36C25525Q0175.pdf

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. UEI: EFT:

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

657-25-1-3755-6726

36C25525Q0175 02-04-2025

Denise Maynard, denise.maynard@va.gov 913-946-1978 02-19-2025

10:00am CST

36C255

Department of Veterans Affairs

Network Contracting Office (NCO) 15

3450 S 4th Street Trafficway

Leavenworth KS 66048

X 100

X

325120

1200 Employees

N/A

X

John J. Pershing VA Medical Center

1500 N. Westwood Blvd.

Poplar Bluff, MO 63901-3318

36C255

Department of Veterans Affairs

Network Contracting Office (NCO) 15

36C255

Financial Services Center http://www.fsc.va.gov/einvoice.asp

Austin TX

877-353-9791 512-460-5429

Oxygen Cylinders

Indefinite Delivery Indefinite Quantity

Please see Section B.2 for details.

TBD

X X

Denise Maynard

Contracting Officer

36C25525Q0175

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 STATEMENT OF WORK

B.3 PRICE/COST SCHEDULE

ITEM INFORMATION

B.4 DELIVERY SCHEDULE

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2023)

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 52.216-18 ORDERING (AUG 2020)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.7 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ...32

C.8 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.9 VAAR 852.219-73 VA NOTICE OF TOTAL SET-ASIDE FOR CERTIFIED

SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESSES (JAN 2023)

(DEVIATION)

C.10 VAAR 852.219-76 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SUPPLIES AND PRODUCTS (NOV 2022)

C.11 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.12 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) ..38

C.13 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (JAN 2025)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.3 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.4 52.204-29 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT

ORDERS—REPRESENTATION AND DISCLOSURES (DEC 2023)

E.5 52.217-3 EVALUATION EXCLUSIVE OF OPTIONS (APR 1984)

E.6 52.217-5 EVALUATION OF OPTIONS (JUL 1990)

E.7 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (MAY 2024)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C255

Network Contracting Office (NCO) 15

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] Monthly

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment

Requests.

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

AMENDMENT NO DATE

B.2 STATEMENT OF WORK

1. SCOPE:

1.1. The John J. Pershing VA Medical Center, Poplar Bluff, MO and the Cape Girardeau VA Health Care

Center require a contractor to provide medical gases. The contractor shall be responsible for the filling, transporting, handling, delivering, pick up and storing of medical cylinders gases. This is for a base plus 4 option year contract.

1.2. All supplies of medical cylinder gases shall be delivered to the John J Pershing VAMC and the Cape

Girardeau Health Care Center. The amount of deliveries is included in the Price/Cost Schedule and the contractor must comply with amount of deliveries specified. If there is emergent need, the response time will be within 2 hours. Through a bilateral modification, the Government may add additional delivery locations or remove any delivery locations any time during the specified period of performance. All rates, contract terms and conditions shall remain the same and the Contractor shall accept any additional locations if delivery will be available within 2 hours. The addresses for delivery are as follows:

a) John J. Pershing VA Medical Center, 1500 N. Westwood Blvd, Poplar Bluff, MO 63901

b) Cape Girardeau Health Care Center, 711 S Mount Auburn Road, Cape Girardeau, MO 63703

1.3. The quantities shown in the Price/Cost Schedule, are estimates of the requirement. There is no express or implied guarantee that these quantities will be purchased. The Government is anticipating awarding an Indefinite Delivery Indefinite Quantity (IDIQ) Firm Fixed Price (FFP) contract with one base year and four (4) option years. The period of performance shall be from September 30, 2025, through September 29, 2030. A 10% increase or decrease of usage may be anticipated annually by the

Government. Adding or removing medical gasses on the list at any location is based on station needs of usage.

