned concentrators
690
EA
$______
$ ______
0017
Annual Maintenance of VA owned ventilators
6
EA
$ ______
$ ______
0018
Compressor – 50 psi – rental
60
EA
$ ______
$ ______
0019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,000
KT
$ ______
$ ______
RICHMOND BASE YEAR COST:
$______
AREA # 3 (HAMPTON & RICHMOND) BASE YEAR TOTAL COST:
$______

AREA # 4 (LOCATION G)

Location G
Salem, VA
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

7,896

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
0003
Rental liquid oxygen system (initial setup & monthly

maintenance)

720
EA
$______
$ ______
0004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
0005
Missed Patient Visit/Patient Refusal at Home
24
EA
$______
$ ______
0006
Emergency Visit
12
EA
$______
$ ______
0007
Cylinder, size M or H set-up (primary)
60
EA
$______
$ ______
0008
Cylinder, size M or H refill - E0443
120
EA
$______
$ ______
0009
Cylinder, size E refills E0443
18,816
EA
$______
$ ______
0010
Cylinder, size D refills E0443
12,960
EA
$______
$ ______
0011
Cylinder, size M6 refills E0443
4,320
EA
$______
$ ______
0012
Liquid oxygen per pound for item E0444
206,700
LB
$______
$ ______
0013
Compressor - 50 psi - rental
12
EA
$______
$ ______
0014
Humidifier, Heated - Rental
12
EA
$______
$ ______
0015
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
0016
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
0017
Recovery of VA owned equipment
12
EA
$______
$ ______
0018
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
0019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,000
KT
$ ______
$ ______
AREA # 4 (SALEM) BASE YEAR TOTAL COST:
$______

REVISED - OPTION YEAR 1 SCHEDULE

Period of Performance: 01 Oct 2019 through 30 Sep 2020

AREA # 1 (LOCATIONS A & B)

Location A
Asheville, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price
1001
Initial setup and monthly maintenance for Government

furnished concentrators

9,540

EA

$______
$ ______
1002
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
1003
Missed Patient Visit/Patient Refusal at Home
36
EA
$______
$ ______
1004
Emergency Visit
12
EA
$______
$ ______
1005
Cylinder, size M or H set-up (primary)
24
EA
$______
$ ______
1006
Cylinder, size M or H refill - E0443
60
EA
$______
$ ______
1007
Cylinder, size E refills E0443
5,112
EA
$______
$ ______
1008
Cylinder, size D refills E0443
5,292
EA
$______
$ ______
1009
Cylinder, size M6 refills E0443
888
EA
$______
$ ______
1010
Compressor - 50 psi - rental
12
EA
$______
$ ______
1011
Humidifier, Heated - Rental
12
EA
$______
$ ______
1012
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
1013
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
1014
Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education.

EA

$______
$ ______
1015
Recovery of VA owned equipment
12
EA
$______
$ ______
1016
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
1017
Annual Maintenance of VA owned concentrators
425
EA
$______
$ ______
1018
Annual Maintenance of VA owned ventilators
8
EA
$ _____
$ ______
1019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,400
KT
$ _____
$ ______

ASHEVILLE OPTION YEAR 1 COST:

Location B
Salisbury, NC

CLIN

Item Description

Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

6,612

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
1003
Rental liquid oxygen system (initial setup & monthly

maintenance)

1,092
EA
$______
$ ______
1004
Initial setup and monthly maintenance for Government

furnished concentrators

2,352

EA

$______
$ ______
1005
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
1006
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
1007
Missed Patient Visit/Patient Refusal at Home
12
EA
$______
$ ______
1008
Emergency Visit
12
EA
$______
$ ______
1009
Cylinder, size M or H set-up (primary)
60
EA
$______
$ ______
1010
Cylinder, size M or H refill - E0443
120
EA
$______
$ ______
1011
Cylinder, size E refills E0443
12,300
EA
$______
$ ______
1012
Cylinder, size D refills E0443
1,428
EA
$______
$ ______
1013
Cylinder, size M6 refills E0443
7,896
EA
$______
$ ______
1014
Liquid oxygen per pound for item E0444
131,844
LB
$______
$ ______
1015
Compressor - 50 psi - Rental
60
EA
$______
$ ______
1016
Humidifier, Heated - Rental
24
EA
$______
$ ______
1017
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
1018
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
1019
Recovery of VA owned equipment
12
EA
$______
$ ______
1020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
1021
Annual Maintenance of VA owned concentrators
200
EA
$ ______
$ ______
1022
Annual Maintenance of VA owned ventilators
6
EA
$ ______
$ ______
1023
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
4,000
KT
$ _____
$ ______
SALISBURY OPTION YEAR 1 COST:
$______
AREA # 1 (ASHEVILLE & SALISBURY) OPTION YEAR 1 COST:
$______
Location C
Durham, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

