36C79119R0004-0004002.xlsx

XLSX spreadsheet 190 KB Posted May 7, 2019

Attached to: Orthotic Soft Goods and Prosthetics Supplies
Solicitation number: 36C79119R0004
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 19

About this file

Written by GovTribe AI · Dec 31, 2023

This is a presolicitation notice for multiple indefinite-delivery, indefinite-quantity contracts for orthotic soft goods and prosthetic commercial items. The Department of Veterans Affairs intends to issue the solicitation on March 18, 2019, with a closing date of April 29, 2019. The base period of performance will be from date of award through June 16, 2020, with four additional option years. Awards will be made for firm-fixed-price CLINs to provide items such as ankle-foot orthoses, knee orthoses, compression stockings, prosthetic socks, and other orthotic and prosthetic supplies. The Denver Logistics Center and VA medical centers will use contracts as primary sources. Small business set-asides include the partial set-aside of some CLINs for SDVOSB/VOSB firms, with other CLINs fully and openly competed.

From the source

36C79119R0004 0004 ATTACHMENT F- PRICE SCHEDULE_Ammendment 4.xlsx

View the file

Other files

File	Type	Posted
36C79119R0004 0009.docx	DOCX document	May 20, 2020
Attachment-Pricing Schedule Attachment F errors.docx	DOCX document	May 20, 2020
36C79119R0004-0008000.docx	DOCX document	Jun 5, 2019
36C79119R0004-0008000.docx	DOCX document	Jun 5, 2019
36C79119R0004-0007000.docx	DOCX document	Jun 4, 2019
36C79119R0004-0007000.docx	DOCX document	Jun 4, 2019
36C79119R0004-0006000.docx	DOCX document	May 31, 2019
36C79119R0004-0006000.docx	DOCX document	May 31, 2019
36C79119R0004-0005000.docx	DOCX document	May 16, 2019
36C79119R0004-0005000.docx	DOCX document	May 16, 2019
36C79119R0004-0004002.xlsx	XLSX spreadsheet	May 7, 2019
36C79119R0004-0004003.pdf	PDF	May 7, 2019
36C79119R0004-0004000.docx	DOCX document	May 7, 2019
36C79119R0004-0004001.docx	DOCX document	May 7, 2019
36C79119R0004-0004003.pdf	PDF	May 7, 2019
36C79119R0004-0004000.docx	DOCX document	May 7, 2019
36C79119R0004-0004001.docx	DOCX document	May 7, 2019
36C79119R0004-0003000.docx	DOCX document	Apr 25, 2019
36C79119R0004-0003000.docx	DOCX document	Apr 25, 2019
36C79119R0004-0002000.docx	DOCX document	Apr 18, 2019
36C79119R0004-0002000.docx	DOCX document	Apr 18, 2019
36C79119R0004-0001001.xlsx	XLSX spreadsheet	Apr 8, 2019
36C79119R0004-0001000.docx	DOCX document	Apr 8, 2019
36C79119R0004-0001000.docx	DOCX document	Apr 8, 2019
36C79119R0004-0001001.xlsx	XLSX spreadsheet	Apr 8, 2019
36C79119R0004-001.docx	DOCX document	Apr 8, 2019
36C79119R0004-002.xlsx	XLSX spreadsheet	Apr 8, 2019
36C79119R0004-001.docx	DOCX document	Apr 8, 2019
36C79119R0004-002.xlsx	XLSX spreadsheet	Apr 8, 2019
36C79119R0004-000.docx	DOCX document	Mar 5, 2019
36C79119R0004-000.docx	DOCX document	Mar 5, 2019

Show all 31

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Instructions

Instructions/Examples: Each sheet within this workbook shall be used per CLIN. All Sub-CLINS shall be under the appropriate CLIN in order to be considered.

Note that each size per CLIN being bid on must be offered for the base and option years to be considered for award.

Please fill out the Unit Price for the Base Year and all Option Years for each item on your offer along with your commercially published list price.

Offerors must complete the colums "warranty period" and "place of manufacturer".

CLIN 01

PRODUCT and HCPCS: ELASTIC PULL-ON ANKLE ORTHOSES WITH GEL MALLEOLI SUPPORT (L1902)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0001, HCPCS L1902, estimated quantity is 8,000 in the base year, 8,400 Option Period 1, 8,820 Option Period 2, 9,260 Option Period 3, 9,725 Option Period 4. ward.