1.4. The Contractor will be provided with the name and contact information of the primary Contracting

Officer Representative (COR) within 20 days after award of the Contract. The following information applies to all deliveries, regardless of the time or day of execution: Cylinders shall be filled to the maximum functional capacity during each refilling procedure unless otherwise specified in the facility requirements or as agreed upon in a written document signed and dated by the Contracting Officer (CO);

The Contractor shall provide a legible signed and dated written or online document that identifies the number of cylinders at the ordering facility prior to delivery, the number of cylinders being delivered, the number of cylinders being picked-up, and the number of cylinders at the ordering facility after the delivery has been made. This document must be counter-signed by the facility representative supervising the delivery.

2. MEDICAL GAS SPECIFICATION AND REQUIREMENTS:

2.1. All medical gases under the Contract shall be medical-grade and shall meet or exceed the standards cited in the current edition of the United States Pharmacopoeia/National Formulary (U.S.P.). The

Contractor shall be registered with the FDA and all medical gases shall be manufactured, processed, packaged, transported, and stored according to the FDA’s CGMP regulations and Labeling Section 21, Code of Federal Regulations, parts 820.80(b), 820.70(f), 820.120 or most current codes as they update during the period of the contract. All products, equipment and services provided under this contract shall follow all applicable Federal, State and Local regulations.

2.2. In addition, the following specifications are incorporated into the contract or most current codes as they update during the period of the contract.: 2.2.1. BB-A-1034B, FEDERAL SPECIFICATION:

COMPRESSED AIR, BREATHING (20 DEC 1985) http://everyspec.com/FED_SPECS/B/BB-A-

1034B_9157/

2.2.2. BB-C-101D, FEDERAL SPECIFICATION: CARBON DIOXIDE (CO2): TECHNICAL AND

USP (07 MAR 2011) http://everyspec.com/FED_SPECS/B/BB-C-101D_31791/

2.2.3. Compressed Gas Association (CGA) Publication G-7 – Compressed Air for Human Respiration, dated 08-04-2003 and ANSI/CGA G-7.1 Commodity Specification for Air, dated 08-27-2004.

http://www.cganet.com.

2.3. Material Safety Data Sheets shall be provided to the facility COR upon request. VA may request training on procedures associated with safety data and maintaining medical gas cylinders while on VA facilities.

2.4. A copy of all inspection reports shall be provided to the facility COR upon the completion of any contractor-owned or government-owned system inspections that are required by regulation.

3. CYLINDERS AND ASSOCIATED COMPONENTS:

3.1. Laws and regulations: Cylinders and other containers for gaseous and liquid forms of gas shall comply with the most current codes as they update during the period of performance of the contract and based on best and most current industry standards, policy and regulations. Not limited to the following addressed below:

3.2. DOT specifications and shall be maintained, filled, marked, labeled, and shipped to comply with current DOT regulations (Title 49 – Transportation, Code of Federal Regulations). Filling, packaging, and labeling for medical gases shall also comply with the Federal Food, Drug, and Cosmetics Act, and the

FDA.

3.3. Marking: In addition to marking required by the laws and regulations, marking shall comply with the most current codes as they update during the period of performance of the contract CGA Publication C-7

– Guide to Preparation of precautionary Labeling and Marking of Compressed Gas Containers, dated

January 01, 2014 https://www.cganet.com/.

3.4. Color Coding: Cylinders shall be color coded in accordance with the most current codes as they update during the period of performance of the contract CGA Publication C-9 – Standard Color Marking of Compressed Gas Containers Intended for Medical Use, dated September 2013 https://www.cganet.com/.

3.5. Valves: Valves shall comply with the most current codes as they update during the period of performance of the contract with CGA Safety Bulletin SB-26 dated August 2014 and CGA Publication V-

1 -Compressed Gas Association Standard for Compressed Gas Cylinder Valve Outlet and Inlet

Connections, dated September 2019. Valve protection caps for cylinders designed to receive such caps shall be securely attached to the cylinders in a manner to protect the valves from injury during transit and delivery to the purchaser’s receiving area. For cylinders, all fittings must be permanently brazed to prevent their removal. In addition, each container should contain a 360-degree cryoband applied to the top of the container with the drug product name repeated around the entire container.