3,876

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
1003
Rental liquid oxygen system (initial setup & monthly

maintenance)

EA

$______
$ ______
1004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
1005
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
1006
Missed Patient Visit/Patient Refusal at Home
12
EA
$______
$ ______
1007
Emergency Visit
12
EA
$______
$ ______
1008
Cylinder, size M or H set-up (primary)
396
EA
$______
$ ______
1009
Cylinder, size M or H refill - E0443
132
EA
$______
$ ______
1010
Cylinder, size E refills E0443
13,764
EA
$______
$ ______
1011
Cylinder, size D refills E0443
2,892
EA
$______
$ ______
1012
Cylinder, size M6 refills E0443
5,808
EA
$______
$ ______
1013
Liquid oxygen per pound for item E0444
27,756
LB
$______
$ ______
1014
Compressor - 50 psi - rental
132
EA
$______
$ ______
1015
Humidifier, Heated - Rental
24
EA
$______
$ ______
1016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
1017
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
1018
Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education.

1,320

EA

$______
$ ______
1019
Recovery of VA owned equipment
12
EA
$______
$ ______
1020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
1021
Annual Maintenance of VA owned ventilators
8
EA
$ _____
$ ______
1022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,400
KT
$ _____
$ ______
DURHAM OPTION YEAR 1 COST:
$______
Location D
Fayetteville, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

4,740

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
1003
Rental liquid oxygen system (initial setup & monthly maintenance)
120
EA
$______
$ ______
1004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
1005
Initial setup and monthly maintenance for

Government furnished ventilators

EA

$______
$ ______
1006
Missed Patient Visit/Patient Refusal at Home
60
EA
$______
$ ______
1007
Emergency Visit
36
EA
$______
$ ______
1008
Cylinder, size M or H set-up (primary)
24
EA
$______
$ ______
1009
Cylinder, size M or H refill - E0443
60
EA
$______
$ ______
1010
Cylinder, size E refills E0443
8,868
EA
$______
$ ______
1011
Cylinder, size D refills E0443
3,912
EA
$______
$ ______
1012
Cylinder, size M6 refills E0443
7,596
EA
$______
$ ______
1013
Liquid oxygen per pound for item E0444
23,364
LB
$______
$ ______
1014
Compressor - 50 psi - rental
168
EA
$______
$ ______
1015
Humidifier, Heated - Rental
12
EA
$______
$ ______
1016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
1017
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
1018
Delivery of VA provided CPAP and BiPAP

equipment, including setup and patient education.

EA

$______
$ ______
1019
Recovery of VA owned equipment
12
EA
$______
$ ______
1020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
1021
Annual Maintenance of VA owned ventilators
8
EA
$ _______
$ ______
1022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,000
KT
$ ______
$ ______
FAYETTEVILLE OPTION YEAR 1 COST:
$______
AREA #2 (DURHAM & FAYETTEVILLE) OPTION YEAR 1 TOTAL COST:
$______
Location E
Hampton, VA
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price
1001
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

3,948

EA

$______
$ ______
1002
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
1003
Rental liquid oxygen system (initial setup &

monthly maintenance)

312
EA
$______
$ ______
1004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
1005
Initial setup and monthly maintenance for