CLIN 0001	SIZES	MODEL/MANUFACTUERER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0001aa	XS- OR EQUIVALENT					1,600	$0.00	$0.00	1,680	$0.00	$0.00	1,764	$0.00	$0.00	1,852	$0.00	$0.00	1,945	$0.00	$0.00	$0.00	$0.00
0001ab	S- OR EQUIVALENT					1,600	$0.00	$0.00	1,680	$0.00	$0.00	1,764	$0.00	$0.00	1,852	$0.00	$0.00	1,945	$0.00	$0.00	$0.00	$0.00
0001ac	M- OR EQUIVALENT					1,600	$0.00	$0.00	1,680	$0.00	$0.00	1,764	$0.00	$0.00	1,852	$0.00	$0.00	1,945	$0.00	$0.00	$0.00	$0.00
0001ad	L- OR EQUIVALENT					1,600	$0.00	$0.00	1,680	$0.00	$0.00	1,764	$0.00	$0.00	1,852	$0.00	$0.00	1,945	$0.00	$0.00	$0.00	$0.00
0001ae	XL- OR EQUIVALENT					1,600	$0.00	$0.00	1,680	$0.00	$0.00	1,764	$0.00	$0.00	1,852	$0.00	$0.00	1,945	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				8,000		$0.00	8,400		$0.00	8,820		$0.00	9,260		$0.00	9,725		$0.00	$0.00

CLIN 02

PRODUCT and HCPCS: HEEL OFF-LOADING SHOE (A9283)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0002, HCPCS A9283, estimated quantity is 1,000 in the base year, 1,030 Option Period 1, 1,061 Option Period 2, 1,093 Option Period 3, 1,126 Option Period 4.

CLIN 0002	SIZES	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0002aa	WOMENS EXTRA SMALL (XS) - US SHOE SIZE 4-7 -OR EQUIVALENT- RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002ab	WOMENS SMALL (S) - US SHOE SIZE 7.5-10 -OR EQUIVALENT- RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002ac	WOMENS MEDIUM (M) - US SHOE SIZE 10.5-13 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002ad	MENS SMALL (S) - US SHOE SIZE 6-8 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002ae	MENS MEDIUM (M) - US SHOE SIZE 8.5-10 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002af	MENS LARGE (L) - US SHOE SIZE 10.5-12 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002ag	MENS EXTRA LARGE (XL) - US SHOE SIZE 12.5-14 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002ah	WOMENS EXTRA SMALL (XS) - US SHOE SIZE 4-7 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002ai	WOMENS SMALL (S) - US SHOE SIZE 7.5-10 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002aj	WOMENS MEDIUM (M) - US SHOE SIZE 10.5-13 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002ak	MENS SMALL (S) - US SHOE SIZE 6-8 -OR EQUIVALENT -LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002al	MENS MEDIUM (M) - US SHOE SIZE 8.5-10 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002am	MENS LARGE (L) - US SHOE SIZE 10.5-12 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0002an	MENS EXTRA LARGE (XL) - US SHOE SIZE 12.5-14 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				1,000		$0.00	1,030		$0.00	1,061		$0.00	1,093		$0.00	1,126		$0.00	$0.00

CLIN 03

PRODUCT and HCPCS: GEL HEEL CUPS (L3170)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0003, HCPCS L3170, estimated quantity is 2,500 in the base year, 2,575 Option Period 1, 2,650 Option Period 2, 2,730 Option Period 3, 2,815 Option Period 4.

CLIN 0003	SIZES	MODEL/MANUFACTUERER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0003aa	XS- OR EQUIVALENT					500	$0.00	$0.00	515	$0.00	$0.00	530	$0.00	$0.00	546	$0.00	$0.00	563	$0.00	$0.00	$0.00	$0.00
0003ab	S- OR EQUIVALENT					500	$0.00	$0.00	515	$0.00	$0.00	530	$0.00	$0.00	546	$0.00	$0.00	563	$0.00	$0.00	$0.00	$0.00
0003ac	M- OR EQUIVALENT					500	$0.00	$0.00	515	$0.00	$0.00	530	$0.00	$0.00	546	$0.00	$0.00	563	$0.00	$0.00	$0.00	$0.00
0003ad	L- OR EQUIVALENT					500	$0.00	$0.00	515	$0.00	$0.00	530	$0.00	$0.00	546	$0.00	$0.00	563	$0.00	$0.00	$0.00	$0.00
0003ae	XL- OR EQUIVALENT					500	$0.00	$0.00	515	$0.00	$0.00	530	$0.00	$0.00	546	$0.00	$0.00	563	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				2,500		$0.00	2,575		$0.00	2,650		$0.00	2,730		$0.00	2,815		$0.00	$0.00

CLIN 04

PRODUCT and HCPCS: HEEL/ELBOW PADS (E0191)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0004, HCPCS E0191, estimated quantity is 10,000 in the base year, 10,600 Option Period 1, 11,235 Option Period 2, 11,910 Option Period 3, 12,625 Option Period 4.

