864252603 Attachments.docx

Randolph Community College Mammography Equipment Solicitation Attachment Packet (A–E) Solicitation Title: Refurbished Mammography Equipment Solicitation Number: 864252603 Issuing Agency: Randolph Community College Division: College Services / Purchasing

Table of Contents Attachment A – Refurbishment Certification Form Attachment B – Installer & Technician Credential Form Attachment C – Service Provider Disclosure Form Attachment D – System Equivalency Evaluation Matrix Attachment E – Manufacturing Date Verification Form

ATTACHMENT A – REFURBISHMENT CERTIFICATION FORM

Vendor Name: __________________________________________ Equipment Make/Model Offered: __________________________________________ Serial Number(s): __________________________________________ A. Refurbishment Steps Completed (Vendor shall check each completed item) [ ] Full electrical inspection and reconditioning [ ] Replacement of worn electrical components [ ] Replacement or refurbishment of detector components [ ] X-ray generator calibration [ ] Detector calibration [ ] Mechanical component restoration [ ] Cosmetic restoration (covers, panels, shielding surfaces) [ ] System-level quality control testing [ ] OEM-equivalent tomosynthesis and CAD performance verification B. Required Documentation Attached (Vendor must attach all items) [ ] Refurbishment checklist [ ] Component replacement list [ ] Electrical safety testing report [ ] Final QC and calibration results [ ] Detector performance documentation (uniformity, bad pixel map, flat-field) Certification I hereby certify that the equipment offered meets or exceeds the refurbishment requirements of this solicitation.

Authorized Representative Name: ___________________________________ Title: ___________________________________ Signature: ___________________________________ Date: ___________________________________

ATTACHMENT B – INSTALLER & TECHNICIAN CREDENTIAL FORM

A. Installer Personnel Information Paste the table below into Word and then Convert Text to Table (Tabs).

(Add rows as needed) B. Documentation Attached [ ] OEM training credentials [ ] Equivalent manufacturer-recognized training [ ] Electrician licenses (if applicable) [ ] Proof of mammography installation experience Certification I certify that the installers listed meet all qualifications required in Sections 3.9 and 3.12 of the solicitation.

ATTACHMENT C – SERVICE PROVIDER DISCLOSURE FORM

A. Primary Warranty Service Provider Company Name: __________________________________________ Location: __________________________________________ Distance from RCC: __________ miles Average On-Site Response Time: __________ hours B. Technician Credentials Attached [ ] OEM or factory training certificates [ ] Service technician resumes or experience summaries [ ] Documentation of specialization in mammography systems C. Subcontractor Disclosure If subcontractors will be used for any installation, repair, or maintenance activities, complete the table below.

Certification I certify that the above information is accurate and complete.

ATTACHMENT D – SYSTEM EQUIVALENCY EVALUATION MATRIX

(To be completed only when offering an “or equal” system)

Certification I certify that this matrix accurately reflects the system offered.

Signature: ___________________________________ Date: ___________________________________

ATTACHMENT E – MANUFACTURING DATE VERIFICATION FORM

Vendor Name: __________________________________________ Equipment Offered: __________________________________________ A. Proof of Original Manufacturing Date Vendor must attach one or more of the following:

[ ] OEM-issued manufacture date statement [ ] FDA 2579 form [ ] OEM configuration/build report [ ] System log showing original build date B. Mixed-Component Disclosure Does the system contain components from multiple manufacturing years?

[ ] NO

[ ] YES — If yes, list each component and its manufacturing year below:

C. Certification I certify that the equipment offered meets the solicitation requirement of being 2014 or newer.