36C26119Q0987-002.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. 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 11

593-19-3-136-0167

36C26119Q0987 09-25-2019

Shannon Archer 702-791-9000 x18932 09-26-2019

00261

Department of Veterans Affairs

Network Contracting Office 21

VA Southern Nevada Healthcare System

6900 N. Pecos Road, Building 6

North Las Vegas NV 89086 x

339112

1000 Employees

Net 30 Days

N/A

X

See Delivery Schedule

00261

Department of Veterans Affairs

Network Contracting Office 21

Southern Nevada Healthcare System

6900 N. Pecos Road, Building 6

North Las Vegas NV 89086

Department of Veterans Affairs

Financial Services Center

See VAAR 852.232-72 Payment Instructions

See CONTINUATION Page

Request for Quote - Stryker Surgical Equipment/Services

Responses shall be submitted to Shannon Archer, Shannon.Archer@va.gov

See CONTINUATION Page x X

Don Neal

Contracting Officer

36C26119Q0987

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 PRICE/COST SCHEDULE

ITEM INFORMATION

B.2 DELIVERY SCHEDULE

SECTION C - CONTRACT CLAUSES

C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.2 - SUPPLEMENTAL INSURANCE REQUIREMENTS

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

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

1998)

E.2 52.209-11 – REPRESENTATION BY CORPORATIONS REGARDING

DELINQUENT TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL

LAW (FEB 2016)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

38.00 EA __________________ __________________

Camera Head with Integrated Coupler

LOCAL STOCK NUMBER: 1688-610-122

8.00 EA __________________ __________________

1688 CAMERA CONTROL UNIT (CCU) WITH HDMI TO DVI CABLE

KIT INCLUDES PRODUCT NUMBER 1688-010-000 1688 Camera Control Unit (CCU)

LOCAL STOCK NUMBER: 1688-010-001

CONNECTED OR HUB BASE WITH DEVICE CONTROL AND 4K

RECORDING KIT INCLUDES: 0240-200-100 PKG, Connected OR Hub Base System 0240-200-103 CONNECTED OR HUB DEVICE CONTROL PACKAGE 0240-200-111 Connected OR Hub 4K Recording Package

LOCAL STOCK NUMBER: 0240-200-223

L11 Light Source

LOCAL STOCK NUMBER: 0220-230-300

13.00 EA __________________ __________________

PRECISION IE 4K EYEPIECE ARTHROSCOPE, AUTOCLAVABLE,

4MM X 30, 140MM, SPEED-LOCK

LOCAL STOCK NUMBER: 0502-444-030

10.00 EA __________________ __________________

SURGICAL HUDSON/MODIFIED TRINKLE REAMER

LOCAL STOCK NUMBER: 4100-235-000

10.00 EA __________________ __________________

SYNTHES DRILL

LOCAL STOCK NUMBER: 4100-110-000

3.00 EA __________________ __________________

UNIVERSAL CHARGER

LOCAL STOCK NUMBER: 7110-120-000

40.00 EA __________________ __________________

System 8 Battery Pack, Large

LOCAL STOCK NUMBER: 8215-000-000

20.00 EA __________________ __________________

System 8 Battery Pack, Small

LOCAL STOCK NUMBER: 8212-000-000

COMMUNICATIONS ASSY, HD CAMERA

LOCAL STOCK NUMBER: P22338

CABLE ASSY DVI M TO DVI M 15 FT

LOCAL STOCK NUMBER: 0100-224-637

CABLE,S-VIDEO,F TO DUAL BNC-M

LOCAL STOCK NUMBER: 0100-222-252

HI-DEF CAMERA DECODER ASSEMBLY

LOCAL STOCK NUMBER: P22059

CABLE, 6 FT. HOSPITAL GRADE PO

LOCAL STOCK NUMBER: 0682-001-305

26.00 EA __________________ __________________

UNIVERSAL YOKE RETROFIT KIT

LOCAL STOCK NUMBER: 0682-400-060

16.00 EA __________________ __________________

(Disregard this item will be substituted) UPGRADE KIT SP13 VIDEO

LOCAL STOCK NUMBER: 0678-001-132

(Disregard this item will be substituted) 4K SOURCE PACKAGE

LOCAL STOCK NUMBER: 0678-001-401

(Disregard this item will be substituted) 4K Switch Package with

Power Strip

LOCAL STOCK NUMBER: 0678-001-400US

(Disregard this item will be substituted) 4K DISPLAY PACKAGE

LOCAL STOCK NUMBER: 0678-001-402

SUITE STATUS IP ROOM

LOCAL STOCK NUMBER: 0678-001-201

WALL MOUNT

LOCAL STOCK NUMBER: 0678-001-219

SUITE STATUS ALL-IN-ONE

LOCAL STOCK NUMBER: 0678-001-204

INSTALLATION ORIS-SUITESTATUS

LOCAL STOCK NUMBER: 8888888229

PKG, LCD MONITOR 55"