CLIN 0004	SIZES	MODEL/MANUFACTUERER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0004aa	M- OR EQUIVALENT					3,333	$0.00	$0.00	3,533	$0.00	$0.00	3,745	$0.00	$0.00	3,970	$0.00	$0.00	4,208	$0.00	$0.00	$0.00	$0.00
0004ab	L- OR EQUIVALENT					3,333	$0.00	$0.00	3,533	$0.00	$0.00	3,745	$0.00	$0.00	3,970	$0.00	$0.00	4,208	$0.00	$0.00	$0.00	$0.00
0004ac	XL- OR EQUIVALENT					3,333	$0.00	$0.00	3,533	$0.00	$0.00	3,745	$0.00	$0.00	3,970	$0.00	$0.00	4,208	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				9,999		$0.00	10,599		$0.00	11,235		$0.00	11,910		$0.00	12,624		$0.00	$0.00

CLIN 05

PRODUCT and HCPCS: FOREFOOT OFF-LOADING SHOE (A9283)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0005, HCPCS A9283, estimated quantity is 1,000 in the base year, 1,030 Option Period 1, 1,060 Option Period 2, 1,090 Option Period 3, 1,125 Option Period 4.

CLIN 0005	SIZES	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0005aa	WOMENS EXTRA SMALL (XS) - US SHOE SIZE 4-7 -OR EQUIVALENT-RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005ab	WOMENS SMALL (S) - US SHOE SIZE 7.5-10 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005ac	WOMENS MEDIUM (M) - US SHOE SIZE 10.5-13 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005ad	MENS SMALL (S) - US SHOE SIZE 6-8 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005ae	MENS MEDIUM (M) - US SHOE SIZE 8.5-10 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005af	MENS LARGE (L) - US SHOE SIZE 10.5-12 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005ag	MENS EXTRA LARGE (XL) - US SHOE SIZE 12.5-14 -OR EQUIVALENT - RIGHT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005ah	WOMENS EXTRA SMALL (XS) - US SHOE SIZE 4-7 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005ai	WOMENS SMALL (S) - US SHOE SIZE 7.5-10 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005aj	WOMENS MEDIUM (M) - US SHOE SIZE 10.5-13 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005ak	MENS SMALL (S) - US SHOE SIZE 6-8 -OR EQUIVALENT- LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005al	MENS MEDIUM (M) - US SHOE SIZE 8.5-10 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005am	MENS LARGE (L) - US SHOE SIZE 10.5-12 -OR EQUIVALENT -LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
0005an	MENS EXTRA LARGE (XL) - US SHOE SIZE 12.5-14 -OR EQUIVALENT - LEFT					71	$0.00	$0.00	74	$0.00	$0.00	76	$0.00	$0.00	78	$0.00	$0.00	80	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				1,000		$0.00	1,030		$0.00	1,061		$0.00	1,093		$0.00	1,126		$0.00	$0.00

CLIN 06

PRODUCT and HCPCS: KNEE IMMOBILIZER (L1830)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0006, HCPCS L1830, estimated quantity is 5,000 in the base year, 5,150 Option Period 1, 5,300 Option Period 2, 5,465 Option Period 3, 5,625 Option Period 4.

