D. 1 Price Schedule.xlsx

XLSX spreadsheet 146 KB Posted Dec 5, 2023

Attached to: 6515-- Artificial Limbs Solicitation 36S79723R0001
Solicitation number: 36S79723R0001
Issued by: Department of Veterans Affairs National Acquisition Center

About this file

Written by GovTribe AI · Dec 21, 2023

This document is a price schedule template for a federal solicitation seeking prosthetic devices and components. The solicitation is issued by the Department of Veterans Affairs National Acquisition Center under number 36S79723R0001.

The template includes 23 clinical item numbers (CLINs) seeking various prosthetic feet, knees, liners, covers, and suspension systems. Offerors must provide unit pricing for the base year and four one-year options for each CLIN. Additional requirements include identifying product manufacturers, warranty periods, and countries of origin. Estimated quantities are provided for each CLIN and period. The solicitation seeks a range of HCPCS coded products, including various prosthetic feet coded L5976 through L5999, knees coded L5611 through L5828, liners coded L5673 and L5679, and suspension components coded L5655, L5671, and L5700 through L5701.

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Other files

File	Type	Posted
36S79723R0001 0003.docx	DOCX document	Apr 18, 2024
Group 1 Revision.xlsx	XLSX spreadsheet	Apr 18, 2024
D. 1 Price Schedule Updated 1.9.xlsx	XLSX spreadsheet	Jan 9, 2024
36S79723R0001 0002.docx	DOCX document	Jan 9, 2024
D. 1 Price Schedule Updated.xlsx	XLSX spreadsheet	Dec 27, 2023
36S79723R0001 0001_1.docx	DOCX document	Dec 27, 2023
36S79723R0001_2.docx	DOCX document	Dec 5, 2023
D. 3 PAST PERFORMANCE QUESTIONNAIRE.pdf	PDF	Dec 5, 2023
D. 2 Purchase Order and Invoice Processes V3- FINAL (updated May 2023).pdf	PDF	Dec 5, 2023
D.4 Electronic Transaction Record Layouts.pdf	PDF	Dec 5, 2023
36S79723R0001_1.docx	DOCX document	Dec 5, 2023

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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 L5976

PRODUCT and HCPC: Prosthetic Foot L5976

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, HCPC L5976

CLIN 0001	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
L5976						$0.00	$0.00	118	$0.00	$0.00	112	$0.00	$0.00	126	$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	118		$0.00	112		$0.00	126		$0.00	0		$0.00	$0.00

CLIN 02 L5972

PRODUCT and HCPCS: Prosthetic Foot L5972,

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 L5972,

CLIN 0002	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
L5972						$0.00	$0.00	54	$0.00	$0.00	56	$0.00	$0.00	58	$0.00	$0.00	60	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	54		$0.00	56		$0.00	58		$0.00	60		$0.00	$0.00

CLIN 0003 L5971

PRODUCT and HCPCS: Prosthetic Foot L5971

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 L5971

CLIN 0003	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
L5971						$0.00	$0.00	18	$0.00	$0.00	18	$0.00	$0.00	19	$0.00	$0.00	20	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	18		$0.00	18		$0.00	19		$0.00	20		$0.00	$0.00

CLIN 04 L5968

PRODUCT and HCPC: Prosthetic Foot L5968

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, HCPC L5968,

CLIN 0004	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
L5968						$0.00	$0.00	16	$0.00	$0.00	16	$0.00	$0.00	17	$0.00	$0.00	17	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	16		$0.00	16		$0.00	17		$0.00	17		$0.00	$0.00

CLIN 05 L5999

PRODUCT and HCPC: Prosthetic Foot L5999

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, HCPC L5999

CLIN 0005	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
L5999						$0.00	$0.00	107	$0.00	$0.00	111	$0.00	$0.00	115	$0.00	$0.00	119	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	107		$0.00	111		$0.00	115		$0.00	119		$0.00	$0.00