Government furnished ventilators

EA

$______
$ ______
1006
Missed Patient Visit/Patient Refusal at Home
12
EA
$______
$ ______
1007
Emergency Visit
12
EA
$______
$ ______
1008
Cylinder, size M or H set-up (primary)
24
EA
$______
$ ______
1009
Cylinder, size M or H refill - E0443
132
EA
$______
$ ______
1010
Cylinder, size E refills E0443
8,040
EA
$______
$ ______
1011
Cylinder, size D refills E0443
1,776
EA
$______
$ ______
1012
Cylinder, size M6 refills E0443
8,316
EA
$______
$ ______
1013
Liquid oxygen per pound for item E0444
24,180
LB
$______
$ ______
1014
Compressor - 50 psi - rental
120
EA
$______
$ ______
1015
Humidifier, Heated - Rental
48
EA
$______
$ ______
1016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
1017
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
1018
Delivery of VA provided CPAP and BiPAP

equipment, including setup and patient education.

EA

$______
$ ______
1019
Recovery of VA owned equipment
12
EA
$______
$ ______
1020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
1021
Annual Maintenance of VA owned ventilators
6
EA
$ ______
$ ______
1022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
2,800
KT
$ ______
$ ______
HAMPTON OPTION YEAR 1 COST:
$______
Location F
Richmond, VA
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price
1001
Initial setup and monthly maintenance for Government

furnished concentrators

6,000

EA

$______
$ ______
1002
Rental ventilator system (initial setup and monthly

maintenance)

EA

$______
$ ______
1003
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
1004
Missed Patient Visit/Patient Refusal at Home
84
EA
$______
$ ______
1005
Emergency Visit
12
EA
$______
$ ______
1006
Cylinder, size M or H set-up (primary)
36
EA
$______
$ ______
1007
Cylinder, size M or H refill - E0443
132
EA
$______
$ ______
1008
Cylinder, size E refills E0443
14,172
EA
$______
$ ______
1009
Cylinder, size D refills E0443
12,672
EA
$______
$ ______
1010
Cylinder, size M6 refills E0443
7,884
EA
$______
$ ______
1011
Humidifier, Heated - Rental
12
EA
$______
$ ______
1012
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
1013
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
1014
Recovery of VA owned equipment
96
EA
$______
$ ______
1015
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
1016
Annual Maintenance of VA owned concentrators
690
EA
$______
$ ______
1017
Annual Maintenance of VA owned ventilators
6
EA
$ ______
$ ______
1018
Compressor – 50 psi – rental
60
EA
$ ______
$ ______
1019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,000
KT
$ ______
$ ______
RICHMOND OPTION YEAR 1 COST:
$______
AREA # 3 (HAMPTON & RICHMOND) OPTION YEAR 1 TOTAL COST:
$______
Location G
Salem, VA
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

8,688

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
1003
Rental liquid oxygen system (initial setup &

monthly maintenance)

792
EA
$______
$ ______
1004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
1005
Missed Patient Visit/Patient Refusal at Home
24
EA
$______
$ ______
1006
Emergency Visit
12
EA
$______
$ ______
1007
Cylinder, size M or H set-up (primary)
60
EA
$______
$ ______
1008
Cylinder, size M or H refill - E0443
132
EA
$______
$ ______
1009
Cylinder, size E refills E0443
20,700
EA
$______
$ ______
1010
Cylinder, size D refills E0443
14,256
EA
$______
$ ______
1011
Cylinder, size M6 refills E0443
4,752
EA
$______
$ ______
1012
Liquid oxygen per pound for item E0444
227,364
LB
$______
$ ______
1013
Compressor - 50 psi - rental
12
EA
$______
$ ______
1014
Humidifier, Heated - Rental
12
EA
$______
$ ______
1015
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
1016
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
1017
Recovery of VA owned equipment
12
EA
$______
$ ______
1018
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
1019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,000
KT
$ ______
$ ______
AREA # 4 (SALEM) OPTION YEAR 1 TOTAL COST:
$______

REVISED - OPTION YEAR 2 SCHEDULE

Period of Performance: 01 Oct 2020 through 30 Sep 2021

AREA # 1 (LOCATIONS A & B)