CLIN 0006	SIZES	MODEL/MANUFACTUERER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0006aa	16" - OR EQUIVALENT					1,250	$0.00	$0.00	1,288	$0.00	$0.00	1,326	$0.00	$0.00	1,366	$0.00	$0.00	1,407	$0.00	$0.00	$0.00	$0.00
0006ab	18"- OR EQUIVALENT					1,250	$0.00	$0.00	1,288	$0.00	$0.00	1,326	$0.00	$0.00	1,366	$0.00	$0.00	1,407	$0.00	$0.00	$0.00	$0.00
0006ac	20"- OR EQUIVALENT					1,250	$0.00	$0.00	1,288	$0.00	$0.00	1,326	$0.00	$0.00	1,366	$0.00	$0.00	1,407	$0.00	$0.00	$0.00	$0.00
0006ad	24"- OR EQUIVALENT					1,250	$0.00	$0.00	1,288	$0.00	$0.00	1,326	$0.00	$0.00	1,366	$0.00	$0.00	1,407	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				5,000		$0.00	5,152		$0.00	5,304		$0.00	5,464		$0.00	5,628		$0.00	$0.00

CLIN 07

PRODUCT and HCPCS: LUMBAR-SACRAL ORTHOSIS (L0626)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0007, HCPCS L0626, estimated quantity is 15,000 in the base year, 16,500 Option Period 1, 18,150 Option Period 2, 19,965 Option Period 3, 21,962 Option Period 4.

CLIN 0007	SIZES	MODEL/MANUFACTUERER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0007aa	Universal					15,000	$0.00	$0.00	16,500	$0.00	$0.00	18,150	$0.00	$0.00	19,965	$0.00	$0.00	21,962	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				15,000		$0.00	16,500		$0.00	18,150		$0.00	19,965		$0.00	21,962		$0.00	$0.00

CLIN 08

PRODUCT and HCPCS: SURGICAL SHOE (L3260)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0008, HCPCS L3260, estimated quantity is 20,000 in the base year, 21,400 Option Period 1, 22,900 Option Period 2, 24,500 Option Period 3, 26,215 Option Period 4.

CLIN 0008	SIZES	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0008aa	WOMENS EXTRA SMALL (XS) - US SHOE SIZE 4-7 -OR EQUIVALENT - RIGHT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008ab	WOMENS SMALL (S) - US SHOE SIZE 7.5-10 -OR EQUIVALENT -RIGHT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008ac	WOMENS MEDIUM (M) - US SHOE SIZE 10.5-13 -OR EQUIVALENT -RIGHT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008ad	MENS SMALL (S) - US SHOE SIZE 6-8 -OR EQUIVALENT - RIGHT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008ae	MENS MEDIUM (M) - US SHOE SIZE 8.5-10 -OR EQUIVALENT - RIGHT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008af	MENS LARGE (L) - US SHOE SIZE 10.5-12 -OR EQUIVALENT -RIGHT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008ag	MENS EXTRA LARGE (XL) - US SHOE SIZE 12.5-14 -OR EQUIVALENT -RIGHT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008ah	WOMENS EXTRA SMALL (XS) - US SHOE SIZE 4-7 -OR EQUIVALENT -LEFT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008ai	WOMENS SMALL (S) - US SHOE SIZE 7.5-10 -OR EQUIVALENT - LEFT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008aj	WOMENS MEDIUM (M) - US SHOE SIZE 10.5-13 -OR EQUIVALENT - LEFT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008ak	MENS SMALL (S) - US SHOE SIZE 6-8 -OR EQUIVALENT -LEFT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008al	MENS MEDIUM (M) - US SHOE SIZE 8.5-10 -OR EQUIVALENT -LEFT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008am	MENS LARGE (L) - US SHOE SIZE 10.5-12 -OR EQUIVALENT -LEFT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
0008an	MENS EXTRA LARGE (XL) - US SHOE SIZE 12.5-14 -OR EQUIVALENT -LEFT					1,429	$0.00	$0.00	1,529	$0.00	$0.00	1,636	$0.00	$0.00	1,750	$0.00	$0.00	1,873	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				20,000		$0.00	21,400		$0.00	22,898		$0.00	24,501		$0.00	26,216		$0.00	$0.00

CLIN 09

PRODUCT and HCPCS: TENNIS ELBOW SUPPORT (A4467)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0009, HCPCS A4467, estimated quantity is 20,000 in the base year, 21,000 Option Period 1, 22,050 Option Period 2, 23,150 Option Period 3, 24,310 Option Period 4.

CLIN 0009	SIZES	MODEL/MANUFACTUERER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0009aa	Universal					20,000	$0.00	$0.00	21,000	$0.00	$0.00	22,050	$0.00	$0.00	23,150	$0.00	$0.00	24,310	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				20,000		$0.00	21,000		$0.00	22,050		$0.00	23,150		$0.00	24,310		$0.00	$0.00

CLIN 10

PRODUCT and HCPCS: SEMI RIGID CERVICAL ORTHOSIS (L0172)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0010, HCPCS L0172, estimated quantity is 5,000 in the base year, 5,250 Option Period 1, 5,500 Option Period 2, 5,790 Option Period 3, 6,075 Option Period 4.