3.6. Hydrostatic Testing:

3.6.1. Retest Date: If applicable the contractor shall comply with the most current codes as they update during the period of performance of the contract of DOT regulations require retesting of cylinder(s) within three (3) months after scheduled date of shipment to a continental U.S. destination or within six (6) months after scheduled date of shipment to an overseas destination, the cylinder(s) shall be retested. The

Contractor will be required to retest any government-owned cylinder when requested by ordering facility, regardless of scheduled retest date . NOTE: Government-owned cylinders have both a 5-Year and a 10-

Year Hydrostatic Testing requirement.

3.6.2. Method: Government-owned cylinders, which are eligible for extended hydrostatic retesting by a modified hydrostatic method or by visual inspection in lieu of hydrostatic testing, shall be serviced by the most economical means and shall comply with the most current codes as they update during the period of performance of the contract of DOT regulations (49 CFR 173) unless otherwise specified by the ordering facility. When modified or reduced DOT test requirements are contingent upon past usage of the cylinders, a written statement from the ordering activity indicating that the cylinders have been used exclusively for a specific gas may be considered acceptable evidence of the cylinders’ eligibility for modified testing or inspection.

3.6.3. Hydrostatic testing shall comply with the most current codes as they update during the period of performance of the contract be performed in accordance with CGA’s Publication – C-q, Methods for

Hydrostatic Testing of Compressed Gas Cylinders, dated June 24, 2019 https://www.cganet.com/.

3.6.4. Visual inspection shall comply with the most current codes as they update during the period of performance of the contract be performed in accordance with the applicable CGA publications C-6 –

Standards for Visual Inspection of Steel Compressed Gas Cylinders, dated January 1, 2013 or as applicable C-6.1 – Standards for Visual Inspection of High-Pressure Aluminum Compressed Gas

Cylinders, dated January 1, 2013 https://www.cganet.com/.

3.6.5. Cylinder Sizes: Cylinder sizes shown in the Item Description chart below, indicates product capacity of the cylinder(s) currently being used. All capacities are approximate, and the government shall be billed only for the actual amount of gas delivered. In accordance with the most current codes as they update during the period of performance of the contract Federal Food, Drug, and Cosmetic Act, the actual contents of the container must appear on the label.

Cylinder Size Outer Diameter (inches) Height (inches)

B 3 5/16 - 3 1/2 13 - 13 1/4

C 3 1/2 8

D 4 3/16-4 1/2 16 3/4 - 19

E 4 3/16 - 4 1/2 24 3/4 - 30

F 4 1/4 17

G 8 1/2 51 - 51 3/4

H 9 - 9 1/4 51

J 9 - 9 1/4 51 - 51 3/4

K 9 56

M 7 43

Q 7 - 7 1/2 32 - 49

S 7 1/4 - 7 1/2 46

T 9 1/4 - 10 55 - 61

230 LT Nitrogen (on wheels) 26 57

100 LT Helium 24 59

3.6.6. E-Sized oxygen cylinder – fixed regulator system requirements: lightweight aluminum construction; easy-to-carry wide permanent handle to make it easy to lift; minimum flow of 15 Liters Per

Minute (LPM); flow rates ranging from 0.25 LPM minimum to 25 LPM; a Diameter Index Safety System

(DISS) 50 PSI fitting for transport ventilator hook-up, magnetic resonance imaging (MRI) compatibility and easy to read contents gauge and utilize single-stage valves only.

3.6.7. Method of Shipment: Empty government-owned cylinders that are picked up from an ordering facility for re-fill or service shall be transported in accordance with the most current codes as they update during the period of performance of the contract DOT Regulations, using normal commercial practice to prevent damage to cylinders.