CLIN 06 L5981

PRODUCT and HCPCS: Prosthetic Foot L5981

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, HCPC L5981,

CLIN 0006	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
L5981						$0.00	$0.00	54	$0.00	$0.00	56	$0.00	$0.00	58	$0.00	$0.00	60	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	54		$0.00	56		$0.00	58		$0.00	60		$0.00	$0.00

CLIN 07 L5973

PRODUCT and HCPCS: Prosthetic Foot L5973

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 L5973

CLIN 0007	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
L5973						$0.00	$0.00	21	$0.00	$0.00	21	$0.00	$0.00	22	$0.00	$0.00	23	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	21		$0.00	21		$0.00	22		$0.00	23		$0.00	$0.00

CLIN 08 L5979

PRODUCT and HCPCS: Prosthetic Foot L5979

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 HCPC L5979

CLIN 0008	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
L5979						$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	7	$0.00	$0.00	7	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	6		$0.00	6		$0.00	7		$0.00	7		$0.00	$0.00

CLIN 09 L5987

PRODUCT and HCPCS: Prosthetic Foot L5987

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 HCPC L5987

CLIN 0009	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
L5987						$0.00	$0.00	7	$0.00	$0.00	7	$0.00	$0.00	8	$0.00	$0.00	8	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	7		$0.00	7		$0.00	8		$0.00	8		$0.00	$0.00

CLIN 10 L5980

PRODUCT and HCPCS: Prosthetic Foot L5980

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 HCPC L5980

CLIN 0010	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		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
L5980						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	0		$0.00	0		$0.00	0		$0.00	0		$0.00	$0.00

CLIN 11 L5974

PRODUCT and HCPCS: Prosthetic Foot L5974

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, HCPC L5974,

CLIN 0011	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
L5974						$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	5		$0.00	5		$0.00	6		$0.00	6		$0.00	$0.00

CLIN 12 L5611

PRODUCT and HCPCS: Prosthetic Knee Units, L5611

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 HCPC L5611

CLIN 0012	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
L5611						$0.00	$0.00	5	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	5		$0.00	6		$0.00	6		$0.00	6		$0.00	$0.00

CLIN 13 L5810

PRODUCT and HCPCS: Prosthetic Knee Units, L5810

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 HCPC L5810

CLIN 0013	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
L5810						$0.00	$0.00	4	$0.00	$0.00	4	$0.00	$0.00	4	$0.00	$0.00	5	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	4		$0.00	4		$0.00	4		$0.00	5		$0.00	$0.00

CLIN 14 L5811

PRODUCT and HCPCS: Prosthetic Knee Units, L5811

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 HCPC L5811

CLIN 0014	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
L5811						$0.00	$0.00	3	$0.00	$0.00	3	$0.00	$0.00	3	$0.00	$0.00	3	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	3		$0.00	3		$0.00	3		$0.00	3		$0.00	$0.00

CLIN 15 L5812

PRODUCT and HCPCS: Prosthetic Knee Units, L5812

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 HCPC L5812

CLIN 0015	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
L5812						$0.00	$0.00	7	$0.00	$0.00	7	$0.00	$0.00	8	$0.00	$0.00	8	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	7		$0.00	7		$0.00	8		$0.00	8		$0.00	$0.00

CLIN 16 L5814

PRODUCT and HCPCS: Prosthetic Knee Units L5814

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 HCPC LL5814

CLIN 0016	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
L5814						$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	5		$0.00	5		$0.00	6		$0.00	6		$0.00	$0.00

CLIN 17 L5822

PRODUCT and HCPCS: Prosthetic Knee Units, L5822

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 HCPC L5822

CLIN 0017	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
L5822						$0.00	$0.00	5	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	5		$0.00	6		$0.00	6		$0.00	6		$0.00	$0.00