CLIN 0010	SIZES	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0010aa	Universal					5,000	$0.00	$0.00	5,250	$0.00	$0.00	5,500	$0.00	$0.00	5,790	$0.00	$0.00	6,075	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				5,000		$0.00	5,250		$0.00	5,500		$0.00	5,790		$0.00	6,075		$0.00	$0.00

CLIN 11

PRODUCT and HCPCS: KNEE ORTHOSIS (A4467)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0011, HCPCS A4467, estimated quantity is 25,000 in the base year, 26,250 Option Period 1, 27,563 Option Period 2, 28,940 Option Period 3, 30,390 Option Period 4.

CLIN 0011 SIZES

Pfenninger, Jenna: Pfenninger, Jenna:

Does this need to have Left and Right?	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
	0011aa	12"-13" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011ab	13"-14" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011ac	14"-15" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011ad	15"-16" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011ae	16"-17" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011af	17"-18" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011ag	18"-19" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011ah	19"-20" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011ai	20"-21" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011aj	21"-22" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011ak	22"-23" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
	0011al	23"-24" -OR EQUIVALENT					2,083	$0.00	$0.00	2,188	$0.00	$0.00	2,297	$0.00	$0.00	2,412	$0.00	$0.00	2,532	$0.00	$0.00	$0.00	$0.00
			TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				25,000		$0.00	26,250		$0.00	27,563		$0.00	28,941		$0.00	30,388		$0.00	$0.00

CLIN 12

PRODUCT and HCPCS: KNEE ORTHOSIS (L1810)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0012, HCPCS L1810, estimated quantity is 95,000 in the base year, 99,750 Option Period 1, 104,740 Option Period 2, 109,975 Option Period 3, 115,475 Option Period 4.

CLIN 0012 SIZES MODEL/MANUFACTURER

Pfenninger, Jenna: Pfenninger, Jenna:

Does this need left and right?	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
	0012aa	12"-13" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012ab	13"-14" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012ac	14"-15" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012ad	15"-16" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012ae	16"-17" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012af	17"-18" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012ag	18"-19" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012ah	19"-20" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012ai	20"-21" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012aj	21"-22" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012ak	22"-23" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
	0012al	23"-24" -OR EQUIVALENT					7,917	$0.00	$0.00	8,313	$0.00	$0.00	8,728	$0.00	$0.00	9,165	$0.00	$0.00	9,623	$0.00	$0.00	$0.00	$0.00
			TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				95,000		$0.00	99,750		$0.00	104,738		$0.00	109,974		$0.00	115,473		$0.00	$0.00

CLIN 13

PRODUCT and HCPCS: KNEE ORTHOSIS (A4467)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0013, HCPCS A4467, estimated quantity is 50,000 in the base year, 52,500 Option Period 1, 55,125 Option Period 2, 57,880 Option Period 3, 60,775 Option Period 4.

CLIN 0013 SIZES MODEL/MANUFACTURER

Pfenninger, Jenna: Pfenninger, Jenna:

Does this need left and right?	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
	0013aa	12"-13" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013ab	13"-14" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013ac	14"-15" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013ad	15"-16" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013ae	16"-17" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013af	17"-18" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013ag	18"-19" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013ah	19"-20" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013ai	20"-21" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013aj	21"-22" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013ak	22"-23" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
	0013al	23"-24" -OR EQUIVALENT					4,167	$0.00	$0.00	4,375	$0.00	$0.00	4,594	$0.00	$0.00	4,823	$0.00	$0.00	5,065	$0.00	$0.00	$0.00	$0.00
			TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				50,000		$0.00	52,500		$0.00	55,125		$0.00	57,881		$0.00	60,775		$0.00	$0.00

CLIN 14

PRODUCT and HCPCS: KNEE ORTHOSIS- OPEN PATELLA SLIP-ON (A4467)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0014, HCPCS A4467, estimated quantity is 75,000 in the base year, 78,745 Option Period 1, 82,690 Option Period 2, 86,820 Option Period 3, 91,165 Option Period 4.

CLIN 0014 SIZES MODEL/MANUFACTURER

Pfenninger, Jenna: Pfenninger, Jenna:

Does this need left and right?

ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0014aa	12"-13" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014ab	13"-14" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014ac	14"-15" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014ad	15"-16" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014ae	16"-17" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014af	17"-18" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014ag	18"-19" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014ah	19"-20" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014ai	20"-21" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014aj	21"-22" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014ak	22"-23" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0014al	23"-24" -OR EQUIVALENT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				75,000		$0.00	78,744		$0.00	82,692		$0.00	86,820		$0.00	91,164		$0.00	$0.00

CLIN 15

PRODUCT and HCPCS: ANKLE ORTHOSIS (L4350)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0015, HCPCS L4350, estimated quantity is 4,000 in the base year, 4,120 Option Period 1, 4,245 Option Period 2, 4,370 Option Period 3, 4,500 Option Period 4.

CLIN 0015	SIZES	MODEL/MANUFACTUERER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0015aa	Universal					4,000	$0.00	$0.00	4,120	$0.00	$0.00	4,245	$0.00	$0.00	4,370	$0.00	$0.00	4,500	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				4,000		$0.00	4,120		$0.00	4,245		$0.00	4,370		$0.00	4,500		$0.00	$0.00

CLIN 16

PRODUCT and HCPCS: ANKLE FOOT ORTHOSIS GAUNTLET (L1902)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0016, HCPCS L1902, estimated quantity is 25,000 in the base year, 26,250 Option Period 1, 27,560 Option Period 2, 28,940 Option Period 3, 30,390 Option Period 4.

CLIN 0016	SIZES	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0016aa	10"-11" - OR EQUIVALENT					3,571	$0.00	$0.00	3,750	$0.00	$0.00	3,938	$0.00	$0.00	4,134	$0.00	$0.00	4,341	$0.00	$0.00	$0.00	$0.00
0016ab	11"-12" -OR EQUIVALENT					3,571	$0.00	$0.00	3,750	$0.00	$0.00	3,938	$0.00	$0.00	4,134	$0.00	$0.00	4,341	$0.00	$0.00	$0.00	$0.00
0016ac	12"-13"-OR EQUIVALENT					3,571	$0.00	$0.00	3,750	$0.00	$0.00	3,938	$0.00	$0.00	4,134	$0.00	$0.00	4,341	$0.00	$0.00	$0.00	$0.00
0016ad	13"-14" -OR EQUIVALENT					3,571	$0.00	$0.00	3,750	$0.00	$0.00	3,938	$0.00	$0.00	4,134	$0.00	$0.00	4,341	$0.00	$0.00	$0.00	$0.00
0016ae	14"-15" -OR EQUIVALENT					3,571	$0.00	$0.00	3,750	$0.00	$0.00	3,938	$0.00	$0.00	4,134	$0.00	$0.00	4,341	$0.00	$0.00	$0.00	$0.00
0016af	15"-16" -OR EQUIVALENT					3,571	$0.00	$0.00	3,750	$0.00	$0.00	3,938	$0.00	$0.00	4,134	$0.00	$0.00	4,341	$0.00	$0.00	$0.00	$0.00
0016ag	16"PLUS -OR EQUIVALENT					3,571	$0.00	$0.00	3,750	$0.00	$0.00	3,938	$0.00	$0.00	4,134	$0.00	$0.00	4,341	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				25,000		$0.00	26,250		$0.00	27,563		$0.00	28,941		$0.00	30,388		$0.00	$0.00

PRODUCT and HCPCS: STATIC ANKLE FOOT ORTHOSIS - Multipodus type (L4396)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0017, HCPCS L4396, estimated quantity is 12,000 in the base year, 13,200 Option Period 1, 14,520 Option Period 2, 15,970 Option Period 3, 17,570 Option Period 4.

CLIN 0017	SIZES	MODEL/MANUFACTUERER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0017aa	S- OR EQUIVALENT					3,000	$0.00	$0.00	3,300	$0.00	$0.00	3,630	$0.00	$0.00	3,993	$0.00	$0.00	4,392	$0.00	$0.00	$0.00	$0.00
0017ab	M- OR EQUIVALENT					3,000	$0.00	$0.00	3,300	$0.00	$0.00	3,630	$0.00	$0.00	3,993	$0.00	$0.00	4,392	$0.00	$0.00	$0.00	$0.00
0017ac	L- OR EQUIVALENT					3,000	$0.00	$0.00	3,300	$0.00	$0.00	3,630	$0.00	$0.00	3,993	$0.00	$0.00	4,392	$0.00	$0.00	$0.00	$0.00
0017ad	XL- OR EQUIVALENT					3,000	$0.00	$0.00	3,300	$0.00	$0.00	3,630	$0.00	$0.00	3,993	$0.00	$0.00	4,392	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				12,000		$0.00	13,200		$0.00	14,520		$0.00	15,972		$0.00	17,568		$0.00	$0.00

