36C25618U0233-001.docx

Market Research Vendor Response Form

Name of Requirement: Olympus Visera Elite Video System Center OTV-S190, a video processor and light source for endoscopic procedures for use at the Gulf Coast Veterans Health Care System’s Urology Department, Biloxi, MS.

RFI / Sources Sought: 36C25618U0233 NAICS: 339112 –Surgical and Medical Instrument Manufacturing Size Standard: Small – 1,000 PSC: 6515 – Medical and Surgical Instruments, Equipment, and Supplies Deadline for Response: August 20, 2018 10:00 AM EDT

Please answer the following questions related to the above requirement and return to Arlene A. Blade at arlene.blade@va.gov before the deadline listed above.

1. The NAICS identified above is appropriate for this requirement.

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2. The PSC identified above is appropriate for this requirement: Choose an item.

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3. Small Business Requirements: Choose an item.

4. Manufacturer/Authorized Distributor Verification: Choose an item.

5. Are there any specifications for individual items that you believe may be too restrictive when taking into consideration industry standards (see draft Statement of Work)? Choose an item.. Click or tap here to enter text.

6. Are there accessories for any equipment item(s) that are normally separately priced? Choose an item. Click or tap here to enter text.

7. Are there any items that you would recommend be purchased separately? Choose an item. Click or tap here to enter text.

8. Lead time: In approximately how many days would you be able to deliver all items in this requirement after the government places an order? Click or tap here to enter text.

9. Lead time: In approximately how many days would you be able to install all items in this requirement after the government accepts the delivery? Click or tap here to enter text.

10. Are there any times during the year where lead time may be longer (e.g. end of the calendar year)? Choose an item. Click or tap here to enter text.

11. Is there any reason you would not be interested in responding to a solicitation for this requirement? Choose an item. Click or tap here to enter text.

12. Please briefly explain how your company complies with FAR 52.219-14 – Limitation on Subcontracting Click or tap here to enter text.

13. Please explain if, and how, your company labels boxes, crates, pallets, etc. for delivery, and can your company label with the following information. Example of format:

PO number: 1234567 Contract number and name: 1234567 | Curtains On-Site Points of Contact:

Jane Doe (W) ###-###-#### (C) ###-###-#### Jane.Doe@website John Doe (W) ###-###-#### (C) ###-###-#### John.Doe@website CLIN number and Item description: 2.5.4. Curtain, Shower Quantity in box: 11 total Box number: 1 of 3 Estimated delivery date: MM/DD/YYYY

If this labelling is not possible or advisable please explain why or why not or offer other labelling solutions.

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14. Please provide any additional information, comments, or questions that might assist us in our market research: Click or tap here to enter text.

Please provide some basic information about your company below:

Company Name: Click or tap here to enter text.

Company Point of Contact Name: Click or tap here to enter text.

Company Point of Contact Email: Click or tap here to enter text.

Company Point of Contact Phone: Click or tap here to enter text.

Company DUNS Number: Click or tap here to enter text.

Company CAGE Code: Click or tap here to enter text.

My company has a GSA schedule under which these items can be purchased. Choose an item.

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My company is eligible for set-asides under the following small business programs: (Check all boxes that apply below) ☐Vets First Program – Service Disabled Veteran-owned small business ☐Vets First Program – Veteran-owned small business ☐8(a) Business Development Program participant ☐HUBZone small business ☐Economically Disadvantaged Woman-owned small business ☐Woman-owned small business ☐Small business

Please provide the following Optional Information below:

Pricing Information (Optional): If available, please attach a price list for these items (some or all) to illustrate typical pricing in the marketplace. Do not attach a quote or offer. The price list is for market research purposes only and will not be used to make an award.

Equal Items (Optional): If intending to provide “equal” items to the manufacturer/model specified, please attach cut sheets or other information so the government can verify the items meet the government’s requirement.

Market Research Vendor Response Form

Authorized Distributor (Optional): If your company qualifies as a non-manufacturer of these items, please provide or include documentation illustrating that your company is an authorized distributor.

Attachment 2