Location A
Asheville, NC

CLIN

Item Description

Est. Qty.
Unit
Unit Price
Total Price
2001
Initial setup and monthly maintenance for Government

furnished concentrators

10,500

EA

$ ______
$ ______
2002
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$ ______
$ ______
2003
Missed Patient Visit/Patient Refusal at Home
36
EA
$ ______
$ ______
2004
Emergency Visit
12
EA
$ ______
$ ______
2005
Cylinder, size M or H set-up (primary)
24
EA
$ ______
$ ______
2006
Cylinder, size M or H refill - E0443
60
EA
$ ______
$ ______
2007
Cylinder, size E refills E0443
5,628
EA
$ ______
$ ______
2008
Cylinder, size D refills E0443
5,820
EA
$ ______
$ ______
2009
Cylinder, size M6 refills E0443
972
EA
$ ______
$ ______
2010
Compressor - 50 psi - rental
12
EA
$ ______
$ ______
2011
Humidifier, Heated - Rental
12
EA
$ ______
$ ______
2012
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$ ______
$ ______
2013
Pulse Conserver Device (purchase)
12
EA
$ ______
$ ______
2014
Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education.

EA

$ ______
$ ______
2015
Recovery of VA owned equipment
12
EA
$ ______
$ ______
2016
Relocation of equipment due to change in beneficiary’s residence
24
EA
$ ______
$ ______
2017
Annual Maintenance of VA owned concentrators
425
EA
$ ______
$ ______
2018
Annual Maintenance of VA owned ventilators
8
EA
$______
$ ______
2019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,400
KT
$ ______
$ ______
ASHEVILLE OPTION YEAR II COST:
$ ______
Location B
Salisbury, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

7,272

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
2003
Rental liquid oxygen system (initial setup & monthly

maintenance)

1,200
EA
$______
$ ______
2004
Initial setup and monthly maintenance for

Government furnished concentrators

2,592

EA

$______
$ ______
2005
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
2006
Initial setup and monthly maintenance for

Government furnished ventilators

EA

$______
$ ______
2007
Missed Patient Visit/Patient Refusal at Home
12
EA
$______
$ ______
2008
Emergency Visit
12
EA
$______
$ ______
2009
Cylinder, size M or H set-up (primary)
60
EA
$______
$ ______
2010
Cylinder, size M or H refill - E0443
120
EA
$______
$ ______
2011
Cylinder, size E refills E0443
13,536
EA
$______
$ ______
2012
Cylinder, size D refills E0443
1,572
EA
$______
$ ______
2013
Cylinder, size M6 refills E0443
8,688
EA
$______
$ ______
2014
Liquid oxygen per pound for item E0444
145,032
LB
$______
$ ______
2015
Compressor - 50 psi - Rental
60
EA
$______
$ ______
2016
Humidifier, Heated - Rental
24
EA
$______
$ ______
2017
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
2018
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
2019
Recovery of VA owned equipment
12
EA
$______
$ ______
2020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
2021
Annual Maintenance of VA owned concentrators
200
EA
$ ______
$ ______
2022
Annual Maintenance of VA owned ventilators.
6
EA
$ ______
$ ______
2023
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
4,000
KT
$ ______
$ ______
SALISBURY OPTION YEAR 2 COST:
$______
AREA # 1 (ASHEVILLE & SALISBURY) OPTION YEAR 2 TOTAL COST:
$______
Location C
Durham, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

4,260

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
2003
Rental liquid oxygen system (initial setup & monthly

maintenance)

EA

$______
$ ______
2004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
2005
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
2006
Missed Patient Visit/Patient Refusal at Home
12
EA
$______
$ ______
2007
Emergency Visit
12
EA
$______
$ ______
2008
Cylinder, size M or H set-up (primary)
432
EA
$______
$ ______
2009
Cylinder, size M or H refill - E0443
132
EA
$______
$ ______
2010
Cylinder, size E refills E0443
15,144
EA
$______
$ ______
2011
Cylinder, size D refills E0443
3,180
EA
$______
$ ______
2012
Cylinder, size M6 refills E0443
6,384
EA
$______
$ ______
2013
Liquid oxygen per pound for item E0444
30,528
LB
$______
$ ______
2014
Compressor - 50 psi - rental
132
EA
$______
$ ______
2015
Humidifier, Heated - Rental
24
EA
$______
$ ______
2016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
2017
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
2018
Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education.