CLIN 18

PRODUCT and HCPCS: NIGHT SPLINT (L4396)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0018, HCPCS L4396, estimated quantity is 12,000 in the base year, 13,200 Option Period 1, 14,520 Option Period 2, 15,970 Option Period 3, 17,570 Option Period 4.

CLIN 0018	SIZES	MODEL/MANUFACTUERER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0018aa	M- OR EQUIVALENT					4,000	$0.00	$0.00	4,400	$0.00	$0.00	4,840	$0.00	$0.00	5,324	$0.00	$0.00	5,856	$0.00	$0.00	$0.00	$0.00
0018ab	L- OR EQUIVALENT					4,000	$0.00	$0.00	4,400	$0.00	$0.00	4,840	$0.00	$0.00	5,324	$0.00	$0.00	5,856	$0.00	$0.00	$0.00	$0.00
0018ac	XL- OR EQUIVALENT					4,000	$0.00	$0.00	4,400	$0.00	$0.00	4,840	$0.00	$0.00	5,324	$0.00	$0.00	5,856	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				12,000		$0.00	13,200		$0.00	14,520		$0.00	15,972		$0.00	17,568		$0.00	$0.00

CLIN 19

PRODUCT and HCPCS: HAND FINGER ORTHOSIS (L3923)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0019, HCPCS L3923, estimated quantity is 6,000 in the base year, 6,300 Option Period 1, 6,610 Option Period 2, 6,950 Option Period 3, 7,300 Option Period 4.

CLIN 0019	SIZES	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0019aa	5"-6" - OR EQUIVALENT- RIGHT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019ab	6"-7" -OR EQUIVALENT - RIGHT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019ac	7"-8"-OR EQUIVALENT - RIGHT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019ad	8"-9" -OR EQUIVALENT - RIGHT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019ae	9"-10" -OR EQUIVALENT -RIGHT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019af	10 1/2 "-12" -OR EQUIVALENT - RIGHT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019ag	5"-6" - OR EQUIVALENT - LEFT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019h	6"-7" -OR EQUIVALENT - LEFT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019ai	7"-8"-OR EQUIVALENT - LEFT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019aj	8"-9" - OR EQUIVLENT- LEFT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019ak	9"-10" -OR EQUIVALENT -LEFT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
0019aj	10 1/2 "-12" -OR EQUIVALENT - LEFT					500	$0.00	$0.00	525	$0.00	$0.00	551	$0.00	$0.00	579	$0.00	$0.00	608	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				6,000		$0.00	6,300		$0.00	6,612		$0.00	6,948		$0.00	7,296		$0.00	$0.00

CLIN 20

PRODUCT and HCPCS: WRIST HAND ORTHOSIS (L3908)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0020, HCPCS L3908, estimated quantity is 75,000 in the base year, 78,744 Option Period 1, 82,690 Option Period 2, 86,820 Option Period 3, 91,165 Option Period 4.

CLIN 0020	SIZES	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0020aa	5"-6" - OR EQUIVALENT- RIGHT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020ab	6"-7" -OR EQUIVALENT - RIGHT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020ac	7"-8"-OR EQUIVALENT - RIGHT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020ad	8"-9" -OR EQUIVALENT - RIGHT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020ae	9"-10" -OR EQUIVALENT -RIGHT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020af	10 1/2 "-12" -OR EQUIVALENT - RIGHT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020ag	5"-6" - OR EQUIVALENT - LEFT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020ah	6"-7" -OR EQUIVALENT - LEFT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020ai	7"-8"-OR EQUIVALENT - LEFT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020aj	8"-9" - OR EQUIVLENT- LEFT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020ak	9"-10" -OR EQUIVALENT -LEFT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
0020al	10 1/2 "-12" -OR EQUIVALENT - LEFT					6,250	$0.00	$0.00	6,562	$0.00	$0.00	6,891	$0.00	$0.00	7,235	$0.00	$0.00	7,597	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				75,000		$0.00	78,744		$0.00	82,692		$0.00	86,820		$0.00	91,164		$0.00	$0.00

CLIN 21

PRODUCT and HCPCS: LUMBOSACRAL ORTHOSIS (L0628)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0021, HCPCS L0628, estimated quantity is 30,000 in the base year, 31,500 Option Period 1, 33,070 Option Period 2, 34,730 Option Period 3, 36,460 Option Period 4 .