LOCAL STOCK NUMBER: 0678-001-223

ASSY, CAMERA COVER FOR SRYKECAM

LOCAL STOCK NUMBER: P27047

4.00 EA __________________ __________________

ARM, ART., CHAN, VESA, 12IN EXT., 1300N, DOWN, CIM

LOCAL STOCK NUMBER: 5002028

2.00 EA __________________ __________________

REDUCER RING, 182MM TO BLANK

LOCAL STOCK NUMBER: 0682-001-093

INSTALLATION BNL-HD CAMERA DECODER BOX

LOCAL STOCK NUMBER: 8888888371

26.00 EA __________________ __________________

INSTALLATION BNL CEILING MOUNT

LOCAL STOCK NUMBER: 888-8888-301

INSTALLATION ORIS-SUITESTATUS

LOCAL STOCK NUMBER: 8888888228

32.00 EA __________________ __________________

INSTALLATION ORIS UPGRADE-SPI3

LOCAL STOCK NUMBER: 8888888215

1.00 EA __________________ __________________

ICTS ENGINEERING SERVICES

LOCAL STOCK NUMBER: 888-8888-900

INSTALLATION-BASE INSTALLATION CHARGE

LOCAL STOCK NUMBER: 888-8888-401

CHROMOPHARE DE-INSTALLATION

LOCAL STOCK NUMBER: RS 0006136

1.00 EA __________________ __________________

OR RENOVATION SERVICES

LOCAL STOCK NUMBER: 8888-888-720

(Additional Item)

678-008-001 Connected OR Hub

GRAND TOTAL __________________

B.2 DELIVERY SCHEDULE

ITEM NUMBER QUANTITY

DELIVERY

DATE

0001 SHIP TO: VA Warehouse/Logistics 5406 E. El Campo Grande Ave Suite 150 Las Vegas, NV 89115 U.S

All TBD

MARK

FOR:

Brennon Cucullu 702-791-9000 x19436 Brennon.Cucullu@va.gov

SECTION C - CONTRACT CLAUSES

C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): http://www.acquisition.gov/far/index.html, http://www.va.gov/oal/library/vaar/

(End of Clause)

FAR

Number

Title Date

52.203-17

CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS

AND REQUIREMENT TO INFORM EMPLOYEES OF

WHISTLEBLOWER RIGHTS

APR 2014

52.204-4

PRINTED OR COPIED DOUBLE-SIDED ON

POSTCONSUMER FIBER CONTENT PAPER

MAY 2011

52.204-18

COMMERCIAL AND GOVERNMENT ENTITY CODE

MAINTENANCE

JUL 2016

52.212-4

CONTRACT TERMS AND CONDITIONS—COMMERCIAL

ITEMS

OCT 2018

52.212-5

CONTRACT TERMS AND CONDITIONS REQUIRED TO

IMPLEMENT STATUTES OR EXECUTIVE ORDERS—

COMMERCIAL ITEMS

(Insertion: 1, 4, 8, 22, 25, 26, 27, 28, 30, 32, 33, 42, 46, 55, 59)

MAY 2019

522.228-5

INSURANCE—WORK ON A GOVERNMENT

INSTALLATION

JAN 1997

52.232-40

PROVIDING ACCELERATED PAYMENTS TO SMALL

BUSINESS SUBCONTRACTORS

DEC 2013

52.237-2

PROTECTION OF GOVERNMENT BUILDINGS,

EQUIPMENT, AND VEGETATION

APR 1984

52.236-9

PROTECTION OF EXISTING VEGETATION,

STRUCTURES, EQUIPMENT, UTILITIES AND

IMPROVEMENTS.

APR 1984

852.228-71 INDEMNIFICATION AND INSURANCE MAR 2018

852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS NOV 2018

852.237-70 CONTRACTOR RESPONSIBILITIES APR 1984

852.247-73 PACKING FOR DOMESTIC SHIPMENT OCT 2018

852.203-70 COMMERCIAL ADVERTISING MAY 2018

852.246-71 REJECTED GOODS OCT 2018

http://www.acquisition.gov/far/index.html http://www.va.gov/oal/library/vaar/

C.2 - SUPPLEMENTAL INSURANCE REQUIREMENTS

In accordance with FAR 28.307-2 and FAR 52.228-5, the following minimum coverage shall apply to this contract:

(a) Workers' compensation and employer’s liability: Contractors are required to comply with applicable Federal and State workers' compensation and occupational disease statutes. If occupational diseases are not compensable under those statutes, they shall be covered under the employer's liability section of the insurance policy, except when contract operations are so commingled with a Contractor's commercial operations that it would not be practical to require this coverage. Employer's liability coverage of at least $100,000 is required, except in States with exclusive or monopolistic funds that do not permit workers' compensation to be written by private carriers.

(b) General Liability: $500,000.00 per occurrences.

(c) Automobile liability: $250,000.00 per person; $500,000.00 per occurrence and $100,000.00 property damage.

(d) The successful bidder must present to the Contracting Officer, prior to award, evidence of general liability insurance without any exclusionary clauses for asbestos that would void the general liability coverage.

