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36C24619R0023 (VISN 6 Prescription Eyeglass Supply and Service)

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C24619R0023 03-12-2019 Larry Lapp 757-315-3988 04-11-2019

4:00 PM EST

Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 X X Y 446130 $20.5 Million Net 30 X N/A X 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

Department of Veterans Affairs Financial Services Center P.O. Box 149971 Austin TX 78714-9971 The Department of Veterans Affairs Medical Center, VISN 6, has a requiement for Prescription Eyeglass Supply & Service to all beneficiaries serviced by VISN 6.

See the Performance Work Statement for complete description of required supplies and services.

See Attached Schedule Pages.

X X X Marchelle Peyton Contracting Officer Table of Contents

SECTION A1
A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS1
SECTION B - CONTINUATION OF SF 1449 BLOCKS4
B.1 CONTRACT ADMINISTRATION DATA4
B.2 SCHEDULE SUPPLIES/SERVICES5
B.3 PERFORMANCE WORK STATEMENT75
B.4 SPECIAL CONTRACT REQUIREMENTS84
SECTION C - CONTRACT CLAUSES98
C.1 ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS98
C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)98
C.3 52.216-18 ORDERING (OCT 1995)98
C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)98
C.5 52.216-21 REQUIREMENTS (OCT 1995) ALTERNATE I (APR 1984)99
C.6 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)99
C.7 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)100
C.8 52.228-5 INSURANCE—WORK ON A GOVERNMENT INSTALLATION (JAN 1997)100
C.9 SUPPLEMENTAL INSURANCE REQUIREMENTS100
C.10 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)101
C.11 52.237-3 CONTINUITY OF SERVICES (JAN 1991)101
C.12 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008)101
C.13 VAAR 852.219-10 VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS SET-ASIDE (JUL 2016)(DEVIATION)101
C.14 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING—MONITORING AND COMPLIANCE (JUL 2018)102
C.15 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND COMPLIANCE (JUL 2018)103
C.16 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012)103
C.17 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)104
C.18 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2019)104
SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS109
D.1 ATTACHMENT A – FACILITY AND COR LISTING109
D.2 ATTACHMENT B - PAST PERFORMANCE QUESTIONNAIRE110
D.3 ATTACHMENT C – DEPARTMENT OF LABOR WAGE DETERMINATION114
D.4 ATTACHMENT D – QASP “VISN 6 PRESCRIPTION EYEGLASS SUPPLY & SERVICES”115
D.5 ATTACHMENT E - CONTRACTOR CERTIFICATION: Immigration and Nationality Act of 1952, As Amended121
SECTION E - SOLICITATION PROVISIONS122
E.1 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)122
E.2 SPECIFIC INSTRUCTIONS TO OFFERORS REGARDING PROPOSAL PREPARATION123
E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (FEB 2012)126
E.4 52.216-1 TYPE OF CONTRACT (APR 1984)127
E.5 52.233-2 SERVICE OF PROTEST (SEP 2006)127
E.6 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008)127
E.7 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008)128
E.8 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO BENEFICIARIES (JAN 2008)128
E.9 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003)128
E.10 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (OCT 2018) ALTERNATE I (OCT 2014)128

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT:Contracting Officer 36C246
Department of Veterans Affairs
Network Contracting Office 6
100 Emancipation Drive
Hampton VA 23667

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X]52.232-33, Payment by Electronic Funds Transfer -
System For Award Management, or
[]52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly[]
b. Semi-Annually[]
c. Other[X] in arrears

4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be mailed to the following address:

Department of Veterans Affairs
Financial Services Center
P.O. Box 149971
Austin TX 78714-9971

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 SCHEDULE SUPPLIES/SERVICES

The Department of Veterans Affairs (VA) is seeking contractors capable of providing all labor, material, supplies, management and supervision necessary to provide eyeglasses to Veteran beneficiaries in seven (7) medical centers (Asheville VAMC, Durham VAMC, Fayetteville HCC, Hampton VAMC, Richmond VAMC, Salem VAMC and Salisbury). In addition, services will also be needed at Community Based Outpatient Clinics (CBOC) and Health Care Centers (HCC) that provide optical services.

Schedules are listed below by VISN 6 Facility and include Base Year and all four Option Years.

