36C25520Q0543 0001.docx

36C25520Q0543 0001

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 NUMBERE

D 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 amendmen t, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

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) 589-20-4-5695-0123 36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048 36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048 To all Offerors/Bidders

36C25520Q0543 08-28-2020

X X X

See CONTINUATION Page

EYE EXAM LANES PURCHASE - COLUMBIA VAMC

The Purpose of this amendment is to:

1. Amend the salient characteristics of items in the St atement of Work.

A. Amended Statement of Work is attached and replaces the requirements in the original RFQ.

All questions are due NLT September 7, 2020 by 3:00pm CST Quotes are due NLT September 21, 2020 by 8:00am CST.

JEANIE WALLACE

CONTRACTING OFFICER

A.1 STATEMENT OF WORK

Eye Lanes Harry S Truman VAMC

Truman VA needs multiple pieces of equipment to complete the new clinic area expansion and provide safe and up to date patient care. The space available and existing equipment has all been consider when determining needs going forward. The following equipment works as a system to optimize workflow and increase efficiency and quality of care. This equipment must include necessary peripherals to give comprehensive Optometry and Ophthalmology care within the staffs Scope of Practice at Truman VA. This equipment will be used for routine eye exams and for determination of ocular disease. The contractor must be onsite to assist with installation of all equipment and all installation must be done in a way to not interfere with patient care.

Specific needs:

This solicitation uses a Brand Name or Equal Description of the product required. This permits prospective contractors to offer products other than those specifically referenced by brand name.

The proposed solution must meet or exceed the following criteria:

Marco Deluxe Stand-with table for microscope and arm for phoropter (standard) – Quantity 11 Marco deluxe instrument stand to hold and charge three instruments and with slit lamp arm, adjustment. This must be compatible with the Haag-Streit 900 BQ LED Slit Lamp. 3 way locking of the refractor arm compatible with racket handles for secure locking. Scuff resistant base to withstand damage from usage. Must be wheelchair accessible. Base width less than 22 inches Height (minus arm) less than 75 inches Arm Length less than 37 inches.

Marco E-Z Deluxe exam chair – Quantity 17 Examination chair that adjusts the seated height as well as the reclines. This chair must have low profile double hydraulic cylinder system to provide optimal range in positions. In addition, this chair much be auto reclining. The chair needs to allow accessories to accommodate handicap and wheelchair users. No greater than the following dimensions Length 54 inches Width 22 inches Height 44 inches Reclined Height 33 inches.

Marco Deluxe Stand Rachet Handle and Safety Collar – Quantity 17 Marco deluxe stand rachet handles compatible with Marco deluxe stand to provide patient safety.

Marco Extended Bar for Wheelchair Stand – Quantity 17 Marco extended bar for wheelchair stand that is compatible with Marco deluxe stand to accommodate wheelchair uses.

Marco Chair Glide System for Wheelchair Accessibility - Quantity 17 Sturdy and solid with wide surface to move exam chair. Requirement must include a foot release for ergonomic reasons.

Marco Pneumatic Stool with Back – Quantity 6 Circular ring stool with back for providers use. Air spring pneumatic height adjustment to hold up to 250 lbs. No greater than these dimensions: Height 20 inches to 28 inches. Color: Black

Lombart CVS Essential Acuity – Quantity 18 Lombart CVS essential acuity system must include monitor, HDMI device with software, luminous RF remote, and a wall-mounting bracket with swivel. Monitor size no larger than 23 inches

Haag-Streit 900 BQ LED Slit Lamp, Unit Model – Quantity 16 Haag-Streit BQ 900 LED slit lamps with mounted and affixed tonometer. The proposed solution shall employee convergent, stereoscopic optics and enable adjustment for provider interpupillary distance. The included eye pieces need to be independently adjusted for focus and a light source with 600,000 Lux. The light source must offer a beam that can be tilted. Rotated and is not less than 8mm in vertical height and horizontal width. The eyepiece must be 10X utilization. The slip lamp cannot be used without the stand and the sole purpose of the stand is to support the slit-lamp and other devices.

Haag-Streit 50/50 Selectable Beamsplitter for BQ Observer – Quantity 16 Must interface with Haag-Streit slit lamp

Haag-Streit Short Observer Tube with Eyepiece that works with Beamsplitter – Quantity 16 Haag-Streit beam splitter observer will attach the eye piece to the Haag-Streit slit lamp.

Haag-Streit BP/BQ/BX Applanation Tonometer – Quantity 16 Haag-Streit applanation tonometer that is made to fit the BQ stereo-microscope

Marco RT-700 Black Illuminated Refractor with Minus Cylinders – Quantity 18 Marco RT-700 Illuminated Manual Refractor with (O) – Open aperture (two positions) (R) – Retinoscopic lens, +1.50D (P) – Polarizing lens 45º left eye, 135º right eye (WMV) White Maddox rod, vertical (RMV) Red Maddox rod, vertical (WMH) White Maddox rod, horizontal (RMH) Red Maddox rod, horizontal (RL) – red lens (GL) – green lens (+.12) – +0.12 sphere (PH) –Pin hole (10 l) or (6 U) – 10 base-in – left eye 6 base-up – right eye (Disassociating prisms) (±.50) – ±0.50 fixed cross cylinder (OC) – Occluder to ±6.00 diopters 0.00 to ±8.00 diopters with additional lens of ±2.0 diopters)

Marco 101 Lensmeter – Quantity 11 Macro 101 lensmeter that is equipped to measure lenses from 30mm to 90mm

Lombart Full Diameter Trial Lens Set with Plus and Minus Cylinders in Case with Metal trial frames – Quantity 7 Lombart full set of trial lenses to be compatible with Lombart metal trial frames.

Reichert AVIA Tonopen – Quantity 23 Reichert AVIA tono-pen is required to measure intraocular pressure in corneas with scarring.. The device is required to be portable and handheld. The proposed solution will have a statistical analysis of measurements and be calibration free.

Heine Omega 500 LEDHQ Unplugged with HC50L Rheostat, Battery & EN50U Wall Charger – Quantity 18 Heine Omega 500 LED indirect ophthalmoscope is needed for the performance of retinal exams. This requirement is lightweight, portable, and cordless allowing provider to move freely around the veteran during exam. The light source will utilize LED bulb and Lithium Polymer battery that allows 6 hours of clinical use on a single charge. The solution will incorporate a rheostat onto the binocular indirect headset. Large, intermediate, and small apertures that are integrated with internal mirrors and optics will allow single step adjustment o desired aperture and related settings to allow stereopsis with all aperture settings. Filters for red free and cobalt blue filters will be required and a diffuser is also necessary. The range of interpupillary distances is 48 and 76mm. The charging station and docking station will be wall mountable.

Marco HandyRef-K Palm Automatic Refractor/Keratometer – Quantity 2 Marco handyRef-k palm auto refractor is needed to measure the patient’s retractive error and determine prescription need. This requirement needs to be compatible and similar to currently used equipment to standardize care. This device must be handheld.

Delivery Information:

All items will be delivered to:

800 HOSPITAL DR

COLUMBIA MO 65201

Additional information:

Some end of life equipment that is on hand will continue to be utilized to reduce cost and keep within budget restraints. Due to utilization of current equipment, it is in the staff and the patient’s best interest that new equipment is as standardized and close as possible to existing equipment as possible. This will provide best continuity of care from patient to patient.