(End of Clause)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR

ATTACHMENTS

ATTACHED PLEASE FIND A BRAND NAME ONLY JUSTIFICATION

SECTION E - SOLICITATION PROVISIONS

E.1 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY

REFERENCE (FEB 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es):

http://www.acquisition.gov/far/index.html, http://www.va.gov/oal/library/vaar/, (End of Provision)

FAR

Number

Title Date

52.204-7 SYSTEM FOR AWARD MANAGEMENT OCT 2018

52.204-16

COMMERCIAL AND GOVERNMENT ENTITY CODE

REPORTING

JUL 2016

52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS OCT 2018

52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS OCT 2018

52.212-2

EVALUATION—COMMERCIAL ITEMS

(Insertion: Price)

OCT 2014

52.212-3

OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL ITEMS

OCT 2018

52.233-2

SERVICE OF PROTEST

(Insertion: Don Neal, Don.Neal@va.gov)

SEP 2006

852.233-70

PROTEST CONTENT/ALTERNATIVE DISPUTE

RESOLUTION

OCT 2018

852.233-71 ALTERNATE PROTEST PROCEDURE OCT 2018

852.233-71 ALTERNATE PROTEST PROCEDURE (MAY 2010) NOTE MAY 2010

http://www.acquisition.gov/far/index.html http://www.va.gov/oal/library/vaar/

E.2 – ADDENDUM TO 52.212-1 INSTRUCTIONS TO OFFERORS—

COMMERCIAL ITEMS (OCT 2018)

1. FACTOR X: SDVOSB/VOSB Participation - This is a standalone factor and contains no sub-factors. Offerors must read the following and respond below to receive ratings as follows:

In accordance with VAAR 852.215-70 included herein, eligible service-disabled veteran-owned Offerors will receive full credit, and Offerors qualifying as veteran-owned small businesses will receive partial credit for the Service-Disabled Veteran-Owned and Veteran-owned Small Business Status evaluation factor. To receive credit, an Offeror must be registered and verified in Vendor Information Pages (VIP) database.

(http://www.VetBiz.gov). Non-veteran Offerors proposing to use service-disabled veteran-owned small businesses or veteran-owned small businesses as subcontractors will receive some consideration under this evaluation factor.

Please read “VAAR 852.215-70 Service-Disabled Veteran-Owned and Veteran-Owned small business Evaluation Factors (DEC 2009)” very carefully and proceed with your answer.

(1) For SDVOSBs/VOSBs: In order to receive credit under this Factor, an Offeror shall submit a statement of compliance that it qualifies as a SDVOSB or VOSB in accordance with VAAR 852.215-70 (Service-Disabled Veteran-Owned and Veteran-Owned Small

Business Evaluation Factors). Offerors are cautioned that they must be registered and verified in Vendor Information Pages (VIP) database (http://www.VetBiz.gov).

(2) For Non SDVOSB/VOSB Offerors Proposing to Subcontract to SDVOSBs/VOSBs: To receive some consideration under this Factor, an Offeror must state in its proposal the names of SDVOSB(s) and/or VOSB(s) with whom it intends to subcontract and provide a brief description and the approximate dollar values of the proposed subcontracts.

Additionally, proposed SDVOSB/VOSB subcontractors must be registered and verified in

Vendor Information Pages (VIP) database (http://www.VetBiz.gov) in order to receive some consideration under the Veterans Involvement Factor.

(3) With regard to the requirements for registration and verification in the VetBiz database, reference VAAR 804.1102 (Vendor Information Pages (VIP) Database).

Offeror shall select one item below and provide the required information listed above: (All replies that are not completed will be scored as if N/A were selected):

____ SDVOSB (registered and verified in VIP)

____ VOSB (registered and verified in VIP)

____ Non-Veteran proposing to subcontract with SDVOSB or VOSB (registered and verified in VIP)

____ N/A http://www.vetbiz.gov/

E.3 ADDENDUM TO 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT

2014)

For evaluation purposes, this factor will be evaluated as follows:

Full credit for a registered and verified SDVOSB means a reduction of 5% of total price.

Partial credit for a registered and verified VOSB means a reduction of 2% of total price.

Partial credit for Offerors proposing to subcontract with a registered and verified SDVOSB or

VOSB means a reduction of 1% of total price.

For example, if an offeror is a registered and verified SDVOSB and their total price is

$1,000,000.00 then 5% would be $50,000.00. The offerors adjusted price would then be

$950,000.00. The adjusted price of $950,000.00 would be the price used for the price evaluation. The same process would be applied to a registered and verified VOSB and non-

Veteran proposing to subcontract with an SDVOSB or VOSB, but the reduction percentage would be at the amount listed above. However, the award price will be the offered price.

E.4 52.209-11 – REPRESENTATION BY CORPORATIONS REGARDING

DELINQUENT TAX LIABILITY OR A FELONY CONVICTION UNDER ANY

FEDERAL LAW (FEB 2016)

(a) As required by sections 744 and 745 of Division E of the Consolidated and Further

Continuing Appropriations Act, 2015 (Pub. L 113-235), and similar provisions, if contained in subsequent appropriations acts, the Government will not enter into a contract with any corporation that--

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that—

(1) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months. (End of provision)