Asheville, NC & CBOC Hickory, NC – Base Year (1 Oct 2019 – 30 Sep 2020)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
0001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
0002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
25
0003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
0003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,400
0003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
100
0003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
100
0004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
12
0004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
0005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
6
0006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
0007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3
0008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
0008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
0009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
0009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
0010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

0011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
780
0011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
0012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
240
0013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
0014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
0015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
0016
Premium Progressives Add On; Varilux (or equal)
PR
400
0017
Add Power over +4.00
PR
4
0018
Lens Over Power +/- 10D
Per eye
4
0019
Roll and Polish
PR
5
0020
Balance Lens
PR
60
0021
Prism
Per eye
20
0022
Anti-Reflective Coating
PR
400
0023
Frost/Blackout Lenses
PR
4
0024
Fresnel Prism
Per eye
6

Estimated Total Amount $___________________

Asheville, NC& CBOC Hickory, NC – Option Year 1 (1 Oct 2020 – 30 Sep 2021)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
1001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
1002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
25
1003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
1003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,400
1003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
00
1003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
100
1004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
12
1004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
1005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
6
1006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
1007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3
1008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
1008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
1009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
1009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
1010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

1011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
780
1011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
1012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
240
1013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
1014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
1015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
1016
Premium Progressives Add On; Varilux (or equal)
PR
400
1017
Add Power over +4.00
PR
4
1018
Lens Over Power +/- 10D
Per eye
4
1019
Roll and Polish
PR
5
1020
Balance Lens
PR
60
1021
Prism
Per eye
20
1022
Anti-Reflective Coating
PR
400
1023
Frost/Blackout Lenses
PR
4
1024
Fresnel Prism
Per eye
6

Estimated Total Amount $______________

Asheville, NC& CBOC Hickory, NC – Option Year 2 (1 Oct 2021 – 30 Sep 2022)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
2001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
2002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
25
2003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
2003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,400
2003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
100
2003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
100
2004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
12
2004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
2005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
6
2006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
2007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3
2008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
2008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
2009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
2009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
2010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

2011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
780
2011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
2012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
240
2013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
2014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
2015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
2016
Premium Progressives Add On; Varilux (or equal)
PR
400
2017
Add Power over +4.00
PR
4
2018
Lens Over Power +/- 10D
Per eye
4
2019
Roll and Polish
PR
5
2020
Balance Lens
PR
60
2021
Prism
Per eye
20
2022
Anti-Reflective Coating
PR
400
2023
Frost/Blackout Lenses
PR
4
2024
Fresnel Prism
Per eye
6

Estimated Total Amount $_______________

Asheville, NC& CBOC Hickory, NC – Option Year 3 (1 Oct 2022 – 30 Sep 2023)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
3001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
3002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
25
3003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
3003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,400
3003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
100
3003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
100
3004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
12
3004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
3005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
6
3006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
3007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3
3008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
3008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
3009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
3009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
3010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

3011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
780
3011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
3012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
240
3013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
3014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
3015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
3016
Premium Progressives Add On; Varilux (or equal)
PR
400
3017
Add Power over +4.00
PR
4
3018
Lens Over Power +/- 10D
Per eye
4
3019
Roll and Polish
PR
5
3020
Balance Lens
PR
60
3021
Prism
Per eye
20
3022
Anti-Reflective Coating
PR
400
3023
Frost/Blackout Lenses
PR
4
3001
Fresnel Prism
Per eye
6

Asheville, NC& CBOC Hickory, NC – Option Year 4 (1 Oct 2023 – 30 Sep 2024)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
4001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
4002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
25
4003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
4003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,400
4003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
100
4003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
100
4004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
12
4004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
4005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
6
4006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
2,000
4007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3
4008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
4008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
8
4009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
4009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
4010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

4011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
780
4011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
4012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
240
4013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
4014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
4015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
4016
Premium Progressives Add On; Varilux (or equal)
PR
400
4017
Add Power over +4.00
PR
4
4018
Lens Over Power +/- 10D
Per eye
4
4019
Roll and Polish
PR
5
4020
Balance Lens
PR
60
4021
Prism
Per eye
20
4022
Anti-Reflective Coating
PR
400
4023
Frost/Blackout Lenses
PR
4
4024
Fresnel Prism
Per eye
6

Estimated Total Amount $________________

Durham, NC & HCC Greenville, NC – Base Year (1 Oct 19 – 30 Sep 20)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
0001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
3,000
0002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
0003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5,000
0003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
11,000
0003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
200
0003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
200
0004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
20
0004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
30
0005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
8
0006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,500
0007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
0008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
10
0008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
12
0009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
450
0009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
500
0010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
5

ADD-ONS

0011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
1,000
0011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
500
0012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
400
0013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
0014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
8
0015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
7
0016
Premium Progressives Add On; Varilux (or equal)
PR
600
0017
Add Power over +4.00
PR
5
0018
Lens Over Power +/- 10D
Per eye
5
0019
Roll and Polish
PR
6
0020
Balance Lens
PR
75
0021
Prism
Per eye
24
0022
Anti-Reflective Coating
PR
600
0023
Frost/Blackout Lenses
PR
6
0024
Fresnel Prism
Per eye
6

