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?.## PRICE/COST SCHEDULE
ITEM INFORMATION
| ITEM NUMBER |
| DESCRIPTION OF SUPPLIES/SERVICES |
| QTY |
| UNIT |
| UNIT PRICE |
| AMOUNT |
| 0001 |
| Simplus Mask, Small, MFR Fischer & Paykel, MFR# 400475 |
| 20.00 |
| EA |
| __________________ |
| __________________ |
| 0002 |
| Simplus Mask Medium, MFR Fisher & Paykel, MFR# 400476 |
| 80.00 |
| EA |
| __________________ |
| __________________ |
| 0003 |
| Simplus Mask Large, MFR Fisher & Paykel, MFR# 400477 |
| 80.00 |
| EA |
| __________________ |
| __________________ |
| 0004 |
| Forma Mask with Headgear Medium / Large, MFR Fisher & Paykel, MFR# 400471 |
| 12.00 |
| EA |
| __________________ |
| __________________ |
| 0005 |
| Mirage FX STD / REG Mask, MFR ResMed, MFR# 62103 |
| 100.00 |
| EA |
| __________________ |
| __________________ |
| 0006 |
| Mirage FX Wide Mask, MFR ResMed, MFR# 62118 |
| 40.00 |
| EA |
| __________________ |
| __________________ |
| 0007 |
| Mirage Quattro Mask Medium, MFR ResMed, MFR# 61202 |
| 120.00 |
| EA |
| __________________ |
| __________________ |
| 0008 |
| Swift FX System, MFR ResMed, MFR# 61500 |
| 120.00 |
| EA |
| __________________ |
| __________________ |
| 0009 |
| Mirage Quattro Large, MFR ResMed, MFR# 61203 |
| 80.00 |
| EA |
| __________________ |
| __________________ |
| GRAND TOTAL |
| __________________ |
?.## DELIVERY SCHEDULE
| ITEM NUMBER |
| DELIVERY DATE |
| ALL LINE ITEMS |
| SHIP TO: |
| Department of Veterans Affairs |
Saint Cloud VAMC
ATTN: PROSTHETICS – BLDG 51
4801 Veterans Drive Saint Cloud, MN 56303 2015 10 Days ARO