1,452

EA

$______
$ ______
2019
Recovery of VA owned equipment
12
EA
$______
$ ______
2020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
2021
Annual Maintenance of VA owned ventilator
8
EA
$ ______
$ ______
2022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,400
KT
$ ______
$ ______
DURHAM OPTION YEAR 2 COST:
$______
Location D
Fayetteville, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

5,220

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
2003
Rental liquid oxygen system (initial setup & monthly maintenance)
120
EA
$______
$ ______
2004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
2005
Initial setup and monthly maintenance for

Government furnished ventilators

EA

$______
$ ______
2006
Missed Patient Visit/Patient Refusal at Home
60
EA
$______
$ ______
2007
Emergency Visit
36
EA
$______
$ ______
2008
Cylinder, size M or H set-up (primary)
24
EA
$______
$ ______
2009
Cylinder, size M or H refill - E0443
60
EA
$______
$ ______
2010
Cylinder, size E refills - E0443
9,756
EA
$______
$ ______
2011
Cylinder, size D refills - E0443
4,308
EA
$______
$ ______
2012
Cylinder, size M6 refills - E0443
8,352
EA
$______
$ ______
2013
Liquid oxygen per pound for item E0444
25,704
LB
$______
$ ______
2014
Compressor - 50 psi - rental
168
EA
$______
$ ______
2015
Humidifier, Heated - Rental
12
EA
$______
$ ______
2016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
2017
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
2018
Delivery of VA provided CPAP and BiPAP

equipment, including setup and patient education.

EA

$______
$ ______
2019
Recovery of VA owned equipment
12
EA
$______
$ ______
2020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
2021
Annual Maintenance of VA owned ventilators.
8
EA
$ ______
$ ______
2022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,000
KT
$ ______
$ ______
FAYETTEVILLE OPTION YEAR 2 COST:
$______
AREA #2 (DURHAM & FAYETTEVILLE) OPTION YEAR 2 TOTAL COST:
$______
Location E
Hampton, VA
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

4,344

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
2003
Rental liquid oxygen system (initial setup & monthly

maintenance)

348
EA
$______
$ ______
2004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
2005
Initial setup and monthly maintenance for

Government furnished ventilators

EA

$______
$ ______
2006
Missed Patient Visit/Patient Refusal at Home
12
EA
$______
$ ______
2007
Emergency Visit
12
EA
$______
$ ______
2008
Cylinder, size M or H set-up (primary)
24
EA
$______
$ ______
2009
Cylinder, size M or H refill - E0443
132
EA
$______
$ ______
2010
Cylinder, size E refills - E0443
8,844
EA
$______
$ ______
2011
Cylinder, size D refills - E0443
1,956
EA
$______
$ ______
2012
Cylinder, size M6 refills - E0443
9,144
EA
$______
$ ______
2013
Liquid oxygen per pound for item E0444
26,604
LB
$______
$ ______
2014
Compressor - 50 psi - rental
120
EA
$______
$ ______
2015
Humidifier, Heated - Rental
48
EA
$______
$ ______
2016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
2017
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
2018
Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education.

EA

$______
$ ______
2019
Recovery of VA owned equipment
12
EA
$______
$ ______
2020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
2021
Annual Maintenance of VA owned ventilators
6
EA
$ ______
$ ______
2022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
2,800
KT
$ ______
$ ______
HAMPTON OPTION YEAR 2 COST:
$______
Location F
Richmond, VA
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price
2001
Initial setup and monthly maintenance for Government

furnished concentrators

6,600

EA

$______
$ ______
2002
Rental ventilator system (initial setup and monthly

maintenance)