4. GOVERNMENT OWNED-MEDICAL GAS CYLINDERS:

4.1. Government-owned medical gas cylinders and appurtenances shall be maintained by the Contractor in a manner that will ensure compliance with applicable regulations, and standards. Expenses that occur

(i.e.: valve replacements) shall be paid for by the Government via purchase card.

4.2. Government-owned medical gas cylinders and appurtenances that do not meet compliance requires the contractor to inform the Contracting Officers’ Representative (COR) at the facility. The COR will provide a disposition slip to the contractor to dispose of the specific government-owned medical gas cylinders. Government owned property also includes abandoned medical gas cylinders from other vendors to be disposed.

4.3. Individual Agency Ownership of Cylinders: Government-owned cylinders shall remain the property of the individual ordering (owning) agency and shall not be exchanged for other cylinders, either government-owned or contractor-owned, without authorization of the ordering facility.

4.4. The contractor is required to pick up government-owned medical gas cylinders and appurtenances shall be filled to the maximum functional capacity during each refilling procedure unless otherwise specified in the facility requirements. Each Government-owned medical gas cylinders and appurtenances shall be returned one for one to match the pick-up number.

4.5. The contractor is required to provide a legible signed and/or electronic delivery slip that has been signed by the deliverer as well as the countersigned by the facility representative supervising the delivery.

The delivery slip must include:

4.5.1.1. The number of cylinders at the ordering facility prior to delivery

4.5.1.2. The number of cylinders being delivered

4.5.1.3. The number of cylinders being picked-up

4.6. The facilities will identify government owned cylinders and will perform delivery audits every delivery date and if one for one matching is not accurate, missing cylinder quantities will be identified and documented on the delivery slip of government owned cylinders. A quarterly audit by the government will determine if the contractor lost any government-owned medical gas cylinders and appurtenances. The contractor will be responsible to pay for lost government-owned medical gas cylinders and appurtenances at agreed upon rates as identified on Attachment 2, Schedule of Items.

5. NON-REPAIRABLE GOVERNMENT OWNED MEDICAL CYLINDERS:

5.1. Prior to disposing of non-repairable government-owned cylinders, parts, fittings, and appurtenances, the Contractor shall contact the ordering (owning) facility COR. The Contractor shall also list reason for disposition. Contractor shall make disposition in accordance with ordering activity’s instructions.

5.2. Contractor shall be paid for all services performed and authorized by the ordering activity in accordance with the price schedule.

5.3. Contractor shall not charge any additional fees for the return of non-repairable cylinders to the ordering activity.

6. CONTRACTOR-FURNISHED MEDICAL CYLINDERS:

6.1. Contractor shall install and maintain cylinders with appropriate back-up systems, if applicable, with approval from the COR. Through the duration of the Contract, the Contractor shall be liable for the integrity, suitability, and safety of contractor-owned cylinder(s) that will ensure compliance with applicable regulations and standards.

6.2. Contractor-owned equipment shall be installed, inspected and maintained by the Contractor at the

Contractor’s expense (i.e., all med gas cylinder tracking, electronic access to information, installation, inspection and maintenance costs shall be included in the Contract’s monthly fee for the applicable facility).

6.3. Contractor-owned equipment shall be kept in good operating condition, clean, rust free, labels and appearance must be in accordance with applicable regulations and standards. Each station shall provide the Contractor reasonable access to the facilities they are responsible for.

6.4. Stations have a right to refuse cylinders that do not meet applicable regulations and standards.

Contractor shall legibly document, date and sign any written delivery issues and include images of the number of cylinders rejected. The contractor must replace rejected cylinders within 24 hours at no cost to the government.

6.5. The contractor is required to provide a legible signed and/or electronic delivery slip that has been signed by the deliverer as well as the countersigned by the facility representative supervising the delivery.