Durham, NC & HCC Greenville, NC – Option Year 1 (1 Oct 20 – 30 Sep 21)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
1001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
3,000
1002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
1003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5,000
1003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
11,000
1003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
200
1003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
200
1004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
20
1004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
30
1005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
8
1006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,500
1007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
1008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
10
1008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
12
1009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
450
1009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
500
1010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
5

ADD-ONS

1011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
1,000
1011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
500
1012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
400
1013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
1014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
8
1015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
7
1016
Premium Progressives Add On; Varilux (or equal)
PR
600
1017
Add Power over +4.00
PR
5
1018
Lens Over Power +/- 10D
Per eye
5
1019
Roll and Polish
PR
6
1020
Balance Lens
PR
75
1021
Prism
Per eye
24
1022
Anti-Reflective Coating
PR
600
1023
Frost/Blackout Lenses
PR
6
1024
Fresnel Prism
Per eye
6

Estimated Total Amount $_____________

Durham, NC & HCC Greenville, NC – Option Year 2 (1 Oct 21 – 30 Sep 22)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
2001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
3,000
2002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
2003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5,000
2003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
11,000
2003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
00
2003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
200
2004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
20
2004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
30
2005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
8
2006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,500
2007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
2008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
10
2008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
12
2009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
450
2009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
500
2010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
5

ADD-ONS

2011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
1,000
2011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
500
2012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
400
2013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
2014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
8
2015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
7
2016
Premium Progressives Add On; Varilux (or equal)
PR
600
2017
Add Power over +4.00
PR
5
2018
Lens Over Power +/- 10D
Per eye
5
2019
Roll and Polish
PR
6
2020
Balance Lens
PR
75
2021
Prism
Per eye
24
2022
Anti-Reflective Coating
PR
600
2023
Frost/Blackout Lenses
PR
6
2024
Fresnel Prism
Per eye
6

Durham, NC & HCC Greenville, NC – Option Year 3 (1 Oct 22 – 30 Sep 23)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
3001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
3,000
3002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
3003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5,000
3003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
11,000
3003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
200
3003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
200
3004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
20
3004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
30
3005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
8
3006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,500
3007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
3008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
10
3008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
12
3009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
450
3009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
500
3010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
5

ADD-ONS

3011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
1,000
3011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
500
3012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
400
3013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
3014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
8
3015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
7
3016
Premium Progressives Add On; Varilux (or equal)
PR
600
3017
Add Power over +4.00
PR
5
3018
Lens Over Power +/- 10D
Per eye
5
3019
Roll and Polish
PR
6
3020
Balance Lens
PR
75
3021
Prism
Per eye
24
3022
Anti-Reflective Coating
PR
600
3023
Frost/Blackout Lenses
PR
6
3024
Fresnel Prism
Per eye
6

Durham, NC & HCC Greenville, NC – Option Year 4 (1 Oct 23 – 30 Sep 24)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
4001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
3,000
4002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
4003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5,000
4003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
11,000
4003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
200
4003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
200
4004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
20
4004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
30
4005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
8
4006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,500
4007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
4008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
10
4008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
12
4009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
450
4009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
500
4010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
5

ADD-ONS

4011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
1,000
4011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
500
4012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
400
4013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
4014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
8
4015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
7
4016
Premium Progressives Add On; Varilux (or equal)
PR
600
4017
Add Power over +4.00
PR
5
4018
Lens Over Power +/- 10D
Per eye
5
4019
Roll and Polish
PR
6
4020
Balance Lens
PR
75
4021
Prism
Per eye
24
4022
Anti-Reflective Coating
PR
600
4023
Frost/Blackout Lenses
PR
6
4024
Fresnel Prism
Per eye
6

Fayetteville, NC & HCC Wilmington, NC – Base Year (1 Oct 2019 – 30 Sep 2020)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
0001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
0002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
0003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
4,000
0003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,000
0003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
0003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
0004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
14
0004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
0005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
5
0006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,000
0007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
0008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
0008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
0009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
0009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
0010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

0011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
800
0011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
0012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
0013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
0014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
6
0015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
0016
Premium Progressives Add On; Varilux (or equal)
PR
450
0017
Add Power over +4.00
PR
4
0018
Lens Over Power +/- 10D
Per eye
4
0019
Roll and Polish
PR
4
0020
Balance Lens
PR
60
0021
Prism
Per eye
20
0022
Anti-Reflective Coating
PR
500
0023
Frost/Blackout Lenses
PR
4
0024
Fresnel Prism
Per eye
6