EA

$______
$ ______
2003
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
2004
Missed Patient Visit/Patient Refusal at Home
84
EA
$______
$ ______
2005
Emergency Visit
12
EA
$______
$ ______
2006
Cylinder, size M or H set-up (primary)
36
EA
$______
$ ______
2007
Cylinder, size M or H refill - E0443
132
EA
$______
$ ______
2008
Cylinder, size E refills - E0443
15,588
EA
$______
$ ______
2009
Cylinder, size D refills - E0443
13,944
EA
$______
$ ______
2010
Cylinder, size M6 refills - E0443
8,676
EA
$______
$ ______
2011
Humidifier, Heated - Rental
12
EA
$______
$ ______
2012
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
2013
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
2014
Recovery of VA owned equipment
96
EA
$______
$ ______
2015
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
2016
Annual Maintenance of VA owned concentrators
690
EA
$______
$ ______
2017
Annual Maintenance of VA owned ventilators
6
EA
$ ______
$ ______
2018
Compressor – 50 psi - rental
60
EA
$ ______
$ ______
2019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,000
KT
$ ______
$ ______
RICHMOND OPTION YEAR 2 COST:
$______
AREA # 3 (HAMPTON & RICHMOND) OPTION YEAR 2 TOTAL COST:
$______
Location G
Salem, VA
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

9,552

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
2003
Rental liquid oxygen system (initial setup & monthly

maintenance)

876
EA
$______
$ ______
2004
Rental ventilator system (initial setup and monthly

maintenance)

EA

$______
$ ______
2005
Missed Patient Visit/Patient Refusal at Home
24
EA
$______
$ ______
2006
Emergency Visit
12
EA
$______
$ ______
2007
Cylinder, size M or H set-up (primary)
60
EA
$______
$ ______
2008
Cylinder, size M or H refill - E0443
132
EA
$______
$ ______
2009
Cylinder, size E refills - E0443
22,776
EA
$______
$ ______
2010
Cylinder, size D refills - E0443
15,684
EA
$______
$ ______
2011
Cylinder, size M6 refills - E0443
5,232
EA
$______
$ ______
2012
Liquid oxygen per pound for item E0444
250,104
LB
$______
$ ______
2013
Compressor - 50 psi - rental
12
EA
$______
$ ______
2014
Humidifier, Heated - Rental
12
EA
$______
$ ______
2015
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
2016
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
2017
Recovery of VA owned equipment
12
EA
$______
$ ______
2018
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
2019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,000
KT
$ _____
$ ______
AREA # 4 (SALEM) OPTION YEAR 2 TOTAL COST:
$______

REVISED - OPTION YEAR 3 SCHEDULE

Period of Performance: 01 Oct 2021 through 30 Sep 2022

AREA # 1 (LOCATIONS A & B)

Location A
Asheville, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price
3001
Initial setup and monthly maintenance for

Government furnished concentrators

11,556

EA

$______
$ ______
3002
Initial setup and monthly maintenance for

Government furnished ventilators

EA

$______
$ ______
3003
Missed Patient Visit/Patient Refusal at Home
36
EA
$______
$ ______
3004
Emergency Visit
12
EA
$______
$ ______
3005
Cylinder, size M or H set-up (primary)
24
EA
$______
$ ______
3006
Cylinder, size M or H refill - E0443
60
EA
$______
$ ______
3007
Cylinder, size E refills - E0443
6,192
EA
$______
$ ______
3008
Cylinder, size D refills - E0443
6,408
EA
$______
$ ______
3009
Cylinder, size M6 refills - E0443
1,068
EA
$______
$ ______
3010
Compressor - 50 psi - rental
12
EA
$______
$ ______
3011
Humidifier, Heated - Rental
12
EA
$______
$ ______
3012
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
3013
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
3014
Delivery of VA provided CPAP and BiPAP

equipment, including setup and patient education.

EA

$______
$ ______
3015
Recovery of VA owned equipment
12
EA
$______
$ ______
3016
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
3017
Annual Maintenance of VA owned concentrators
425
EA
$______
$ ______
3018
Annual Maintenance of VA owned ventilators
8
EA
$ _____
$ ______
3019
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,400
KT
$ _____
$ ______
ASHEVILLE OPTION YEAR 3 COST:
$______
Location B
Salisbury, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

8,004

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
3003
Rental liquid oxygen system (initial setup & monthly

maintenance)