The delivery slip must include: 6.5.1.1. The number of cylinders at the ordering facility prior to delivery

6.5.1.2. The number of cylinders being delivered

6.5.1.3. The number of cylinders being picked-up

6.5.1.4. Liquid Nitrogen fill (if applicable)

7. TRANSITION/IMPLEMENTATION OF CONTRACTOR FURNISHED MEDICAL GAS

CYLINDERS:

7.1. Phase In: Upon receipt of an order via COR and/or alternate COR, the incoming contractor shall be responsible for replacing all appropriate VA authorized (incumbent contractor-owned) equipment presently located at each facility with the incoming contractor’s equipment as soon as possible after award, but not to exceed forty-five (45) days from date of contract award. Incoming contractor shall coordinate with the incumbent contractor during the transition period relating to the removal of the incumbent contractor’s equipment form each facility. The change shall include delivery, setup, and instructions as further specified herein, and shall be accomplished without disruption in supplies and services. The billing period shall begin on the noted transition date. Upon completion of phase in transition, payments shall be assessed based on the provider’s established rate and prorated from setup date. Prorated monthly rates are based on a 30-day month.

7.2. Unless otherwise directed by the ordering facility, contractor-owned equipment shall be installed by the effective date of the Contract provided that the Contractor shall be allowed a maximum of forty-five

(45) days, after receipt of notice of award, to complete installation. If the Contractor replaces equipment already in use, the exchange of equipment shall be accomplished without interruption of gas supply to the ordering agency. Contractor-installed equipment shall remain the property of the Contractor and shall be removed upon termination of the Contract, when directed by the ordering facility and in full cooperation with the succeeding Contractor to avoid interruption of gas supply.

7.3. To permit orderly transition from one contractor to another, the Contractor shall continue to honor the

Contract’s monthly equipment rental fee and gas contract price for a maximum of sixty days (60) days beyond the scheduled expiration of the contract period), unless transition from one contractor to another is completed prior to the 60th day of the transition period. For any partial month, the Contractor shall prorate the monthly equipment rental fee accordingly. The Contractor shall continue to provide and maintain its equipment during the transition period.

7.4. Phase Out: The Contractor realizes that the supplies being provided under this Contract are vital and must be continued uninterrupted. The outgoing contractor shall not remove any equipment from the facility until replacement equipment has been installed. The outgoing contractor shall coordinate the transition of equipment/services with the incoming contractor as soon as possible, but not to exceed sixty

(60) days from date of contract expiration. If additional transition time is required beyond contract expiration, a separate Purchase Order shall be issued to the Contractor for payment of services on a prorated basis. Prorated monthly rates are based on a 30-day month.

7.5. During transition of both Phase In and Phase Out from one contractor to another, the Contractor must reconcile in conjunction with the Government and the incoming contractor, in writing, the accuracy of the cylinder count for each type of gas listed in the Schedule of Items. During the transition period, both

Contractors, incoming and outgoing, shall separately conduct an inventory audit that documents the number of contractor-owned and government-owned cylinders. All auditing documents must be approved and signed by all parties involved during the transition periods as emphasized above.

8. MEASUREMENT AND CONVERSION COMPUTATION, ATMOSPHERIC GASES AND

HYDROGEN:

8.1. Density data and volume measurement equivalents printed in CGA Publication P-6 – Standard

Density Data, Atmospheric Gases and Hydrogen, dated October 2012 shall be used when necessary to convert measurement of these gases from one form to another; for example, from cubic feet to gallons

9. ORDERING PROCESSES:

9.1. The Contractor will be provided with names and contact information of the primary Contracting

Officer Representatives (CORs) within 20 days after award of the contract for each ordering facility.

9.2. An Authorized Customer may place orders that are emergency or routine. The Contractor must designate a central location for Authorized Customer orders to be sent. The Contractor is required to have the capability to receive, manage, and fulfill manual orders in instances where there are power outages, security breaches or other electronic systems issues.

9.3. Confirmation: The Contractor must respond to the facility by electronic commerce on the same day after receipt of order for non-emergency deliveries. Orders shall be accepted until 12:00pm for next day deliveries. If the day following the order falls on a federal holiday, then the delivery confirmation shall be the next business day following the federal holiday.