Estimated Total Amount $__________________

Fayetteville, NC & HCC Wilmington, NC – Option Year 1 (1 Oct 2020 – 30 Sep 2021)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
1001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
1002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
1003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
4,000
1003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,000
1003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
1003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
1004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
14
1004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
1005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
5
1006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,000
1007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
1008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
1008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
1009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
1009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
1010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

1011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
800
1011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
1012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
1013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
1014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
6
1015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
1016
Premium Progressives Add On; Varilux (or equal)
PR
450
1017
Add Power over +4.00
PR
4
1018
Lens Over Power +/- 10D
Per eye
4
1019
Roll and Polish
PR
4
1020
Balance Lens
PR
60
1021
Prism
Per eye
20
1022
Anti-Reflective Coating
PR
500
1023
Frost/Blackout Lenses
PR
4
1024
Fresnel Prism
Per eye
6

Fayetteville, NC & HCC Wilmington, NC – Option Year 2 (1 Oct 2021 – 30 Sep 2022)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
2001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
2002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
2003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
4,000
2003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,000
2003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
2003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
2004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
14
2004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
2005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
5
2006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,000
2007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
2008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
2008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
2009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
2009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
2010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

2011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
800
2011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
2012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
2013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
2014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
6
2015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
2016
Premium Progressives Add On; Varilux (or equal)
PR
450
2017
Add Power over +4.00
PR
4
2018
Lens Over Power +/- 10D
Per eye
4
2019
Roll and Polish
PR
4
2020
Balance Lens
PR
60
2021
Prism
Per eye
20
2022
Anti-Reflective Coating
PR
500
2023
Frost/Blackout Lenses
PR
4
2024
Fresnel Prism
Per eye
6

Fayetteville, NC & HCC Wilmington, NC – Option Year 3 (1 Oct 2022 – 30 Sep 2023)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
3001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
3002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
3003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
4,000
3003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,000
3003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
3003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
3004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
14
3004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
3005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
5
3006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,000
3007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
3008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
3008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
3009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
3009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
3010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

3011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
800
3011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
3012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
3013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
3014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
6
3015
Aspheric Lenticular Lenses Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
5
3016
Premium Progressives Add On; Varilux (or equal)
PR
450
3017
Add Power over +4.00
PR
4
3018
Lens Over Power +/- 10D
Per eye
4
3019
Roll and Polish
PR
4
3020
Balance Lens
PR
60
3021
Prism
Per eye
20
3022
Anti-Reflective Coating
PR
500
3023
Frost/Blackout Lenses
PR
4
3024
Fresnel Prism
Per eye
6

Fayetteville, NC & HCC Wilmington, NC – Option Year 4 (1 Oct 2023 – 30 Sep 2024)

CLIN Item
Description
Unit
Est. Qty
Unit Price
Extended Price
4001
Single Vision, in plastic or Polycarbonate; includes Tint: solid, gradient, U.V./coat, frames and case
PR
2,400
4002
Single Vision, in glass includes Tint: solid, gradient, U.V./coat, frames & case
PR
20
4003a
Bifocal Lenses (seg width 28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
4,000
4003b
Bifocal Lenses (seg width 35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
10,000
4003c
Bifocal Lenses (seg width 45) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
4003d
Bifocal Lenses (seg width Executive) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
180
4004a
Bifocal Lenses (seg width 28) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
14
4004b
Bifocal Lenses (seg width 35) in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
24
4005
Double D Bifocal; Clear Plastic or Polycarbonate
PR
5
4006
Progressive Bifocal in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
3,000
4007
Progressive Bifocal in glass; Includes tint: solid, gradient, U.V./coat, frames and case
PR
5
4008a
Trifocal Lenses (7x28) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
4008b
Trifocal Lenses (8x35) in glass, includes tint: solid, gradient, U.V./coat, frames and case
PR
6
4009a
Trifocal Lenses (7x28) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
300
4009b
Trifocal Lenses (8x35) in plastic or Polycarbonate; Includes tint: solid, gradient, U.V./coat, frames and case
PR
400
4010
Double D Trifocal: Clear Plastic or Polycarbonate
PR
4

ADD-ONS

4011a
Photochromic lenses Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
800
4011b
Transition Xtra Active Add on (Plastic, Polycarbonate, High Index); provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
4012
Hi-Index (1.67) Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
300
4013
Glass PGX Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
4
4014
Slab Off-Prism Add on; provide pricing as add-on to the per pair price of eyeglasses listed above
PR
6
4015

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