1,320
EA
$______
$ ______
3004
Initial setup and monthly maintenance for Government

furnished concentrators

2,856

EA

$______
$ ______
3005
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
3006
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
3007
Missed Patient Visit/Patient Refusal at Home
12
EA
$______
$ ______
3008
Emergency Visit
12
EA
$______
$ ______
3009
Cylinder, size M or H set-up (primary)
60
EA
$______
$ ______
3010
Cylinder, size M or H refill - E0443
120
EA
$______
$ ______
3011
Cylinder, size E refills - E0443
14,892
EA
$______
$ ______
3012
Cylinder, size D refills - E0443
1,728
EA
$______
$ ______
3013
Cylinder, size M6 refills - E0443
9,552
EA
$______
$ ______
3014
Liquid oxygen per pound for item E0444
157,380
LB
$______
$ ______
3015
Compressor - 50 psi - Rental
60
EA
$______
$ ______
3016
Humidifier, Heated - Rental
24
EA
$______
$ ______
3017
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
3018
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
3019
Recovery of VA owned equipment
12
EA
$______
$ ______
3020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
3021
Annual Maintenance of VA owned concentrators
200
EA
$ ______
$ ______
3022
Annual Maintenance of VA owned ventilators
6
EA
$ ______
$ ______
3023
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
4,000
KT
$ ______
$ ______
SALISBURY OPTION YEAR 3 COST:
$______
AREA # 1 (ASHEVILLE & SALISBURY) OPTION YEAR 3 TOTAL COST:
$______
Location C
Durham, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

4,692

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
3003
Rental liquid oxygen system (initial setup & monthly

maintenance)

EA

$______
$ ______
3004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
3005
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
3006
Missed Patient Visit/Patient Refusal at Home
12
EA
$______
$ ______
3007
Emergency Visit
12
EA
$______
$ ______
3008
Cylinder, size M or H set-up (primary)
480
EA
$______
$ ______
3009
Cylinder, size M or H refill - E0443
132
EA
$______
$ ______
3010
Cylinder, size E refills - E0443
1,6656
EA
$______
$ ______
3011
Cylinder, size D refills - E0443
3,504
EA
$______
$ ______
3012
Cylinder, size M6 refills - E0443
7,020
EA
$______
$ ______
3013
Liquid oxygen per pound for item - E0444
33,576
LB
$______
$ ______
3014
Compressor - 50 psi - rental
132
EA
$______
$ ______
3015
Humidifier, Heated - Rental
24
EA
$______
$ ______
3016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
3017
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
3018
Delivery of VA provided CPAP and BiPAP

equipment, including setup and patient education.

1,596

EA

$______
$ ______
3019
Recovery of VA owned equipment
12
EA
$______
$ ______
3020
Relocation of equipment due to change in beneficiary’s residence

EA

$______
$ ______
3021
Annual Maintenance of VA owned ventilators
8
EA
$ ______
$ ______
3022
Thermal Fuse Kit: 2 Thermal Fuses and a 2” tube
3,400
KT
$ ______
$ ______
DURHAM OPTION YEAR 3 COST:
$______
Location D
Fayetteville, NC
CLIN
Item Description
Est. Qty.
Unit
Unit Price
Total Price

Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390

5,748

EA

$______
$ ______

Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390

EA

$______
$ ______
3003
Rental liquid oxygen system (initial setup & monthly maintenance)
120
EA
$______
$ ______
3004
Rental ventilator system (initial setup and monthly

maintenance)

12
EA
$______
$ ______
3005
Initial setup and monthly maintenance for Government

furnished ventilators

EA

$______
$ ______
3006
Missed Patient Visit/Patient Refusal at Home
60
EA
$______
$ ______
3007
Emergency Visit
36
EA
$______
$ ______
3008
Cylinder, size M or H set-up (primary)
24
EA
$______
$ ______
3009
Cylinder, size M or H refill - E0443
60
EA
$______
$ ______
3010
Cylinder, size E refills - E0443
10,728
EA
$______
$ ______
3011
Cylinder, size D refills - E0443
4,740
EA
$______
$ ______
3012
Cylinder, size M6 refills - E0443
9,192
EA
$______
$ ______
3013
Liquid oxygen per pound for item E0444
28,272
LB
$______
$ ______
3014
Compressor - 50 psi - rental
168
EA
$______
$ ______
3015
Humidifier, Heated - Rental
12
EA
$______
$ ______
3016
Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111

EA

$______
$ ______
3017
Pulse Conserver Device (purchase)
12
EA
$______
$ ______
3018

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