9.4. Emergent Confirmation: Contractor must respond to the facility by either telephone or email within one (1) hour to confirm receipt of emergency notification and to ascertain the nature of the emergency.

10. DELIVERY REQUIREMENTS:

10.1. The following information applies to all deliveries, regardless of the time or day of execution:

Cylinders shall be filled to the maximum functional capacity during each refilling procedure unless otherwise specified in the facility requirements or as agreed upon in a written document signed and dated by the Contracting Officer (CO); The Contractor shall provide a legible signed and dated written document that identifies the number of cylinders at the ordering facility prior to delivery, the number of cylinders being delivered, the number of cylinders being picked-up, and the number of cylinders at the ordering facility after the delivery has been made. This document must be counter-signed by the facility representative supervising the delivery.

10.2. All orders shall be delivered to the individual ordering facility on the specified delivery date or within twenty-four (24) hours after confirmation if emergent. It is the responsibility of the awardee to ensure that the station receives their orders on the specified delivery dates.

10.3. Backorder Notification shall be provided to the COR or designated POC immediately when back order is known. Contractor must also provide estimated lead time of medical gas and provide details of the shortage in marketplace. Any medical gases that can be identified as difficult to fill, must be identified to the COR as soon as possible. Each week the back order is not filled, a status update must be provided to the COR or designated POC.

10.4. The Government retains the right to investigate the backorder situation to determine the cause of the backorder and to aid during the backorder period.

10.5. Cancellation of back order by the Contractor is considered a failure to perform and may be considered grounds for adverse action.

10.6. All medical gas deliveries shall be made per each state’s Department of Transportation (DOT)

Regulations. Empty government owned cylinders that are picked up from an ordering facility for re-fill or servicing shall be transported according to DOT Regulations, using normal commercial practices to prevent damage to cylinders.

10.7. Upon delivery, the delivery driver and facility POC will conduct a cylinder delivery count.

Cylinders will be logged in on a paper or electronic delivery slip with the delivery date and driver ID specified. The delivery slip shall be signed by both the facility POC and delivery driver. This information will be given to the COR.

10.8. Upon delivery, the delivery driver and facility POC will conduct an empty cylinder delivery count.

Empty cylinders will be logged in on a paper or electronic delivery slip with the delivery date and driver

ID specified. The delivery slip shall be signed by both the facility POC and delivery driver. This information will be given to the COR.

10.9. Deliveries shall be completed weekly on Mondays between the hours of 8:00am – 4:00pm Local

Standard Time, unless that day is a Federal Holiday, in which case the delivery shall be completed on the following day. The Contractor and ordering facility COR may adjust the delivery day and/or time upon mutual written agreement. All deliveries shall be coordinated with the facility POCPOC.

10.10. Routine orders shall be accepted by the Contractor until 12:00 PM, facility local time, 24 hours before the next regularly scheduled delivery.

10.11. All transportation charges for delivering/picking up cylinders shall be included in the price of the medical gas. Additional charges such as delivery fees, hazardous material fees, fuel surcharges, shall

NOT be billed to, or collected from, the facilities for orders received under this Contract.

10.12. Emergency deliveries shall be delivered within twenty-four (24) hours after receipt of government notification. Emergency status is determined by the Government when conditions warrant, such as an actuated imminent alarm condition, or system leak. Failure of the Contractor to remain current with the agreed delivery schedule and requirements does not constitute an “emergency” for purposes of charging an emergency delivery fee.

11. EMERGENCY DELIVERY REQUIREMENTS:

This facility is designated as a Federal Emergency Medical Facility with significant contingency and emergency response roles. Accordingly, the Contractor shall offer strategies to provide emergency supply support during major catastrophic events. These strategies shall include additional methods of contacting for ordering medical gas and offering Federal Emergency Medical Facilities, at no cost, the option to pre-prepare order lists tailored to potential catastrophic events likely to occur in their area (fire, mass contamination, epidemic, earthquake, tornados, typhoons, etc.). Because of the emergency nature of these orders Contractor must perform with full delivery to the facility of the required quantities of 90% or more of the order within 24 hours of callout by the facility or their geographical location.

