Price Cost Schedule.docx

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H365--ANNUAL MEDICAL GAS TESTING POP: 11/20/2026 - 11/19/2031
Solicitation number
36C26227Q0022
Issued by

About this file

This is a Price/Cost Schedule for a Request for Quote (RFQ) solicitation numbered 36C26227Q0022 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 22 (VA Loma Linda Healthcare System). The solicitation seeks annual inspection and testing services for a Medical Gas Distribution System, with a contract period beginning November 20, 2026, and ending November 19, 2031. The requirement includes a one-year base period of performance (Item 0001) followed by four optional one-year periods (Items 1001, 2001, 3001, and 4001), each covering the period from November 20 through November 19 of the respective years. The services must be performed in accordance with the Statement of Work and are classified under NAICS Code 541380 (Testing Laboratories and Services) with Product/Service Code H365 (Inspection—Medical, Dental, and Veterinary Equipment and Supplies).

This is a 100% Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside procurement with a small business size standard of $19 Million. The price/cost schedule template contains blank fields for unit price and total amount entries for each contract period, requiring offerors to complete pricing for all five periods. The grand total field is also blank, indicating that offerors must provide complete pricing information for evaluation. No specific response dates, award dates, or other administrative deadlines are included in this pricing template document.

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36C26227Q0022

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM NUMBER
DESCRIPTION OF SUPPLIES/SERVICES
QUANTITY
UNIT
UNIT PRICE
AMOUNT
1.00
JB
_______________
__________________

Annual inspection for Medical Gas Distribution System in accordance to the Statement of Work Contract Period: Base POP Begin: 11-20-2026 POP End: 11-19-2027

PRINCIPAL NAICS CODE: 541380 - Testing Laboratories and Services PRODUCT/SERVICE CODE: H365 - Inspection - Medical, Dental, and Veterinary Equipment and Supplies

1.00
JB
_______________
__________________

Annual inspection for Medical Gas Distribution System in accordance to the Statement of Work Contract Period: Option 1 POP Begin: 11-20-2027 POP End: 11-19-2028

1.00
JB
_______________
__________________

Annual inspection for Medical Gas Distribution System in accordance to the Statement of Work Contract Period: Option 2 POP Begin: 11-20-2028 POP End: 11-19-2029

1.00
JB
_______________
__________________

Annual inspection for Medical Gas Distribution System in accordance to the Statement of Work Contract Period: Option 3 POP Begin: 11-20-2029 POP End: 11-19-2030

1.00
JB
_______________
_________________

Annual inspection for Medical Gas Distribution System in accordance to the Statement of Work Contract Period: Option 4 POP Begin: 11-20-2030 POP End: 11-19-2031

GRAND TOTAL
__________________

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