CLIN 0021	SIZES	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0021aa	22"-26" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
0021ab	26"-30" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
0021ac	30"-34" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
0021ad	34"-38" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
0021ae	38"-42" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
0021af	42"-46" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
0021ag	46"-50" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
0021ah	50"-54" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
0021ai	54"-58" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
0021aj	58"-62" -OR EQUIVALENT					3,000	$0.00	$0.00	3,150	$0.00	$0.00	3,307	$0.00	$0.00	3,473	$0.00	$0.00	3,646	$0.00	$0.00	$0.00	$0.00
		TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				30,000		$0.00	31,500		$0.00	33,070		$0.00	34,730		$0.00	36,460		$0.00	$0.00

CLIN 22

PRODUCT and HCPCS: LUMBAR SACRAL ORTHOSIS (L0630)

Instructions/Examples: Each sheet within this workbook shall be used per CLIN.

IDENTIFYING THE COUNTRY(IES) OF ORIGIN IN THE COLUMN TITLED "PLACE OF MANUFACTURE CONSTITUTES THE CERTIFICATIONS REQUIRED IN SECTION E.19, 52.212-4, SUBPARAGRAPHS (f) and (g)(1) through (5)

CLIN 0022, HCPCS L0630, estimated quantity is 12,000 in the base year, 12,360 Option Period 1, 12,730 Option Period 2, 13,110 Option Period 3, 13,500 Option Period 4.

CLIN 0022	SIZES	MODEL/MANUFACTURER	ITEM DESCRIPTION	WARRANTY PERIOD	PLACE OF MANUFACTURE	Est. QTY* BASE YEAR	UNIT PRICE BASE YEAR	TOTAL PRICE BASE YEAR	Est. QTY* OPTION PERIOD I	UNIT PRICE OPTION PERIOD I	TOTAL PRICE OPTION PERIOD I	Est. QTY* OPTION PERIOD II	UNIT PRICE OPTION PERIOD II	TOTAL PRICE OPTION PERIOD II	Est. QTY* OPTION PERIOD III	UNIT PRICE OPTION PERIOD III	TOTAL PRICE OPTION PERIOD III	Est. QTY* OPTION PERIOD IV	UNIT PRICE OPTION PERIOD IV	TOTAL PRICE OPTION PERIOD IV	BASE YEAR AND 4 YEAR OPTION PERIODS -TOTAL PRICE FOR PRODUCT	Published List Price
0022aa	22"-26" -OR EQUIVALENT					1,200	$0.00	$0.00	1,236	$0.00	$0.00	1,273	$0.00	$0.00	1,311	$0.00	$0.00	1,350	$0.00	$0.00	$0.00	$0.00
0022ab	26"-30" -OR EQUIVALENT					1,200	$0.00	$0.00	1,236	$0.00	$0.00	1,273	$0.00	$0.00	1,311	$0.00	$0.00	1,350	$0.00	$0.00	$0.00	$0.00
0022ac	30"-34" -OR EQUIVALENT					1,200	$0.00	$0.00	1,236	$0.00	$0.00	1,273	$0.00	$0.00	1,311	$0.00	$0.00	1,350	$0.00	$0.00	$0.00	$0.00
0022ad	34"-38" -OR EQUIVALENT					1,200	$0.00	$0.00	1,236	$0.00	$0.00	1,273	$0.00	$0.00	1,311	$0.00	$0.00	1,350	$0.00	$0.00	$0.00	$0.00
0022ae	38"-42" -OR EQUIVALENT					1,200	$0.00	$0.00	1,236	$0.00	$0.00	1,273	$0.00	$0.00	1,311	$0.00	$0.00	1,350	$0.00	$0.00	$0.00	$0.00
0022af	42"-46" -OR EQUIVALENT					1,200	$0.00	$0.00	1,236	$0.00	$0.00	1,273	$0.00	$0.00	1,311	$0.00	$0.00	1,350	$0.00	$0.00	$0.00	$0.00

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Dec 31, 2023.