12. DELIVERY TICKETS:

Each delivery must contain a legible delivery ticket covering the following:

12.1.1. Contract Number,

12.1.2. Facility Purchase Order Number

12.1.3. Delivery Order Number

12.1.4. Date of Order

12.1.5. Date of Delivery

12.1.6. Item number(s) and/or product identification number(s)

12.1.7. The number of cylinders being delivered

12.1.8. The number of cylinders being picked up

13. PRICE OF SERVICES FOR GOVERNMENT OWNED/CONTRACTOR OWNED

CYLINDERS:

13.1. Services Included in the Price of Gas (Both Government and Contractor-Owned Cylinders): The

Contractor’s price for the gas shall include the following, at no additional cost, of all services which are required at each filling of a cylinder to comply with applicable regulations, and specifications. Such services shall include but may not be limited to: tags indicating cylinders as “Full”, “In Use”, or “Empty”;

inspection, testing, and evaluation required at each filling; pin-indexing, when required, and attachment of government-furnished warning tags, when required. Attaching oxygen cylinders to manifold systems, when required, shall also be performed by the Contractor at no additional cost. In addition to services listed in this paragraph, the Contractor shall be responsible for all maintenance and testing of contractor-owned cylinders.

13.2. The Contractor shall ensure all cylinders are clean, free from dirt/rust, and in acceptable use for both inpatient/outpatient Health Care Environments.

14. MONTHLY RENTAL OF CONTRACTOR-OWNED MEDICAL GAS CYLINDERS:

14.1. When gases are ordered in contractor-owned cylinders, monthly rental rates shall apply to those cylinders in the possession of the ordering facility on a specific day of the month (e.g. 15th, 25th, last day).

NOTE: Please indicate the day of the month that rental charges will be applied (see 12.1).

____________________ (e.g. 15th, 25th, last day)

15. LOST OR DAMAGED CONTRACTOR-OWNED CYLINDERS:

The Contractor shall submit a list of replacement costs for all individual lost or damaged cylinders in the possession of the facility. These cylinders shall become government property. If the facility elects to self-certify missing cylinders at their CBOC locations, the facility will be responsible for paying for these missing cylinders prior to having rental fees removed.

16. REVIEW/AUDITS:

16.1. The COR or Facility POC will conduct at a minimum, an annual review of inventory to reconcile the number of cylinders on hand in comparison to the number of cylinders held on the delivery ticket. An inventory report will be provided to the COR, CO and Contractor.

16.2. Annual inventory audits will be conducted jointly with facility and contractor representatives. Due to the size of the main facility, the audit can be expected to take approximately two days (based on a single audit team).

16.3. Contractor must be present until audit is completed in its entirety. Audits that are conducted may be performed outside of normal business hours. The COR will only sign complete audits that are mutually agreed upon.

16.4. Upon concurrence and signed audit, facility will be authorized one (1) year to pay for the audited missing cylinders. Upon payment, the rental fees are to be removed from total cylinder count. If discrepancies continue, the Contractor must return at a mutually agreed upon date to redo the audit. If the facility is unable to reschedule with 90 days, the facility must honor initial audit findings

17. REPORTS:

17.1. A tracking system will be provided and maintained by the Contractor and access to the CORs will be provided for each station to review whenever needed. The tracking system shall provide the ability to:

17.1.1.1. Review all legible delivery tickets that have been countersigned by the facility

17.1.1.2. Review all past invoices

17.1.1.3. Review all countersigned and mutually agreed audits

17.1.1.4. Current cylinder counts

18. PERSONNEL:

18.1. The Contractor shall provide one (1) representative who shall act as the primary liaison between the facility and the contractor in regard to this contract.

