36C25019Q1071-001.pdf

VHAPM Part 813.106 Simplified Acquisition Procedures: Soliciting from a Single Source Attachment 1: Single Source Justification for SAP under the SAT

VHAPM Part 813.106 Page 1 of 7 Original Date: 08/30/17 Revision 01 Eff Date: 04/23/2018

DEPARTMENT OF VETERANS AFFAIRS

Justification for Single Source Awards IAW FAR 13.106‐1 For

Over Micro‐Purchase Threshold but Not Exceeding the SAT ($250K)

Acquisition Plan Action ID: 36C250‐19‐AP‐5101

1. Contracting Activity: Department of Veterans Affairs, VISN 10, John D. Dingell VA Medical Center

PR 553‐19‐3‐063‐0224

2. Brief Description of Supplies/ Services required and the intended use/Estimated Amount:

This is a firm‐fixed price request to upgrade the existing Telemetry system with the EXACT BRAND NAME products/services included below:

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

40.00 EA $_________ $_________

ICU UNIT-UPGRADE LICENSE, 1 PATIENT CAPABILITY FOR

CENTRAL STATION 96102

LOCAL STOCK NUMBER: 910-6102-01U

2.00 EA $_________ $_________

A2 ADDITIONAL BEDSIDES, NO MODULES - XPRESSON MONITOR

LOCAL STOCK NUMBER: 91393

XPREZZON BASE

LOCAL STOCK NUMBER: 91393-A*

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ENGLISH LANGUAGE

LOCAL STOCK NUMBER: 91393-1

EIGHT WAVEFORMS

LOCAL STOCK NUMBER: 91393-08*

DATA SHUTTLE

LOCAL STOCK NUMBER: 91393-Q*

19th PREMIUM XPREZZON DISPLAY W/INTEGRATED HIGH

RESOLUTION FRONT & REAR LED ALARM LIGHTS & AMBIENT

LIGHT DIMMING SENSOR

LOCAL STOCK NUMBER: 94267-19

1 BED CLINICAL ACCESS BUNDLE LICENSE

LOCAL STOCK NUMBER: 910-3999-01

4.00 EA $_________ $_________

DEPOT SUPPORT PLAN

LOCAL STOCK NUMBER: 999-9999-42

VHAPM Part 813.106 Page 3 of 7

VHM ARM, BACKPACK, 40lb LIMIT

LOCAL STOCK NUMBER: 016-0887-01

KIT BRACKET, BKPK, 91393

LOCAL STOCK NUMBER: 016-0899-00

POWER SUPPLY HOLSTER, WALL MOUNTED

LOCAL STOCK NUMBER: 016-0863-00

CROSSMEMBER FOR MOUNTING POWER SUPPLY HOLSTERS

SIDE/SIDE

LOCAL STOCK NUMBER: 016-0512-00

MOUNT, WALL CHANNEL, 19" GCX

LOCAL STOCK NUMBER: 016-0506-00

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Revision 01 Eff Date: 04/23/2018

20" DISPLAY ALARM CABLE**

LOCAL STOCK NUMBER: 012-0887-02

16" DVI CABLE **

LOCAL STOCK NUMBER: 012-0893-01

12" TOUCH SCREEN CABLE**

LOCAL STOCK NUMBER: 012-0894-01

1.00 JB $_________ $_________

MANAGED INSTALLATION: STD INSTALLATION W/MGMT OF

ALL ASPECTS OF IMPLEMENTATION AND INSTALLATION

LOCAL STOCK NUMBER: 999-9999-79

1 BED INTERFACE BUNDLE LICENSE

LOCAL STOCK NUMBER: 910-3998-01

1.00 EA $_________ $_________

ENHANCED SOFTWARE SUPPORT PLAN (ICS/XPREZZNET/XHIBIT)

LOCAL STOCK NUMBER: 999-1898-11

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PATIENT MONITORING SERVICE MANUAL, CD-ROM

LOCAL STOCK NUMBER: 084-0700-03

PATIENT MONITORING OPERATIONS MANUAL, CD-ROM,

ENGLISH

LOCAL STOCK NUMBER: 084-1101-03

POWER CORD, NORTH AMERICA,3',120V,10A

LOCAL STOCK NUMBER: 161-0246-00

4EA DISPLAYS FOR UNIT-XHIBIT DISPLAY, 22" HIGH

RESOLUTION TOUCHSCREEN

LOCAL STOCK NUMBER: 011-0241-01

30-BED CENTRAL - ARCTIC WHITE 8' SWIVEL ONLY PIVOT ARM

FOR WALL OR PEDESTAL CHANNEL

LOCAL STOCK NUMBER: 016-0931-00

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ARCTIC WHITE DUAL DISPLAY VERTICAL BRACKET

LOCAL STOCK NUMBER: 016-0933-00

18.00 EA $_________ $_________

UPGRADE: SLA 1017F03156 - UPGRADE LICENSE, 1 PATIENT

CAPABILITY FOR CENTRAL STATION 96102

LOCAL STOCK NUMBER: 910-6102-01U

2.00 JB $_________ $_________

SERVICE TNG - XHIBIT, XTR & ARIA TELE TELEMETRY SYSTEMS.

OPERATIONS CONFIGURATION AND PMs - LEVELS 1 & 2

LOCAL STOCK NUMBER: 999-1887-54

2.00 JB $_________ $_________

SVC TNG - XHIBIT, XTR & ARIA TELE TELEMETRY SYSTEMS:

CORRECTIVE MAINTENANCE - LEVEL 3

LOCAL STOCK NUMBER: 999-1887-55

GRAND

TOTAL

Products are anticipated to be delivered within 90 days ARO.

3. Unique characteristics that limit availability to only one source, with the reason no other supplies or services can be used:

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Revision 01 Eff Date: 04/23/2018

Spacelabs telemetry and bedside monitors already exist in the building and additional equipment that is similar and compatible with the current system is required.

4. Description of market research conducted and results or statement why it was not conducted:

Market research was conducted via VIP, FPDS, GSA, FBO, and internet sources. Market research confirmed the brand name product was required as stated above and 2 vendors can provide the requirement, therefore this will be posted along side a brand name solicitation on FBO to allow the maximum competition possible.

5. Contracting Officer's Certification: Purchase is approved in accordance with FAR13.106‐1(b). I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief. .

Brooke L. Hansen Date Contract Specialist