CLIN 18 L5824

PRODUCT and HCPCS: Prosthetic Knee Units,L5824

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 HCPC L5824

CLIN 0018	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
L5824						$0.00	$0.00	4	$0.00	$0.00	4	$0.00	$0.00	4	$0.00	$0.00	5	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	4		$0.00	4		$0.00	4		$0.00	5		$0.00	$0.00

CLIN 19 L5826

PRODUCT and HCPCS: Prosthetic Knee Units, L5826

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 HCPC L5826

CLIN 0019	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
L5826						$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	5		$0.00	5		$0.00	6		$0.00	6		$0.00	$0.00

CLIN 20 L5828

PRODUCT and HCPCS: Prosthetic Knee Units,L5828

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 HCPC L5828

CLIN 0020	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
L5828						$0.00	$0.00	13	$0.00	$0.00	14	$0.00	$0.00	14	$0.00	$0.00	15	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	13		$0.00	14		$0.00	14		$0.00	15		$0.00	$0.00

CLIN 21 L5856

PRODUCT and HCPCS: Prosthetic Knee Units L5856

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 HCPC L5856

CLIN 0021	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
L5856						$0.00	$0.00	14	$0.00	$0.00	15	$0.00	$0.00	16	$0.00	$0.00	16	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	14		$0.00	15		$0.00	16		$0.00	16		$0.00	$0.00

CLIN 22 L5673

PRODUCT and HCPCS: Prosthetic Liners L5673

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 L5673

CLIN 0022	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
L5673						$0.00	$0.00	52	$0.00	$0.00	54	$0.00	$0.00	55	$0.00	$0.00	57	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS					$0.00	$0.00	52	$0.00	$0.00	54	$0.00	$0.00	55	$0.00	$0.00	57	$0.00	$0.00	$0.00	$0.00

CLIN 23 L5679

PRODUCT and HCPCS: Prosthetic Liners L5679

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 0023, HCPCS L5679

CLIN 0023	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
L5679						$0.00	$0.00	47	$0.00	$0.00	48	$0.00	$0.00	50	$0.00	$0.00	52	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS					$0.00	$0.00	47	$0.00	$0.00	48	$0.00	$0.00	50	$0.00	$0.00	52	$0.00	$0.00	$0.00	$0.00

CLIN 24 L5950

PRODUCT and HCPCS: PProsthetic Liners L5950

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)

CLIN0024 HCPC L5950

CLIN 0024	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
L5950						$0.00	$0.00	21	$0.00	$0.00	21	$0.00	$0.00	22	$0.00	$0.00	23	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	21		$0.00	21		$0.00	22	0	0	23	$0.00	$0.00	$0.00	$0.00

CLIN 25 L5962

PRODUCT and HCPCS: Prosthetic Covers L5962

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 0025 HCPC L5962

CLIN 0025	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
L5962						$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	5		$0.00	5		$0.00	6	0	0	6	$0.00	$0.00	$0.00	$0.00

CLIN 26 L5652

PRODUCT and HCPCS: Prosthetic Covers L5652

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 0026 HCPC L5652

CLIN 0026	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
L55652						$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00
	TOTAL PRICE FOR BASE AND ALL OPTION PERIODS				0		$0.00	5		$0.00	5		$0.00	6	0	0	6	$0.00	$0.00	$0.00	$0.00

CLIN 27 L5655

PRODUCT and HCPCS: Components & Suspension System L5655

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 0027, HCPCS L5655

CLIN 0027	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
L5655						$0.00	$0.00	5	$0.00	$0.00	5	$0.00	$0.00	6	$0.00	$0.00	6	$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00
						$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00		$0.00	$0.00	$0.00	$0.00

TOTAL PRICE FOR BASE AND ALL OPTION PERIODS 0 $0.00 5 $0.00 5 $0.00 6 $0.00 6 $0.00 $0.00

CLIN 28 L5671

PRODUCT and HCPCS: Components & Suspension System L5671

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 0028 HCPCS L5671

CLIN 0028

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

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 5, 2023.