18.2. The representative shall be available regardless of ordering method. No later than 30 days after contract start date, the VA shall be provided with the name, phone, and email of the representative.

18.3. The name of the person shall be designated in writing to the Contracting Officer. The contractor’s liaison shall have full authority to act for the contractor on all matters related to:

18.3.1.1. Daily operations of the contract

18.3.1.2. Assist in resolving invoice issues

18.3.1.3. Assist in resolving delivery issues,

18.3.1.4. Main point of contact for arranging annual auditing of medical gases

19. CONDUCT OF CONTRACTOR PERSONNEL:

19.1. Contractor employees shall conduct themselves in a manner socially acceptable. Loudness, vulgarity, rudeness, or other similar offensive conduct by an employee of the Contractor will be grounds for denying the employee further access to the VA premises.

19.2. Contractor employees shall always wear visible identification while on the premises of the VA medical facility, warehouse, CBOC, etc.

(END OF SOW)

B.3 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

144.00 EA

Demurrag -H- Cylinder-Tanks Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing PRODUCT/SERVICE CODE: Q201 - Medical - Managed Healthcare

854.00 EA

Oxygen-E-Tank Refill Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

64.00 EA

Gas, Liquid Nitrogen, Medical Bulk Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

20.00 EA

CO2-Size E Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

2.00 EA

Refil Oxygen D Cylinder Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas

Manufacturing

10.00 EA

Refill H Tanks Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Refill on Air Compressed E Tank Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Value Replacement Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Test, Hydrostatic Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Emergency Delivery Contract Period: Base POP Begin: 09-30-2025 POP End: 09-29-2026 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Refill H Tanks Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 1 POP Begin: 09-30-2026 POP End: 09-29-2027 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 2 POP Begin: 09-30-2027

POP End: 09-29-2028 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 2 POP Begin: 09-30-2027 POP End: 09-29-2028 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 2 POP Begin: 09-30-2027 POP End: 09-29-2028 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 2 POP Begin: 09-30-2027 POP End: 09-29-2028 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 2 POP Begin: 09-30-2027 POP End: 09-29-2028 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 2 POP Begin: 09-30-2027 POP End: 09-29-2028

Contract Period: Option 2 POP Begin: 09-30-2027 POP End: 09-29-2028 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 2 POP Begin: 09-30-2027 POP End: 09-29-2028 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 2 POP Begin: 09-30-2027 POP End: 09-29-2028 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 2 POP Begin: 09-30-2027 POP End: 09-29-2028 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3 POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3 POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3 POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3 POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3 POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3 POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3

POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3 POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3 POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 3 POP Begin: 09-30-2028 POP End: 09-29-2029 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030

Manufacturing

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030 PRINCIPAL NAICS CODE: 325120 - Industrial Gas

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

Contract Period: Option 4 POP Begin: 09-30-2029 POP End: 09-29-2030 PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing

GRAND

TOTAL

B.4 DELIVERY SCHEDULE

ITEM

NUMBER SHIPPING INFORMATION

ALL

John J. Pershing VA Medical Center 1500 N. Westwood Blvd.

Poplar Bluff, MO 63901-3318

FOB: DESTINATION

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (NOV 2023)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The

Government must exercise its post-acceptance rights—

(1) Within a reasonable time after the defect was discovered or should have been discovered;

and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims

Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the

Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at Federal Acquisition Regulation (FAR) 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the

Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the

Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include—

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer—System for Award Management, or 52.232-34, Payment by

Electronic Funds Transfer—Other Than System for Award Management), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR part 1315.

(h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.

(i) Payment.—

(1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract.

(2) Prompt payment. The Government will make payment in accordance with the Prompt

Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR part 1315.

(3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-

5(b) for the appropriate EFT clause.

(4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made.

(5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall—

(i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the—

(A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment);

(B) Affected contract number and delivery order number, if applicable;

(C) Affected line item or subline item, if applicable; and

(…